Whooping Cough (Pertussis)

Topic Overview

What is whooping cough?

Whooping cough is a disease that causes very severe coughing that may last for months. You can cough so hard that you hurt a rib.

Whooping cough is also called pertussis.

Whooping cough is contagious. This means it spreads easily from one person to another. You can prevent whooping cough by getting shots, called vaccines, that protect you from the disease.

Whooping cough can lead to other problems, such as pneumonia. These problems can be very serious in adults ages 60 and older and in young children, especially babies who are born early or have not had shots to prevent whooping cough.

With good care, most people recover from whooping cough with no problems.

Anyone can get whooping cough. Before the vaccine was available, whooping cough was most common in infants and young children. Because most infants now get the vaccine, people ages 11 and up are now more likely to get it.

You can get whooping cough more than once, and you may get it years apart. But you will be less likely to get it again if you get the shots as recommended.

What causes whooping cough?

Whooping cough is caused by bacteria that infect the top of the throat (pharynx) where it meets the nasal passages. The bacteria bother the throat, which causes coughing.

See a picture of the respiratory system , including the pharynx.

Whooping cough spreads easily from person to person. When someone with the disease coughs, sneezes, or laughs, tiny drops of fluid holding the bacteria are put into the air. The bacteria can infect others when they breathe in the drops or get them on their hands and touch their mouth or nose. After the bacteria infect someone, symptoms appear about 7 to 14 days later.

What are the symptoms?

Adults usually have milder symptoms than children. How bad your symptoms are also depends on whether you had the vaccine and how long ago it was.

Symptoms of whooping cough usually last 6 to 10 weeks, but they may last longer. In young children, three stages can occur. Older children and adults don't always have the same stages.

In stage 1, symptoms are like those of a cold:

• You sneeze and have a runny nose, a mild cough, watery eyes, and sometimes a mild fever.
• The symptoms last from several days to 2 weeks.
• This is when you are most likely to spread the disease.

In stage 2, the cold symptoms get better, but the cough gets worse.

• The cough goes from a mild, dry, hacking cough to a severe cough that you can't control.
• You may cough so long and hard that you can't breathe. When you can take a breath of air, it may make a whooping noise.
• After a coughing fit, you may vomit and feel very tired.
• Between coughing fits, you feel normal.
• Symptoms are most severe in this stage. It usually lasts 2 to 4 weeks or longer.

In stage 3, you get better and grow stronger.

• The cough may get louder.
• Coughing fits may happen off and on for weeks.
• Coughing fits may flare up if you get a cold or have a similar illness.
• This stage may last longer if you have never had the vaccine.

How is whooping cough diagnosed?

Your doctor will ask you questions about your symptoms and do a physical exam. He or she may order tests to rule out other health problems. Your doctor may ask if you have had the necessary shots.

It can sometimes be hard to diagnose whooping cough, because a person appears healthy between coughing episodes. Your doctor may take a sample of mucus from your throat and have it tested for the bacteria that cause whooping cough.

How is it treated?

You will be given antibiotics. These make it less likely that you will spread the disease. If you start taking the antibiotics when you first get whooping cough, the disease may not last as long.

Young infants usually are treated for whooping cough in the hospital so the doctor can see how well the baby deals with and recovers from the coughing.

Over-the-counter medicines, such as cough syrups, have not been shown to help whooping cough. You can increase your comfort by using a humidifier and getting enough fluids.

Can whooping cough be prevented?

You can prevent whooping cough or reduce how bad it is by being sure that you and your children have had the vaccine. Any child, teen, or adult who has or expects to have close contact with babies younger than 1 year old should get the vaccine. Caregivers who never got the shots-and may not even know that they have the illness-can spread whooping cough to babies.

Washing your hands often and staying away from people who have a bad cough also may help you avoid getting the disease.

If you get whooping cough, you can avoid spreading it by taking antibiotics and waiting the right amount of time before you and your children go back to school or work:

• Children with whooping cough need to take antibiotics for at least 5 days before going back to day care or school. If your child did not take antibiotics, wait 21 days after the start of symptoms before sending your child to school or day care.
• Adults or teens with whooping cough need to take antibiotics for at least 5 days before being near young children or going to work at a school, a day care center, or a health facility.

Frequently Asked Questions

Symptoms

Symptoms of whooping cough typically last 6 to 10 weeks (but may last longer). In young children, three stages can occur. Older children and adults don't always go through the same stages.

First stage

Coldlike symptoms begin and last for several days to 2 weeks. Symptoms usually include sneezing, a runny nose, mild coughing, watery eyes, and sometimes a mild fever. An infected person is most contagious during this stage.

Second stage

The most serious symptoms develop during this phase and last about 2 to 4 weeks or longer. As coldlike symptoms fade, the cough gets worse. A dry, hacking cough turns into bursts of uncontrollable, often violent coughing that may make it temporarily impossible to breathe. This may happen up to 30 times a day. The person may quickly inhale when trying to take a breath through airways narrowed by inflammation, which sometimes creates a whooping noise.

