Topic Overview
What is whooping cough?
Whooping cough is a
disease that causes very severe coughing that may last for months. You can
cough so hard that you hurt a rib.
Whooping cough is also called
pertussis.
Whooping cough is contagious. This means it spreads
easily from one person to another. You can prevent whooping cough by getting
shots, called vaccines, that protect you from the disease.
Whooping cough can lead to other problems, such as
pneumonia. These problems can be very serious in
adults ages 60 and older and in young children, especially babies who are born
early or have not had shots to prevent whooping cough.
With good
care, most people recover from whooping cough with no problems.
Anyone can get whooping cough. Before the vaccine was available, whooping
cough was most common in infants and young children. Because most infants now
get the vaccine, people ages 11 and older are now more likely to get it.
You can get whooping cough more than one time, and you may get it years
apart. But you will be less likely to get it again if you get the shots as
recommended.
What causes whooping cough?
Whooping cough is
caused by bacteria that infect the top of the throat (pharynx) where it meets
the nasal passages. The bacteria bother the throat, which causes
coughing.
See a picture of the
respiratory system, including the pharynx.
Whooping cough spreads easily from person to person. When someone with
the disease coughs, sneezes, or laughs, tiny drops of fluid holding the
bacteria are put into the air. The bacteria can infect others when they breathe
in the drops or get them on their hands and touch their mouths or noses. After
the bacteria infect someone, symptoms appear about 7 to 14 days later.
What are the symptoms?
Adults usually have milder
symptoms than children. How bad your symptoms are also depends on whether you
had the vaccine and how long ago it was.
Symptoms of whooping
cough usually last 6 to 10 weeks, but they may last longer. In young children,
three stages can occur. Older children and adults don't always have the same
stages.
In stage 1, symptoms are like those
of a cold:
- You sneeze and have a runny nose, a mild
cough, watery eyes, and sometimes a mild fever.
- The symptoms last
from several days to 2 weeks.
- This is when you are most likely to
spread the disease.
In stage 2, the cold symptoms get
better, but the cough gets worse.
- The cough goes from a mild, dry, hacking
cough to a severe cough that you can't control.
- You may cough so
long and hard that you can't breathe. When you can take a breath of air, it may
make a whooping noise.
- After a coughing fit, you may vomit and
feel very tired.
- Between coughing fits, you feel normal.
- Symptoms are most severe in this stage. They usually last 2 to 4
weeks or longer.
In stage 3, you get better and grow
stronger.
- The cough may get louder.
- Coughing fits may happen off and on for weeks.
- Coughing fits may flare up if you get a cold or have a similar
illness.
- This stage may last longer if you have never had the
vaccine.
How is whooping cough diagnosed?
Your doctor will
ask you about your symptoms and do a physical examination. He or she may
order tests to rule out other health problems. Your doctor may ask if you have
had the necessary shots.
It can sometimes be hard to diagnose
whooping cough, because a person appears healthy between coughing episodes.
Your doctor may take a sample of mucus from your nose or throat and have it tested for
the bacteria that cause whooping cough.
How is it treated?
You will be given
antibiotics. These make it less likely that you will
spread the disease. If you start taking the antibiotics when you first get
whooping cough, the disease may not last as long.
Young infants
usually are treated for whooping cough in the hospital so the doctor can see
how well the baby deals with and recovers from the coughing.
Over-the-counter medicines, such as cough syrups, have
not been shown to help whooping cough. You can increase your comfort by using a
humidifier and getting enough fluids.
Can whooping cough be prevented?
Immunizations can prevent whooping cough or reduce how bad it is. Children, starting at age 2 months, need a series of shots to protect against whooping cough. Teens ages 14 to 16 and adults need one booster shot. This booster shot is especially important for those who have or expect to have close contact with babies younger than 1 year old. Caregivers who never got the shots—and may not even know that they have the illness—can spread whooping cough to babies and to other people who aren't protected.
Washing your hands
often and staying away from people who have a bad cough may help you avoid
getting the disease.
If you get whooping cough, you can avoid
spreading it by taking antibiotics and waiting the right amount of time before
you and your children go back to school or work:
- Children with whooping cough need to take
antibiotics for at least 5 days before going back to daycare or school. If
your child did not take antibiotics, wait 21 days after the start of symptoms
before sending your child to school or daycare.
- Adults or teens
who have whooping cough need to take antibiotics for at least 5 days before being
near young children or going to work at a school, a daycare centre, or a
health facility.
