Whooping cough

What is whooping cough?

Whooping cough, also called pertussis, is a bacterial infection that affects the lungs and upper airways. It is named after the "whoop" sound that some people with whooping cough make when they gasp for breath during a coughing spell. Whooping cough is highly contagious, meaning it can spread easily to other people. The infection can lead to serious complications and even death, particularly in babies under a year old.

Whooping cough cases have been on the rise in the UK since December 2023 and the government is urging people to get their children vaccinated against this potentially deadly disease.

What causes whooping cough?

Whooping cough is caused by a type of bacteria called Bordetella pertussis. The bacteria attach to tiny, hair-like extensions (cilia) that line your respiratory tract. The bacteria then release toxins that damage your cilia and cause your airways to swell leading to an increase in mucus and the severe bouts of coughing associated with whooping cough.

Who can get whooping cough?

Anyone can get whooping cough, but the infection is more common in young babies, children and adolescents.

Whooping cough symptoms

Early symptoms of whooping cough are often similar to those of the common cold and may include:

• Feeling generally unwell
• Low-grade fever
• Runny or blocked nose
• Sore throat
• Sporadic coughing
• Red, watery eyes

After a week or two the following symptoms may develop:

• Severe bouts of prolonged coughing (paroxysms) that are often worse at night
• A "whoop" sound when gasping for air between coughs — this is less common in young babies and adults
• Apnoea (pauses in breathing) in babies
• Bringing up thick mucus
• Vomiting
• Exhaustion
• Redness or blueness (cyanosis) in the face

Whooping cough symptoms usually start to improve after about four weeks, but bouts of coughing can continue for up to three months.

Complications of whooping cough

Whooping cough can cause complications that may be severe or life-threatening. Complications are more common in babies under a year old and include:

• Breathing problems
• Dehydration
• Weight loss
• Seizures (fits)
• Kidney problems
• Pneumonia
• Hypoxic brain damage due to a lack of oxygen reaching the brain
• Encephalopathy
• Death (this is very rare)

Complications from whooping cough can also affect older children and adults, though they are usually less severe. Complications often develop due to repeated bouts of severe coughing and may include:

• Bruised or broken ribs
• Nosebleeds
• Hernia
• Loss of bladder control
• Fainting
• Middle ear infections

How is whooping cough spread?

Whooping cough is extremely contagious and can spread easily to other people through tiny droplets in the air when an infected person coughs or sneezes.

You can pass whooping cough to other people from when your symptoms first appear until up to three weeks after the coughing starts. If you are having treatment with antibiotics, you are no longer contagious after five full days of treatment.

Some people with whooping cough have mild symptoms and may not know they have it but can still spread the infection to others.

When to see a consultant for whooping cough

Whooping cough is a notifiable disease in the UK, which means your consultant must report any suspected or confirmed cases of whooping cough to the relevant authorities.

Make an appointment with your consultant if you or your child has symptoms of whooping cough. As whooping cough is highly contagious, call the hospital before your appointment to inform them that you or your child may have whooping cough.

Seek urgent medical attention if:

• You or your child have a severe cough that is getting worse
• You have a baby under 6 months of age with symptoms of whooping cough
• You are pregnant and have been in contact with someone with whooping cough
• You have a weakened immune system and have been in contact with someone with whooping cough

Call an ambulance or go straight to A&E if:

• Your child is having seizures (fits)
• Your child stops breathing periodically (apnoea)
• Your child's face or lips go blue (cyanosis)
• You or your child have difficulty breathing
• You or your child have chest pain that gets worse when breathing or coughing

How is whooping cough diagnosed?

Your consultant will diagnose whooping cough by asking you about your symptoms and performing a physical examination. They will ask you if you have had the whooping cough vaccine and whether you may have been in contact with someone with whooping cough.

In some cases, this may be enough to diagnose whooping cough, but your consultant may order tests to confirm the diagnosis.

