Whooping Cough (Pertussis)

Overview

What is pertussis?

Pertussis, commonly known as whooping cough, is a respiratory infection that is very contagious. It usually results in prolonged and repeated bouts (paroxysms) of coughing in children and adults. These coughing episodes can continue for weeks or even months after the onset of the illness. Prolonged coughing causes air to be expelled from the lungs. When the person gasps for air after a coughing fit, a loud, high-pitched “whooping” noise might accompany the inhalation of air. That is the reason pertussis is called whooping cough. However, someone may still have whooping cough without making a whooping noise.

Instead of coughing spells, babies who are infected with pertussis may experience breathing difficulties, such as a pause in breathing (apnea). About 50 percent of babies less than one year old who get whooping cough have to be hospitalized. In rare cases, death may occur.

How common is pertussis?

Pertussis is a common disease. Throughout the world, there are about 16 million cases of pertussis each year, resulting in about 195,000 deaths. In the United States, over 48,000 cases of pertussis were reported in 2012. However, many more cases occurred that were not reported. The number of reported cases of whooping cough has been increasing since the 1980s.

People of all ages can get pertussis, but it occurs most often in children and adolescents. Even adults and children who have been vaccinated against it can become infected, although their symptoms are usually milder.

Babies are especially susceptible to infection, because they cannot be vaccinated against pertussis until they are at least 2 months old. They may catch whooping cough from their parents, adult caregivers or other children.

Symptoms and Causes

What causes pertussis?

Pertussis is caused by Bordetella pertussis bacteria that can enter the respiratory system. If a person who is infected with the disease coughs or sneezes, tiny droplets of liquid containing the bacteria may be inhaled by a person who is nearby. Bacteria grow on the lining (mucosa) of the respiratory tract and increase the secretions of mucus.

A person with pertussis may be contagious even before symptoms appear and remain contagious for up to 2 weeks after coughing starts.

What are the symptoms of pertussis?

Early symptoms of pertussis may resemble those of the common cold. These symptoms may persist for 1 to 2 weeks.

They may include:

  • Slight fever
  • Mild or occasional coughing
  • Runny nose
  • Pause in breathing in babies

Symptoms of whooping cough after the first or second week has passed usually include:

  • Prolonged, repeated or violent coughing episodes (paroxysms) that recur intermittently for up to 10 weeks or more
  • Whooping sound when inhaling after the coughing stops
  • Vomiting
  • Exhaustion due to prolonged coughing

Symptoms begin to lessen after 4 weeks, although bouts of coughing can recur for months after onset.

Diagnosis and Tests

How is pertussis diagnosed?

The doctor will perform a physical examination and ask questions about you or your child’s symptoms. A sample of nasal secretions may be taken by using a cotton swab to collect fluid from inside the nose. A sample can also be collected by filling a syringe with saline fluid and flushing the fluid through the nose and back of the throat. The samples will be analyzed for the presence of Bordetella bacteria. Blood tests may also be performed.

Management and Treatment

How is pertussis treated?

Medications used to treat the infection include antibiotics that help to prevent infected people from spreading the disease and may also lessen the later symptoms of pertussis if given during the early stage of the illness. Treatment should begin as soon as possible after the illness is diagnosed. People who have been in close contact with someone infected with pertussis also should be treated with antibiotics within 3 weeks of exposure.

Babies and infants who develop pertussis may need to be hospitalized, because they can experience life-threatening complications, such pneumonia or breathing problems.

Prevention

How can pertussis be prevented?

Getting vaccinated against pertussis is the best way to prevent it. All children should be given the diphtheria-tetanus-pertussis (DTaP) vaccine. This is a combination vaccine that also protects them against diphtheria and tetanus. It is safe and effective.

Children should receive five injections of the DTaP vaccine, according to the following vaccination schedule.

  • First dose –2 months of age
  • Second dose –4 months
  • Third dose—6 months
  • Fourth dose--15 to 18 months
  • Fifth dose--4 to 6 years

A booster vaccine is recommended for adults because they are the most likely source of pertussis infection in infants. Adults ages 19 to 64 years should receive a one-time pertussis booster vaccine called Tdap.

Adults over age 64 years should also receive a booster vaccine if they will come into close contact with infants younger than 12 months old. Pregnant women should receive a Tdap injection during the third trimester (between the 27th and 36th week) of their pregnancies. It is necessary for them to have a Tdap injection during each pregnancy.

The vaccine helps to provide babies with short-term protection against whooping cough and also may protect them against serious complications associated with the infection. If you are pregnant, you should also make sure that family members and caregivers have been vaccinated against pertussis.

Last reviewed by a Cleveland Clinic medical professional on 08/12/2019.

References

  • Centers for Disease Control. . Accessed 8/15/2019.Pertussis (Whooping Cough) (http://www.cdc.gov/pertussis)
  • National Foundation for Infectious Diseases. . Accessed 8/15/2019.Pertussis (Whooping Cough) (http://nfid.org/pertussis)
  • The Merck Manual Professional Edition. . Accessed 8/15/2019.Pertussis (Whooping Cough) (http://www.merckmanuals.com/professional/infectious_diseases/gram-negative_bacilli/pertussis.html?qt=pertussis&alt=sh)

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