Whooping Cough

Overview

Whooping cough, otherwise known as pertussis, is a transferable and contagious respiratory tract infection. It often causes an intense, hacking cough and a distinctive high-pitched "whoop" sound when breathing in. Before the development of a vaccine, this cough was mainly a childhood illness. Today, it primarily affects young children who have not yet completed their full vaccination series and teenagers and grown-ups whose immunity has weakened over time. While deaths due to whooping cough are very rare, they occur most frequently in infants. For this reason, expectant women and anyone in contact with a baby must get vaccinated against this disorder.

What is Whooping Cough?

Whooping cough, or pertussis, is an infectious respiratory illness characterised by severe coughing fits. In severe instances, the coughing can be so intense and rapid that it may lead to vomiting. The condition gets its name from the distinctive "whooping" sound when a person gasps for breath after a bout of coughing. This illness is highly contagious and can affect individuals of any age, but it poses a greater risk to infants who have not yet received their vaccinations. Approximately 50% of babies under one-year-old who contract whooping cough require hospitalisation for treatment.

Symptoms of Whooping Cough

In its early stages, whooping cough symptoms can resemble those of a common cold. These initial symptoms typically last one to two weeks and may include mild fever, occasional or mild cough, runny or congested nose, and pauses in breathing (apnea), especially in infants.

After the initial phase, symptoms usually intensify, lasting up to 10 weeks or more. These may include severe, prolonged coughing fits (paroxysms) that can occur multiple times a day, a distinctive "whoop" sound when inhaling after a coughing episode, vomiting after intense coughing fits, and extreme fatigue due to persistent coughing. Symptoms often start to subside after four weeks, but lingering bouts of coughing may persist for several months.

Whooping Cough Causes

The bacterium Bordetella pertussis causes whooping cough. This highly contagious infection spreads easily through respiratory droplets from coughing, sneezing, or close contact with an infected person. Transmission can also occur by touching surfaces contaminated with the bacteria and then touching your nose or mouth. If you develop pertussis, you are typically contagious for about two weeks after coughing begins. However, antibiotic treatment can help shorten the contagious period, reducing the risk of passing the infection to others.

Whooping Cough Diagnosis and Tests

A healthcare provider will perform a physical examination and inquire about your symptoms. They may use a cotton swab to collect a sample of mucus from inside your nose. Alternatively, they can obtain a sample by using a syringe filled with saline solution to flush it through your nose and the back of your throat. The doctor will send these samples to a laboratory, where a technician will analyse them for the presence of Bordetella bacteria. Additionally, the provider may request blood tests to confirm the presence of the bacteria.

Whooping cough progresses through three distinct stages: the catarrhal, paroxysmal, and convalescent stages.

Catarrhal Stage: In this early stage, symptoms are mild and may often be mistaken for a common cold or go unnoticed. Some prominent signs may include a runny nose, mild fever, and occasional cough.

Paroxysmal Stage: This is the hallmark phase of whooping cough. It is marked by severe coughing fits, often accompanied by a characteristic "whoop" sound when inhaling after a cough. These intense coughing episodes can lead to vomiting, fatigue, and difficulty breathing, and are especially severe in infants and young children.

Convalescent Stage: In the final stage, coughing episodes gradually decrease in frequency, and symptoms improve. However, recovery can be slow, and mild coughing may persist for weeks as the body fully heals.

Treatment Required for Whooping Cough

Timely treatment for whooping cough is crucial. Upon diagnosis, healthcare providers typically prescribe antibiotics to limit the spread of infection, though these medications cannot relieve the persistent cough itself. Over-the-counter cough syrups and similar remedies are usually ineffective for managing whooping cough symptoms. Instead, home care and supportive treatments help to alleviate discomfort.

If you have been in close contact with someone suffering from pertussis, it will be prudent to start treatment within three weeks of exposure. In such cases, a healthcare provider may recommend a preventive course of antibiotics to reduce the chance of developing or spreading the infection.

For infants, whooping cough can pose serious risks, including pneumonia and breathing difficulties, which may require hospitalisation. In such cases, a healthcare provider's care may involve:

Clearing the Airways: Suction may be needed to remove mucus and keep breathing passages open.

Monitoring Breathing: Oxygen support will be provided if needed to assist the baby’s breathing.

Preventing Dehydration: IV fluids may be administered to maintain hydration and support the baby’s strength.

Early medical intervention is essential to protect against complications of whooping cough, especially for infants who are more vulnerable to severe outcomes.

Preventive Measures for Whooping Cough

Getting vaccinated against whooping cough (pertussis) is the best way to prevent this highly contagious illness. Healthcare providers recommend that all children receive the diphtheria-tetanus-pertussis (DTaP) vaccine, which protects against whooping cough, diphtheria, and tetanus. This vaccine is both safe and effective.

The recommended DTaP vaccination schedule for children involves five doses:

First Dose: At 2 months

Second Dose: At 4 months

Third Dose: At 6 months

Fourth Dose: Between 15 and 18 months

Fifth Dose: Between 4 and 6 years

Since immunity to pertussis diminishes over time, adults can get a Tdap booster shot. Adults, especially those who care for infants, should get vaccinated to prevent the passing of whooping cough to vulnerable young children. Often, adults with whooping cough may mistake it for bronchitis or sinus infections, unknowingly putting infants at risk of serious complications.

Tdap booster recommendations for adults:

Ages 19 to 64: One-time Tdap booster.

Ages 65 and Over: A booster if in close contact with infants under 12 months.

Pregnant Individuals: A Tdap booster during the third trimester (between weeks 27 and 36) is recommended for every pregnancy.

The Tdap vaccine provides crucial short-term protection for newborns against whooping cough and its complications. Pregnant individuals should also encourage family members and caregivers to get vaccinated against pertussis to create a safe environment for the baby.

Myths and Facts Related to Whooping Cough

Here are some common myths about whooping cough (pertussis) and the facts that debunk them:

Myth 1: A Single Vaccination Provides Lifetime Immunity
Fact: Immunity from the whooping cough vaccine diminishes over time, which is why it is essential to follow the recommended vaccination schedule. Children typically receive five doses of the pertussis vaccine combined with protection against diphtheria and tetanus. These are given at 2 months, 4 months, 6 months, 15-18 months, and 4-6 years. Around age 11, children receive a Tdap booster to extend immunity. Pregnant women should get the Tdap vaccine during the third trimester, as it helps shield the newborn in their early months of life.

Myth 2: Everyone with a Whooping Cough Makes the Characteristic “Whooping” Sound
Fact: While the classic “whoop” sound is a hallmark of whooping cough, not everyone experiences it. Many people initially display symptoms similar to a common cold, such as a runny nose, mild fever, intermittent cough, nasal congestion, and watery eyes. As the illness progresses, mucus thickens in the airways, triggering intense coughing fits that may lead to vomiting, facial redness or bluish discolouration, fatigue, and dehydration. If these symptoms appear, especially after cold-like symptoms, a doctor’s visit is essential.

Myth 3: The Whooping Cough Vaccine is Not Safe
Fact: Despite a resurgence of whooping cough cases due in part to decreased vaccine effectiveness, vaccine hesitancy has also contributed to the rise. The whooping cough vaccine has no links to autism and is generally safe. For pregnant women, the vaccine is especially beneficial. Studies show that 75% of babies born to vaccinated mothers are safe in their first two months. The effectiveness of the whooping cough vaccine exemplifies the life-saving benefits of immunisation.