Frequently Asked Questions
Learning about whooping cough: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Symptoms
Symptoms of
whooping cough typically last 6 to 10 weeks (but may
last longer). In young children, three stages can occur. Older children and
adults don't always go through the same stages.
First stage
Symptoms like those of a cold begin and last for
several days to 2 weeks. Symptoms usually include sneezing, a runny nose, mild
coughing, watery eyes, and sometimes a mild fever. An infected person is most
contagious during this stage.
Second stage
The most serious symptoms occur
during this phase and last about 2 to 4 weeks or longer. As cold symptoms
fade, the cough gets worse. A dry, hacking cough turns into bursts of
uncontrollable, often violent coughing that may make it temporarily impossible
to breathe. This may happen up to 30 times a day. The person may quickly inhale
when trying to take a breath through airways narrowed by inflammation, which
sometimes creates a whooping noise.
In babies, coughing
spells:
- May be triggered by very slight stimulation, such as taking in
food or milk, sucking, exposure to a sudden sound or light, or stretching.
- May cause symptoms of flushed cheeks, pale or bluish complexion
from lack of oxygen, and bulging or watery eyes. A baby may also stick out his
or her tongue, push the chest forward, or flail arms and legs in distress.
- May be frightening to watch, although most babies recover and
regain control of their breathing on their own. Babies generally feel well
between coughing spells but may become exhausted from the physical effort of
coughing. It's also possible that your baby's breathing could stop for a short
time during the coughing spells. This is called apnea.
- May lead to hospitalization, especially if the baby is younger
than 4 months of age. Hospitalization allows health professionals to monitor
the baby's condition and evaluate how well he or she tolerates and recovers
from coughing episodes.
Third stage
The final stage, lasting for a few
weeks or months, is a gradual recovery period. Although the person gains
strength and begins to feel better, the cough may become louder and sound
worse. Coughing spells become less frequent but may flare up again if a cold or
other upper respiratory illness develops. This final stage may last longer in
people who were not given the whooping cough (pertussis) vaccine.
Complications, such as
pneumonia or exertion-related injuries from coughing,
such as a
hernia, can develop from whooping cough. These types
of health problems pose the most serious risk to children younger than 4 months
and to adults ages 60 and older.
Examinations and Tests
A doctor considers the following when
making a preliminary diagnosis of
whooping cough (pertussis):
- Symptoms. A doctor may suspect whooping cough when a person
has recently had cold symptoms and a dry, hacking cough that progresses to
bursts of uncontrollable, often violent coughing that may make it temporarily
impossible to breathe. The characteristic whooping noise sometimes occurs when
the person tries to inhale quickly through airways narrowed by inflammation.
Babies may have flushed cheeks, a pale or bluish complexion from lack of
oxygen, and bulging or watery eyes. A baby may also stick out his or her
tongue, push the chest forward, or flail arms and legs in distress. Fever, sore
throat, and wheezing are usually absent or very mild with whooping cough. When
present, these symptoms can help a doctor distinguish between whooping cough
and other conditions with similar symptoms, such as a cold or
bronchitis.
- Immunization status. An important consideration when making a preliminary diagnosis of
whooping cough (pertussis) is whether a person's immunizations against
pertussis are up to date.
- DTaP. Children start getting their
pertussis immunizations at age 2 months. A total of 5 injections (shots) are
given at different times until ages 4 to 6 years. The pertussis vaccine is
given along with the vaccines for diphtheria and tetanus in a single shot. For
children ages 6 and younger, the vaccine is called DTaP. DTap is sometimes given in one shot with other vaccines in it. This lowers the number of needle pricks at each office visit.
- Tdap. Combination booster vaccines
(for pertussis, diphtheria, and tetanus), known as Tdap, are available for
people older than 10 years of age. A booster dose of Tdap is recommended for teens ages 14 to 16. Any adult or health professional who
expects to have close contact with a baby less than 1 year old should also get
a shot.
- For routine prevention,
adults should have one dose of this booster shot instead
of Td (tetanus and diphtheria) vaccine.1 People who
get booster shots for whooping cough get continued protection, which helps
prevent the spread of the disease. This is especially important for protecting
babies and others who are at high risk for becoming
infected and developing complications from the disease.
- Community outbreaks. Whooping cough may be suspected when other cases of whooping
cough have recently been reported within the local community.