In babies, coughing spells:

• May be triggered by very slight stimulation, such as taking in food or milk, sucking, exposure to a sudden sound or light, or stretching.
• May cause symptoms of flushed cheeks, pale or bluish complexion from lack of oxygen, and bulging or watery eyes. A baby may also stick out his or her tongue, push the chest forward, or flail arms and legs in distress.
• May be frightening to watch, although most babies recover and regain control of their breathing on their own. Babies generally feel well between coughing spells but may become exhausted from the physical effort of coughing. It's also possible that your baby's breathing could stop for a short time during the coughing spells. This is called apnea.
• May lead to hospitalization, especially if the baby is younger than 4 months of age. Hospitalization allows health professionals to monitor the baby's condition and evaluate how well he or she tolerates and recovers from coughing episodes.

Third stage

The final stage, lasting for a few weeks or months, is a gradual recovery period. Although the person gains strength and begins to feel better, the cough may become louder and sound worse. Coughing spells become less frequent but may flare up again if a cold or other upper respiratory illness develops. This final stage may last longer in people who were not given the whooping cough (pertussis) vaccine.

Complications, such as pneumonia or exertion-related injuries from coughing, such as a hernia, can develop from whooping cough. These types of health problems pose the most serious risk to children younger than 4 months and adults ages 60 and older.

Exams and Tests

A doctor considers the following when making a preliminary diagnosis of whooping cough (pertussis):

• Symptoms. A health professional may suspect whooping cough when a person has recently had cold symptoms and a dry, hacking cough that progresses to bursts of uncontrollable, often violent coughing that may make it temporarily impossible to breathe. The characteristic whooping noise sometimes occurs when the person tries to inhale quickly through airways narrowed by inflammation. Babies may have flushed cheeks, a pale or bluish complexion from lack of oxygen, and bulging or watery eyes. A baby may also stick out his or her tongue, push the chest forward, or flail arms and legs in distress. Fever, sore throat, and wheezing are usually absent or very mild with whooping cough. When present, these symptoms can help a doctor distinguish between whooping cough and other conditions with similar symptoms, such as a cold or bronchitis.
• Immunization status. An important consideration when making a preliminary diagnosis of whooping cough (pertussis) is whether a person's immunizations against pertussis are up to date.
  • DTaP. Children start getting their pertussis immunizations at age 2 months. A total of 5 injections (shots) are given at different times until ages 4 to 6 years. The pertussis vaccine is given along with the vaccines for diphtheria and tetanus in a single shot. For children, ages 6 and younger, the vaccine is called DTaP.
  • Tdap. Combination booster vaccines (for pertussis, diphtheria, and tetanus), known as Tdap, are available for people ages 10 to 64. (Until recently, no vaccine was available for pertussis after age 6.) A booster dose of Tdap is recommended for adolescents ages 11 to 12.¹ And any teen, adult, or health professional who expects to have close contact with a baby less than 1 year old should also get a shot.
    • Teens who have not had a booster shot should get one between ages 13 and 18.¹ For routine prevention, adults 19 to 64 years of age should have one dose of this booster shot instead of Td (tetanus and diphtheria) vaccine.² People who get booster shots for whooping cough get continued protection, which helps prevent the spread of the disease. This is especially important for protecting babies younger than 2 months and others who are at high risk for becoming infected and developing complications from the disease.
• Community outbreaks. Whooping cough may be suspected when other cases of whooping cough have recently been reported within the local community.

Doctors can diagnose whooping cough by testing mucus from the nasopharynx region, which is where nasal passages meet the back of the throat. To collect a mucus sample, doctors may pass a swab or suction tube deep into the back of the nose. The sample can be tested by culture. It is the most accurate method, but it takes 10 to 14 days to get the results. Polymerase chain reaction (PCR) is often used along with culture to get test results within several days. PCR detects the genetic material (DNA) of whooping cough bacteria.

Treatment will usually start right away if your doctor strongly suspects whooping cough as a cause of your symptoms.

Other tests that may help your doctor make the diagnosis include:

• A serologic test, such as ELISA. This test also finds whooping cough antigens.
• Direct fluorescent antibody testing (DFA). This quick test finds substances (whooping cough antigens) that trigger the immune system to fight the infection.

More than one lab test may be done to confirm a diagnosis.

Other tests may also be done to rule out other problems, to monitor the person's condition, or to find out whether complications have developed.

• A complete blood count or other blood tests may be done to help rule out other diseases.
• Chest X-rays may be done, especially in infants. Although X-rays images often appear normal in whooping cough, they may be needed to rule out other possible causes of symptoms or to find out whether complications, such as pneumonia, have developed.
• A pulse oximeter may be used to check the blood oxygen levels, which helps a doctor monitor how well the lungs are working and decide what treatments to use.

Treatment Overview

The aim of treatment is to make symptoms less severe and reduce the spread of infection to close contacts.

Whooping cough is generally treated with antibiotics, which may help shorten the course of the disease if they are taken early in the first stage of illness. But they may not be prescribed right away, because it's hard to tell the difference between the first symptoms of whooping cough and the symptoms of a common cold. As symptoms progress, they become more distinctive of whooping cough. Antibiotics are usually given at this point. Antibiotics can help reduce the spread of infection while you are waiting for PCR or culture results to confirm the diagnosis. Results may take up to 10 to 14 days to get back. Family members and others who have had close contact with someone infected with whooping cough are usually prescribed antibiotics before any symptoms start.

