The introduction of routine vaccination against Bordetella pertussis more than a half century ago led to a drastic decline in the number of reported cases of pertussis. It was originally believed that lifelong immunity was afforded after vaccination. Unfortunately, this belief is flawed, as the highest number of pertussis cases since 1959 was reported in 2004. This significant increase has led to additional research on immunity, vaccination, and treatment of B. pertussis in all age groups. We performed a MEDLINE search of literature from 1966-2006 to evaluate and review the existing data on immunity to and prevention or treatment of B. pertussis infections. Additional articles were identified from the bibliographies of reviewed literature. Numerous articles pertaining to these topics have been published recently. The most significant changes in the management of this infectious disease surround the new recommendations by the Advisory Committee on Immunization Practices for adult and adolescent immunizations to assist in preventing outbreaks of B. pertussis. The Centers for Disease Control and Prevention recently published guidelines updating the recommended pharmacologic agents for treatment or prevention of B. pertussis. Despite decades of successful vaccination programs, pertussis continues to be a problematic disease. Fortunately, data and vaccines are now available that make development of a pertussis booster vaccination campaign reasonable. However, until widespread compliance with such programs is achieved, clinicians need to maintain vigilance against pertussis.