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Whooping cough

Introduction

Whooping cough is a highly contagious bacterial infection of the lungs and airways. The medical term for whooping cough is pertussis.

The condition usually begins with a persistent dry and irritating cough which progresses to intense bouts of coughing. These are followed by 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’).

Read more about the symptoms of whooping cough.

Whooping cough is caused by a bacterium called Bordetella pertussis, which can be passed from person to person through droplets in the air from coughing and sneezing.

Read more about what causes whooping cough.

Treating whooping cough

Whooping cough can be treated successfully with antibiotics and most people make a full recovery.

It is important to take steps to avoid spreading the infection to others; especially young babies under the age of six months.

Children with whooping cough should be kept away from school or nursery until they have taken antibiotics for five days. The same applies to adults returning to their workplace.

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

Read more about treating whooping cough.

Young babies under the age of six months 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).

Read more about the complications of whooping cough.

Vaccination

In the UK, all pregnant women are now to be 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. Read more about vaccination for pregnant women.

Children are vaccinated against whooping cough at two, three and four months of age, and again before starting school at about three years and four months of age. Read more about preventing whooping cough.

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 vaccinated against whooping cough the less chance there is of them passing on the infection to a young baby in which it could cause serious, and possible fatal, complications.

The effectiveness of the whooping cough vaccination may fade over time meaning it is possible to develop the condition during adulthood if you were previously vaccinated.

Who is affected

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

Most cases now occur in adults whose immunity has faded and in these cases symptoms tend to be less serious (although having to live with a persistent cough can be both frustrating and unpleasant).

Whooping cough is a cyclical disease with the number of cases peaking every 3-4 years and at the time of writing (June 2012) a peak is occurring.

There were 1,080 cases in the first quarter of 2012 in England and Wales. While there were only 910 cases during the whole of 2011.

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Symptoms

The symptoms of whooping cough usually take 6-20 days to appear after infection with the Bordetella pertussis bacterium. This delay is known as the incubation period.

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:

  • runny or blocked nose
  • sneezing
  • watering eyes
  • dry, irritating cough
  • sore throat 
  • slightly raised temperature
  • feeling generally unwell

These early symptoms of whooping cough can last for one to two weeks, 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 usually last at least two weeks, but can last longer, 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 far less severe than in young children, and may appear more like symptoms of a milder respiratory infection, such as bronchitis.

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 three 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 - read more about spotting signs of serious illness in young children
  • you (or your child) appears to be experiencing significant breathing difficulties such as extended periods of breathlessness
  • you (or your child) develops serious complications, such as seizures (fits) or pneumonia, an infection that causes inflammation of the tissues in your lungs

Call your GP immediately. If this is not possible then call NHS Direct Wales on 0845 46 47 or your local out-of-hours service.

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Causes

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

When the Bordetella pertussis bacterium comes into contact with the lining of these airways, it multiplies and causes a build-up of thick mucus. It is the mucus that causes the intense bouts of coughing as your body tries to expel it.

The bacterium also causes the airways to inflame (swell up), making them narrower than usual. As a result, breathing is made difficult, which causes the 'whoop' sound as you gasp for breath after a bout of coughing.

How whooping cough spreads

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

The Bordetella pertussis bacterium is carried in droplets of moisture in the air. When someone with whooping cough sneezes or coughs, they propel hundreds of infected droplets into the air. If the droplets are breathed in by someone else, the bacterium will infect their airways.

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Diagnosis

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

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

Sometimes, your GP will need to confirm the diagnosis by taking a blood test to check for antibodies to the whooping cough bacterium. The HPA has made available sophisticated methods for analysing blood samples and confirming the presence of the bacterium. See the Health Protection Agency's Bordetella reference services for more information.

A whooping cough diagnosis can also be confirmed by taking a sample of mucus from the back of the throat with a swab (a small stick similar to a cotton bud) and testing this for the Bordetella pertussis bacterium. However, this method is not always accurate.

Young babies

If a young baby has suspected whooping cough, they may need to be diagnosed in hospital, where they will be given any necessary treatment. This is because the disease can be severe in babies.

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Treatment

Whooping cough can be treated successfully with antibiotics and most people make a full recovery.

Antibiotics

If whooping cough is diagnosed during the first few weeks of the infection, your GP may prescribe a course of antibiotics to prevent the infection spreading further.

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 (paroxysms) start.

If whooping cough is not diagnosed until the later stages of the infection, your GP may not prescribe antibiotics. This is because the bacterium that causes whooping cough has already gone by this time, so you are no longer infectious. Antibiotics will make no difference to your symptoms at this stage.

Treating babies and young children

Babies are affected most severely by whooping cough, and are most at risk of developing complications. For this reason, babies under one year of age who contract whooping cough will often need treatment in hospital.

If your child is admitted to hospital to be treated for whooping cough, it is likely they will be 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 as well as antibiotics. Corticosteroid medication contains steroids. These are powerful hormones that will reduce inflammation (swelling) in your child's airways, making it easier for them 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.

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 and/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 bacterium has completely cleared.

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

Although bouts of coughing may continue after three weeks, it is unlikely you will still be infectious because the bacterium will have gone.

Preventative treatment

Preventative treatment may be recommended for members of your household (or dorm or residential home) known to be vulnerable to the effects of infection (these people are known as vulnerable contacts).

Vulnerable contacts include:

  • newborn babies
  • young children under the age of one year who have not received the complete course of the DTaP/IPV/Hib vaccine
  • children under the age of ten 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.

