Whooping Cough (Pertussis)

What is whooping cough (pertussis)?

Whooping cough (pertussis) is a highly contagious respiratory infection. With it, you have severe coughing that makes it hard to breathe. It gets its name from the whooping sound people make when they breathe in deeply after a coughing spell.

Whooping cough is caused by a bacteria called Bordetella pertussis. The germ attaches to the lining of the airways and produces toxins that damage the respiratory tract. 

When an infected person coughs or sneezes, droplets become airborne. Other people can breathe in these droplets and be infected. Whooping cough can also spread by coming in contact with the saliva or mucus of someone who is infected.

The disease can spread quickly in communities where people live close together or where vaccination rates are low. 

Symptoms of whooping cough (pertussis)

Symptoms usually begin five to 10 days after exposure but may not start for three weeks. Whooping cough symptoms typically progress in stages: 

Early symptoms

A person with whooping cough may start with mild symptoms similar to a cold, like a runny nose, sneezing, mild cough, watery eyes and a low-grade fever. This stage (the catarrhal stage) can last for one to two weeks.

Severe symptoms

Intense coughing fits can begin in the second stage (the paroxysmal stage). The coughing spells can happen one after the other and cause vomiting or make it hard to breathe. The whooping sound often follows the coughing fits when people breathe in. People may feel better between coughing spells.

Babies and young children may have trouble breathing rather than coughing. They may have pauses (apnea) in their breathing, which can cause complications including death.  Babies also don’t usually have the typical whoop after a coughing spell.   

Recovery

In the third stage (the convalescent stage), symptoms improve but coughing may last for several weeks.

Who is at risk for whooping cough?

Before vaccination, whooping cough was considered a childhood disease. Now it’s more likely to affect children who have not had all of their vaccines and teenagers and adults who haven’t had their boosters.

Whooping cough can affect anyone but people in these groups are at higher risk for severe illness and complications:

• Infants: Babies under 1 year old have immune systems that are still developing, so they are at a higher risk for life-threatening complications like pneumonia.
• Pregnant women: Whooping cough can be passed from mother to baby during birth or shortly after.
• People who aren’t vaccinated: Your risk of whooping cough is much higher when you don’t have the protection of a vaccine.
• People with chronic health conditions: Having asthma or chronic respiratory diseases makes complications more likely.
• People with weakened immune systems: It’s harder for your body to fight off infection with a compromised immune system.

Whooping cough diagnosis

If you or your child are having severe coughing fits, it's important to see a health care provider – especially if you notice a whooping sound. With early diagnosis, you can get treatment for whooping cough started right away and help keep the disease from spreading.

To diagnose whooping cough, your provider will ask about your medical history and symptoms. They may also use these tests:

• Polymerase chain reaction (PCR) test: This pertussis test detects the bacteria’s genetic material from a sample taken from the nose or throat. 
• Blood test: Blood tests can show an increase in white blood cells or antibodies your body produces when it has an infection.
• Culture test: A sample from the throat can grow and identify the bacteria. This method isn’t used often because PCR testing is faster.
• Chest X-ray: This imaging study can show fluid in the lungs, which could be a sign of pneumonia.

Your provider will determine whether you or your child has whooping cough or another condition that could be mistaken for whooping cough, such as:

• The common cold
• Flu (influenza)
• Asthma 
• Bronchitis
• Croup 
• Other cough-related conditions like gastroesophageal reflux disease (GERD) or postnasal drip 

Whooping cough treatment and management

Whooping cough care involves treating symptoms and lowering the risk of complications. Infants may need to be hospitalized. Older children and adults can usually manage whooping cough at home with:

• Antibiotics: Medications like azithromycin, clarithromycin or erythromycin may make symptoms less severe and keep whooping cough from spreading. They work best when you start taking them in early stages and may not help if you’ve been sick for three weeks or more.
• Reducing symptoms: Drinking plenty of fluids can help ease coughing and reduce the risk of dehydration, which can happen when you cough a lot. Using a humidifier and keeping the air free of smoke and irritants can also help.
• Rest: Getting plenty of rest is an important part of managing pertussis since it helps your body recover.
• Frequent small meals: Coughing may disrupt your eating and drinking, so having smaller meals or snacks more often may help you get the nutrients you need.

Over-the-counter (OTC) cough medications aren’t usually recommended because they aren’t very effective.

Get emergency medical care for:

• Difficulty breathing or severe shortness of breath
• Bluish skin or lips, which could be a sign of a lack of oxygen
• Signs of severe dehydration such as extreme thirst, dark urine or dizziness
• High fever or persistent coughing

Whooping cough prevention

Pertussis vaccines and boosters are the best methods for preventing whooping cough and for making symptoms less severe if you get it. Whooping cough vaccinations include:

• DTaP vaccine: The DTaP (diphtheria, tetanus and pertussis) vaccine is recommended for children under 7 years old. It is given in a series of five doses starting at age 2 months. 
• Tdap vaccine: The Tdap (tetanus, diphtheria and pertussis) booster vaccine is recommended for older children and adults. It is typically given at ages 11 to 12 years. It protects the people who get it and also helps keep them from spreading the disease to babies.

Booster shots are important because immunity from the DTaP vaccine can drop over time. Pregnant women should get the Tdap vaccine to protect newborns from whooping cough.

The vaccines and boosters are safe and effective. Some people have mild side effects such as fever, headache, fatigue or soreness and swelling at the injection site.

Your provider may recommend antibiotics if you’ve been exposed to whooping cough, especially if you’re a health care provider or you’re at high risk for complications.

You can also take these steps to help keep whooping cough from spreading:

• Wash your hands regularly with soap and water to help prevent the spread of germs. 
• Cover coughs and sneezes with a tissue or your elbow and throw tissues away right afterward.
• Avoid close contact with others if you have whooping cough.
• Make sure all family members are up to date with vaccinations.

Whooping cough complications

Whooping cough can lead to serious complications, especially in babies, young children and people with weakened immune systems. Complications may include:

• Pneumonia: This lung infection can happen when the intense coughing makes it hard for the lungs to clear mucus and bacteria.
• Dehydration: The persistent, intense coughing fits can make it hard to eat, drink or stay hydrated. 
• Seizures: Severe cases of whooping cough can lead to seizures due to low oxygen levels during coughing fits or because of high fever.
• Rib fractures or abdominal hernias: The force of severe coughing fits may lead to these problems.

Although rare, in some cases, whooping cough can lead to death (especially in infants).

Long-term effects of whooping cough

Most people recover from whooping cough without any long-term effects. But some people may have:

• Persistent coughing for weeks or months 
• Fatigue and weakness, especially after intense coughing fits
• In severe cases, damage to the lungs and airways
• In infants, developmental delays or other health issues

Getting care

Whooping cough (pertussis) is a very contagious bacterial illness. With it, you or your child may have coughing fits followed by a whoop sound when you breathe in. Vaccines protect against it, plus it can often be treated with antibiotics.

At Banner Health, we provide comprehensive care, from vaccination to expert treatment and ongoing support. Our team includes pediatricians, family medicine doctors and infectious disease specialists who have the expertise and resources to ensure the best outcomes. We stay updated on the latest guidelines and treatments, so you and your child get the most effective and current care.