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Whooping cough
medical conditions

Whooping cough

Explore the available health information, treatment context, and integrative evidence for Whooping cough.

Background
  • Whooping cough, also called pertussis, is a highly contagious bacterial infection of the respiratory system that causes uncontrollable coughing. Whooping cough is caused by the bacterium Bordetella pertussis (or B. pertussis). The name comes from the noise made when taking a breath after coughing. Individuals may have choking spells or may cough so hard that they vomit.
  • The bacteria are spread from person to person through tiny drops of fluid from an infected person's nose or mouth. These germs may become airborne when the person sneezes, coughs, or laughs. Other people then can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses. Infected people are most contagious during the earliest stages of the illness and up to about two weeks after the cough begins. Antibiotics shorten the period of contagiousness to about five days following the start of antibiotic treatment.
  • Anyone can get whooping cough, but it has historically been more common in infants (younger than six months of age) and children ages 11-18 whose immune systems are not properly functioning or developed. Whooping cough is especially dangerous in infants. The coughing spells can be so bad that it is hard for the infant to eat, drink, or breathe.
  • Before there was a vaccine, whooping cough was one of the most common childhood diseases and a major cause of childhood deaths in the United States, killing 5,000-10,000 each year. There are fewer cases today because there are both pertussis-only vaccines and combination vaccines for tetanus, diphtheria, and pertussis. If an individual is diagnosed with whooping cough, treatment with antibiotics may help if given early.
  • The American Academy of Pediatrics (AAP) recently recommended that kids who are 11-18 years old get a booster shot that includes a pertussis vaccine, preferably when they are 11-12 years old.
Signs and Symptoms
  • The incubation period (the time between infection and the start of symptoms) for whooping cough is usually seven to 10 days, but can be as long as 21 days.
  • Symptoms of whooping cough typically last six to 10 weeks, but may last longer. Symptoms usually occur in three stages.
  • Stage 1: Stage 1 symptoms include cold-like symptoms, such as sneezing, runny nose, mild coughing, watery eyes, and sometimes a mild fever, lasts several days to two weeks. An infected person is most contagious during this stage.
  • Stage 2: During stage 2, cold-like symptoms fade, but the cough gets worse, changing from a dry, hacking cough to bursts of uncontrollable, often violent coughing. During a coughing episode, it may be temporarily impossible to take a breath because of the intensity and repetition of coughs. When finally able to breathe, the individual may take in a sudden gasp of air through airways narrowed by inflammation, and this sometimes causes a whooping noise. Vomiting and severe exhaustion often follow a coughing spell. But between coughing episodes, the infected person often appears normal. This is the most serious stage of whooping cough, usually lasting from two to four weeks or longer.
  • Stage 3: During stage 3, the individual may improve and gain strength, but the cough may become louder and sound worse. Coughing spells may occur sporadically for weeks to months and may flare up if a cold or other upper respiratory illness develops. This final stage may last longer in people who have never received the whooping cough vaccine.
  • Healthy adults who become infected with whooping cough often have a much milder form of the illness compared with children. But adults age 60 years and older are at increased risk of having severe symptoms and developing complications.
  • The severity of symptoms is, in part, influenced by whether a person was immunized against whooping cough and how long ago the immunization was given.
Diagnosis
  • Diagnosing whooping cough in its early stages can be difficult to diagnose because the signs and symptoms resemble those of other common respiratory illnesses, such as a cold, the flu, or bronchitis.
  • If whooping cough is the diagnosis, the doctor will advise the individual to avoid contact with others during recovery because the condition is highly contagious. It is important not to return to work until a doctor approves. Children should not go to school or child care unless a doctor clears the child.
  • A doctor will also notify health authorities, including the U.S. Centers for Disease Control and Prevention(CDC), who keep track of whooping cough outbreaks.
  • Sometimes, doctors diagnose whooping cough simply by listening to the cough. Medical tests may be needed to confirm the diagnosis, including nose or throat cultures, blood tests, and a chest x-ray.
  • A nose or throat culture and test: A doctor will take a nose or throat swab or suction sample. The sample is then sent to a lab and cultured or otherwise tested for whooping cough bacteria (B. pertussis).
  • Blood tests: A blood sample may be drawn and sent to a lab to check for a high white blood cell count. White blood cells help the body fight infections, such as whooping cough. A high white cell count typically indicates the presence of infection or inflammation. However, this is a general test and not specific for whooping cough.
  • Chest X-ray: A doctor may want to use an X-ray to check for the presence of fluid in the lungs, which can occur when pneumonia complicates whooping cough and other respiratory infections
Complications
  • Respiratory complications can be severe in infants and may include suffocation, also known as asphyxiation. Seizures can occur in infants who have whooping cough. Middle ear infection, inflammation, called otitis media, may occur. A form of pneumonia is a potentially fatal complication in an infected person of any age. Emphysema (a progressive lung disease that results in shortness of breath and reduces the individual's capacity for physical activity), cerebral hemorrhage (bleeding in the brain), and encephalitis (swelling of the brain) can occur. These conditions may be serious.
  • Teenagers and adults (including older adults) usually recover from whooping cough without complications. Excessive coughing may cause a bruised or broken rib or a hernia (an abnormal protrusion of a loop of intestine through a weak area of abdominal muscle).
  • Children with whooping cough also may injure the muscles of the chest wall or develop a hernia that needs to be treated with surgery.
  • In infants, especially those under the age of two, complications from whooping cough are more severe and may include ear infections, pneumonia, slowed or stopped breathing, dehydration, seizures, and brain damage. Because infants and toddlers are at greatest risk of complications from whooping cough, they are more likely to need treatment in a hospital. In infants under six months of age, complications can be life-threatening. If an infant has a cough that has lasted for more than several days and has not gotten better, healthcare providers recommend seeing a doctor.
Treatment
  • Treatment for whooping cough varies, depending on the age and the severity of signs and symptoms.
  • Older children, teens, and adults: When whooping cough is diagnosed early in older children, teenagers, and adults, doctors usually prescribe vaccination, bed rest, and an antibiotic such as azithromycin (Zithromax®) or erythromycin (E-mycin®, Eryped®). Although antibiotics will not cure whooping cough, they can shorten the duration of the illness and they shorten the period of communicability. If there is a confirmed diagnosis but a slow response to antibiotic therapy, it may be necessary to take the antibiotic for at least two weeks and maybe longer.
  • If the illness has progressed to the point of severe coughing spells, antibiotics are not as effective but may still be used. Unfortunately, there are few medications that help provide relief from the symptoms of whooping cough. Over-the-counter (OTC) cough medicines, such as dextromathorpan (Robitussin®), generally have little effect on whooping cough. A case of whooping cough usually resolves in six weeks but may last longer.
  • Infants and toddlers: Almost all infants with whooping cough who are younger than two months, as well as many older babies, are admitted to the hospital due to the potential severity and risks of whooping cough. Most babies treated for whooping cough overcome the condition without lasting effects, but the risk exists until the infection clears. In the hospital, the infant is likely to receive intravenous (IV or in the veins) antibiotics, such as erythromycin, to treat the infection and perhaps corticosteroid drugs, such as hydrocortisone, to help reduce lung inflammation. Sometimes an infant's airway may also be suctioned to remove mucus that is blocking it. The infant's breathing will be carefully monitored in case extra oxygen is needed. If the infant cannot keep down liquids or food, intravenous (IV) fluids may be necessary. In some cases, prescription sedatives (such as lorazepam or Ativan®) will help the infant rest. The infant will also be isolated from others to prevent the infection from spreading.

