Pertussis (whooping cough)

About whooping cough

Whooping cough is a bacterial infection that causes uncontrollable bouts of coughing. The bacteria can easily spread from person to person and cause illness. In some people, particularly young children, a ‘whoop’ sound is made as they draw in breath between coughing.

Whooping cough used to be far more common and cause more serious illness. Now, children in the UK are vaccinated against it, so the number of people who get whooping cough each year is much lower.

However, since mid to late 2011, there has been a sharp increase in the number of young children with whooping cough – the largest seen in the UK for over a decade – especially in young babies. Therefore, an immunisation programme was introduced by the Department of Health in September 2012 for all women who are between 28 and 38 weeks pregnant, so their babies are protected from the day they are born.

Although whooping cough is thought of as a childhood illness, people of any age can catch it. However, in adults the illness is mild and they rarely have complications.

Symptoms of whooping cough

Whooping cough has three phases, each with different symptoms.

The first phase begins between seven and 21 days after you have been infected. The first symptoms are similar to a common cold. You may feel generally unwell with a runny nose, sneezing, a slight fever and, a few days later, a dry cough. These symptoms usually last about a week.

In the next phase, which may last a month or more, you may have uncontrollable bouts of coughing. At the end of a coughing bout, you may make a ‘whoop’ sound as you draw in breath. This is more common in young children than in babies or adults with whooping cough.

As well as having bouts of coughing, babies and children may also:

  • go red in the face while coughing
  • vomit at the end of a bout of coughing
  • have difficulty feeding, which can lead to weight loss and dehydration
  • choke on the thick mucus in their throat and chest
  • have pauses in breathing for up to 20 seconds (known as apnoea) and turn blue from the lack of oxygen

In the last phase, you will gradually get better. You may have a cough for up to two months, but it won’t be as severe as during the second phase of whooping cough.

These symptoms aren't always caused by whooping cough, but if you have them, see your GP.

Complications of whooping cough

There are complications of whooping cough, some of which can be serious and life-threatening. Babies under six months old are most at risk of complications.

Less serious complications include:

  • infection in your middle ear – rarely this can cause temporarily impaired hearing
  • bleeding into your eyes or from your nose
  • red spots under the skin of your face and chest, caused by small blood vessels bursting during coughing bouts

More serious complications include:

  • pauses in breathing for up to 20 seconds (known as apnoea)
  • lung inflammation usually caused by bacteria (known as pneumonia)
  • fits (seizures)
  • disorders of the brain that lead to symptoms including confusion, tiredness and muscle twitches (rare in adults)

Other complications that are directly related to the increased pressure in the chest from coughing can include any of the following.

  • Air trapped in the space between your lungs and the wall of your chest (called a pneumothorax). This causes chest pain.
  • A hernia. This is a bulge or swelling that occurs when the contents from your abdomen, such as your intestines, push through a weakness in the muscle of your abdominal wall.
  • A rectal prolapse. This is when part of your rectum or the lining of your rectum drops through your anus.
  • Rib fracture.
  • Urinary incontinence. This is when you pass urine unintentionally.
  • Frequent vomiting after a bout of coughing, which can lead to severe dehydration or weight loss.

Causes of whooping cough

The bacteria Bordetella pertussis cause whooping cough. When an infected person coughs, fine droplets containing the bacteria are formed and these carry the bacteria through the air to other people. When these droplets are breathed in, the bacteria can infect your airways causing symptoms such as coughing.

Diagnosis of whooping cough

Your GP will ask about your symptoms and medical history. He or she will usually be able to diagnose whooping cough based on your symptoms, but may also take a sample of mucus or saliva from your nose or throat with a swab (like a small round cotton bud). You may also have a blood sample taken. Your GP will send samples to a laboratory to be tested.

Treatment of whooping cough

Your GP may prescribe an antibiotic for you. However, even when you’re treated with antibiotics, the coughing usually last for six to eight weeks. The antibiotics may help to prevent the infection spreading to other people.

You will be advised to rest and drink enough fluids. You can take painkillers, such as paracetamol or ibuprofen, if you’re in pain. Don’t give aspirin to children under 16. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

No over-the-counter cough medicines have been shown to help relieve whooping cough so don’t take these. Especially, don’t give cough medicines to children under six years old because there is a risk of an allergic reaction.

If you’re severely ill with whooping cough or are showing signs of complications, you will be admitted to a hospital. You may need to be admitted to an isolation ward to protect other people from catching the illness.

More than half of babies under six months old will be admitted to hospital for treatment and monitoring if they have whooping cough. Some babies may be treated in a paediatric intensive care unit (PICU). Treatment they may need includes having thick mucus removed from their throat using a suction tube, or being put on a drip to be given fluids if they are having difficulty feeding. They might also require oxygen and other medicines.

