- Pertussis: Practice Essentials, Background, Etiology and Pathophysiology
- Pertussis – NORD (National Organization for Rare Disorders)
- Whooping Cough: Symptoms, Treatment, and Prevention
- Whooping Cough (Pertussis)
- Signs & Symptoms
- Home Care
- When to Call the Doctor
- Whooping Cough: Causes, Symptoms, Treatment and Prevention
- Signs and Symptoms
- Early Symptoms
- Later-stage Symptoms
- Whooping cough overview
- What are the symptoms of whooping cough?
- The first (catarrhal) stage
- The second (paroxysmal) stage
- The third (convalescent) stage
- What causes whooping cough and how does it spread?
- Tests and diagnosis
- Preventing whooping cough
- Vaccinations for children and teenagers
- Vaccinations for adults
- Pertussis vaccine side effects
- Stopping the spread of pertussis
Pertussis: Practice Essentials, Background, Etiology and Pathophysiology
Since the early 1980s, pertussis incidence has cyclically increased, with peaks occurring every 2-5 years.  Most cases occur between June and September. Neither acquisition of the disease nor vaccination provides complete or lifelong immunity. Protection against typical disease wanes 3-5 years after vaccination and is not measurable after 12 years. [11, 12, 13]
The rate of pertussis peaked in the 1930s, with 265,269 cases and 7518 deaths reported in the United States. This rate decreased to a low of 1010 cases in the United States, with 4 deaths, in 1976.
Starting in the 1980s, however, the reported incidence of US pertussis cases dramatically increased across all age groups.
Although the largest increase in pertussis cases has been among adolescents and adults, the annual reported incidence has been highest among infants younger than 1 year. 
In 2010, according to the Centers for Disease Control and Prevention (CDC), the US pertussis rate reached 27,550 cases (the highest number since 1959), with 27 related deaths. [15, 16]
In 2011, according to preliminary statistics from the CDC, adolescents (ages 11-19 years) and adults together accounted for 47% of pertussis cases, while children aged 7-10 years accounted for 18% of cases. [16, 17]
According to the CDC, during the first half of 2012, most states had reported either increased pertussis activity or outbreaks of the disease. By July 5 of that year, 37 states had reported increases in pertussis cases over those reported during the same period in 2011.
For example, as listed by the CDC and the states’ health departments, the number of reported cases in Washington State (where a pertussis epidemic was declared), Minnesota, and Wisconsin in 2012 were as follows  :
- Washington State – 2012: 3400 cases reported through Aug 4; 2011: 287 cases reported through Aug 4
- Minnesota – 2012: 2039 cases reported as of Aug 2; 2011 (entire year): 661 cases reported
- Wisconsin – 2012: 3496 confirmed or probable cases reported through July 31, 2012; 2011 (entire year): 1192 confirmed or probable cases reported
The CDC listed a provisional national figure of 17,000 pertussis cases between Jan 1 and July 21, 2012, including 9 pertussis-related deaths. The reasons that pertussis cases peak in some years is not completely understood, according to the CDC. 
The CDC has estimated that 5-10% of all cases of pertussis are recognized and reported. Pertussis remains the most commonly reported vaccine-preventable disease in the United States in children younger than 5 years. In studies, 12-32% of adults with prolonged (1-4 wk) cough have been found to have pertussis.
Between January 1, 2014 and June 10, 2014 California's public health department reported 3,458 cases of pertussis. The department declared the outbreak to have reached epidemic proportions, with 800 cases reported in the span of just 2 weeks.  A study that examined a similar outbreak in California in 2010 determined that nonmedical vaccine exemptions played a role. 
Nationally, the CDC stated that the 4,838 cases of pertussis reported from January 1, 2014 to April 14, 2014 represented a 24% increase over the same period in 2013. 
The CDC reports that during January 1–November 26, 2014, a total of 9,935 cases of pertussis with onset in 2014 were reported in California.
Severe and fatal disease occurs almost exclusively in infants who are too young to be vaccinated against pertussis.
Therefore, pregnant women are encouraged to receive tetanus, diphtheria, and acellular pertussis vaccine (Tdap) during the third trimester of each pregnancy to provide placental transfer of maternal antibodies to the infant. [21, 22]
The annual worldwide incidence of pertussis is estimated to be 48.5 million cases, with a mortality rate of nearly 295,000 deaths per year.  The case-fatality rate among infants in low-income countries may be as high as 4%. 
