NORFOLK, Va. (WAVY) — A spike in pertussis cases across the country is now the worst surge in almost a decade. "Children under the age of one are most likely to suffer complications from pertussis or whooping cough, including apnea, which is absence of breathing and even death," said Dr. Annie Williams, deputy district director for the Norfolk Health Department. Pertussis is often called whooping cough because of the noise children often make as they struggle for air during a coughing fit. On Thursday, the CDC reported more than 14,500 cases so far in 2024, four times the rate of the previous year. Virginia is reporting one of the biggest spikes — from 66 total in 2023 to nearly 400 already this year. That's five times as many cases as compared to last year. "It is concerning because groups are starting to congregate again," Williams said."Just talking can put droplets in the air and cause infection." Symptoms vary and can be mild, with some people just having sniffles, so those numbers may be largely underestimated. There is also a long incubation period of 21 days. "Anyone exposed is at-risk and would need to see their provider and consider what we call post-exposure treatment," Williams said. Antibiotics can treat pertussis, but the best protection is vaccination. Pertussis is part of the DTaP series required for children to enter school. Its effectiveness, however, wanes over time. Experts say it's tweens and teens that are driving outbreaks in many states, along with post pandemic hesitancy for getting vaccinations of all types — even one that's protected communities, Williams said, for more than a century. "We know that this is both effective and safe," she said. "Literally, the first vaccine was developed in 1914." A booster shot is recommended every 10 years for everyone, and especially those who are around babies. You can get a vaccine from your doctor or at the health department.