Severe coughing spells can significantly decrease the blood's oxygen supply. If a pulse oximeter measurement finds that blood oxygen levels are low, oxygen may be given for a short time through a nasal cannula or an oxygen mask.

Infants, especially those younger than 4 months, are typically hospitalized. Hospitalization allows health professionals to ensure the baby is getting enough fluids and nutrients. Also, the baby is monitored and evaluated for how well he or she tolerates and recovers from coughing episodes. If needed, a baby also may receive oxygen therapy and have mucus suctioned from his or her nose and throat. Because suctioning mucus may trigger coughing spells, it is only done in specific situations.

Emergency treatment

Call 911 or other emergency services immediately if a person stops breathing, turns blue, or becomes unconscious. Start rescue breathing immediately or follow instructions given by emergency services while you wait for help. For more information, see the Rescue Breathing section of the topic Dealing With Emergencies.

Home Treatment

If your child has whooping cough (pertussis), the coughing spells can be scary. To help manage the symptoms, you can:

• Create a quiet, calm, restful environment. Keeping stimulation to a minimum can help reduce the number of coughing spells.
• Control possible triggers of a coughing episode, such as smoke, dust, sudden noises or lights, or changes in temperature.
• Give your child frequent, small sips of fluids and nutritious foods to provide needed energy that coughing uses up.
• Use a humidifier in your child's room. But watch closely to see its effect. Sometimes humidity makes coughing spells worse, in which case it should be avoided. Dry, hot, or polluted air may make coughing spells worse.
• Hold your child in a calming manner.
• Have your child lie on his or her side or stomach rather than the back. Lying on the back could trigger a coughing spell.

Over-the-counter medicines, such as cough suppressants and antihistamines, have not been shown to help relieve symptoms.

Frequent hand-washing is important to help prevent the spread of infection. Keep children away from people who have a bad cough, especially if it may be related to whooping cough. People who have whooping cough should take antibiotics for at least 5 days before being near young children. Also, they should not return to work in schools, day care centers, or health facilities until after 5 days of antibiotics.

If your child is infected, he or she should take antibiotics for 5 days before going back to school or day care. If he or she is not treated with antibiotics, your child should wait until 21 days after the start of symptoms.

Immunizations are critical to preventing diseases such as pertussis from becoming widespread (epidemic) problems. Children start getting their immunizations against pertussis (What is a PDF document?) at age 2 months. A total of 5 shots (injections) are given at different times until ages 4 to 6 years. The vaccines for diphtheria, tetanus, and pertussis are all in one shot called DTaP.

A tetanus, diphtheria, and pertussis (Tdap) booster shot (What is a PDF document?) is needed for continued protection. This shot is usually given between the ages of 11 and 12. Adults ages 19 to 64 who never got the Tdap shot should get it in place of a Td (tetanus and diphtheria) shot. For more information, see the topic Immunizations.

Other Places To Get Help

Online Resource

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Related Information

• Coughs
• Dealing With Emergencies
• Immunizations
• Respiratory Problems, Age 11 and Younger
• Respiratory Problems, Age 12 and Older
• Vaccine Information Statements

References

Citations

1. Centers for Disease Control and Prevention (2006). Tetanus, diphtheria, and pertussis (Tdap) vaccine: What you need to know. Vaccine Information Statement. Department of Health and Human Services, National Immunization Program (7/12/06). Available online: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-tdap.pdf.

2. Centers for Disease Control and Prevention (2006). Preventing tetanus, diphtheria, and pertussis among adults: Use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and Recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee, for Use of Tdap Among Health-Care Personnel. MMWR, 55(RR-17): 1-37. Also available online: http://www.cdc.gov/mmwr/PDF/rr/rr5517.pdf.

Other Works Consulted

• American Academy of Pediatrics (2006). Pertussis (whooping cough). In LK Pickering, ed., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 498-520. Elk Grove Village, IL: American Academy of Pediatrics.

• Centers for Disease Control and Prevention (2005). Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis. MMWR, 54(RR-14): 1-16.

• Centers for Disease Control and Prevention (2006). Preventing tetanus, diphtheria, and pertussis among adolescents: Use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 55(RR-3): 1-44. Also available online: http://www.cdc.gov/mmwr/PDF/RR/RR5503.pdf.

• Cherry JD (2005). The epidemiology of pertussis: A comparison of the epidemiology of the disease pertussis with the epidemiology of bordetella pertussis infection. Pediatrics, 115(5): 1422-1427.

• Cherry JD, Harrison RE (2006). Bordetella pertussis (whooping cough). In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 723-727. Philadelphia: Saunders Elsevier.

• Skerrett SJ (2006). Infections due to haemophilus, moraxella, legionella, bordetella, and pseudomonas. In DC Dale, DD Federman, eds., ACP Medicine, section 7, chap. 10. New York: WebMD.

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