Introduction 

Whooping cough (pertussis) is a highly contagious bacterial infection of the lungs and airways.

The condition usually begins with a persistent dry and irritating cough that progresses to intense bouts of coughing. The gasping for breath after one of these coughing bouts causes a distinctive "whooping" noise, which is how the condition gets its name.

Other symptoms include a runny nose, raised temperature and vomiting after coughing.

The coughing can last for around three months (another name for whooping cough is the "hundred day cough").

 

When to see your GP

See your GP as soon as possible if you think you or your child may have whooping cough.

Your GP can usually diagnose the condition by asking about your symptoms and listening to the cough (the whooping cough is very distinctive).

Whooping cough can also be confirmed with:



a blood test – to test for antibodies to Bordetella pertussis bacteria



a sample of mucus taken with a swab – to test for Bordetella pertussis bacteria



Whooping cough can be severe in young babies and, in some cases, they may need to be diagnosed and given immediate treatment in hospital.

 

What causes whooping cough?

Whooping cough is caused by a bacterium called Bordetella pertussis, which infects the lining of the airways, mainly the windpipe (trachea) and the two airways that branch off from it to the lungs (the bronchi).

If the bacteria make contact with your airways, this leads to:



a build-up of thick mucus – which causes the intense bouts of coughing as your body tries to expel it



swollen airways – which makes breathing more difficult and causing the "whoop" sound as you gasp for breath after coughing



People with whooping cough are infectious from six days after exposure to the bacteria to three weeks after the "whooping" cough begins.

The bacteria is passed from person to person by infected droplets in the air, spread by coughing and sneezing.

Treating whooping cough

If whooping cough is diagnosed during the first three weeks (21 days) of infection, a course of antibiotics may be prescribed. This is to prevent the infection being passed on to others.

It's important to take steps to avoid spreading the infection to others, particularly babies under six months of age.

Children with whooping cough should be kept away from school or nursery until either:



five days from the time they start taking antibiotics



they have had three weeks of intense coughing



The same advice applies to adults returning to work.

As a precaution, household members of someone with whooping cough may also be given antibiotics and a booster shot of the vaccine.

Antibiotics won't usually be prescribed if whooping cough is diagnosed in the later stages of infection (two to three weeks after the onset of symptoms). By this time, you will no longer be infectious. It's also very unlikely that antibiotics will improve your symptoms at this stage.

Your GP will be able to advise you about how to manage the infection at home using some simple self-care measures, such as resting and drinking plenty of fluids to avoid dehydration.

Babies under a year old are likely to be admitted to hospital as they are most at risk of severe complications, such as serious breathing difficulties.

They will be treated in isolation to prevent the infection spreading and will be given antibiotics into a vein through a drip (intravenously).

 

Whooping cough vaccination

In the UK, all pregnant women are offered vaccination against whooping cough when they are 28-38 weeks pregnant. Getting vaccinated while you’re pregnant could help to protect your baby from developing whooping cough in its first few weeks of life.

 

Children are vaccinated against whooping cough with the 5-in-1 vaccine at two, three and four months of age, and again with the 4-in-1 pre-school booster before starting school at the age of about three years and four months.

 

Although the number of cases of whooping cough has fallen dramatically since vaccination began, it is still possible for children to get the infection, so having the vaccination is vital.

The more people are vaccinated against whooping cough, the less chance of passing on the infection to a young baby, which could cause serious, and possibly fatal, complications.

The effectiveness of the whooping cough vaccination may fade over time, meaning it's possible to develop the condition during adulthood, even if you were vaccinated as a child.

 

Who is affected?

Due to the success of the vaccination scheme, whooping cough is now uncommon in young children.

Most cases occur in adults whose immunity has faded. In these cases symptoms tend to be less serious, although the persistent cough can be frustrating and unpleasant.

Whooping cough is a cyclical disease with the number of cases thought to peak every three to four years. An outbreak of whooping cough in 2012 meant 9,711 cases were confirmed in England and Wales compared to 4,835 confirmed cases in 2013.

The overall increase in the number of cases of whooping cough is thought to be related to heightened awareness of the disease and more cases being reported.



Whooping cough is caused by a bacterium called Bordetella pertussis

 


Pregnant women

All pregnant women are offered vaccination against whooping cough when they are 28-38 weeks pregnant.

