Whooping Cough (Pertussis)

What is whooping cough (pertussis)?

Whooping cough, or pertussis, primarily affects infants and young children. Caused by a bacterium, it is characterized by paroxysms (intense fits or spells) of coughing that often end with the characteristic whoop as air is inhaled. Whooping cough caused thousands of deaths in the 1930s and 1940s, but, with the advent of the pertussis vaccine, the rate of disease and death has declined dramatically. Recent epidemics have occurred in areas where vaccine rates have fallen. Even though pertussis vaccines are very effective, if pertussis is circulating in the community, there is a possibility that a fully vaccinated person can catch the disease. The vaccine's protection also wears off over time, meaning that adolescents and adults who have not had a booster may contribute to the spread of the disease during an outbreak.

What causes whooping cough?

Whooping cough is caused by the Bordetella pertussis bacterium. It is spread through children from exposure to infected droplets in the air. Once the bacteria are in the child's airways, swelling of the airways and mucus production begins. Usually, the disease starts like the common cold, with a runny nose or congestion, sneezing, and sometimes a mild cough or fever. Usually, after one to two weeks, severe coughing begins.

What are the facts about whooping cough?

  • Although the disease can usually be prevented with the vaccine, it is not 100 percent effective.

  • Whooping cough is worse for children under 1 year of age and is fatal is some cases.

  • In the U.S., thousands of new cases are reported each year.

What are the symptoms of whooping cough?

The disease usually takes one to three weeks to incubate, with the child usually passing through three stages. The following are the most common symptoms of whooping cough, according to each stage. However, each child may experience symptoms differently. In infants, the cough may be very hard to hear. Infants may have a pause in breathing called "apnea" instead of a cough. If you notice this, you should call your doctor or take your child to the hospital immediately. Symptoms may include:

  • Catarrhal stage (often lasts one to two weeks):

    • Mild cough

    • Low grade fever

    • Runny nose

  • Acute phase (may last for several weeks):

    • Cough gets worse and comes in severe fits

    • Cough is dry and harsh

    • Cough ends with a whoop sound on inspiration

    • Child may vomit with the coughing and appear to be strangling on the vomit

    • Cough can be started by many factors, including feeding, crying, or playing

  • Recovery phase (usually begins around the fourth week):

    • Vomiting and the whooping cough cease first

    • The cough usually decreases around the sixth week, but may continue on occasion for the next 1 to 2 months. Whooping cough used to be called the "100-day cough" because it can last for weeks to months.

Whooping cough can lead to pneumonia and other complications.

The symptoms of whooping cough may resemble other medical conditions. Always consult your child's doctor for a diagnosis.

How is whooping cough diagnosed?

In addition to a complete medical history and physical examination, diagnosis of whooping cough is often confirmed with a culture (mucus, nasal secretions) taken from the nose.

What is the treatment for whooping cough?

Specific treatment for whooping cough will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history

  • Extent of the condition

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

In many cases, the child may be hospitalized for supportive care and monitoring. Sometimes, oxygen and intravenous (IV) fluids are needed until the child begins to recover. Antibiotic treatment (for example, clarithromycin [Biaxin] or azithromycin [Zithromax], or a related antibiotic) may also be ordered by your child's doctor. Depending on when they are started, antibiotics may not shorten the course of illness, but they will  prevent the spread of infections.

Family members and other people who have been in close contact with the child usually are started on antibiotic therapy, regardless of whether they have received the vaccine or not.

Other treatment may include the following:

  • Keeping your child comfortably warm

  • Feeding your child small, frequent meals

  • Increasing your child's fluid intake

  • Reducing stimuli that may provoke coughing

How can whooping cough be prevented?

Although a vaccine has been developed against whooping cough, which is routinely given to children in the first year of life, cases of the disease still occur, especially in infants younger than 6 months of age.

According to the CDC, there has been a dramatic increase in the number of cases of pertussis since the 1980s, especially in preteens and teens 10 to 19 years of age and babies less than 5 months of age. The CDC recommends that children receive five DTaP shots for maximum protection against pertussis. A DTaP shot is a combination vaccine that protects against three diseases: diphtheria, tetanus, and pertussis. The first three shots are given at 2, 4, and 6 months of age. Between 15 and 18 months of age, the fourth shot is given, and a fifth shot when a child enters school at 4 to 6 years of age. At regular checkups for 11- or 12-year-olds, a preteen should get a dose of Tdap. The Tdap booster contains tetanus, diphtheria, and pertussis. All adults over 19 who haven't received the Tdap should have a dose, as should all pregnant women in their third trimester even if they have had the Tdap previously. Adults should then have a Td booster every 10 years but shouldn't wait to get Tdap if they recently received a Td booster.  Always consult your doctor for advice.