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Whooping Cough

(Pertussis)

by Rick Alan

En Español (Spanish Version)

Definition

Whooping cough is a bacterial infection of the respiratory tract. The bacteria invade the lining of the respiratory tract and airways. This causes inflammation and increased mucus. It is very contagious. It can be serious.

Upper Respiratory Tract

Causes

Whooping cough is caused by the bacterium Bordetella pertussis. It is spread by:

Inhaling droplets from the sneeze or cough of a person infected with whooping cough
Having direct contact with the mucus of a person infected with whooping cough

Risk Factors

Risk factors that increase your chance of getting whooping cough include:

Not being immunized
Living in the same house or working in close contact with someone infected with whooping cough

Symptoms

Symptoms usually begin 1-2 weeks (at most, three weeks) after exposure to the bacterium.

Initial symptoms last about 7-14 days. They include:

Runny nose and congestion
Sneezing
Mild fever
Mild cough
Watery, red eyes

The second stage of whooping cough is called the paroxysmal stage. This stage usually lasts 1-6 weeks but can last much longer. Symptoms include:

Severe coughing
Long episodes of coughing that start suddenly and may end with a forceful inhale or 'whoop' (the whoop does not occur in all people)
In severe cases, coughing may cause a person to have trouble breathing or turn blue from lack of oxygen
Coughing episodes may result in vomiting

During the final stage, the cough gradually gets better over 2-3 weeks. Episodes of coughing can still occur during this stage.

Complications in infants and young children may include:

Pneumonia
Seizures
Periods of apnea (no breathing)
Abdominal and inguinal hernias
Damage to the brain (rare)
Death (rare)

Complications in teens and adults can include weight loss and accidental urination. Rarely, fainting or rib fractures can occur from severe coughing.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:

Swab of nose and throat for culture and other tests to detect the bacteria
Blood tests

Treatment

Treatment may include:

Antibiotics, such as erythromycin , clarithromycin, or azithromycin are used. They are most effective when started in the early stages.

To help reduce vomiting and reduce the chance of dehydration:

Eat small, frequent meals.
Drink plenty of fluids. For older children and adults, water, unsweetened fruit juices, and clear soup may be good options.

This may be necessary for those who develop pneumonia. Patients are usually isolated to prevent spreading the disease to other people.

Prevention

The best way to prevent whooping cough is immunization. All children (with few exceptions) should receive the DTaP vaccine series. This protects against diphtheria, tetanus, and pertussis. Another vaccine called Tdap is routinely given to children aged 11-12 after they have completed the DTaP series of shots. There are also catch-up schedules for children and adults who have not been fully vaccinated.

People in close contact with someone infected with whooping cough may be advised to take preventive antibiotics, even if they've been vaccinated. This is important in households with members at high risk for severe disease, such as children under one year of age.

American Medical Association

http://www.ama-assn.org/

Center for Disease Control and Prevention

http://www.cdc.gov/

Health Canada

http://www.hc-sc.gc.ca

Healthy U

http://www.healthyalberta.com/

Kleigman RM, Behrman RE, Jenson HB, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia PA: Saunders; 2007.

Pertussis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated September 21, 2012. Accessed December 4, 2012.

Pertussis (whooping cough). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/pertussis/about/index.html. Updated November 1, 2012. Accessed December 4, 2012.

Recommended adult immunization schedule—United States, 2012. MMWR Morb Mortal Wkly Rep. 2012;6(4). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/schedules/downloads/adult/mmwr-adult-schedule.pdf. Accessed December 4, 2012.

Recommended immunization schedule for persons aged 0 through 6 years—United States 2012. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/schedules/downloads/child/0-6yrs-schedule-pr.pdf. Accessed December 4, 2012.

Recommended immunization schedule for persons aged 7 through 18 years—United States 2012. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/schedules/downloads/child/7-18yrs-schedule-pr.pdf. Accessed December 4, 2012.

Tetanus, diphtheria (Td) or tetanus, diphtheria, pertussis (Tdap) vaccine: what you need to know. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-td-tdap.pdf. Published January 24, 2012. Accessed December 4, 2012.

1/31/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years—United States, 2008. MMWR. 2008;57;Q1-Q4. Centers for Disease Control and Prevention, MMWR website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm. Updated January 10, 2008. Accessed January 28, 2008.

1/24/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (tdap) vaccine from the advisory committee on immunization practices, 2010. MMWR Morb Mortal Wkly Rep. 2011;60(1):13-15.

11/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months—Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011;60:1424-1426.

Last reviewed November 2012 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.