Whooping Cough (Pertussis)

Whooping cough is a highly contagious upper respiratory infection that affects babies, children and adults of all ages. Early on, it might feel like a common cold. But after a week or two, a persistent cough develops.

The cough may come and go in what healthcare providers call “paroxysms,” or coughing fits. These coughing fits can make it hard to eat, breathe or sleep. You might make a high-pitched “whoop” sound after coughing as you try to take in air. Infants may struggle to breathe even if they don’t cough.

Pertussis is the medical name for whooping cough. You might also hear people refer to this infection as the “100-day cough.” This is because symptoms can last for weeks or even months before finally clearing up.

Whooping cough symptoms

Symptoms of whooping cough start out cold-like and develop into a severe cough. This happens in stages.

Infants may struggle to breathe even if they never develop a cough. If your baby has a severe cough, has a bluish discoloration around their mouth and/or trouble breathing, seek emergency care right away.

What are the three stages of whooping cough?

The three stages of whooping cough are:

• Common cold symptoms
• Coughing fits
• Gradual recovery

Stage 1: Common cold symptoms

This stage lasts about one to two weeks. You or your child is most contagious during this time, but you might think it’s just a cold. Symptoms include:

• Stuffy nose
• Runny nose
• Sore throat
• Watery eyes
• Mild or occasional cough that gradually gets worse
• Low-grade fever (under 100.4 degrees Fahrenheit/38 degrees Celsius) or normal temperature
• Feeling generally unwell or “off” (malaise)

Infants may struggle to breathe or have pauses in their breathing (apnea). You might notice:

• Your baby is working hard to breathe.
• Their stomach seems to be caving in or breathing looks like they’re panting.
• Their skin or area around their mouth is turning blue or gray from lack of oxygen (cyanosis)

Stage 2: Coughing fits

The second stage usually lasts anywhere from one to six weeks. But it sometimes lasts as long as 10 weeks. During this stage, you have thick mucus in your airways and severe coughing fits (paroxysms). Here’s what to expect:

• A coughing fit means you cough many times in a row for several minutes.
• When you try to catch your breath between coughs, you may make a high-pitched “whoop” sound.
• You may vomit and/or feel exhausted after a coughing fit.
• Crying, eating or laughing may trigger a coughing fit.
• Coughing fits occur during the day and night but may get worse at night.

Coughing fits get more frequent before leveling off and then gradually going down in number.

Stage 3: Gradual recovery

This stage lasts up to six weeks. During this time, you may have a mild cough that comes and goes, but you won’t have severe coughing fits like before. You’ll gradually cough less and less.

Even as you start to feel better, you’re more vulnerable to other respiratory infections during this time. Your body is still healing. Try to avoid exposure to germs. If you do get sick with something else, the coughing fits may return.

Whooping cough sound

Whooping cough gets its name from the “whoop” sound that some people make after coughing. If you’re coughing over and over, it can be difficult to catch your breath. When you finally take in some air, your efforts may come across as a high-pitched “whoop” or gasp. But not everyone with pertussis develops a “whoop sound.”

Whooping cough causes

The bacteria Bordetella pertussis causes whooping cough. The bacteria damage the lining of your airways, causing them to swell. This swelling leads to thick mucus buildup and, in turn, severe coughing.

Whooping cough spreads through respiratory droplets when you cough or sneeze. It usually takes five to 10 days for symptoms to start after exposure, but sometimes it’s as long as 21 days.

Is whooping cough contagious?

Yes, it’s very contagious — that means it spreads easily from person to person. You’re likely to get it from someone you live with, and kids often get it from their classmates.

You can spread whooping cough from the start of symptoms until three weeks after the coughing fits start. This means, for example, if you have one week of cold-like symptoms before the coughing fits begin, you’re contagious for four weeks total.