Getting vaccinated while you’re pregnant could help to protect your baby from developing whooping cough in its first few weeks of life.

 




Does your child have a serious illness?

 

Symptoms to look out for if you're concerned your child may be seriously ill

Symptoms of whooping cough 

The symptoms of whooping cough usually appear around a week after infection with the bacteria Bordetella pertussis. But this delay – known as the incubation period – can last up to 21 days.

Whooping cough tends to develop in stages, with mild symptoms occurring first, followed by a period of more severe symptoms, before improvement begins.

Early symptoms

The early symptoms of whooping cough are often similar to those of a common cold and may include:



dry, irritating cough



runny or blocked nose



sneezing



watering eye



sore throat



slightly raised temperature



feeling generally unwell



These early symptoms of whooping cough can last up to a week, before becoming more severe.

Paroxysmal symptoms

The second stage of whooping cough is often called the paroxysmal stage and is characterised by intense bouts of coughing. The bouts are sometimes referred to as "paroxysms" of coughing.

The paroxysmal symptoms of whooping cough may include:



intense bouts of coughing, which bring up thick phlegm



a "whoop" sound with each sharp intake of breath after coughing (although this may not occur in infants and young children, see below)



vomiting after coughing, especially in infants and young children



tiredness and redness in the face from the effort of coughing



Each bout of coughing usually lasts between one and two minutes, but several bouts may occur in quick succession and last several minutes. The number of coughing bouts experienced each day varies, but is usually between 12 and 15.

The paroxysmal symptoms of whooping cough can last a month or more, even after treatment. This is because the cough continues even after the Bordetella pertussis bacterium has been cleared from your body.

Infants and young children

Infants younger than six months may not make the "whoop" sound after coughing, but they may start gagging or gasping, and may temporarily stop breathing.

Though very rare, it is possible for whooping cough to cause sudden unexpected death in infants (see complications of whooping cough for more information).

Young children may also seem to choke or become blue in the face (cyanosis) when they have a bout of coughing. This looks worse than it is, and breathing will quickly start again.

Adults and older children

In adults and older children, the paroxysmal symptoms of whooping cough are usually less severe than in young children, although the cough may still last for several weeks.

Recovery stage

Eventually, the symptoms of whooping cough gradually start to improve, with fewer and less extreme bouts of coughing occurring. This period of recovery can last up to two months or more.

However, intense bouts of coughing may still occur during this period.

When to seek medical advice

You should always see your GP if you think you or your child may have developed whooping cough.

If this is the case you will need to be prescribed antibiotics.

When to seek immediate medical advice

You should seek immediate medical advice if:



you have a baby of six months or younger who appears to be very unwell – spotting the signs of serious illness in young children



you (or your child) appear to be experiencing significant breathing difficulties such as extended periods of breathlessness



you (or your child) develop serious complications, such as seizures (fits) or pneumonia, an infection that causes inflammation of the tissues in your lungs



 

Treating whooping cough 

Whooping cough is usually treated with antibiotics at home. Young babies (less than a year old) with whooping cough may need hospital treatment to avoid developing complications.

Babies and young children

Children admitted to hospital to be treated for whooping cough, are usually treated in isolation. This means they will be kept away from other patients to prevent the infection spreading.

Your child may need to be given antibiotics intravenously (straight into a vein through a drip).

If your child is severely affected, they may also need corticosteroid medication to reduce inflammation (swelling) in the airways, making it easier to breathe. Like antibiotics, corticosteroids may be given intravenously.

If your child needs additional help with breathing, they may be given extra oxygen through a facemask. A handheld device called a bulb syringe may also be used to gently suction away any mucus that is blocking their airways.

 

Severe whooping cough in young babies

Young babies can be severely affected by whooping cough and it can cause significant damage to their lungs. Therefore, they may need a high level of support in hospital, involving:



ventilation to support their lungs



intravenous medicine to support their blood pressure



If these measures fail, the baby may need extracorporeal membrane oxygenation (ECMO). This is similar to a heart-lung bypass machine and delivers oxygen into the blood. 

Older children and adults

The condition tends to be much less serious in older children and adults and can usually be treated at home with antibiotics and self-help measures.

