Whooping cough

Whooping cough (pertussis) is a bacterial infection that causes severe bouts of coughing, which can last for several weeks or months. The infection is highly contagious – it’s easily spread between people. You can reduce your chance of illness by getting vaccinated against whooping cough.

About whooping cough

Whooping cough gets its name from the fact that some people, particularly children, make a ‘whoop’ sound as they draw in breath between coughing. You can get whooping cough at any age, but young babies and children are more likely to get it. Whooping cough used to be very common in the UK. But since vaccinations against the disease were introduced in the 1950s, the number of people getting it each year has been much lower.

Although it’s less common now, there tends to be an outbreak of whooping cough every so often, when more people than usual are infected. The highest peak of cases in recent years was in 2012.

Symptoms of whooping cough

Whooping cough symptoms usually begin about a week after you’re infected. The first symptoms are similar to those of a cold.

You may:

• have a runny nose
• sneeze
• have a sore throat
• have a slight fever
• have a dry cough

These symptoms usually last for a week or two. After about a week, your cough will get worse, and you may have regular bouts of coughing. In between coughing fits, you might feel okay, because there’s usually no fever. You may have some of the following symptoms too.

• At the end of a bout of coughing, you may make a ‘whoop’ sound as you draw in breath (the whooping cough sound). Many adults and babies don’t have this symptom – it tends to be more common in young children.
• Coughing may be worse at night or a particular thing might set it off. For example, cold temperatures or being suddenly startled by something such as an unexpected noise.
• After a bad fit of coughing, you might be sick.
• Coughing may cause your face to go red and you might start sweating.
• Children might have a bluish-purplish tinge to their lips and skin, caused by lack of oxygen during a coughing fit.
• The cough tends to last for one to six weeks, but it can carry on for months. You should start to gradually feel better, with the coughing becoming less frequent and less severe.

If you have whooping cough symptoms, contact a GP as soon as possible. Whooping cough is a notifiable disease, which means a GP has to tell the health protection team in the local health authority. This is so they can let other people know if they’ve come into contact with the infection.

Diagnosis of whooping cough

A GP will ask about your symptoms and examine you. Tell them if you’ve had the whooping cough vaccine, and if you’ve recently been in contact with anyone who has the infection. Your GP may diagnose you from your symptoms. Or they may want to do some tests, which could include the following.

• A sample test of fluid from your mouth (in children aged 2-16). You can get kits to do this test yourself at home, and a GP may arrange for one to be sent to you.
• A blood test (if you’re over 17 or for children under two, and have had a cough for over two weeks).
• A sample test of fluid from the back of your throat (the swab will be taken through your nose) if you’ve had the cough for less than two weeks.

It can take a while to get the results back from tests. So, if your GP suspects you have whooping cough, they’ll probably say you should start treatment straightaway. Sometimes, the tests can give a negative result, even if you do have whooping cough. This is because the cough can remain after the bacteria that cause it have cleared from your body.

Complications of whooping cough

There are several possible complications of whooping cough, some of which can be serious and life-threatening. Most people aren’t affected, but babies under six months are at the greatest risk. Complications of whooping cough can include:

• infection in your middle ear – caused by the spread of the bacteria that caused whooping cough
• infection of your lung (pneumonia) – also caused by spread of the bacteria
• temporary pauses in your breathing (apnoea)
• fits (seizures)
• inflammation of your brain (encephalitis) – this is rare
• severe dehydration, if you’re being sick after coughing fits

You may develop other complications directly related to the strain of constant, severe coughing, which include:

• bursting the tiny blood vessels in your eye, which causes red eyes
• red spots under the skin of your face and chest, caused by small blood vessels bursting during coughing
• urinary incontinence (unwanted urine leakage)
• trapped air in the space between your lungs and the wall of your chest (a pneumothorax)
• a hernia – this is when the contents from your tummy (abdomen), such as your bowels, push through a weakness in the muscle of your tummy wall
• a rectal prolapse – when part of your rectum or the lining of your rectum drops through your back passage (anus)
• fracturing a rib

If your baby has whooping cough, your GP will examine them to check for complications and explain to you what signs to look out for. If you’re at all worried that your baby is becoming more unwell, seek medical attention straightaway.

Prevention of whooping cough

Whooping cough is highly contagious – it spreads very easily from person to person. You can reduce your chance of being ill with whooping cough by having a vaccine against it.

Vaccination

The whooping cough vaccine is offered to all babies in the UK as part of the routine vaccination schedule.

The whooping cough vaccine is given as three separate doses when your baby is 8, 12 and 16 weeks old. The vaccination also protects against:

• diphtheria
• tetanus
• polio
• Hib (Haemophilus influenzae type b)
• hepatitis B

This combination of vaccines is called DTaP/IPV/Hib/HepB. Your child will be offered a further dose (preschool booster) of the whooping cough vaccine, when they’re around three years and four months old. Children born after 1 July 2024 are also offered a booster at 18 months of age.

The vaccine is very effective at protecting against whooping cough at first, but this protection gradually wears off as you get older. So, you may still get the disease, especially as an adult, although it’s likely to be milder.

Children over 10 years old and adults aren’t normally offered the whooping cough vaccine, although you may be if you’ve been in close contact with an infected person. If your child missed out on the vaccine when they were young, they can have the course up to the age of 10.

How the vaccine works

The whooping cough (pertussis) vaccine contains bacteria that have been killed, so they can’t multiply and give you the disease. When you’re injected, your body starts to make antibodies to fight off the bacteria, even though they’re not alive.

Young children may need several injections to produce this response. When your child is given their booster jab, their body recognises the whooping cough bacteria and makes more antibodies more quickly. If the child comes into contact with the whooping cough infection later, their immune system is ready to respond.

Although your child may have some protection against whooping cough after one dose of the vaccine, each extra dose offers greater protection. The four doses offer the best protection for your child for the longest possible time.

Whooping cough vaccine in pregnant women

In the UK, all pregnant women are offered a booster vaccine for whooping cough. You’ll be offered it between 16 and 32 weeks of pregnancy, but it’s usually timed to coincide with your 20-week scan. Having the vaccination when you’re pregnant will boost levels of antibodies against whooping cough in your blood. These antibodies will then be passed on to your baby. This will help to protect them from whooping cough as soon as they’re born, until they are old enough to have the vaccination themselves.

Antibiotics for prevention

To help prevent the spread of whooping cough, doctors may ask people who’ve been in close contact with whooping cough to take antibiotics even if they don’t have symptoms. Close contact means living in the same house or staying overnight in the same room as someone with whooping cough. This is most likely for:

• babies who haven’t had all their vaccinations yet
• older children and adults who had their whooping cough vaccination more than five years ago
• women who are more than 32 weeks pregnant and haven’t had a whooping cough vaccination in the last five years