In England, the percentage of people vaccinated for pertussis over the last 4 decades has decreased to less than 30%.
This decline has resulted in thousands of recently reported cases of the disease, with the incidence rate approaching that of the prevaccination era.
Similar epidemic outbreaks have recently occurred in Sweden, Canada, and Germany. Nearly 300,000 deaths from pertussis are thought to have occurred in Africa over the last decade.
With regard to race, the CDC reported that among individuals with pertussis between 2001 and 2003, 90% were white, 7% were black, 1% were Asian/Pacific Islander, and 1% were American Indian/Alaska Native, and 1% were identified as “other race”. From 2001-2003, females accounted for 54% of pertussis cases in the United States. 
From 2001-2003, of patients with pertussis, 23% were younger than 1 year, 12% were aged 1-4 years, 9% were aged 5-9 years, 33% were aged 10-19 years, and 23% were older than 20 years. [26, 25]
Because of the lack of maternal immunity transfer, 10-15% of all cases of pertussis occur in infants younger than 6 months; more than 90% of all deaths occur in this same age group. However, the growing majority of cases are now in persons aged 10 years and older, which has led to increased booster recommendations.
Pertussis – NORD (National Organization for Rare Disorders)
The most important treatment for Pertussis is prevention. The DPT vaccine is provided to infants and although there may be some discomfort from the injection, it is generally safe and effective. There may be extremely rare but serious adverse reactions in some children. These should be immediately brought to the attention of a physician when they begin to appear.
An acellular vaccine, which is made with part of the bacterium that causes Pertussis rather than the whole bacterium, is available for vaccination of infants. Known as Tripedia, the vaccine is manufactured by Connaught Laboratories. It is hoped that this acellular vaccine will produce fewer side effects (e.g., fever, seizures, etc.) than cellular vaccines.
Adverse reactions have been associated with the Diphtheria Pertussis Tetanus (DPT) vaccination and the risk for these reactions increases with age. In most circumstances, vaccination is not recommended for children over the age of seven years. Adverse reactions may be local or systemic.
Local reactions may include pain, skin redness (erythema), and/or swelling. Elevated temperature is a common systemic reaction to the pertussis vaccine. In some rare cases, a fever of over 104.9F degrees has been reported.
Other very rare complications have included seizures, shock, and severe hypersensitivity reactions (anaphylaxis). The most severe complication of the DPT vaccination is the very rare occurrence of brain inflammation (encephalopathy).
(For more information on these allergic reactions, choose “Anaphylaxis” as your search term in the Rare Disease Database.)
A new combined vaccine, known as Certiva, for diphtheria, tetanus, and acellular pertussis (DTaP) has been approved by the Food and Drug Administration (FDA) as a preventative measure against these illnesses. For more information, contact:
NIH/National Institute of Child Health and Human Development
9000 Rockville Pike
Building 31 Rm 2a32, Msc 2425
Bethesda, M. 20892
Tel: (301) 496-5133
Fax: (301) 496-7101
The treatment of Pertussis involves the administration of antibiotic drugs that help to clear the bacteria from the throat of affected individuals, usually within three to four days. By the fourth day of treatment, the disease is no longer contagious.
Erythromycin is the antibiotic drug of choice and is routinely given because it halts transmission of the disease to others. A course of antibiotic therapy may also be prescribed to those individuals who have been in close contact with affected individuals, especially children.
The combination of trimethoprim-sulfamethoxazole is an alternative antibiotic therapy that is given to those who cannot tolerate erythromycin.
Recently, the Centers for Disease Control (CDC) reported that erythromycin may caus. pyloric stenosis, a severe stomach disorder, in some babies.
Pyloric stenosis blocks digestion and causes projectile vomiting.
However, while CDC urges physicians and parents to be aware of this potentially serious side-effect, it does not recommend that physicians stop prescribing erythromycin for Pertussis.
Seriously ill infants with Pertussis should be kept in a dark and quiet room. They should be disturbed as little as possible to help prevent frequent episodes of severe coughing.
Close attention should be paid to the nutritional needs of the infant, since poor nutrition can contribute significantly to complications. Small meals should be given as frequently as possible.
Expectorant cough mixtures, cough suppressants, and sedatives are of little value and should be used cautiously or not at all.
