Whooping cough

Also known as pertussis

Whooping cough is an infectious bacterial disease that causes uncontrollable coughing. Complications can be serious, including pneumonia and seizures. Immunisation with the pertussis vaccine is the best way to protect against whooping cough.

Key points

  1. Anyone can get whooping cough, but it causes the most severe, sometimes life-threatening, symptoms in babies, young children and elderly people.
  2. Whooping cough can still be highly unpleasant to severe in older children and adults.
  3. Coughing can continue for up to 3 months.
  4. The NZ immunisation schedule offers vaccination against whooping cough (pertussis vaccine) to children. Booster vaccinations are available for other groups.
  5. If your child gets whooping cough and they have not been vaccinated, they are more likely to develop pneumonia and other potentially serious complications.
  6. If you think your child has whooping cough or if you have concerns about your child's health, call your doctor or practice nurse. You can also free phone Healthline 0800 611 116.

Whooping cough NZKidsHealth, NZ

Why is whooping cough a concern?

In New Zealand, epidemics of whooping cough occur about every 3 to 5 years. Infants and children are most vulnerable to the disease:

  • Around 5 in 10 babies who catch pertussis before the age of 12 months require hospitalisation.
  • Of those hospitalised, 1 to 2 in 100  die from pertussis infection.
  • Severe coughing can temporarily stop the oxygen supply to the brain (hypoxia).
  • In around 2 in 1000 children pertussis leads to permanent brain damage, paralysis, deafness or blindness.
  • Secondary infections such as pneumonia and ear infections can occur.

The disease is usually milder in adolescents and adults, consisting of a persistent cough similar to that found in other upper respiratory infections.

  • It has been estimated that up to 20% of severe adult coughs lasting 1-3 months could be caused by pertussis infection.
  • Some adults will collapse or experience a rib fracture from violent coughing.
  • Both hospitalisations and deaths are likely to be under-estimated in adults due to the lack of the ‘whooping’ sound.

Causes of whooping cough

Whooping cough is caused by infection with a bacterium known as Bordetella pertussis.

  • Bacteria enter the air passages and damage the lining of the windpipe and the main airways in the lungs. 
  • The inflamed airways produce more mucus, which starts an irritating cough. 
  • The bacteria is spread from person to person through coughing and sneezing, or touching something that the infected person has touched.

Who is most at risk?

Babies and toddlers who have not yet completed the National Immunisation Schedule (see prevention below) and children who are not immunised, or only partially immunised, are most at risk from pertussis.

On-time vaccination is the best way to protect these groups as it:

  • protects against infection
  • reduces the number of people in the community that can transmit the bacteria.

Booster vaccinations are recommended for adults in regular contact with infants, for the following reasons: (1)

  • The immunity given by the pertussis vaccine to whooping cough decreases with time.
  • This means that you can catch whooping cough some years later, even if you have been immunised in the past or have previously had the disease.
  • Many babies often catch it from their older siblings or parents, often before they are old enough to be fully immunised.
  • To protect children during their first year of their life, when they are most at-risk, it is recommended that adults caring for babies and older siblings are up to date with their immunisations.  

Read more about the whooping cough (pertussis) vaccine

Symptoms of whooping cough

Symptoms of whooping cough develop about 7 to 10 days after being exposed to the bacteria. Whooping cough can last up to 3 months and usually runs in 3 stages.

The first stage usually starts like a 'cold'.

  • It produces an irritating cough, sneezing, runny nose and possibly a slight fever.
  • It is highly contagious at this stage but difficult to diagnose.
  • As with a cold, these symptoms usually go away over a week or so.

The second stage begins after 1 or 2 weeks when the coughing gets worse.

  • The coughing bouts often end in a high-pitched whooping sound as the person takes a breath.
  • Coughing spells may produce plenty of mucus, and choking on the mucus can cause vomiting.
  • The typical 'whoop' sound may not be present in very young children or adults diagnosed with whooping cough. The persistent coughing spells can cause a child to temporarily stop breathing, or turn blue.
  • Complications such as pneumonia or middle ear infections (glue ear) are more likely to develop at this time.

The third stage (convalescent) is when the coughing and vomiting start to subside. Sometimes, the coughing can start again months later if the child develops an upper respiratory tract infection.

Diagnosis of whooping cough

If you think you or your child may have whooping cough, see your doctor or practice nurse as soon as possible.