Tests for whooping cough include:

• A sample of fluid from the mouth —  this test is performed on children aged five to 16 and can be done at home
• A blood test  — your consultant may request a blood test if you're over 17 or a child under five and have had a cough for over two weeks
• A sample of fluid from the back of the throat —  may be done if you've had the cough for less than two weeks

If your consultant suspects that you have whooping cough, they will likely prescribe treatment right away rather than waiting for the test results. In some cases, the test results can come back negative even when you have whooping cough as the cough can continue after the bacteria have cleared from your body.

How is whooping cough treated?

Whooping cough treatment depends on your age and how long you've had symptoms of whooping cough.

Babies with whooping cough are usually treated in hospital as the risk of complications is higher in this age group.

Older children and adults can usually be treated at home.

Antibiotics

If you are diagnosed with whooping cough within the first three weeks of the infection, your consultant may prescribe antibiotics. These may not reduce your symptoms but will help reduce the risk of spreading whooping cough to others. Other members of your household, or with whom you have frequent contact may also be treated with antibiotics or given a dose of the whooping cough vaccine as a preventative measure.

If you've had whooping cough symptoms for more than three weeks, your consultant won't usually prescribe any treatment. This is because you are no longer contagious, and antibiotics are unlikely to help at this stage.

Self-care for whooping cough

Whether you are taking antibiotics or not, there are some things you can do at home to treat whooping cough symptoms and aid your recovery including:

• Drink plenty of fluids such as water, juice and soup to prevent dehydration. Warm drinks may be soothing and help to ease coughing.
• Rest
• Eat small, frequent meals
• Keep your home free from anything that may trigger or worsen coughing such as tobacco smoke
• Take over-the-counter medications like paracetamol or ibuprofen to relieve any pain and reduce a fever
• Avoid cough medicines as they are unsuitable for young children and do not help with this kind of cough
• Do not give aspirin to children under 16

Can whooping cough be prevented?

Whooping cough can't always be prevented, but you can reduce your risk of getting whooping cough by getting vaccinated (if recommended) and taking measures to reduce the risk of spreading the infection to others.

The whooping cough vaccine

The best way to prevent whooping cough is with the whooping cough (pertussis) vaccine. In the UK, the whooping cough vaccine is routinely given to babies, children and pregnant women. The vaccine doesn't offer lifelong protection against whooping cough but can help prevent cases in babies and young children who are most at risk of complications from whooping cough. Getting vaccinated during pregnancy is the best way to protect your baby from whooping cough until they receive the whooping cough vaccine when they are eight weeks old.

The whooping cough vaccine is safe and effective and serious side effects are extremely rare. Mild side effects may include localised swelling, redness and tenderness at the injection site.

• Babies are vaccinated against whooping cough with the 6-in-1 vaccine which includes diphtheria, tetanus, hepatitis B, Haemophilus influenza type B (Hib) and polio at eight, 12 and 16 weeks of age
• Children are vaccinated against whooping cough as part of the 4-in-1-pre-school-booster by three years and 4 months of age
• Pregnant women should be offered the whooping cough vaccine soon after the 16th week of pregnancy. Contact your consultant or pregnancy care team if you are 20 weeks pregnant and have not been offered the whooping cough vaccine.

Getting vaccinated during pregnancy is the best way to protect your baby from whooping cough in the first few weeks of their life and will provide protection until they receive the whooping cough vaccine at eight weeks of age.

Preventing the spread of whooping cough

If you or your child has whooping cough, you should take the following measures to prevent spreading the infection to others.

• Stay home from work/ keep your child off nursery or school for two days after starting antibiotics. If you are not taking antibiotics, stay off school, work or nursery for three weeks from when the coughing bouts started
• Cover your/ your child's mouth and nose with a tissue when coughing and sneezing and throw the tissue away immediately
• Wash hands frequently with soap and warm water
• Avoid close contact with other people where possible while you are contagious (from the start of symptoms until up to three weeks after the coughing starts, or after five full days of antibiotic treatment)

Summary

Whooping cough is a highly contagious bacterial infection that causes a distinctive "whooping" cough. It can be especially dangerous for babies and may lead to life-threatening complications.

A vaccine against whooping cough is routinely given to babies, young children and pregnant women in the UK.