Hospitalization may be recommended for seriously ill infants with Pertussis. Parenteral fluid (IV) therapy may be required to replace salt and water loss if vomiting is severe. Careful suctioning of the throat may become necessary to clear excessive mucous secretions.
When suctioning is not able to clear the airway, a surgical procedure may be performed to create a temporary opening into the throat (tracheostomy). A tube is then inserted into this opening, through which oxygen is supplied to the lungs.
Oxygen may also be administered to affected infants if their skin and mucous membranes have a bluish discoloration (cyanotic) after the removal of secretions from the throat. This type of intensive supportive care may be lifesaving in very severe cases of Pertussis.
Whooping Cough: Symptoms, Treatment, and Prevention
Whooping cough, also called pertussis, is a serious respiratory infection caused by a type of bacteria called Bordetella pertussis. The infection causes violent, uncontrollable coughing that can make it difficult to breathe.
While whooping cough can affect people at any age, it can be deadly for infants and young children.
According to the Centers for Disease Control and Prevention (CDC), before a vaccine was available, whooping cough was a major cause of childhood deaths in the United States. The CDC reports the total number of cases of pertussis in 2016 was just under 18,000, with 7 deaths reported.
The incubation period (the time between initial infection and the onset of symptoms) for whooping cough is about 5 to 10 days, but symptoms might not appear for as long as three weeks, according to the CDC.
Early symptoms mimic the common cold and include a runny nose, cough, and fever. Within two weeks, a dry and persistent cough may develop that makes breathing very difficult.
Children often make a “whoop” sound when they try to take a breath after coughing spells, though this classic sound is less common in infants.
This type of severe cough can also cause:
- blue or purple skin around the mouth
- low-grade fever
- breathing difficulties
Adults and teenagers typically experience milder symptoms, such as a prolonged cough without the “whoop” sound.
If you or your child experience symptoms of whooping cough, seek medical attention right away, especially if members of your family haven’t been immunized.
Whooping cough is highly contagious — bacteria can become airborne when an infected person coughs, sneezes, or laughs — and can quickly spread to others.
To diagnose whooping cough, your doctor will perform a physical exam and take samples of mucus in the nose and throat. These samples will then be tested for the presence of the B. pertussis bacteria. A blood test may also be necessary to make an accurate diagnosis.
Many infants and some young children will need to be hospitalized during treatment, for observation and respiratory support. Some may need intravenous (IV) fluids for dehydration if symptoms prevent them from drinking enough fluids.
Since whooping cough is a bacterial infection, antibiotics are the primary course of treatment. Antibiotics are most effective in the early stages of whooping cough. They can also be used in the late stages of the infection to prevent it from spreading to others.
While antibiotics can help treat the infection, they don’t prevent or treat the cough itself.
However, cough medicines aren’t recommended — they have no effect on whooping cough symptoms and may carry harmful side effects for infants and small children.
Most doctors suggest using humidifiers in your child’s bedroom to keep air moist and help alleviate symptoms of whooping cough.
Infants with whooping cough require close monitoring to avoid potentially dangerous complications due to lack of oxygen. Serious complications include:
- brain damage
- bleeding in the brain
- apnea (slowed or stopped breathing)
- convulsions (uncontrollable, rapid shaking)
If your infant experiences symptoms of infection, call your doctor immediately.
Older children and adults can experience complications as well, including:
Symptoms of whooping cough can last up to four weeks or longer, even during treatment. Children and adults generally recover quickly with early medical intervention.
Infants are at the highest risk of whooping cough-related deaths, even after starting treatment.
Parents should monitor infants carefully. If symptoms persist or get worse, contact your doctor right away.
Vaccination is the key to prevention. The CDC recommends vaccination for infants at:
Booster shots are needed for children at:
- 15 to 18 months
- 4 to 6 years and again at 11 years old
Children aren’t the only ones vulnerable to whooping cough. Talk to your doctor about getting vaccinated if you:
- work with, visit, or care for infants and children
- are over the age of 65
- work in the healthcare industry
Whooping Cough (Pertussis)
Whooping cough (pertussis) is an infection of the respiratory system caused by the bacterium Bordetella pertussis (or B. pertussis). It mainly affects babies younger than 6 months old who aren't yet protected by immunizations, and kids 11 to 18 years old whose immunity has started to fade.
