Whooping Cough (Pertussis) Vaccine, Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

Whooping Cough (Pertussis) Vaccine, Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies


What is Whooping Cough (Pertussis)?


Whooping cough is an infection caused by a bacterium (germ) called Bordetella pertussis. This bacterium is spread to others through contaminated droplets in the air, produced during coughing and by close contact with an affected person. The bacterium attaches to cells which line the airways. It then multiplies and causes the symptoms. 


Whooping Cough (Pertussis) Vaccine, Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

Bordetella pertussis bacteria affect the lining of the airways in some way to cause symptoms (mainly a cough) to continue for a long time after the bacteria have gone.

Before the vaccine was developed, whooping cough was considered a childhood disease. Now whooping cough primarily affects children too young to have completed the full course of vaccinations and teenagers and adults whose immunity has faded.

Deaths associated with whooping cough are rare but most commonly occur in infants. That's why it's so important for pregnant women — and other people who will have close contact with an infant — to be vaccinated against whooping cough.

Causes of whooping cough Whooping Cough (Pertussis)


Whooping cough is caused by a bacterium called Bordetella pertussis. The bacterium infects the lining of the airways, mainly the windpipe (trachea) and the two airways that branch off from it to the lungs (the bronchi).

Most people acquire the bacteria by breathing in the bacteria that are present in droplets released when an infected person coughs or sneezes. The infection is very contagious is often is spread to infants by family members or caregivers, who may be in the early stages of infection and not realize that they are suffering from whooping cough.

When the Bordetella pertussis bacterium comes into contact with the lining of these airways, it multiplies and causes a build-up of thick mucus. It is the mucus that causes the intense bouts of coughing as your body tries to expel it.

The bacterium also causes the airways to swell up, making them narrower than usual. As a result, breathing is made difficult, which causes the 'whoop' sound as you gasp for breath after a bout of coughing.

The Bordetella pertussis bacterium is spread by airborne 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) 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.

What are the symptoms of whooping cough?


Early stage (catarrhal phase)


At first there is often a sore throat. Within a day or so a mild, dry ordinary cough develops. At this stage you may feel mildly unwell and have a mild fever (high temperature). You may also have a runny nose. Over a few days the cough may become more productive with some sputum (phlegm) - but at first it still seems to be an ordinary cough.

Main coughing stage (paroxysmal phase)


After several days, often as many as 10-14 days from the start of the illness, the cough gets worse and becomes paroxysmal. This means there are bouts (paroxysms) of intense coughing. They are sometimes called choking coughs.

  • During a bout of coughing, you repeatedly cough over and over again. The face often goes red and the body becomes tense. Eventually, there is a desperate attempt to breathe in, which may cause a whooping sound. Note: the whooping sound at the end of a bout of coughing only happens in about half of cases.
  • Some children may stop breathing at the end of a bout of coughing and go blue for a short time. This looks worse than it actually is, as breathing usually quickly resumes.
  • Each bout of coughing typically lasts 1-2 minutes.
  • Several bouts of coughing may occur together and last several minutes in total.
  • It is common to vomit at the end of a bout of coughing.
  • The number of coughing bouts per day varies from case to case. You may only have a few bouts each day but some people have up to 100 bouts per day. The average is about 12-15 bouts per day.
  • Between the bouts of coughing you are likely to be well (unless you develop a complication, which is not common). The symptoms of fever, runny nose and other symptoms of illness have usually gone by this main coughing stage. But, each bout of coughing can be distressing. 

This main coughing stage of the illness usually lasts at least two weeks, and often longer.

Easing stage (convalescent phase)


The bouts of coughing then ease gradually over a period which can last up to three months or more. (In some countries whooping cough is known as the cough of a 100 days.) As things seem to be easing, you may still get the odd bout of severe coughing.

Whooping cough can be very miserable, as the bouts of coughing can be distressing. However, in some cases the symptoms are milder than described above. There may be just intermittent bouts of coughing which are not too bad without any whooping or vomiting.


