Whooping Cough (Pertussis)
Whooping cough, also known as pertussis, is a highly contagious, potentially serious, bacterial infection of the respiratory tract. Symptoms occur in three distinct stages, each lasting several weeks. The disease may affect anyone, but it is most dangerous when severe coughing interferes with breathing in children and infants; pneumonia, seizures and encephalopathy can be serious complications in young infants. Pertussis in older children and adults results in mild symptoms such as nasal congestion and cough. Fortunately, the incidence of whooping cough has declined sharply in the United States since the introduction of the pertussis vaccine in the 1940s. The vaccine does not provide indefinite immunity, but it protects children during the ages when they are most at risk.
What Causes Whooping Cough?
- An infection with the bacterium Bordetella pertussis causes whooping cough.
- Whooping cough is spread through the air by the sneeze or cough of an infected person. The infection may spread easily in families, schools and day-care centers; those living in overcrowded or unsanitary conditions are at heightened risk. Infants younger than six months and those born prematurely are also at increased risk for the disease.
Symptoms of Whooping Cough
- First or catarrhal stage (resembling an ordinary cold and lasting 10 days to two weeks): nasal discharge; sneezing; mild cough; general feeling of poor health
- Second or paroxysmal stage (lasting four to six weeks): episodes of severe coughing, sometimes followed by a characteristic “whoop” as air is inhaled sharply at the end of a coughing spasm; bulging eyes and neck veins; blue tinge to the skin during a coughing spasm due to lack of oxygen; vomiting induced by efforts to expel thick sputum; seizures (rare)
- Third or convalescent stage: coughing spasms that become milder and less frequent
Whooping Cough Prevention
- A combination vaccine that protects against diphtheria, tetanus and pertussis, known as DTP, provides immunity from pertussis for a number of years. A new derivation of the vaccine, DTaP (acellular pertussis vaccine), is currently recommended and has fewer side effects of fever and redness at the injection site. Children should receive the DTaP vaccine at two, four, six, and 18 months of age. A DTaP booster shot is given between the ages of four and six years, just before the child starts school.
- A 14-day course of preventive antibiotics may be administered to household members or schoolmates if a child develops whooping cough. Children under seven years of age who are unimmunized or have received fewer than four doses of DTP or DTaP vaccine may be given a booster shot; younger children should be continued on their regular vaccination schedule.
Whooping Cough Diagnosis
- Patient history and physical examination during the paroxysmal stage usually establishes the diagnosis.
- Throat culture
- Chest x-ray if pneumonia is suspected.
- Direct fluorescent antibody (DFA) staining of nasopharyngeal secretions can be performed to provide rapid presumptive diagnosis.
How to Treat Whooping Cough
- Treatment with antibiotics during the first stage may limit or prevent more severe symptoms. Antibiotics administered during the second stage do not alter the course of the infection but can reduce the degree of contagion. Fourteen days of antibiotic therapy is recommended.
- Supportive care is aimed at making the patient as comfortable as possible. Plenty of fluids and frequent small meals are recommended.
- Hospitalization in an isolation room may be necessary for infants, especially those younger than six months of age. Oxygen and intravenous fluids and nutrients may be administered.
When to Call a Doctor
- Call a doctor if a child’s cold persists or worsens.
- EMERGENCY Call an ambulance if a child turns blue or stops breathing.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media