Whooping cough causes severe coughing spells, which can sometimes end in a “whooping” sound when the child breathes in.
Signs & Symptoms
The first symptoms of whooping cough are similar to those of a common cold:
- runny nose
- mild cough
- low-grade fever
After about 1 to 2 weeks, the dry, irritating cough evolves into coughing spells. During a coughing spell, which can last for more than a minute, a child may turn red or purple. At the end of a spell, the child may make the characteristic whooping sound when breathing in or may vomit. Between spells, the child usually feels well.
While many infants and younger kids with whooping cough develop the coughing fits and accompanying whoop, not all do. And sometimes babies don't cough or whoop as older kids do. Infants may look as if they're gasping for air with a reddened face and may actually stop breathing (this is called apnea) for a few seconds during very bad spells.
Adults and teens may have milder or different symptoms, such as a prolonged cough (rather than coughing spells) or coughing without the whoop.
Pertussis is highly contagious. The bacteria spread from person to person through tiny drops of fluid from an infected person's nose or mouth. These may become airborne when the person sneezes, coughs, or laughs. Others then can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses.
Infected people are most contagious during the earliest stages of the illness for up to about 2 weeks after the cough begins. Antibiotics shorten the period of contagiousness to 5 days following the start of antibiotic treatment.
Whooping cough can be prevented with the pertussis vaccine, which is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization.
DTaP immunizations are routinely given in five doses before a child's sixth birthday. For additional protection in case immunity fades, experts recommend that kids ages 11-18 get a booster shot of the new combination vaccine (called Tdap), ideally when they're 11 or 12 years old.
The Tdap vaccine is similar to DTaP but with lower concentrations of diphtheria and tetanus toxoid. It also should be given to adults who did not receive it as preteens or teens. The vaccine is also recommended for all pregnant women during the second half of each pregnancy, regardless of whether or not they had the vaccine before, or when it was last given.
Getting the vaccine is especially important for people who are in close contact with infants, because babies can develop severe and potentially life-threatening complications from whooping cough. An adult's immunity to whooping cough lessens over time, so getting vaccinated and protecting yourself against the infection also helps protect your infant or child from getting it.
As is the case with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information.
People who live with or come into close contact with someone who has pertussis should receive antibiotics to prevent the spread of the disease, even if they've already been vaccinated against it. Young kids who have not received all five doses of the vaccine may need a booster dose if exposed to an infected family member.
The incubation period (the time between infection and the start of symptoms) for whooping cough is usually 7 to 10 days, but can be as long as 21 days.
Pertussis usually causes prolonged symptoms — 1 to 2 weeks of common cold symptoms, followed by up to 3 months of severe coughing.
The last stage consists of another few weeks of recovery with gradual clearing of symptoms. In some children, the recovery period can last for months.
If your child is being treated for pertussis at home, follow the schedule for giving antibiotics exactly as your doctor prescribed.
Giving cough medicine probably will not help, as even the strongest usually can't relieve the coughing spells of whooping cough. The cough is actually the body's way of trying to clear the airways.
(Due to potential side effects, cough medicines are never recommended for children under age 6.)
During recovery, let your child rest in bed and use a cool-mist vaporizer to help soothe irritated lungs and breathing passages. (Be sure to follow directions for keeping it clean and mold-free.) And keep your home free of irritants that can trigger coughing spells, such as aerosol sprays; tobacco smoke; and smoke from cooking, fireplaces, and wood-burning stoves.
Kids with whooping cough may vomit or not eat or drink much because of the coughing. So offer smaller, more frequent meals and encourage your child to drink lots of fluids.
Watch for signs of dehydration, including thirst, irritability, restlessness, lethargy, sunken eyes, a dry mouth and tongue, dry skin, crying without tears, and fewer trips to the bathroom to pee (or in infants, fewer wet diapers).
When to Call the Doctor
Call the doctor if you think that your child has whooping cough or has been exposed to someone with whooping cough, even if your child has already had all scheduled pertussis immunizations.
This is especially important if your child has long coughing spells and:
- the coughing make your child's skin or lips turn red, purple, or blue
- your child vomits after coughing
- there's a whooping sound after the cough
- your child has trouble breathing or seems to have brief periods of not breathing (apnea)
- your child seems very sluggish
If your child has been diagnosed with whooping cough and is being treated at home, get immediate medical care if he or she develops difficulty breathing or shows signs of dehydration.
Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: February 2016
Whooping Cough: Causes, Symptoms, Treatment and Prevention
- Children and Whooping Cough
- Whooping Cough: What Happens
Whooping cough (also known as pertussis) is a bacterial infection that gets into your nose and throat. It spreads very easily, but vaccines DTaP and Tdap can help prevent it in children and adults.
At first, whooping cough has the same symptoms as the average cold:
- Mild coughing
- Runny nose
- Low fever (below 102 F)
You may also have diarrhea early on.
After about 7-10 days, the cough turns into “coughing spells” that end with a whooping sound as the person tries to breathe in air.
Because the cough is dry and doesn't produce mucus, these spells can last up to 1 minute. Sometimes it can cause your face to briefly turn red or purple.
Most people with whooping cough have coughing spells, but not everyone does.
Infants may not make the whooping sound or even cough, but they might gasp for air or try to catch their breath during these spells. Some may vomit.
Sometimes adults with the condition just have a cough that won’t go away.
Whooping cough is dangerous in babies, especially ones younger than 6 months old. In severe cases, they may need to go to an ER.
If you think your child might have it, see your doctor right away.
Children under the age of 18 months with whooping cough should be watched at all times, because the coughing spells can make them stop breathing. Young babies with bad cases may need hospital care, too.
Help protect your child by making sure he and any adult who's around him often gets vaccinated.
For older children and adults, the outlook is usually very good.
If doctors diagnose whooping cough early on, antibiotics can help cut down coughing and other symptoms. They can also help prevent the infection from spreading to others. Most people are diagnosed too late for antibiotics to work well, though.
Don't use over-the-counter cough medicines, cough suppressants, or expectorants (medicines that make you cough up mucus) to treat whooping cough. They don't work.
If your coughing spells are so bad that they keep you from drinking enough fluids, you risk dehydration. Call your doctor right away.
If a person with whooping cough sneezes, laughs, or coughs, small droplets that contain the bacteria may fly through the air. You might get sick when you breathe the droplets.
When the bacteria get into your airways, they attach to the tiny hairs in the linings of the lungs. The bacteria cause swelling and inflammation, which lead to a dry, long-lasting cough and other cold- symptoms.
Whooping cough can cause anyone at any age to get sick. It may last 3 to 6 weeks. You can get sick from it even if you've already been vaccinated, but that's not ly.
CDC: “Pertussis (Whooping Cough) Diagnosis and Treatment;” “Pertussis (Whooping Cough) Vaccination;” and “Protect Babies from Whooping Cough (Pertussis).”
HealthyChildren.org: “Whooping Cough.”
Nemours Foundation: “Infections: Whooping Cough (Pertussis).”
© 2018 WebMD, LLC. All rights reserved.
Signs and Symptoms
Pertussis (whooping cough) can cause serious illness in babies, children, teens, and adults. Symptoms of pertussis usually develop within 5 to 10 days after you are exposed. Sometimes pertussis symptoms do not develop for as long as 3 weeks.
The disease usually starts with cold- symptoms and maybe a mild cough or fever. In babies, the cough can be minimal or not even there. Babies may have a symptom known as “apnea.
” Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for babies. About half of babies younger than 1 year who get the disease need care in the hospital.
Learn more about pertussis complications.
In those who have gotten the pertussis vaccine:
- In most cases, the cough won’t last as many days
- Coughing fits, whooping, and vomiting after coughing fits occur less often
- The percentage of children with apnea (long pause in breathing), cyanosis (blue/purplish skin coloration due to lack of oxygen) and vomiting is less
Early symptoms can last for 1 to 2 weeks and usually include:
- Runny nose
- Low-grade fever (generally minimal throughout the course of the disease)
- Mild, occasional cough
- Apnea – a pause in breathing (in babies)
Pertussis in its early stages appears to be nothing more than the common cold. Therefore, healthcare professionals often do not suspect or diagnose it until the more severe symptoms appear.
After 1 to 2 weeks and as the disease progresses, the traditional symptoms of pertussis may appear and include:
- Paroxysms (fits) of many, rapid coughs followed by a high-pitched “whoop” sound
- Vomiting (throwing up) during or after coughing fits
- Exhaustion (very tired) after coughing fits
It is important to know that many babies with pertussis don’t cough at all. Instead it causes them to stop breathing and turn blue.