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. For more information, see the Great Ormond Street hospital fact sheet on ECMO.

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Complications

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 tissues in your 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, which can occur if breathing difficulties prevent enough oxygen from getting to the brain

However, these complications are rare.

Severe complications such as pneumonia and brain damage can be fatal, although this is extremely rare.

There were fives deaths from whooping cough from the second half of 2011 to May 2012 in England and Wales.

Older children and adults

Older children and adults are occasionally affected by complications of whooping cough. However, 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
  • hernia (where an internal part of the body, such as an organ, 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)
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Pregnant women

It’s recommended that, for the time being, all pregnant women should get vaccinated against whooping cough (pertussis) when they are 28-38 weeks pregnant. This is a new recommendation, as there has been a sharp rise in the number of whooping cough cases in the UK.

Why should pregnant women have the whooping cough vaccine?

Getting vaccinated while you’re pregnant may help to protect your baby from developing whooping cough in his or her first few weeks of life. The immunity you get from the vaccine will pass to your baby through the placenta. Babies are not vaccinated against whooping cough until they are two months old.

Is the whooping cough vaccine safe in pregnancy?

There is no evidence to suggest that the vaccine is unsafe for mother or baby if used in pregnancy.

The vaccine, called Repevax, has not been clinically tested on pregnant women because clinical trials don’t usually involve pregnant women. For this reason, evidence on safety in pregnancy can be limited. A similar vaccine has been used in America in pregnant women, and there is no evidence of risk to the health of the pregnant woman or the baby.

Repevax has been used in the UK childhood immunisation programme since 2004, and has an excellent safety record. All of the components in the vaccine have been given singly or in combination to pregnant women without any evidence of harm to the mother or her baby.

What is whooping cough?

Whooping cough (pertussis) is a serious bacterial infection that causes long bouts of coughing and choking, making it hard to breathe. After each bout of coughing, the person gasps for breath, making the distinctive ‘whoop’ noise. Babies don’t always make this noise. Other symptoms include a raised temperature, runny nose and vomiting after coughing. Whooping cough lasts for around two or three months, and is sometimes called the ‘100 day cough’.

Why do we need to protect against whooping cough?

Whooping cough is a serious illness. Babies who get it can develop severe complications such as pneumonia and brain damage. Most babies with whooping cough will need hospital treatment, and when whooping cough is very severe they may die.

There is a large outbreak of whooping cough in the UK at the moment, with three times more cases in the general population than there were last year. In the first seven months of this year, 235 babies under 12 weeks old had whooping cough. Sadly, nine of these babies died.

Babies who are too young to be vaccinated are at greatest risk.

Will the vaccine give me whooping cough?

The whooping cough vaccine is not a ‘live’ vaccine. This means it doesn’t contain whooping cough, and can’t cause whooping cough in women who have the vaccine, or in their babies.

A vaccine against only whooping cough is not available. It’s part of a vaccine that also protects against diphtheriatetanus and polio. The other components in the vaccine will not place you or your baby at any additional risk, and will not give you any of these illnesses.

When should I have the vaccine?

The best time to get vaccinated to protect your baby is between 28 and 38 weeks of pregnancy, with between 28 and 32 weeks the ideal time. When you're vaccinated against diseases such as whooping cough, your body produces antibodies to protect against the disease. Being immunised between 28 and 38 weeks offers the best chance of your baby receiving as many anti-whooping cough antibodies as possible across the placenta.

You can still have the vaccine after 38 weeks but this may not protect your baby from whooping cough, as your body might not have enough time to produce the antibodies before your baby is born. However, being vaccinated after 38 weeks will help protect you from whooping cough and from passing it on to your baby.

You will only need one dose.

Whenever you have the vaccine, your baby will still need to be vaccinated as normal when he or she reaches two months old.

Can I have the whooping cough vaccine at the same time as the flu jab?

Yes, you can have the whooping cough vaccine when you get the flu vaccine, but do not delay your flu jab so that you can have both at the same time.

Pregnant women are at risk of severe illness from flu at any stage of pregnancy.

How can I get the vaccination?

You should be offered the vaccination at a routine antenatal appointment when you are between 28 and 38 weeks pregnant. 

If you are already 28 weeks pregnant you may have your vaccination at your next routine appointment with your midwife. If you wish to have it sooner, you can make an appointment with your GP.

If you’re 28 weeks pregnant or more, and you haven’t heard from your midwife or GP about the whooping cough vaccine, contact them to discuss having the vaccination.

was vaccinated against whooping cough as a child, do I need to get vaccinated again?

Yes, because any protection you may have had through either having whooping cough or being vaccinated when you were young is likely to have worn off. This means there’s little or no protection to pass on to your baby.

If you are vaccinated during your pregnancy and then get pregnant again, you will need to be vaccinated again in your new pregnancy between 28 and 38 weeks.

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Prevention

In the UK, whooping cough is now rare due to successful vaccination against the bacterium causing 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. A pre-school booster vaccine (DTap/IPV) is also given before children start school (when they are between three to five years old).

The vaccine is an inactive version of the whooping cough infection. After vaccination, the body produces antibodies against the Bordetella pertussis bacterium. These antibodies provide protection against infection.

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

As babies and young children are mostly affected by diseases such as whooping cough, the 5-in-1 vaccine is given at a young age. The vaccine is very safe.

Side effects

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

Read more about side effects of the 5-in-1 vaccine.

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 now to be 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.

Find out more about vaccination for pregnant women.

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