CDC. US: Pertussis, a respiratory illness commonly known as whooping cough, is a very contagious disease caused by a type of bacteria called Bordetella pertussis. These bacteria attach to the cilia (tiny, hair-like extensions) that line part of the upper respiratory system. The bacteria release toxins, which damage the cilia and cause inflammation (swelling).
Transmission
Pertussis is a very contagious disease only found in humans and is spread from person to person. People with pertussis usually spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria. Many infants who get pertussis are infected by older siblings, parents or caregivers who might not even know they have the disease (Bisgard, 2004 & Wendelboe, 2007). Symptoms of pertussis usually develop within 5–10 days after being exposed, but sometimes not for as long as 3 weeks.While pertussis vaccines are the most effective tool we have to prevent this disease, no vaccine is 100% effective. If pertussis is circulating in the community, there is a chance that a fully vaccinated person, of any age, can catch this very contagious disease. If you have been vaccinated, the infection is usually less severe. If you or your child develops a cold that includes a severe cough or a cough that lasts for a long time, it may be pertussis. The best way to know is to contact your doctor.
Symptoms
Pertussis (whooping cough) can cause serious illness in infants, children and adults. The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks.
In infants, the cough can be minimal or not even there. Infants may have a symptom known as "apnea." Apnea is a pause in the child's breathing pattern. Pertussis is most dangerous for babies. About half of infants younger than 1 year of age who get the disease are hospitalized. Learn more about pertussis complications.
Pertussis can cause violent and rapid coughing, over and over, until the air is gone from the lungs and you are forced to inhale with a loud "whooping" sound. This extreme coughing can cause you to throw up and be very tired. The "whoop" is often not there and the infection is generally milder (less severe) in teens and adults, especially those who have been vaccinated.
Early symptoms can last for 1 to 2 weeks and usually include:
- Runny nose
- Low-grade fever (generally minimal throughout the course of the disease)
- Mild, occasional cough
- Apnea — a pause in breathing (in infants)
Because pertussis in its early stages appears to be nothing more than the common cold, it is often not suspected or diagnosed until the more severe symptoms appear. Infected people are most contagious up to about 2 weeks after the cough begins. Antibiotics may shorten the amount of time someone is contagious.
As the disease progresses, the traditional symptoms of pertussis appear and include:
- Paroxysms (fits) of many, rapid coughs followed by a high-pitched "whoop"
- Vomiting (throwing up)
- Exhaustion (very tired) after coughing fits
Although you are often exhausted after a coughing fit, you usually appear fairly well in-between. Coughing fits generally become more common and severe as the illness continues, and can occur more often at night. The illness can be milder (less severe) and the typical "whoop" absent in children, teens, and adults who have been vaccinated with a pertussis vaccine.
Recovery from pertussis can happen slowly. The cough becomes less severe and less common. However, coughing fits can return with other respiratory infections for many months after pertussis started.
Complications
Infants and Children
Pertussis (whooping cough) can cause serious and sometimes life-threatening complications in infants and young children, especially those who are not fully vaccinated.In infants younger than 1 year of age who get pertussis, about half are hospitalized. The younger the infant, the more likely treatment in the hospital will be needed. Of those infants who are hospitalized with pertussis about:
- 1 in 4 (23%) get pneumonia (lung infection)
- 1 or 2 in 100 (1.6%) will have convulsions (violent, uncontrolled shaking)
- Two thirds (67%) will have apnea (slowed or stopped breathing)
- 1 in 300 (0.4%) will have encephalopathy (disease of the brain)
- 1 or 2 in 100 (1.6%) will die
Teens and Adults
Teens and adults can also get complications from pertussis. They are usually less serious in this older age group, especially in those who have been vaccinated with a pertussis vaccine. Complications in teens and adults are often caused by the cough itself. For example, you may pass out or fracture a rib during violent coughing fits.In one study, less than 5% of teens and adults with pertussis were hospitalized. Pneumonia (lung infection) was diagnosed in 2% of those patients. The most common complications in another study of adults with pertussis were:
- Weight loss (33%)
- Loss of bladder control (28%)
- Passing out (6%)
- Rib fractures from severe coughing (4%)
Diagnosis
Pertussis (whooping cough) can be diagnosed by taking into consideration if you have been exposed to pertussis and by doing a:- History of typical signs & symptoms
- Physical examination
- Laboratory test which involves taking a sample of secretions (with a swab or syringe filled with saline) from the back of the throat through the nose — see Figure 1 and video demonstrations.