Pertussis can cause violent and rapid coughing, over and over, until the air is gone from your lungs. When there is no more air in the lungs, you are forced to inhale with a loud “whooping” sound. This extreme coughing can cause you to throw up and be very tired.
Although you are often exhausted after a coughing fit, you usually appear fairly well in-between. Coughing fits generally become more common and bad as the illness continues, and can occur more often at night. The coughing fits can go on for up to 10 weeks or more.
In China, pertussis is known as the “100 day cough.”
The “whoop” is often not there if you have milder (less serious) disease. The infection is generally milder in teens and adults, especially those who have gotten the pertussis vaccine.
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Recovery from pertussis can happen slowly. The cough becomes milder and less common. However, coughing fits can return with other respiratory infections for many months after the pertussis infection started.
- McNamara LA, Skoff T, Faulkner A, et al. Reduced severity of pertussis in person with age-appropriate pertussis vaccination — United States, 2010–2012External. Clin Infect Dis. Epub ahead of print. 2017.
- Barlow RS, Reynolds LE, Cieslak PR, et al. Vaccinated children and adolescents with pertussis infections have decreased illness severity and duration, Oregon 2010-2012External. Clin Infect Dis. 2014;58(11):1523–9.
- Stehr K, Cherry JD, Heininger U, et al. A comparative effectiveness trial in Germany in infants who received either the Lederle/Takeda acellular pertussis component DTP (DTaP) vaccine, the Ledele whole-cell component DTP vaccine, or DT vaccineExternal. Pediatrics. 1998;101(1 Pt 1):1–11.
- Tozzi AE, Ravá L, Ciofi ML, et al. Clinical presentation of pertussis in unvaccinated and vaccinated children in the first six years of lifeExternal. Pediatrics. 2003;112(5):1069–75.
- Ward JI, Cherry JD, Swei-Ju C, et al. Bordetella pertussis infections in vaccinated and unvaccinated adolescents and adults, as assessed in a national prospective randomized acellular pertussis vaccine trial (APERT)External. Clin Infect Dis. 2006;43:151–7.
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Whooping cough overview
Whooping cough (pertussis) is a highly contagious bacterial infection that can affect people of all ages, but is most severe in babies. The disease causes coughing attacks that can end in a high-pitched whooping sound.
Whooping cough epidemics occur in Australia every 3 to 4 years. Antibiotics may help reduce whooping cough symptoms if given early enough, and they can help stop the spread of the disease. But in some people the cough persists even after antibiotic treatment. Vaccination is the best way to protect yourself and your family from whooping cough.
What are the symptoms of whooping cough?
The symptoms of whooping cough develop about 7 to 20 days after catching the infection. Whooping cough symptoms can be divided into 3 stages – see below.
The first (catarrhal) stage
The first stage of whooping cough resembles the common cold, with a mild occasional cough, loss of appetite, runny nose and sneezing that lasts a week or 2. A mild fever is possible but not common. Whooping cough is highly contagious at this stage, but difficult to diagnose.
The second (paroxysmal) stage
The second stage is known as the paroxysmal stage due to the coughing spells. The cough commonly persists for up to 3 months. However, in adolescents and adults, or children who have been vaccinated, the disease is often milder and people may even not show any symptoms, or they may have mild or persistent cough.
Coughing fits are often violent and the cough may finish with a loud ‘whoop’ sound when you breathe in. However, many people (especially older children and adults) do not make the typical ‘whoop’ sound.
Vomiting after a b coughing is common, and the persistent coughing spells can cause you to stop breathing temporarily. Children may turn red or blue during the coughing fits. Babies with whooping cough may not have a noticeable cough – the only signs of illness may be trouble feeding or pauses in their breathing.
If you or your child is having trouble breathing or turns blue, call 000 for an ambulance.
The third (convalescent) stage
The third stage of whooping cough is when the coughing spells starts to subside. Sometimes, coughing can start again months later if you develop another upper respiratory tract infection.
What causes whooping cough and how does it spread?
Whooping cough is caused by the bacterium Bordetella pertussis, although sometimes other bacteria can cause a pertussis- syndrome.
Whooping cough is very contagious. The bacteria can be easily passed from person to person. It is mainly spread through coughing and sneezing, which causes infected particles to travel through the air.
