Whooping Cough
What is it?
Whooping cough (also known as pertussis) is a highly contagious bacterial infection (caused by Bordetella pertussis) that affects the upper respiratory tract, and the most distinguishing symptom is the persistent cough that is often (but not always) characterised by a ‘whoop’ sound (Health Direct, 2022).
It is spread through the air when an infected person sneezes or coughs near you, this is also known as airborne transmission (Ather, Mirza, & Edemekong., 2023). After contact with whooping cough you can be contagious, but without symptoms for 1-3 weeks. The most contagious stage is 1-2 weeks after symptoms begin (Lauria & Zabbo., 2022).
Symptoms
The symptoms vary depending on age and severity of the disease and it is important to note they often begin similar to a common cold. It can be mild in adults/teenagers, but it can be serious/life-threatening in infants/children. (Centers for Disease Control and Prevention , 2020)
Initial symptoms include:
- Runny/congested nose
- Sneezing
- Mild cough
- Low-grade fever
The cough becomes more severe and distinctive after 1-2 weeks. The coughing fits can be intense and uncontrollable, often ending with a high-pitched ‘whoop’ sound as the person gasps for air. During these coughing fits, vomiting and turning red/blue in the face may occur due to forceful coughing. In some adult cases, they may not experience the ‘whoop’ and it may present solely as a persistent hacking cough.
In infants, the symptoms can appear differently. They may experience trouble breathing and can also experience apnoea (temporarily stop breathing) and a cough is not always present (Mayo Clinic, 2022)
If you or your child are experiencing any trouble breathing or serious symptoms, please contact your doctor or seek medical assistance immediately.
Diagnosis
It is important to see a medical practitioner if you have knowingly been exposed to whooping cough and/or if you have a cough worsening or lasting longer than 2 weeks with similar characteristics to the cough described above. Whooping cough is most commonly diagnosed by a PCR with nasal/throat swab. This sample can detect the presence of the bacteria, Bordetella pertussis. The sensitivity of the PCR can vary depending on the stage of the infection and the quality of the sample. Blood tests are rarely used as a diagnostic tool to check for Whooping cough as the antibodies are only detected around 2 weeks after the onset of the infection long after the infectious period. (Royal Children's Hospital Melbourne, 2019)
Treatment
- Antibiotics
- Your doctor will choose the most appropriate antibiotic for you. The key is early treatment as this can reduce the severity and duration of symptoms and limits the spread of the infection.
- Close contacts (ie. Household members, carers etc) of a confirmed pertussis case may be prescribed prophylactic antibiotic treatment to prevent infection and complications. It is important to discuss with your doctor if this is appropriate. (Queensland Government , 2023)
- People with confirmed whooping cough should be excluded from school/daycare and avoid contact outside the household (especially infants/young children) until 5 days of antibiotics are complete or coughing for longer than 21 days. (Royal Children's Hospital Melbourne, 2019)
- Nonpharmacological therapies
- Get plenty of rest
- Keep hydrated with plenty of water/fluids – it is best to take small sips often as this will be tolerated better between coughing fits
Other cold-like symptoms can be managed with symptom-based treatment, please see your friendly pharmacist for further advice.
Complications
Whooping cough can affect people of all ages, but certain populations are more susceptible to complications. The at-risk populations and potential complications include:
- Infants and young children – infants younger than 1 year old are at the highest risk of severe complications and even death from whooping cough with approximately one-third requiring treatment in hospital. Vaccination is key to preventing these serious complications. Complications include apnoea, pneumonia, and seizures. (Centers for Disease Control and Prevention , 2020)
- While complications are generally less severe in other populations people can still experience a hacking persistent cough that lasts weeks up to months. The most common complication is pneumonia with seizures and brain disease occurring rarely. (World Health Organization , n.d.)
Vaccinations
Vaccination is the best prevention against whooping cough and is part of the Australian National Immunisation Program (NIP) as per the following:
- Infants can receive their first dose at as young as 6 weeks and should receive 5 doses in total at 2 (or 6 weeks), 4, 6, 18 months and 4 years of age
- Adolescent booster – the optimal age to have this is 11-13 years of age
- Pregnant women – they should receive a booster dose during each pregnancy to ensure antibodies are passed onto the infant, the optimal time of these vaccinations is between 20-32 weeks gestation. However, if not given during this time it should be administered as soon as practical (but if given less than 2 weeks before birth, the infant will not be fully protected)
Please note the above doses are available free through the NIP
Booster doses are also recommended every 10 years as the protection/immunity decreases over this time. It is particularly recommended for the following populations:
- Healthcare workers
- Early childhood educators
- Travellers
- Adult household contacts/carers of infants
- People with a history of whooping cough infection (Australian Government, 2023)
These boosters can be provided at your local pharmacy, please speak to your friendly pharmacist for further advice.
Keeping your vaccinations up to date is essential. Whooping cough vaccinations are effective in preventing typical whooping cough around 85% of the time and if an infection does occur symptoms are usually milder and the likelihood of complications is also decreased. (NSW Health, 2017). By keeping your Whooping cough vaccinations up to date you are to protect yourself, those at risk, those close to you and the wider community.
Michelle Thomas B.Pharm
References
Ather, B., Mirza, T. M., & Edemekong., P. F. (2023, March 13). Airborne Precautions. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK531468/
Australian Government. (2023, June). Australian Immunisation Handbook - Pertussis (Whooping Cough). Retrieved from https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pertussis-whooping-cough#recommendations
Centres for Disease Control and Prevention . (2020). Pertussis (Whooping Cough). Retrieved from https://www.cdc.gov/pertussis/about/signs-symptoms.html
Health Direct. (2022, May). Whooping Cough. Retrieved from https://www.healthdirect.gov.au/whooping-cough
Lauria, A. M., & Zabbo., C. P. (2022, October 7). Pertussis. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519008/
Mayo Clinic. (2022, February 11). Whooping Cough. Retrieved from https://www.mayoclinic.org/diseases-conditions/whooping-cough/symptoms-causes/syc-20378973
NSW Health. (2017). Facts and Figures. Retrieved from https://www.health.nsw.gov.au/Infectious/whoopingcough/Pages/facts-and-figures.aspx#bookmark6
Queensland Government . (2023, May 19). Whooping Cough (Pertussis). Retrieved from http://conditions.health.qld.gov.au/HealthCondition/condition/14/33/150/whooping-cough-pertussis
Royal Children's Hospital Melbourne. (2019, April). Whooping cough (pertussis). Retrieved from https://www.rch.org.au/clinicalguide/guideline_index/whooping_cough_pertussis/
World Health Organization . (n.d.). Pertussis . Retrieved from https://www.who.int/health-topics/pertussis#tab=tab_1
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