To diagnose whooping cough, doctors may test
mucus from the nasopharynx region, which is where
nasal passages meet the back of the throat. To collect a mucus sample, doctors
may pass a swab or suction tube deep into the back of the nose. The sample can
be tested by
culture. It is the most accurate method, but it takes
10 to 14 days to get the results. Polymerase chain reaction (PCR) is often used
along with culture to get test results within several days. PCR detects the
genetic material (DNA) of whooping cough bacteria.
The doctor may do more than one test to find out if you or your child has whooping cough. Treatment will usually start right away if your doctor strongly suspects
whooping cough as a cause of the symptoms.
Other tests may be done to rule out other
problems, to monitor the person's condition, or to find out whether
complications have developed.
- A
complete blood count or other blood tests may be done
to help rule out other diseases.
- Chest
X-rays may be done, especially in infants. Although
X-ray images often appear normal in whooping cough, they may be needed to rule
out other possible causes of symptoms or to find out whether
complications, such as
pneumonia, have developed.
- A
pulse oximeter may be used to check the blood oxygen
levels, which helps a doctor monitor how well the lungs are working and decide
what treatments to use.
Treatment Overview
The aim of treatment is to make
symptoms less severe and reduce the spread of infection to close
contacts.
Whooping cough
is generally treated with
antibiotics, which may help shorten the course of the
disease if they are taken early in the first stage of illness. But they may not
be prescribed right away, because it's hard to tell the difference between the
first symptoms of whooping cough and the symptoms of a common cold. As symptoms
progress, they become more distinctive of whooping cough. Antibiotics are
usually given at this point. Antibiotics can help reduce the spread of
infection while you are waiting for PCR or
culture results to confirm the diagnosis. Results may
take up to 10 to 14 days to get back. Family members and others who have had
close contact with someone infected with whooping cough are usually prescribed
antibiotics before any symptoms start.
Severe coughing spells can
significantly decrease the blood's oxygen supply. If a
pulse oximeter measurement finds that blood oxygen
levels are low, oxygen may be given for a short time through a
nasal cannula or an oxygen mask.
Infants,
especially those younger than 4 months, are typically hospitalized.
Hospitalization allows health professionals to make sure the baby is getting
enough fluids and nutrients. Also, the baby is monitored and evaluated for how
well he or she tolerates and recovers from coughing episodes. If needed, a baby
also may receive oxygen therapy and have mucus suctioned from his or her nose
and throat. Because suctioning mucus may trigger coughing spells, it is only
done in certain situations.
Emergency treatment
Call 911 or other emergency services immediately if a person stops breathing, turns blue, or becomes
unconscious. Start rescue breathing immediately or follow instructions given by
emergency services while you wait for help. For more information, see the
Rescue Breathing section of the topic
Dealing With Emergencies.
Home Treatment
If your child has
whooping cough (pertussis), the coughing spells can be
scary. To help manage the symptoms, you can:
- Create a quiet, calm, restful environment. Keep stimulation to
a minimum to help reduce the number of coughing spells.
- Control possible triggers of a coughing episode, such as smoke,
dust, sudden noises or lights, or changes in temperature.
- Give your child frequent, small sips of fluids and nutritious
foods to provide needed energy that coughing uses up.
- Use a
humidifier in your child's room. But watch closely to
see its effect. Sometimes humidity makes coughing spells worse, in which case
it should be avoided. Dry, hot, or polluted air may make coughing spells worse.
- Hold your child in a calming manner.
- Have your child who is age 1 year or older lie on his or her side or stomach rather than the
back. Lying on the back could trigger a coughing spell. If your baby is younger than 1 year old, talk to your baby's doctor about the best way to position your child.
Over-the-counter medicines, such as
cough suppressants and
antihistamines, have not been shown to help relieve
symptoms.
Frequent
handwashing is important to help prevent the spread
of infection. Keep children away from people who have a bad cough, especially
if it may be related to whooping cough. If you have whooping cough, take antibiotics for at least 5 days before being near young children. And don't return to work in schools, daycare centres, or health
facilities until after 5 days of antibiotics.
If your child has whooping cough, he or she can go back to school or daycare after 5 days of taking antibiotics. But if your child does not take antibiotics, have him or her wait 21 days after the start of symptoms before going back to school or daycare.