These infectious airborne droplets can be breathed in by others.
They can also contaminate surfaces such as door knobs, toys or eating utensils, and infect others when they touch these surfaces and then touch their eyes, mouth or nose.
If your child has never had the disease and has not been vaccinated against it, they are ly to get whooping cough if they come into contact with the bacteria. Even people who have had whooping cough can get the infection again, because natural immunity to the infection wanes over time.
Getting vaccinated and having regular booster doses is the best way to protect yourself against whooping cough.
If your child gets whooping cough and they have not been vaccinated, they are more ly to develop complications such as pneumonia. A severe case of whooping cough or pneumonia in a young child could result in seizures, brain damage or death.
Whooping cough is also dangerous in older people. While it tends to be less severe in adolescents and adults, complications due to persistent coughing are common. They include sleep disturbance, urinary incontinence, fractured ribs and fainting.
Tests and diagnosis
Your doctor may suspect infection with whooping cough your symptoms, or from witnessing the coughing. Swabs from the nose or throat or blood tests are usually used to confirm the diagnosis.
Nose and throat swabs that detect the pertussis bacteria only help with diagnosis if done in the early stages of the disease. Throat swabs can usually detect pertussis germs for 3 weeks from the onset of illness. If your doctor suspects whooping cough because of the classic cough symptoms, they may take a swab to make sure of the diagnosis.
Blood tests can also be done for pertussis, but they are not always reliable or easy to interpret. Blood tests may become positive 2 weeks after the onset of illness.
It’s important that you rest and drink plenty of fluids – this is especially important for children. Small, frequent meals may help prevent vomiting after bouts of coughing.
Make sure you avoid anything that may trigger coughing, including smoke from cigarettes or fireplaces.
Preventing whooping cough
The best way of preventing or reducing the severity of whooping cough is to be immunised. All whooping cough vaccines available in Australia are combination vaccines that also protect against other illnesses. There are very few medical reasons why someone should not have a pertussis vaccination.
Vaccinations for children and teenagers
In Australia, vaccination against whooping cough is recommended at age 2, 4, and 6 months as part of the National Immunisation Program Schedule. The 2-month dose can be given as early as 6 weeks of age.
Two booster doses are recommended – one at 18 months and one at age 4 years. An additional booster dose is recommended for adolescents between 11 and 13 years. This booster can be given as part of a school-based vaccination programme.
Vaccinations for adults
Because the protection from the vaccine wears off over time, booster doses are also recommended for adults who want to avoid getting whooping cough. Vaccination is especially important for anyone coming into close contact with babies. That’s because babies under 6 months of age (who have the highest risk of severe whooping cough) are too young to be fully immunised themselves.
To protect very young babies, a single booster dose of pertussis vaccine is recommended for pregnant women. The best time for vaccination is between 20 and 32 weeks.
This is recommended with each pregnancy, even if 2 pregnancies are close together.
Vaccination at this time means that the baby will be born with some of the mother’s antibodies to pertussis (passive immunity) and so have some protection during the most vulnerable newborn stage.
Vaccination is also recommended for all carers of young children, including fathers and grandparents. Mothers not vaccinated during pregnancy should be vaccinated as soon as possible after birth. Anyone in close contact with infants should get a booster every 10 years.
There is a higher risk of severe symptoms and complications in older people who get whooping cough. Vaccination is recommended for all adults at ages 50 and 65 years.
Pertussis vaccine side effects
Side effects may include mild pain, swelling and redness at the injection site. Uncommon and rare side effects can include fever, significant swelling of the limb where the injection was given and febrile convulsions in children. Overall, the risk of not being vaccinated (and more vulnerable to infection) far outweighs the risk of side effects for most people.
Stopping the spread of pertussis
If you have whooping cough, stay at home to prevent the spread of the disease. People with whooping cough need to stay away from work, school or childcare facilities until they have been on antibiotics for 5 days or they have had the cough for more than 3 weeks. Your doctor will let you know when you are no longer contagious and can return to your usual activities.
While you are sick, practice good cough etiquette and wash your hands frequently.
1. Australian Technical Advisory Group on Immunisation (ATAGI). Pertussis (whooping cough). Australian Immunisation Handbook, Australian Government Department of Health, Canberra, 2018. https://immunisationhandbook.health.gov.
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