Whooping cough

What is whooping cough?

Whooping cough is a highly contagious infection caused by the bacterium) Bordetella pertussis. Whooping cough is also called 'pertussis'. The bacterium attaches to cells which line the airways. It then multiplies and causes the symptoms.

Bordetella pertussis bacterium affects the lining of the airways to cause the cough to continue for a long time after the bacteria have gone.

What are the symptoms of whooping cough?

The illness typically follows a pattern. Symptoms develop 5-12 days after being infected.

Early stage (catarrhal phase)

In the early stage symptoms are similar to the common cold. At first there is often a sore throat. Within a day or so a mild, dry cough develops. You may also have a runny nose. Most people do not have a high temperature (fever). Over a few days the cough may become more productive with some phlegm (sputum).

Main coughing stage (paroxysmal phase)

Around 7-14 days from the start of the illness, the cough usually worsens and becomes paroxysmal. This means there are bouts (paroxysms) of intense coughing. The average is about 12-15 bouts per day but some people have up to 100 per day. Between the bouts of coughing you are likely to be well. The symptoms of fever, runny nose and other symptoms of illness have usually gone by this stage.

This main coughing stage of the illness usually lasts at least two weeks and often longer.

Easing stage (convalescent phase)

The bouts of coughing then ease gradually over a period which can last up to three months or more. (In some countries whooping cough is known as the cough of a hundred days.) As things seem to be easing, you may still have the odd bout of severe coughing.

Whooping cough can be very miserable, as the bouts of coughing can be distressing. However, in some cases the symptoms are milder than described above.

What does whooping cough sound like?

During a bout of coughing, you repeatedly cough over and over again. The face often goes red and the body becomes tense. Eventually, there is a desperate attempt to breathe in, which may cause a high-pitched whoop sound. The whoop sound at the end of a bout of coughing only happens in about half of cases. Each bout of coughing typically lasts 1-2 minutes.

Several bouts of coughing may occur together and last several minutes in total. It is quite common to be sick (vomit) at the end of a bout of coughing.

Who can get whooping cough?

Anybody of any age can get whooping cough. Most cases in the UK are in older children and adults. People who have not been immunised, or have not previously been infected with whooping cough are more likely to be affected.

Is whooping cough contagious?

It is very contagious for the first three weeks of the illness. Whooping cough is spread to others by contaminated droplets in the air, produced when an infected person coughs, sneezes, or laughs. It can also be spread by close contact with an affected person. To try to avoid passing on the infection, cover your mouth when you cough or sneeze, throw away used tissues immediately and wash your hands regularly. You may consider wearing a facemask and keeping your distance from others. Taking a course of antibiotics from a doctor can reduce how infectious a person is in the early stage of the illness.

Does my child need to stay off school?

Do I need to stay off work?

How is whooping cough diagnosed?

Whooping cough is often diagnosed by the typical symptoms. If it is suspected, you may have a test to confirm the diagnosis. However, results can take some time, so you will normally be treated without waiting for a result if your symptoms are typical.

In the early stages, there is a test that can confirm the diagnosis. This involves taking a swab from the very back of the nose to send to the laboratory for testing. A swab is much like a cotton bud on a long stick or wire.

However, in many cases of 'cough for several weeks', the bacterium that causes whooping cough will have gone from the body but the cough continues for several further weeks. Therefore, a negative test, with no bacterium found, does not rule out whooping cough..

A blood test may also be used, especially in adults who have had symptoms for more than two weeks. This test detects the protective proteins your immune system produces (antibodies) in response to the whooping cough bacterium.

Complications of whooping cough

Most people fully recover but some develop complications. Complications most commonly develop in babies under the age of 6 months.

Possible complications include:

Lung infection (pneumonia)

Other germs (bacteria) can infect the lungs more easily if you have whooping cough. So, pneumonia caused by other bacteria (a secondary infection) sometimes occurs. Pneumonia is suspected in someone if they become more ill, have a high temperature (fever), breathe fast, or have difficulty breathing between bouts of coughing.

Burst blood vessels

The increased pressure in the face caused by coughing can cause small blood vessels in the face to burst, resulting in nosebleeds, blood in the eyes (subconjunctival haemorrhage), or skin bruises around the eyes. These usually heal without any treatment needed as the cough improves.

Sore ribs

Severe coughing can cause rib pain because it causes strong contractions of the muscles around the ribs. Very rarely the pressure may be so strong it can cause a rib to break (fracture).

Hernia

The increase of pressure in the tummy (abdomen) during bouts of coughing may cause a split in the muscle wall, called a hernia.

Emergency situations

Complications such as pneumonia, a hole in the lung (pneumothorax) or dehydration in children, particularly babies, can be life-threatening. It is important to look out for these in an unwell person and call for an emergency ambulance (999 in the UK) if the person:

• Has difficulty breathing, has periods of stopping breathing or is breathing very fast.

• Becomes blue around the face or mouth.

• Appears to be more unwell.

• Is dehydrated.

Treatment for whooping cough

Antibiotics

The bacterium which causes whooping cough can be killed by antibiotics. These are usually given if whooping cough is diagnosed within the first three weeks of the illness. Antibiotics reduce the chance of an infected person passing their illness on to others but do not improve a person's symptoms. Without antibiotics, you are infectious for three weeks after the illness starts.

The antibiotics usually used for whooping cough are clarithromycin, azithromycin or erythromycin.

General measures

Unfortunately there is nothing that has been shown to work to soothe or prevent the coughing bouts.

General measures include:

• General comforting.

• Clearing away mucus and sick (vomit) during bouts of coughing.

• Looking out for complications such as pneumonia which may be more serious.

• Making sure an ill child is getting enough food and drink.

Can whooping cough be prevented?

Antibiotics

A course of antibiotics may be given to some people who have come into close contact with a person with whooping cough. This may prevent the illness from developing. This is particularly used for babies aged 6 months or less, as they are most at risk of a more serious form of the illness. It may also be given to people who are likely to come into contact with small babies.

Whooping cough vaccine (pertussis vaccine)

In the UK, immunisation against whooping cough is routinely offered to all children. It is part of the 6-in-1 vaccine given at 2, 3 and 4 months of age. Children then have a preschool booster when aged between 3-5 years.

In the UK pregnant women are offered whooping cough immunisation. This is because whooping cough is usually a more serious illness in babies under 6 months of age and immunising pregnant women helps protect the baby until they are old enough to receive their own immunisations. Pregnant women who have not been immunised and who have been in contact with someone who has whooping cough should contact their midwife or doctor so treatment can be discussed to reduce the risk of illness.

What is the outlook (prognosis)?

Most people who develop whooping cough make a full recovery. However, it can be a miserable illness, as the relentless bouts of coughing can be distressing. The total length of the illness is commonly 6-8 weeks but often lasts three months or more.

Severe complications and death are uncommon but occur mostly in babies under 6 months of age. Serious illness is less common in older children and adults. Once recovered, you usually have a little immunity from the infection but this may drop. This could mean that you could get whooping cough again- but it would be unusual.