Usually the history and sound of the cough will make diagnosis fairly easy, but your doctor will take a nose and throat swab and send it to the laboratory to make sure of the diagnosis. The tests that detect the pertussis bacteria will only show up in the early stages of the disease.

Treatment of whooping cough

If whooping cough is diagnosed during the first 3 weeks of the infection, your doctor may prescribe a course of antibiotics. This helps to prevent the bacteria from spreading to other people.

  • Cough medicine is of little value in controlling the coughing (and is not recommended in young children).
  • Paracetamol may be helpful if the child is in pain with the coughing. Ensure you follow the product directions and measure children's doses accurately. Never give more than the recommended dose. If unsure about any product, ask your doctor or pharmacist for advice.

How long is whooping cough infectious?

You may be infectious to others for up to a month after the start of the cough, but if an antibiotic has been prescribed the infectious period is reduced to less than a week. To reduce the risk of infection:

  • keep your child away from others during the infectious period to prevent infection spreading
  • take extra precautions with hygiene measures
  • if there is an outbreak of whooping cough and your child is not immunised keep them away from their early childhood centre until the outbreak is over.

Self care

Mild cases of whooping cough can be treated at home.

  • Comfort and plenty of cuddles for young children will aid in recovery.
  • Small healthy meals and fluids can be given to your child.
  • Steam in the bedroom or sitting the child on your knee in a steamy bathroom may give some temporary relief.

Make sure you and your child get as much rest as you can. Caring for your child with whooping cough is hard work, especially as the cough is often worse at night.

Prevention of whooping cough – pertussis vaccine

"Before there was a vaccine, whooping cough was one of the most common childhood diseases and a major cause of childhood deaths in many countries. There are fewer cases today because there are both pertussis-only vaccines and combination vaccines for tetanus, diphtheria and pertussis" —Centres for Disease Control and Prevention (CDC), USA

The NZ Immunisation Schedule offers vaccination against whooping cough (pertussis vaccine) to children. The schedule consists of a course of 5 injections combined with others (for tetanus and diphtheria). It is given at ages 6 weeks, 3 months and 5 months. Booster doses are then given at ages 4 years and 11 years.

Babies are at the greatest risk until they have had their first 3 immunisations. It is important to immunise babies on time, every time and to keep them away from or people who have a cough.

Pregnant or have young children?

Pregnant women are at much higher risk of getting whooping cough. If they do, the risks can be life-threatening, both for mum and the unborn infant.

To reduce this risk, a free whooping cough booster immunisation is recommended between 28-38 weeks of pregnancy. (The ideal time is between weeks 31 to 33) The immunisation stimulates the mother’s immune system to make antibodies and these are also passed to the infant via the placenta. This helps protect both the mother from getting sick with pertussis and the new baby.

Key points from the Immunisation Advisory Centre pertussis factsheet

  • The whooping cough booster immunisation is so important for infant protection that pregnant women are recommended to have one every pregnancy.
  • It always comes combined with tetanus and diphtheria immunisations (Boostrix®), and it doesn’t matter how recently a pregnant woman had her last tetanus/diphtheria immunisation. 

What about for dads, grandparents and other adult carers?

Most cases of whooping cough in infants are passed on by family members as you can be infectious and pass it on without realising you have whooping cough. To protect pregnant mums and baby, "all other people in your household, as well as other close family members, such as grandparents, should have a whooping cough vaccination, as they could be at risk of passing it onto your baby."

  • For dads, grandparents and other caregivers, see your family doctor/nurse to check you have had a pertussis vaccination within the last 10 years.
  • Check that older siblings are also up-to-date with their vaccinations.

Read more about childhood immunisationpertussis vaccine

Learn more

Whooping cough  Immunisation Advisory Centre, NZ
Boostrix (whooping cough vaccination) is given in every pregnancy Immunisation Advisory Centre, 2015
Pregnancy and whooping cough Centres for Disease Control and Prevention, USA, 2015
Pertussis – whooping cough Centres for Disease Control and Prevention, USA, 2015

References

  1. Pertussis: halting the epidemic by protecting infants Best Practice Journal, NZ, 2013 
  2. Whooping coughImmunisation Advisory Centre, NZ
  3. Immunisation against whooping cough during pregnancy: Factsheet for parents and caregivers Immunisation Advisory Centre, 2014
  4. Recommended and funded vaccinations during pregnancy Immunisation Advisory Centre, 2015
Credits: Health Navigator, latest update April 2017.