Whooping cough

Produced by Louise Abbott, Bupa Health Information Team, February 2012.

This factsheet is relevant both for adults who have whooping cough and parents of children with the condition. However, for simplicity we will refer to you throughout.

Whooping cough (also known as pertussis) is a bacterial infection of the lining of your respiratory tract. This is the tube that carries air from your nose and mouth, to and from your lungs. The infection causes severe and uncontrollable bouts of coughing and is easily spread between people.

About whooping cough

Whooping cough is a bacterial infection that causes uncontrollable bouts of coughing. The bacteria can easily spread from person to person and cause illness. In some people, particularly young children, a ‘whoop’ sound is made as they draw in breath between coughing.

Whooping cough used to be far more common and cause more serious illness. Now, children in the UK are vaccinated against it, so the number of people who get whooping cough each year is much lower. In 2009, around 1,100 people were diagnosed with the illness in the UK.

Although whooping cough is thought of as a childhood illness, people of any age can catch it. However, in adults the illness is mild and they rarely have complications.

Symptoms of whooping cough

Whooping cough has three phases, each with different symptoms.

The first phase begins between seven and 21 days after you have been infected. The first symptoms are similar to a common cold. You may feel generally unwell with a runny nose, sneezing, a slight fever and, a few days later, a dry cough. These symptoms usually last about a week.

In the next phase, which may last a month or more, you may have uncontrollable bouts of coughing. At the end of a coughing bout, you may make a ‘whoop’ sound as you draw in breath. This is more common in young children than in babies or adults with whooping cough.

As well as having bouts of coughing, babies and children may also:

• go red in the face while coughing
• vomit at the end of a bout of coughing
• have difficulty feeding, which can lead to weight loss and dehydration
• choke on the thick mucus in their throat and chest
• have pauses in breathing for up to 20 seconds (known as apnoea) and turn blue from the lack of oxygen

In the last phase, you will gradually get better. You may have a cough for up to two months, but it won’t be as severe as during the second phase of whooping cough.

These symptoms aren't always caused by whooping cough, but if you have them, see your GP.

Complications of whooping cough

There are complications of whooping cough, some of which can be serious and life-threatening. Babies under six months old are most at risk of complications.

Less serious complications include:

• infection in your middle ear – rarely this can cause temporarily impaired hearing
• bleeding into your eyes or from your nose
• red spots under the skin of your face and chest, caused by small blood vessels bursting during coughing bouts

More serious complications include:

• pauses in breathing for up to 20 seconds (known as apnoea)
• lung inflammation usually caused by bacteria (known as pneumonia)
• fits (seizures)
• disorders of the brain that lead to symptoms including confusion, tiredness and muscle twitches (rare in adults)

Other complications that are directly related to the increased pressure in the chest from coughing can include any of the following.

• Air trapped in the space between your lungs and the wall of your chest (called a pneumothorax). This causes chest pain.
• A hernia. This is a bulge or swelling that occurs when the contents from your abdomen, such as your intestines, push through a weakness in the muscle of your abdominal wall.
• A rectal prolapse. This is when part of your rectum or the lining of your rectum drops through your anus.
• Rib fracture.
• Urinary incontinence. This is when you pass urine unintentionally.
• Frequent vomiting after a bout of coughing, which can lead to severe dehydration or weight loss.

Causes of whooping cough

The bacteria Bordetella pertussis cause whooping cough. When an infected person coughs, fine droplets containing the bacteria are formed and these carry the bacteria through the air to other people. When these droplets are breathed in, the bacteria can infect your airways causing symptoms such as coughing.

Diagnosis of whooping cough

Your GP will ask about your symptoms and medical history. He or she will usually be able to diagnose whooping cough based on your symptoms, but may also take a sample of mucus or saliva from your nose or throat with a swab (like a small round cotton bud). You may also have a blood sample taken. Your GP will send samples to a laboratory to be tested.

Treatment of whooping cough

Your GP may prescribe an antibiotic for you. However, even when you’re treated with antibiotics, the coughing usually last for six to eight weeks. The antibiotics may help to prevent the infection spreading to other people.

You will be advised to rest and drink enough fluids. You can take painkillers, such as paracetamol or ibuprofen, if you’re in pain. Don’t give aspirin to children under 16. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

No over-the-counter cough medicines have been shown to help relieve whooping cough so don’t take these. Especially, don’t give cough medicines to children under six years old because there is a risk of an allergic reaction.

If you’re severely ill with whooping cough or are showing signs of complications, you will be admitted to a hospital. You may need to be admitted to an isolation ward to protect other people from catching the illness.

More than half of babies under six months old will be admitted to hospital for treatment and monitoring if they have whooping cough. Some babies may be treated in a paediatric intensive care unit (PICU). Treatment they may need includes having thick mucus removed from their throat using a suction tube, or being put on a drip to be given fluids if they are having difficulty feeding. They might also require oxygen and other medicines.

Prevention of whooping cough

You should stay away from work or school for five days after starting antibiotics, or 21 days after you started coughing (whichever is sooner). It’s also best to stay away from babies under six months old to help prevent them from getting infected.

Vaccination

Children can be vaccinated against whooping cough. This vaccine is available as part of the national immunisation programme in the UK. It’s given in a series of injections at two, three and four months old. A pre-school booster is given to children when they are between three and five years old. Other vaccines are given at the same time against diphtheria, tetanus, polio and Hib (Haemophilus influenzae type b). The combination of vaccines is called DTaP/IPV/Hib. See our Common questions for more information.

If you choose not to have your child vaccinated, he or she will be more at risk of catching whooping cough. Even if you were vaccinated in infancy, your immunity will decrease over time, so it’s possible to get whooping cough as an adult, especially if you travel to countries where vaccination isn’t routinely performed.

Medicines

If you have whooping cough, your GP may offer antibiotics to you and other family members, especially any children under 10 years old who haven’t been vaccinated. Other people in your family who may benefit from antibiotics include anyone who has asthma, heart disease or a weakened immune system, for example, those who have HIV/AIDS or are being treated for cancer. Antibiotics can help prevent family members catching and spreading whooping cough.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.