11/14/24, 10\:38 AM Whooping Cough

Whooping Cough

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Whooping cough\: Highly contagious acute respiratory infection, life-threatening in babies under 3 months. Known as "100-
day cough"
; severe coughing spasms can lead to cyanosis or apnoea.
Vaccine-preventable\: Causes nearly 300,000 deaths in children worldwide annually; most common vaccine-preventable
disease.
Aetiology\: Typically caused by Gram-negative B o r d e t e l l a p e r t u s s i s ; milder infection by B o r d e t e l l a p a r a p e r t u s s i s .
Transmitted via respiratory droplets; incubation period 6-20 days. Vaccination has reduced endemic cases in the UK, but
epidemics still occur.
Risk factors\: More common in infants under 3 months and unvaccinated children, who experience more severe illness.
Clinical features\:
Catarrhal phase\: Nasal discharge, sore throat, conjunctivitis, malaise, dry cough, mild fever for 1-2 weeks.
Paroxysmal phase\: Severe dry cough, inspiratory “whoop,
” post-tussive vomiting, apnoea in infants. More severe in younger
children; cough persists for weeks despite antibiotics.
Convalescent phase\: Paroxysms decrease in frequency/severity, lasting 2 months or more.
Di
Investigations\: Noti
aspirates or nasal swabs, PCR of throat/nasopharyngeal swabs, serology or oral
Vaccination\: Pertussis vaccine part of DTaP/IPV/Hib/HepB at 8, 12, 16 weeks; DTaP/IPV at 3 years 4 months; during
pregnancy to protect infants. B . p a r a p e r t u s s i s not covered by current vaccine; immunity decreases over time.
Acute infection management\:
Low threshold for hospital admission, especially under 6 months.
Macrolide antibiotics (erythromycin, azithromycin, clarithromycin) if cough onset within 21 days to reduce infectivity.
Supportive care\: rest, hydration, analgesics/antipyretics. Stay home from school/work until 48 hours after antibiotics or 21
days after symptom onset if untreated.
Prophylaxis\: Macrolide antibiotics for contacts of index case, especially in high-risk groups (preterm/unimmunised babies,
unimmunised pregnant mothers, healthcare workers).
Complications\: Most serious in infants under 6 months; 3.5% mortality. Complications include secondary pneumonia,
apnoea, cerebral hypoxia, dehydration, weight loss, rectal prolapse, hernias, rib fractures, pneumothorax. Less serious\:
epistaxis, subconjunctival haemorrhage, facial/truncal petechiae, otitis media.
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Introduction

Whooping cough is a highly contagious, acute respiratory tract infection which can be life-threatening, especially in
babies under three months of age. It is prolonged (previously being referred to as the “100-day cough”) and severe, with
spasms of coughing so intense they can lead to cyanosis or apnoea.
1
Whooping cough is the most common vaccine-preventable disease in the world and causes almost 300,000 deaths in
children worldwide each year.
2,3
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Aetiology

Whooping cough is usually caused by the Gram-negative coccobacillus B o r d e t e l l a p e r t u s s i s , but a milder infection can be
1
caused by B o r d e t e l l a p a r a p e r t u s s i s . The bacteria are transmitted via respiratory droplets, with an incubation period of 6-
20 days.
4
Due to the success of the vaccination programme, whooping cough is no longer endemic in the UK but does still occur in
epidemics, with peaks of cases occurring every three to four years.
5
Figure 1. Gram stain of the bacteria
Bordetella pertussis, which is responsible
for most cases of whooping cough.

Risk factors

Whooping cough is more common in infants under three months and in unvaccinated children (who experience a more
severe illness).
5

Clinical features

Whooping cough initially presents with a non-speci
malaise, dry cough and mild fever. 5 4
This prodrome lasts one to two weeks.
This then progresses to the paroxysmal phase, where the classic “whoop” might be heard. 5
Episodes of a severe dry
cough (which can be triggered by a startle) can be so prolonged (without the child being able to draw breath) that they can
become cyanotic, choking and gasping.
1
In younger children, an inspiratory “whoop” can then be heard as the child tries to catch their breath through partially
closed vocal cords. There is also often post-tussive vomiting, and paroxysms may result in apnoea in younger infants.
5
The symptoms tend to be more severe in younger children, but patients are generally relatively well between paroxysms.
5
The cough can persist for several weeks even when treated with antibiotics.
5
The
5