When to see a doctor


Call your doctor if prolonged coughing spells cause you or your child to:

  • Vomit
  • Turn red or blue
  • Inhale with a whooping sound

Who gets whooping cough?


Anybody of any age can get whooping cough.

Children


In countries with no immunisation, most children develop whooping cough at some stage.

Adults and older children


Whooping cough is not just a childhood illness. Adults can get whooping cough.  This is because some adults have not been immunised. Also, the protection from whooping cough immunisation may wane over the years in some people. So, even if you were immunised as a young child, you may still get whooping cough as an older child or adult. 

It is hard to prove the diagnosis of whooping cough definitely from tests (see below). Whooping cough is probably a common cause of many 'mystery coughs' which last for several weeks and which occur in adults and older children who appear otherwise well between bouts of coughing.

Complications of whooping cough


Whooping cough is most serious in babies under 12 months of age. 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 periods of time)
  • pneumonia
  • inflammation of the brain
  • convulsions (fits) and coma
  • permanent brain damage
  • death.

How is whooping cough diagnosed?


When a patient has the typical symptoms of whooping cough, the diagnosis can be made from the clinical history. However, the disease and its symptoms, including its severity, can vary among affected individuals. In cases in which the diagnosis is not certain or a doctor wants to confirm the diagnosis, laboratory tests can be carried out. Culture of the bacterium Bordetella pertussis from nasal secretions can establish the diagnosis. Another test that has been used to successfully identify the bacterium and diagnose whooping cough is the polymerase chain reaction (PCR) test that can identify genetic material from the bacterium in nasal secretions.

What is the treatment for whooping cough?


Antibiotics directed against Bordetella pertussis can be effective in reducing the severity of whooping cough when administered early in the course of the disease. Antibiotic therapy can also help reduce the risk of transmission of the bacterium to other household members as well as to others who may come into contact with an infected person. Unfortunately, most people with whooping cough are diagnosed later with the condition in the second (paroxysmal) stage of the disease.

Treatment with antibiotics is recommended for anyone who has had the disease for less than three to four weeks. Azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), and trimethoprim and sulfamethoxazole (Bactrim, Septra) are antibiotics which have been shown to be effective in treating whooping cough. It is unclear whether antibiotics have any benefit for people who have been ill with whooping cough for longer than three to four weeks, although antibiotic therapy still is often considered for this group often. There is no proven effective treatment for the paroxysms of coughing that accompany whooping cough.

Antibiotics also are routinely administered to people who have had close contact with an infected person, regardless of their vaccination status.

You should not give an infected child cough syrup or cough medicines unless instructed to do so by a doctor. They have not been shown to be of benefit, and they may cause sedation that leads to worsened outcomes.

What is the treatment for whooping cough in Babies and young children


Babies are affected most severely by whooping cough, and are most at risk of developing complications. For this reason, babies under 12 months who contract whooping cough will often need treatment in hospital.

If your child is admitted to hospital to be treated for whooping cough, it is likely they will be treated in isolation. This means they will be kept away from other patients to prevent the infection spreading.

Your child may need to be given antibiotics intravenously (straight into a vein through a drip).

If your child is severely affected, they may also need corticosteroid medication as well as antibiotics. Corticosteroid medication contains steroids. These are powerful hormones that will reduce inflammation (swelling) in your child's airways, making it easier for them to breathe. Like antibiotics, corticosteroids may be given intravenously.

If your child needs additional help with breathing, they may be given extra oxygen through a facemask. A handheld device called a bulb syringe may also be used to gently suction away any mucus that is blocking their airways.

How to avoid passing on the infection of Whooping Cough (Pertussis)


Whooping cough is highly infectious, so if you or your child have it, it is important to stay away from others until the bacterium has completely cleared.

The affected person should stay at home until they have completed a five-day course of antibiotics from their GP, or had intense bouts of coughing (paroxysms) for three weeks (whichever is sooner).

Although bouts of coughing may continue after three weeks, it is unlikely you will still be infectious because the bacterium will have gone.