 

Antibiotic  s  

If whooping cough is diagnosed during the first three weeks (21 days) of the infection, your GP may prescribe a course of antibiotics to prevent the infection spreading.

Antibiotics will stop you being infectious after five days of taking them. However, without antibiotics, you may still be infectious until three weeks after your intense bouts of coughing start.

If whooping cough is diagnosed in the later stages it's unlikely you'll be prescribed antibiotics as you'll no longer be infectious and they won't improve your symptoms.

 

Self-help measures

Whooping cough is much less serious in older children and adults than it is in babies and young children. Your GP will usually advise you to manage the infection at home and follow some simple advice:



get plenty of rest



drink lots of fluids to prevent dehydration



clear away excess mucus or vomit during bouts of coughing so it cannot be inhaled and cause choking



ibuprofen or paracetamol can be used to relieve other symptoms such as a high temperature and sore throat – aspirin should not be given to children under the age of 16



 

How to avoid passing on the infection

Whooping cough is highly infectious, so if you or your child have it, it is important to stay away from others until the infection has completely cleared.

The affected person should stay at home until they have completed a five-day course of antibiotics from their GP, orhad intense bouts of coughing (paroxysms) for three weeks (whichever is sooner).

Although bouts of coughing may continue after three weeks, it is unlikely you'll still be infectious.

Preventative treatment

Preventative treatment may be recommended for people you live with, if they are vulnerable to infection (known as vulnerable contacts).This includes:



newborn babies



young children under the age of 12 months who have not received the complete course of the DTaP/IPV/Hib vaccine



children under the age of 10 who have not been vaccinated



women in the last month of pregnancy



people with a weakened immune system, such as people with HIV or people undergoing chemotherapy



people with a long-term health condition such as asthma or heart failure



Preventative treatment is also usually recommended if a household member works in a healthcare, social care or childcare facility as they could pass the infection on to other vulnerable contacts.

Preventative treatment usually involves a short course of antibiotics, and in some cases, a booster dose of the vaccine.

 

Complications of whooping cough 

Babies and young children are usually most severely affected by whooping cough. They are most likely to develop severe complications, such as:



pneumonia, an infection that causes inflammation of the lungs



dehydration



temporary pauses in breathing as a result of severe difficulty with breathing



weight loss due to excessive vomiting



seizures (fits)



low blood pressure, requiring medication



kidney failure, requiring temporary dialysis



brain damage, if breathing difficulties prevent enough oxygen from getting to the brain



Severe complications such as pneumonia and brain damage can be fatal, although this is extremely rare. There were three deaths in infants with whooping cough in 2013.

 

Older children and adults

Older children and adults are occasionally affected by complications of whooping cough. But the complications are usually much less serious than those experienced by babies and young children.

Less serious complications can include:



nosebleeds and burst blood vessels in the whites of the eyes from intense bouts of coughing



bruised ribs as a result of intense coughing



a hernia (where an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall) due to intense coughing



a swollen face



ulcers on the tongue and mouth



ear infections such as otitis media (a build-up of fluid in the middle ear)



 

Preventing whooping cough 

In the UK, whooping cough is now rare due to children and pregnant women being vaccinated against it.

The 5-in-1 vaccine

The whooping cough vaccine is given as part of the 5-in-1 vaccine (DTaP/IPV/Hib), which also protects against diphtheria, tetanus, polio and Hib (haemophilus influenzae type b).

In the UK, babies are given the 5-in-1 vaccine when they are two, three and four months old.

The pre-school booster

The 4-in-1 pre-school booster (DTap/IPV) is given before children start school (when they are between three and five years old) to boost their protection against whooping cough.

The whooping cough vaccine is given in three separate jabs plus a booster, so that your child's body has time to build up an effective level of protection.

 

Side effects of the whooping cough vaccine

The whooping cough vaccine is very safe. The most common side effects that babies experience are:



pain, redness and swelling at the injection site



irritability and increased crying



being off colour or having a fever



 

If your child has a problem with their immune system, speak to your GP for advice about vaccination. Babies with mild coughs or colds can still have the vaccine.

 


Pregnant women

All pregnant women are offered vaccination against whooping cough when they are 28-38 weeks pregnant.

Getting vaccinated while you’re pregnant could help to protect your baby from developing whooping cough in its first few weeks of life.

 




Whooping cough