What to Know About Whooping Cough Symptoms and Prevention
Here's a look at whooping cough symptoms, causes, and treatments, as well as how to prevent it with vaccines.
When you have a persistent cough
You have dry, irritating cough that hasn’t stopped for weeks, and now its been over a month. At first, you may think is it allergies? A cold? The flu?
If your persistent coughing bouts get worse and are accompanied by a “whoop” sound as you inhale, you could have pertussis, also known as whooping cough.
This condition isn’t as common as it once was (thanks, vaccines). In fact, many people seem to have forgotten that it still exists.
There are still around 24 million pertussis cases reported annually around the world, according to a 2017 study published in Lancet Infectious Diseases.
Whooping cough can be serious for both kids and adults (and potentially life-threatening for babies), although it is treatable. The best way to prevent whooping cough is to get vaccinated.
The coughing fits can be so severe it can cause you to vomit, pass out, crack or break a rib, or experience broken blood vessels in the whites of the eyes.
What is whooping cough?
Whooping cough is a highly infectious bacterial illness that affects the respiratory system. It’s caused by a type of bacteria called Bordetella pertussis.
The bacteria produce several toxins that can affect the function of the respiratory tract, leading to swelling of the airways and triggering coughing spells, says Carlos Oliveria, MD, a pediatric infectious diseases expert and assistant professor at Yale School of Medicine in New Haven, Connecticut.
“The classic presentation of pertussis is marked by rapid staccato-like episodes of coughing that are often followed by a ‘whoop’ and/or an episode of vomiting,” he says. “The ‘whoop’ refers to the noise made by the forced inspiratory effort that follows the coughing attack.”
The coughing episodes can last for months, hence its nickname, “the 100-day cough.”
The rise and fall (and rise) of whooping cough
The first outbreaks of pertussis were described in the 16th century, but the organism wasn’t isolated until 1906.
For many years, it was one of the most common diseases in children, causing many deaths. But in the 1940s, once a vaccine started being administered, numbers dropped by over 80 percent.
Unfortunately, in recent decades the incidence of whooping cough has increased.
According to the Centers for Disease Control and Prevention, in 2010 there was a surge of cases among kids ages 7 to 10. In 2012, the total number of pertussis cases peaked at 48,277—the highest since 1955, when public health experts reported 62,786 cases.
How is it transmitted?
Pertussis is highly contagious and spreads from one person to another via respiratory droplets that aerosolize during coughing or sneezing, says Darren P. Mareiniss, MD, assistant professor of emergency medicine at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.
In general, widespread vaccination leads to herd immunity, which can protect people who can’t get vaccinated. (For example, young babies, can’t get their first shot of the pertussis vaccine until 2 months of age.)
Unfortunately, vaccine protection can wane over time. (That’s why you need booster shots.)
If the bacteria circulate in the population, even vaccinated people may get sick or get infected with the bacteria without showing symptoms. Unvaccinated children are eight times more likely to get sick than children who have all five doses of the vaccine.
(Here are 6 pertussis precautions you can take for prevention.)
Whooping cough symptoms
There is a wide spectrum of the disease, ranging from mild symptoms to apnea (a period of not breathing) in some infants.
Dr. Mareiniss says that, classically, there are three phases. Each comes with its own set of whooping cough symptoms:
Catarrhal phase: Lasting one to two weeks, symptoms include nonspecific runny nose, malaise, low-grade fever, and cough.
Paroxysmal phase: This phase is defined by multiple rapid coughs in succession. “This is the phase where you may have a post-tussive (after-cough) whoop or vomiting or passing out,” says Dr. Mareiniss. “This phase is characterized by these uncontrolled bouts of coughing and may last months.”
Convalescent phase: In this final stage of symptoms, cough frequency gradually decreases.
Who gets whooping cough?
Prior to the introduction of the vaccine, whooping cough predominantly affected children under 10 years of age.
“Since vaccination, most of the disease is seen in adults and adolescents,” says Mareiniss. Of course, that doesn’t mean younger people are in the clear. It’s still incredibly common in young children and infants.
Older populations can be a source of potential infection of young children and infants, who can experience more serious symptoms.
In fact, the CDC says that many of the infants who get it are infected by older siblings, parents, or caregivers who aren’t aware they are infected.
That’s why parents and caregivers need vaccinations too.
Complications of whooping cough
Infants and children are also more at risk for complicated pertussis and death from the illness.
According to the CDC, approximately half of all babies under the age of 1 who get whooping cough need to be hospitalized and 23 percent get pneumonia.
What’s more, about 1 percent of infants will have convulsions (violent, uncontrolled shaking), 61 percent will experience apnea, 0.3 percent will have encephalopathy (disease of the brain), and 1 percent will die.