Prevention of whooping cough

You should stay away from work or school for five days after starting antibiotics, or 21 days after you started coughing (whichever is sooner). It’s also best to stay away from babies under six months old to help prevent them from getting infected.

Vaccination

Because there was a sharp increase in the number of children and young babies catching whooping cough in late 2011 and 2012, the Department of Health introduced an immunisation programme in September 2012 for all women who are between 28 and 38 weeks pregnant. This means their babies will be protected from the bacteria that cause whooping cough from the day they are born. There were over four times as many children and young babies with whooping cough in England and Wales up to the end of August 2012 compared to the same number up to the end of August 2011.

Young babies are particularly at risk of serious disease because they can’t be vaccinated until they reach two months of age. If you’re pregnant, you can help protect your unborn baby from getting whooping cough in their first weeks after birth by having the whooping cough vaccination from week 28 of your pregnancy. You should have the vaccination even if you have been vaccinated before or have had whooping cough yourself.

Your baby will still need to be vaccinated as usual when he or she reaches two months of age. This vaccine is available as part of the national immunisation programme in the UK. It’s given in a series of injections at two, three and four months old. A pre-school booster is given to children when they are between three and five years old. Other vaccines are given at the same time against diphtheria, tetanus, polio and Hib (Haemophilus influenzae type b). The combination of vaccines is called DTaP/IPV/Hib. See our Common questions for more information.

If you choose not to have your child vaccinated, he or she will be more at risk of catching whooping cough. Even if you were vaccinated in infancy, your immunity will decrease over time, so it’s possible to get whooping cough as an adult, especially if you travel to countries where vaccination isn’t routinely performed.

Medicines

If you have whooping cough, your GP may offer antibiotics to you and other family members, especially any children under 10 years old who haven’t been vaccinated. Other people in your family who may benefit from antibiotics include anyone who has asthma, heart disease or a weakened immune system, for example, those who have HIV/AIDS or are being treated for cancer. Antibiotics can help prevent family members catching and spreading whooping cough.

Animation - How bacterial vaccines work

My child has whooping cough. Can he go to school?

Answer

If your child has whooping cough, he should be kept away from school for five days from when he starts a course of antibiotics.

Explanation

Whooping cough is easily spread between people when an infected person coughs or sneezes. Tiny droplets containing the bacteria are released into the air, which can then be breathed in by other people.

If you think that your child has whooping cough, you should keep him home from school or nursery and visit your GP. If your child has whooping cough, he will be given antibiotics and should be kept at home for at least five days after starting the course. You should keep infected children away from their brothers and sisters, particularly if they are younger or haven't been vaccinated yet.

Adults can also get whooping cough, but symptoms tend to be milder and there is less chance of having complications compared to young children. If you have whooping cough, even if you feel well enough to go back to work, you must stay at home for five days after starting antibiotics if you work with children who are under five years old, the elderly, or people who have a long-term diseases or a weakened immune system, such as those who have HIV/AIDS.

Why does my daughter have to have three doses of vaccine? Why can't she be given it all in one go?

Answer

The pertussis (whooping cough) vaccination is given to your child over three doses and then a later booster dose because this produces the strongest immune response.

Explanation

Pertussis vaccination is given alongside other vaccines, including diphtheria and polio. These vaccines are given at age two, three and four months. This is because it’s known that babies are particularly vulnerable to these infections and early vaccination helps to protect them against getting ill and any complications this can cause.

Each dose of vaccine will produce a stronger immune response. This won’t make your child ill but it will prepare her body in case she is exposed to a disease that she has been vaccinated against. If this happens, her immune system can work faster than if she hadn’t been vaccinated and she will most likely be able to fight the infection and show no signs of having caught it.

Does the whooping cough vaccine last forever?

Answer

The vaccine against whooping cough protects babies and young children, but over time the protection drops, so older children, adolescents and adults can still become ill with whooping cough.

Explanation

By having the vaccine at a young age (between two and four months), babies are protected against whooping cough and any possible complications whooping cough may cause. Babies are the most vulnerable to having complications from whooping cough, with more than half being admitted to hospital when they have this illness.

The vaccine doesn’t protect people for life, neither does having a previous infection with whooping cough. You can still catch it again, but as an adult the symptoms are much less severe.

It’s not recommended for older children and adults to routinely be given the whooping cough vaccine, but sometimes it may be offered to them if they are in close contact with someone known to have whooping cough. The vaccine that is used is called DTaP-IPV (Repevax) and is the only type licensed for this use. This helps prevent the illness being spread to other people, especially babies under three months old who won’t have had the complete vaccination course.