- Blood test
Treatment
Pertussis is generally treated with antibiotics and early treatment is very important. Treatment may make your infection less severe if it is started early, before coughing fits begin. Treatment can also help prevent spreading the disease to close contacts (people who have spent a lot of time around the infected person). Treatment after three weeks of illness is unlikely to help because the bacteria are gone from your body, even though you usually will still have symptoms. This is because the bacteria have already done damage to your body.There are several antibiotics available to treat pertussis. If you or your child is diagnosed with pertussis, your doctor will explain how to treat the infection. Learn more about the antimicrobial treatment recommended by CDC for treatment of pertussis.
Pertussis can sometimes be very serious, requiring treatment in the hospital. Infants are at greatest risk for severe complications from pertussis. View photos of an infant being treated for pertussis in the hospital.
If Your Child is Treated for Pertussis at Home
Do not give cough medications unless instructed by your doctor. Giving cough medicine probably will not help and is often not recommended for kids younger than 4 years old.Manage pertussis and reduce the risk of spreading it to others by:
- Following the schedule for giving antibiotics exactly as your doctor prescribed.
- Keeping your home free from irritants - as much as possible - that can trigger coughing, such as smoke, dust, and chemical fumes.
- Using a clean, cool mist vaporizer to help loosen secretions and soothe the cough.
- Practicing good handwashing.
- Drinking plenty of fluids, including water, juices, and soups, and eating fruits to prevent dehydration (lack of fluids). Report any signs of dehydration to your doctor immediately. These include dry, sticky mouth, sleepiness or tiredness, thirst, decreased urination or fewer wet diapers, few or no tears when crying, muscle weakness, headache, dizziness or lightheadedness.
- Eating small, frequent meals to help prevent vomiting if occurring.
If Your Child is Treated for Pertussis in the Hospital
Your child may need help keeping breathing passages clear, which may require suctioning (drawing out) of thick respiratory secretions. Breathing is monitored and oxygen will be given, if needed. Intravenous (IV, through the vein) fluids might be required if your child shows signs of dehydration or has difficulty eating. Precautions, like practicing good hand hygiene and keeping surfaces clean, should be taken.Prevention
Vaccines
The best way to prevent pertussis (whooping cough) among infants, children, teens, and adults is to get vaccinated. Also, keep infants and other people at high risk for pertussis complications away from infected people.In the United States, the recommended pertussis vaccine for infants and children is called DTaP. This is a combination vaccine that protects against three diseases: diphtheria, tetanus and pertussis.
The easiest thing for adults to do is to get Tdap instead of their next regular tetanus booster-that Td shot that they were supposed to get every 10 years. The dose of Tdap can be given earlier than the 10-year mark, so it is a good idea for adults to talk to a healthcare provider about what is best for their specific situation.
Being up-to-date with pertussis vaccines is especially important for families with and caregivers of new infants.
Learn more about how pertussis vaccines can help protect the following groups of people:
Infection
If your doctor confirms that you have pertussis, your body will have a natural defense (immunity) to future infections. Some observational studies suggest that pertussis infection can provide immunity for 4-20 years. Since this immunity fades and does not offer lifelong protection, routine vaccines are recommended.Antibiotics
If you or a member of your household has been diagnosed with pertussis, your doctor or local health department may recommend preventive antibiotics (medications that can help prevent diseases caused by bacteria) to other members of the household to prevent spread of disease. Additionally, other people outside the household who have been exposed to a person with pertussis may be given preventive antibiotics depending on whether or not they are considered at risk for serious disease or if they have routine contact with someone that is considered at high risk of serious disease.Infants younger than 12 months old are most at risk for serious complications from pertussis. Although pregnant women are not at increased risk for serious disease, those in their third trimester would be considered at increased risk since they could in turn expose their newborn to pertussis. You should discuss whether or not you need preventative antibiotics with your doctor, especially if there is an infant or pregnant woman in your household or you plan to have contact with an infant or pregnant woman.
Hygiene
Like many respiratory illnesses, pertussis is spread by coughing and sneezing while in close contact with others, who then breathe in the pertussis bacteria. Practicing good hygiene is always recommended to prevent the spread of respiratory illnesses:- Cover your mouth and nose with a tissue when you cough or sneeze.
- Put your used tissue in the waste basket.
- If you don't have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands.
- Wash your hands often with soap and water for at least 20 seconds.
- If soap and water are not available, use an alcohol-based hand rub.