In comparison, just 5 percent of teens and adults with pertussis require hospitalization, with just 2 percent being diagnosed with pneumonia.
Whooping cough affects children worse than adults because of their relatively smaller airways, Dr. Oliveria explains.
Infants are more likely to have complications such as apnea, a ruptured lung, nosebleeds, and brain bleeds. Most of the complications result from the high internal pressures generated during the intense coughing fits.
Another severe manifestation of pertussis is called extreme leukocytosis.
“This is where the immune system produces an excessive amount of white blood cells to combat the infection,” Dr. Oliveria explains. “These white blood cells are very sticky and can clog up the blood vessels in the lung and lead to catastrophic pulmonary disease when present at high numbers.”
Other risk factors that can increase the likelihood of severe infection and/or hospitalization include asthma, chronic obstructive pulmonary disease (COPD), and tobacco use.
“For adults, the risk of hospitalization also increases for patients older than 65,” explains Dr. Mareiniss.
(Here’s how one family lost their baby to whooping cough and now advocates for the importance of vaccination.)
How is whooping cough diagnosed?
If you’re experiencing signs of whooping cough, make an appointment with your doctor, stat.
Early diagnosis and treatment is important. Not only will it lead to a less-severe case of whooping cough and help you feel better sooner, but it will prevent the spread of the contagious infection.
A physician will generally diagnose whooping cough if there are more than two weeks of persistent cough without known cause and one of the following: frequent, violent coughing fits; whooping when you inhale; or vomiting after coughing.
“PCR [polymerase chain reaction] tests and/or bacterial culture can aid in the diagnosis,” Dr. Mareiniss says.
By his estimation, whooping cough is likely underdiagnosed by most physicians.
Whooping cough treatments
How whooping cough is treated depends on when it is diagnosed, Dr. Oliveria explains.
If the infection is diagnosed early, within the first week of symptoms, antibiotics can be given to shorten the duration and severity of symptoms.
“Unfortunately, diagnosis this early rarely occurs in real life, and most cases are diagnosed much later, when antibiotics are unlikely to affect their clinical course,” states Dr. Oliveria.
This is because most of the symptoms caused by pertussis are due to the toxins it produces, and antibiotics have no effect on existing toxins.
He adds that although antibiotics generally aren’t prescribed after you’ve had the illness for three weeks, some clinicians might still offer antibiotics at later stages of the disease.
“This is primarily a public health measure to kill the small number of bacteria remaining and eliminate the risk of further transmission to close contacts,” he says.
Supportive care, like fluids and nutrition, is the backbone of most treatment strategies for pertussis.
Treating whooping cough in infants
Additional treatments may be needed for infants with the infection. Doctors may need to suction mucus for them, for instance.
Critically ill infants often require more-aggressive management, like supplemental oxygen and blood exchange transfusions.
If the lungs get clogged up and cease functioning, doctors will try extracorporeal membrane oxygenation (ECMO), an aggressive treatment that involves taking the infant’s blood out, oxygenating it, and transfusing it back into them.
Whooping cough prevention
“Bottom line: get vaccinated to prevent pertussis,” urges Dr. Mareiniss.
The most effective preventative measures against whooping cough are the DTaP and the Tdap vaccines, which protect against tetanus, diphtheria, and pertussis.
“It typically allows five to 10 years of protection,” he explains.
It is also recommended that people who are pregnant get vaccinated in order to prevent potentially passing pertussis to their newborn children, he adds.
Mothers also can pass antibodies on to their newborns, which can help protect them in the window of time before they can be vaccinated themselves.
Keep in mind that no vaccine is 100 percent effective.
“When pertussis circulates in the community, there is a chance that a fully vaccinated person, of any age, can catch this disease,” the CDC states. “If you have gotten the pertussis vaccine but still get sick, the infection is usually not as bad.”
Additionally, once infected with pertussis, your body will have natural immunity for four to 20 years, according to a study in The Pediatric Infectious Disease Journal.
However, vaccines are still recommended for people who have been infected since immunity will wane over time.
- Darren P. Mareiniss, MD, assistant professor of emergency medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia
- Carlos Oliveria, MD, PhD, pediatric infectious diseases and assistant professor, Yale School of Medicine, New Haven, Connecticut
- Lancet Infectious Diseases: "An update of the global burden of pertussis in children younger than 5 years: a modeling study"
- Centers for Disease Control and Prevention: "Pertussis (Whooping Cough) Fast Facts"
- Centers for Disease Control and Prevention: "Pertussis (Whooping Cough) Complications"
- The Pediatric Infectious Disease Journal: "Duration of immunity against pertussis after natural infection or vaccination"
- Centers for Disease Control and Prevention: "Pink Book Immunology and Vaccine-Preventable Diseases – Pertussis"