Complications of whooping cough

Possible complications of whooping cough in infants and children include:

• Ear infections
• Nosebleeds
• Nutritional deficiencies (malnutrition)
• Pneumonia
• Problems with brain function (encephalopathy), which can lead to permanent brain damage or death
• Pulmonary hypertension
• Respiratory failure

Complications are usually the most severe in babies under 12 months of age. Infants are most likely to be hospitalized due to pertussis. And those who face the greatest risk of severe complications or death include infants who:

• Aren’t vaccinated (or whose birth mother didn’t receive the vaccine during pregnancy)
• Are immunocompromised
• Have severe asthma

Possible complications in adolescents and adults include:

• Broken rib
• Ear infections
• Fainting
• Migraines
• Pee leaking out (urinary incontinence)
• Pneumonia
• Unintended weight loss

How doctors diagnose whooping cough

Healthcare providers diagnose whooping cough by:

• Doing a physical exam
• Asking about your symptoms
• Collecting a mucus sample (nasopharyngeal swab) to send to a lab for testing

Tell your provider if you were around anyone who had whooping cough or a chronic cough. This information will help your provider make a diagnosis.

What is the treatment for pertussis?

Providers treat whooping cough with antibiotics like azithromycin, clarithromycin or erythromycin. Take your medicine exactly as your provider tells you to. The sooner you start taking antibiotics, the more they can help you.

Antibiotics won’t stop you from getting coughing fits or help the cough go away. But they keep you from spreading the infection to others. If taken early, they might make your symptoms less severe.

If your child is very sick, they may need to be monitored in the hospital. There, a team of healthcare providers can keep a close eye on your child’s breathing and give them oxygen and fluids if necessary.

When should I see a healthcare provider?

Contact your pediatrician if your child:

• Isn’t up to date on their pertussis vaccines
• Was exposed to whooping cough
• Has a cough that’s severe, getting worse or causing vomiting
• Has a cough along with a fever
• Can’t keep down milk, formula or food

Call 911 or your local emergency services number if your child has trouble breathing or their skin looks blue or gray (check their lips and fingertips).

Call your primary care provider if you:

• Have questions about vaccination
• Were exposed to whooping cough
• Have symptoms of whooping cough
• Develop new or unexplained symptoms
• Have chest pain when coughing or taking a deep breath (a possible sign of pneumonia)

Can whooping cough be prevented?

Pertussis vaccines can reduce your risk of getting an infection or having severe symptoms if you do get sick. The vaccines that help prevent pertussis are the DTaP in children and Tdap in teens, pregnant women and adults. But they become less effective the longer it’s been since your last shot. Talk to your healthcare provider or your child’s pediatrician about when to get vaccinated.

Providers prescribe preventive (prophylactic) antibiotics in some cases. These are medicines you take after exposure to whooping cough even if you don’t yet have symptoms. They can help you avoid coming down with whooping cough.

Your provider may prescribe preventive antibiotics if you:

• Are at high risk of getting very sick from whooping cough
• Spend time with people who’d get very sick from whooping cough (for example, infants)

It’s important to keep in mind that good handwashing may prevent the spread of respiratory infections.

What can I expect if I have pertussis?

Whooping cough can make you feel miserable for weeks or months. And it’s possible to develop severe complications.

The good news is that your body will likely build up some immunity against Bordetella pertussis bacteria. So, you won’t get whooping cough again for a while — anywhere from four to 20 years, according to some experts. But you can get whooping cough again in the future once immunity wanes.

Your child might need to stay in the hospital, especially if they’re very young.

When is it safe to return to daycare, school or work?

It depends. If you or your child is taking antibiotics, it’s generally safe to return after five full days of treatment. Otherwise, you’re still contagious for three weeks after the start of the coughing fits.

Is there anything I can do to feel better?

Things you can do to feel a little better — and possibly ease coughing at night — include:

• Take some honey. This may help calm your cough. But it’s only safe for adults and kids over age 1. Never give honey to an infant (because of the risk of botulism).
• Rest. Getting lots of rest helps your body heal.
• Keep up the fluids. Drinking plenty of fluids can help thin the mucus that’s making you cough.
• Use a cool-mist humidifier. This helps break up mucus.
• Eat small meals. Eating just a small amount of food at a time may keep you from vomiting.
• Avoid irritants. Things like dust, smoke and chemical fumes (for example, from some cleaning supplies) might make you cough.