Di

Other causes of acute cough to consider include\:
Viral upper respiratory tract infection (URTI) and post-viral cough
Pneumonia (bacterial or viral)
Other causes of chronic cough to consider include\:
Asthma (and COPD in adults)
Lung malignancy
GORD
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Investigations

Whooping cough is a noti
1
Once noti
5
Options for laboratory testing to con
5
Culture of nasopharyngeal aspirates or nasal swabs
PCR of the throat or nasopharyngeal swabs
Serology or oral

Management

Vaccination

Prevention of whooping cough caused by B o r d e t e l l a p e r t u s s i s is with the pertussis vaccine which was introduced in the
1950s. 4
It is now given as part of the DTaP/IPV/Hib/HepB combined vaccine administered at 8, 12 and 16 weeks of age,
and then as DTaP/IPV at 3 years 4 months, and from 16 weeks of pregnancy (to protect the very young infant).
6
However, B . p a r a p e r t u s s i s is not covered by the present vaccine and both natural and vaccine immunity decrease over
time.
1,4

Management of acute infection

There should be a low threshold for admitting unwell children to hospital, especially those under six months of age.
Macrolide antibiotics (erythromycin, azithromycin or clarithromycin) are used if the onset of the cough was within the last
5
21 days. Antibiotic treatment does not a
nasopharynx and so is used to reduce infectivity.
7
Other supportive care advice includes rest, hydration, and analgesics/antipyretics.
5
Children with whooping cough should stay home from school, and healthcare workers should avoid entering the
workplace, until 48 hours after antibiotics have started, or 21 days after symptom onset if antibiotic treatment is not given.
5

Prophylaxis

Antibiotic prophylaxis (macrolide antibiotics) should be considered for contacts of an index case, particularly if the contact

healthcare workers.
1

Complications

The most serious complications and deaths occur in infants younger than 6 months old. 4
mortality rate of 3.5%.
5
In this age group, pertussis has a
B o r d e t e l l a p e r t u s s i s infection can be complicated by pneumonia (secondary infection), and the paroxysms can lead to
apnoea and/or cerebral hypoxia (with subsequent brain damage, seizures or encephalopathy).
4,5
Recurrent vomiting can lead to dehydration and weight loss. The increased thoracic pressure can cause rectal prolapse,
umbilical and inguinal hernias, rib fractures or pneumothorax.
4,5
Less serious complications include epistaxis, subconjunctival haemorrhage, facial and truncal petechiae and otitis media.
4

References

Patient UK. W h o o p i n g c o u g h . Last edited September 2020. Available from\: [LINK]
Hartzell and Blaylock. W h o o p i n g C o u g h i n 2 0 1 4 a n d B e y o n d . Published July 2014. Available from\: [LINK]
Crowcroft and Pebody. R e c e n t d e v e l o p m e n t s i n p e r t u s s i s . Published June 2006. Available from\: [LINK]
https\://app.geekymedics.com/notebook/2734/ 3/411/14/24, 10\:38 AM Whooping Cough
UK Health Security Agency. P e r t u s s i s \: t h e g r e e n b o o k , c h a p t e r 2 4 . Published March 2013. Available from\: [LINK]
NICE CKS. W h o o p i n g c o u g h . Last revised April 2022. Available from\: [LINK]
UK Health Security Agency. T h e c o m p l e t e r o u t i n e i m m u n i s a t i o n s c h e d u l e f r o m F e b r u a r y 2 0 2 2 . Updated February Available from\: [LINK]
2022.
Altunaiji et al. A n t i b i o t i c s f o r w h o o p i n g c o u g h ( p e r t u s s i s ) . Published July 2007. Available from\: [LINK]

Image references

Figure 1. CDC Public Health Image Library. Gram stain of the bacteria B o r d e t e l l a p e r t u s s i s . License\: [Public domain]

Reviewer

Dr Amraj Dhami
Neonatal Registrar

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Contents

Introduction
Aetiology
Risk factors
Clinical features
Di
Investigations
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