Whooping cough

Whooping cough (pertussis) is a serious, contagious respiratory infection caused by the bacterium Bordetella pertussis. The disease begins like a cold and then the characteristic cough develops. This cough may last for months, even after antibiotic treatment is completed and the person is no longer infectious. The ‘whoop’ (which is not always obvious) is due to a deep breath at the end of a bout of coughing. Vomiting after coughing is common.

Whooping cough is particularly dangerous for babies aged less than six months. They are affected more seriously by the disease than older children or adults and are more likely to develop complications. One in every 200 babies who contract whooping cough will die. Immunisation is the best way to prevent whooping cough.

Symptoms
Whooping cough begins with symptoms similar to those of a cold. These can rapidly progress to include:

• Severe cough, which occurs in bouts of coughing
• Characteristic ‘whooping’ sound on inhalation
• Vomiting at the end of a bout of coughing
• Apnoea – the child stops breathing for periods of time and may go blue.

These symptoms may be associated with poor appetite, fatigue and dehydration. The person may appear normal between bouts of coughing. During the convalescent phase, the cough gradually decreases but can take weeks to disappear.

Babies are at increased risk
In young babies less than six months of age, the symptoms can be severe or life threatening. Seek urgent medical attention if your child’s lips or skin go blue (cyanosis) or if they are having breathing difficulties associated with the coughing. Some of the complications of whooping cough in young babies include:

• Haemorrhage (bleeding)
• Apnoea (stopping breathing for long periods of time)
• Pneumonia
• Inflammation of the brain
• Convulsions and coma
• Permanent brain damage
• Death.

How it is spread
The Bordetella pertussis bacterium is spread by air-borne droplets from the upper respiratory tract (when the infected person coughs or sneezes) and is highly infectious. The time from infection to appearance of symptoms (incubation period) for whooping cough is between six and 20 days. A person is infectious for the first 21 days of their cough or until they have had five days of a 10-day course of antibiotics. In countries where immunisation rates are high, the risk of catching whooping cough is low.

Diagnosis
Whooping cough should be diagnosed and treated immediately if there is a typical history of the disease. There are a number of tests, but they are not always reliable and may take weeks to become positive. Treatment should not be withheld while waiting for these results.

Treatment
In its early stages, the symptoms of whooping cough can be reduced by taking antibiotics. Treatment will reduce the risk of passing the infection to others, if it is given in the first 21 days of the illness. Members of the infected person’s household are at increased risk of acquiring the disease and are usually prescribed a strong antibiotic such as erythromycin as a preventative measure, regardless of whether or not they are fully immunised.

Immunisation can prevent illness
A combined vaccine against whooping cough and other diseases is available under the National Immunisation Schedule. In Victoria, it is given free of charge to all children when they are:

• Two, four and six months of age (diphtheria, tetanus, pertussis, hepatitis B, polio and haemophilus influenzae type b vaccine)
• Four years of age (diphtheria, tetanus, pertussis and polio vaccine)
• In Year 10 at secondary school – adolescents receive a booster dose of diphtheria, tetanus and pertussis vaccine.

Children need all of these injections in order to be fully protected.

It is also recommended that new parents or women planning on becoming pregnant (and members of their household or family) receive a booster dose of the diphtheria, tetanus and pertussis vaccine to protect the new baby from whooping cough in the first months of life. The vaccine for adults is not available as part of the National Immunisation Program and must be purchased privately.

Before immunisation
Before you receive the vaccine, tell your doctor or nurse if you or your child:

• Has had a serious reaction to any vaccine or vaccine component (for example, neomycin)
• Is unwell on the day of immunisation (temperature over 38.5˚C)

or if:

• You are pregnant.

Possible side effects of the vaccine
Immunisation prevents the child from catching whooping cough, or at least protects them from a severe bout should they become infected. Severe reactions to the vaccine are rare, and they are much less common than the effects that occur with the disease itself.

Some of the mild side effects of the vaccine include:

• A mild temperature
• Irritability or crying. Your child may appear generally unsettled
• Drowsiness or tiredness
• Soreness and swelling in the area where the injection was given.

There is a very small risk of a serious allergic reaction to any vaccine. It is important to stay at the clinic where the immunisation was given for 15 minutes after the immunisation.

Reducing the side effects
Side effects of the vaccine may last one to two days and can be reduced by:

• Drinking extra fluids
• Placing a cold, wet cloth on the sore injection site
• Taking paracetamol to reduce any fever or discomfort – check the label for the correct dose (especially for children)
• Not overdressing.
• If you are concerned about any reaction to the vaccine, contact your doctor or hospital.

Where to get help

• Your doctor
• Your local Maternal and Child Health nurse
• Nurse-on-Call Tel. 1300 606 024 – for expert health information and advice (24 hours, 7 days)
• Immunisation Program, Department of Health Victoria Tel. 1300 882 008
• Immunise Australia Information Line Tel. 1800 671 811

Things to remember

• Whooping cough (pertussis) is a very contagious respiratory infection caused by the bacterium Bordetella pertussis.
• The major symptom of whooping cough is the characteristic cough, which is often followed by a ‘whooping’ sound on inhalation.
• One in every 200 babies who contract whooping cough will die.
• It is possible to prevent whooping cough by immunisation.

You might also be interested in:

• Coughing and wheezing in children.
  
• Diphtheria.
  
• Immunisation - childhood.
  
• Infections - bacterial and viral.
  
• Tetanus.
  

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Last updated: November 2009

The information published here was accurate at the time of publication and is not intended to take the place of medical advice. Please seek advice from a qualified healthcare professional.

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