Prevention
  • Experts believe that up to 80% of non-immunized family members will develop whooping cough if they live in the same house as someone who has the infection. For this reason, anyone who comes into close contact with an individual who has whooping cough should receive antibiotics to prevent spread of the disease. Young children who have not received all five doses of the vaccine may require a booster dose if exposed to an infected family member.
  • Children: The best way to prevent whooping cough is with the pertussis vaccine, which doctors often give in combination with vaccines against two other serious diseases, diphtheria and tetanus. This three-in-one combination is known as the DTaP vaccine. It is a newer and safer version of the DTaP vaccine, which is no longer used in the United States. Doctors recommend beginning DTaP vaccination during infancy. The vaccine consists of a series of five shots, typically given in the arm and given to children at these ages: two months; four months; six months; 12-18 months; and four to six years. It takes at least three shots of the pertussis vaccine to fully protect a child against whooping cough, but a total of five shots are recommended by age six.
  • Because immunity from the pertussis vaccine tends to wane by age 11, and because of the increase in cases of whooping cough in adolescents and teens between 11-18 years of age, doctors now recommend a booster shot for those in this age group (the tetanus, diphtheria and pertussis vaccine, or Tdap. DTaP is the name of the pediatric vaccine; Tdap is the name of the booster for people 11 years of age and older. The booster is given preferably at ages 11-12. This is in place of the traditional tetanus and diphtheria (Td) vaccine received at this age.
  • Adults: The U.S. Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices also advises adults to receive a Tdap booster shot every ten years. The Tdap vaccine helps protect adults from pertussis and reduces the risk of them transmitting the infection to infants. Adults who are or will be in close contact with infants under 12 months of age should also receive the vaccine. Side effects of the vaccine may include fever, crankiness, vomiting, or soreness at the site of the injection. These problems are more likely to occur after the fourth or fifth dose of the DTaP series than after earlier doses. After late doses, some children may develop swelling of the arm or leg in which the shot was given. In rare cases, severe side effects may occur including: serious allergic reactions, in which hives or a rash develop within minutes of the injection; high fever, greater than 105 degrees Fahrenheit; and seizures, shock, or coma.
  • Some individuals are concerned that the pertussis vaccine may cause neurological (nerve) damage because some children have developed brain damage after the immunizations. So far, however, researchers have not found a definitive link between the pertussis vaccine and brain damage. Still, research into this issue is ongoing. Children with known seizure or brain disorders may not be candidates for the DTaP vaccine.
  • Other vaccines:
    In 2002, the U.S. Food and Drug Administration (FDA) approved a combination pertussis vaccine called Pediarix®. In addition to helping protect against pertussis, diphtheria, and tetanus, Pediarix® immunizes children against polio and hepatitis B (a serious viral liver infection). Because Pediarix® protects against five diseases, children need fewer shots. However, the vaccine also causes a wider range of side effects than does DTaP. In studies, the most common side effects of Pediarix® were pain, redness, and swelling where the shot was given, fever, and fussiness. A pediatrician will help individuals choose the best vaccination for their child.
  • Scientists are studying the genome of Bordetella pertussis, the bacterium that causes whooping cough, in order to monitor its evolution and potentially find vaccine and drug targets specific to the new variations of the bacterium.
  • Antibiotics: If a member of a household develops whooping cough, a doctor will likely prescribe antibiotics for the whole family to prevent spread of the infection to anyone else. Antibiotic treatment may also be prescribed for individuals and their families who have been exposed to B. pertussis in the workplace or in public.
References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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