Whooping cough symptoms, diagnosis and treatment

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Whooping cough is a highly contagious bacterial infection characterised by uncontrollable coughing bouts that can lead to other conditions such as bronchitis and pneumonia.

Medically reviewed by Dr Louise Wiseman MBBS, BSc (Hons), DRCOG, MRCGP and Dr Hanne Korsholm

If you or your child has a persistent cough accompanied by a ‘whooping’ sound, you might be suffering from whooping cough. We look at whooping cough symptoms, diagnosis, treatment and prevention advice:

What is whooping cough?

Whooping cough, also known as pertussis, is a contagious bacterial infection caused by a bacteria (Bordetella pertussis).

The first signs of whooping cough are similar to a cold, but after about a week the infection is characterised by uncontrollable coughing bouts that last for a few minutes and tend to be worse at night.

Whooping cough transmission

How is whooping cough contracted? The infection is transferred through airborne droplets when an infected person coughs. Anyone who has not been vaccinated is highly likely to contract the disease just by spending time in the same room as an infected person.

Anyone who has been vaccinated or has suffered from whooping cough will have a degree of immunity to the disease. They may contract a mild case some years later but this will not develop into a full-blown attack.

The whooping cough incubation period – the time between contracting the infection and the appearance of the main symptoms – can vary from 5 to 15 days or even longer.

How infectious is whooping cough?

If one child in a group of siblings gets whooping cough, the other children are extremely likely to become infected if they have not already had the disease or been vaccinated. This also includes babies.

Although infants who are breastfed are usually protected against most common childhood infections through the mother’s antibodies in breast milk, they don’t seem to receive protection against whooping cough. This is why early vaccination is recommended. Children with a cold or cough should be kept away from non-vaccinated children as well as women in labour and newborn babies.

If one child in a group gets whooping cough, the other children are extremely likely to become infected.

Whooping cough is infectious from about six days after the start of cold-like symptoms until three weeks after the coughing starts. This is a much longer period than with other children’s diseases. It is thought that one person with whooping cough can infect about 12 to 15 other people. If antibiotics are started within three weeks of starting to cough, this will reduce the length of time the person is contagious for.

Whooping cough symptoms

Whooping cough is typically characterised by the following symptoms:

  • Whooping cough begins with symptoms of a cold and a mild, dry, irritating cough.
  • After this, one to two weeks later, the typical coughing bouts set in. The coughing continues until no air is left in the lungs.
  • After this comes a deep intake of breath that produces a heaving, ‘whooping’ sound when the air passes the larynx (windpipe) that gives rise to the name of the infection.
  • The patient may eventually cough up some phlegm and these attacks may well be followed by vomiting. The child’s temperature is likely to remain normal, but can become slightly raised.
  • A bout of whooping coughcan be very distressing for both the child and the parents who feel unable to help.
  • Coughing attacks occur on average around 15 times a day and whooping cough can last for up to 12 weeks.

⚠️ Make an urgent appointment with your GP if you are pregnant and believe you may have been in contact with someone who has whooping cough or your child is under 6 months old and has symptoms of whooping cough.

Whooping cough diagnosis

How does a doctor diagnose whooping cough? The diagnosis is usually made from the symptoms and the history of contact with a person suffering from whooping cough.In case of doubt, the doctor can take swabs from the nose and throat for analysis and have the results in about five days.

In older children and adults with whooping cough, the symptoms are often far milder and the condition is often not diagnosed. The diagnosis can also be made from blood tests, but these are often avoided in young children owing to their invasive nature.

In older children and adults with whooping cough, the symptoms are often far milder.

A new enhanced surveillance test for pertussis was launched by the Health Protection Agency in 2007. The test involves taking a specimen by brushing along the gum line with a saliva-collecting device. It’s used to estimate antibody levels directed against a toxin produced by the bacterium and is suitable for assisting in the diagnosis of those patients who have been coughing for more than two weeks and are suspected of having whooping cough.

Whooping cough complications

While whooping cough is very unpleasant, there may also be other complications, such as bronchitis, pneumonia and ear infections. These complications may cause a high temperature, and change the course of the disease. If one or more of these problems occur, they will usually be treated with antibiotics.

Whooping cough treatments

Treatment of whooping cough depends on the severity of the condition and how long the person has had it:

✔️ Babies under six months of age that are acutely unwell will be admitted to hospital.

✔️ Anyone who has significant breathing difficulties or complications from whooping cough such as pneumonia will also be admitted.

✔️ If the cough began less than three weeks before seeing the doctor, then antibiotics (eg clarithromycin) will be prescribed to reduce the likelihood of the infection spreading. Even with antibiotics the condition will take weeks to resolve.

✔️ If the cough began more than three weeks before seeing the doctor then antibiotics will not be given because the risk of passing on infection is so low.

✔️ Rest, plenty to drink and the use of paracetamol or ibuprofen to ease symptoms is recommended.

Whooping cough prevention

Vaccination is essential for preventing whooping cough. Just as significant as vaccination is the need to prevent infection spreading, especially to small children. This is especially important for children in nursery school.

Children (or those who work in healthcare) with proven or suspected whooping cough should not attend nursery or school or stay off work until they have completed at least 48 hours of antibiotic treatment. If they have not had antibiotics then they need to wait until 21 days after their cough began before returning.

Those who work in other settings should avoid contact with children under one year of age who aren’t fully vaccinated until they meet the above criteria.

Certain close contacts of the person with whooping cough may be prescribed antibiotics if the infection would pose a significant risk to them. Your doctor will advise if this is necessary.

Whooping cough vaccination

Who should be vaccinated for whooping cough? Vaccination takes place at the age of two, three and four months as part of the six-in-one vaccine that all children receive at these ages.

After the first two vaccinations protection is almost 100 per cent. The vaccination policy is aimed at protecting young babies who are most at risk and works very well in protecting against severe disease.

In 2001, a preschool booster vaccination (Repevax) was also introduced and is offered between the ages of three years and four months and five years. This is part of the 4-in-1 preschool booster.

It’s advisable that all children should be vaccinated against whooping cough, as it is important to prevent this dangerous disease.

Whooping cough and pregnancy

Vaccination against whooping cough has been introduced in the UK for pregnant women. Repevax is administered ideally between 16 and 32 weeks of pregnancy, being offered during a routine antenatal appointment and given during each successive pregnancy.

The vaccine boosts the number of whooping cough antibodies that pass from the mother through the placenta to the developing baby. This helps protect the newborn baby from catching whooping cough before they are given their first immunisations at two months of age. It also protects the mother from whooping cough, which reduces the risk of her catching whooping cough and passing it on to the new baby.

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