Immunizations are critical to preventing diseases such
as pertussis from becoming widespread (epidemic) problems. Children start
getting their
immunizations against pertussis at age 2 months. A total of 5 shots (injections)
are given at different times until ages 4 to 6 years. The vaccines for
diphtheria, tetanus, and pertussis are all in one shot called DTaP.
A
tetanus, diphtheria, and pertussis (Tdap) booster shot is needed for continued
protection. This shot is usually given at age 14 to 16. Adults who never got the Tdap shot should get it in place of a Td
(tetanus and diphtheria) shot. For more information, see the topic
Immunizations.
Other Places To Get Help
Organizations
| Canadian Immunization Awareness Program |
| Canadian Coalition for Immunization Awareness and
Promotion (CCIAP) |
| Web Address: | www.immunize.cpha.ca/en/default.aspx |
| |
The Canadian Coalition for Immunization Awareness and
Promotion (CCIAP) is a coalition of national organizations committed to
promotion and education on immunization. Its Web site includes information on
immunizations, diseases, and vaccines for adults and children. |
|
| Canadian Paediatric Society |
| 2305 Saint Laurent Boulevard |
| Ottawa, ON K1G 4J8 |
| Phone: | (613) 526-9397 |
| Fax: | (613) 526-3332 |
| Email: | info@cps.ca |
| Web Address: | www.cps.ca |
| |
The Canadian Paediatric Society (CPS) promotes quality health care
for Canadian children and establishes guidelines for paediatric care. The
organization offers educational materials on a variety of topics, including
information on immunizations, pregnancy, safety issues, and teen health. |
|
| Public Health Agency of Canada
(PHAC) |
| 130 Colonnade Road |
| A.L. 6501H |
| Ottawa, ON K1A 0K9 |
| Phone: | Telephone numbers for PHAC vary by region. For your regional number, go to the listing on the PHAC website at www.phac-aspc.gc.ca/contac-eng.php. |
| Web Address: | www.phac-aspc.gc.ca/index-eng.php |
| |
The Public Health Agency of Canada (formerly the
Population and Public Health Branch of Health Canada) is primarily responsible
for policies, programs, and systems relating to disease prevention, health
promotion, disease surveillance, community action, and disease control. |
|
References
Citations
- National Advisory Committee on Immunization (NACI)
(2006). Pertussis vaccine. In Canadian Immunization Guide, 7th ed., pp. 257–266. Ottawa: Public Health Agency of Canada.
Also available online: http://publications.gc.ca.
Other Works Consulted
- American Academy of Pediatrics (2009). Pertussis
(whooping cough). In LK Pickering et al., eds., Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed., pp. 504–519. Elk
Grove Village, IL: American Academy of Pediatrics.
- Bravender T, Walter EB (2008). Pertussis section of Infectious respiratory illnesses. In LS Neinstein et al., eds., Adolescent Health Care: A Practical Guide, 5th ed., pp. 419–421. Philadelphia: Lippincott Williams and Wilkins.
- Centers for Disease Control and Prevention (2006).
Preventing tetanus, diphtheria, and pertussis among adolescents: Use of tetanus
toxoid, reduced diphtheria toxoid and acellular pertussis vaccines:
Recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR, 55(RR-3): 1–44. Also available online:
http://www.cdc.gov/mmwr/PDF/RR/RR5503.pdf.
- Centers for Disease Control and Prevention (2008).
Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum
women and their infants: Recommendations of the Advisory Committee on
Immunization Practices (ACIP). MMWR, 57(RR-4): 1–51.
[Erratum in MMWR, 57(26): 723. Also available online:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5726a3.htm.]
- Cherry JD, Harrison RE (2006). Bordetella pertussis (whooping cough). In FD Burg et al.,
eds., Current Pediatric Therapy, 18th ed., pp. 723–727.
Philadelphia: Saunders Elsevier.
- Long SS (2007). Pertussis (bordetella pertussis and bordetella parapertussis). In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 1178–1182. Philadelphia: Saunders Elsevier.
- Skerrett SJ (2006). Infections due to haemophilus,
moraxella, legionella, bordetella, and pseudomonas. In DC Dale, DD Federman,
eds., ACP Medicine, section 7, chap. 10. New York:
WebMD.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Susan C. Kim, MD - Pediatrics |
|---|
| Primary Medical Reviewer | Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine |
|---|
| Specialist Medical Reviewer | Christine Hahn, MD - Epidemiology |
|---|
| Last Revised | February 26, 2010 |
|---|