Preventative treatment


Preventative treatment may be recommended for members of your household (or dorm or residential home) known to be vulnerable to the effects of infection (these people are known as vulnerable contacts).
Vulnerable contacts include:
  • newborn babies
  • young children under the age of 12 months who have not received the complete course of the DTaP/IPV/Hib vaccine
  • children under the age of 10 who have not been vaccinated
  • women in the last month of pregnancy
  • people with a weakened immune system, such as people with HIV or people undergoing chemotherapy
  • people with a long-term health condition such as asthma or heart failure
Preventative treatment is also usually recommended if a household member works in a healthcare, social care or childcare facility as they could pass the infection on to other vulnerable contacts.

Preventative treatment usually involves a short course of antibiotics, and in some cases, a booster dose of the vaccine.

Can whooping cough be prevented?


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. Doctors recommend beginning vaccination during infancy.

The vaccine consists of a series of five injections, typically given to children at these ages:

  • 2 months
  • 4 months
  • 6 months
  • 15 to 18 months
  • 4 to 6 years

Vaccine side effects


Side effects of the vaccine may include fever, crankiness or soreness at the site of the injection. In rare cases, severe side effects may occur, including:

  • Persistent crying, lasting more than three hours
  • High fever
  • Seizures, shock or coma

Booster shots


Adolescents. Because immunity from the pertussis vaccine tends to wane by age 11, doctors recommend a booster shot at that age to protect against whooping cough (pertussis), diphtheria and tetanus.

Adults. Some varieties of the every-10-year tetanus and diphtheria vaccine also include protection against whooping cough (pertussis). In addition to protecting you against whooping cough, this vaccine will also reduce the risk of your transmitting whooping cough to infants.

Pregnant women. The Centers for Disease Control and Prevention now recommends that pregnant women receive the pertussis vaccine between 27 weeks and 36 weeks of gestation. This may also give some protection to the infant during the first few months of life.

Home remedies for Whooping Cough (Pertussis)


The following tips on dealing with coughing spells apply to anyone being treated for whooping cough at home:

Get plenty of rest


A cool, quiet and dark bedroom may help you relax and rest better.

Drink plenty of fluids


Water, juice and soups are good choices. In children, especially, watch for signs of dehydration, such as dry lips, crying without tears and infrequent urination.

Eat smaller meals


To avoid vomiting after coughing, eat smaller, more-frequent meals rather than large ones.

Vaporize the room


Use a mist vaporizer to help soothe irritated lungs and to help loosen respiratory secretions. If you use a vaporizer, follow directions for keeping it clean. If you don't have a vaporizer, a warm shower or bath can temporarily help clear the lungs and ease breathing.

Clean the air


Keep your home free of irritants that can trigger coughing spells, such as tobacco smoke and fumes from fireplaces.

Prevent transmission


Cover your cough and wash your hands often; if you must be around others, wear a mask.

Adult and Whooping Cough (Pertussis) immunisation


Childcare, healthcare workers and some adults should also be vaccinated, especially those who are, or will be, in close contact with babies. The whooping cough vaccine for adolescents and adults also contains diphtheria and tetanus protection in a combination vaccine. Immunity provided by the vaccine decreases after six to 10 years.

Pregnancy and Whooping Cough (Pertussis) immunisation


Combination vaccines against diphtheria, tetanus and whooping cough are not recommended for pregnant women although they can be given in some circumstances. Immunisation against whooping cough is recommended as part of your pre-pregnancy planning or as soon as possible after the birth of your baby. Women who are breastfeeding can receive the combination vaccines. Speak with your doctor for more information.

What is the outlook (prognosis)?


Most people who develop whooping cough make a full recovery. However, it can be a miserable illness, as the relentless bouts of coughing can be distressing. The total length of the full illness is commonly 6-8 weeks but can be longer. Severe complications and death are uncommon but occur mostly in babies under six months of age. Serious illness is less common in older children and adults. Once recovered, you are usually then immune to whooping cough and so are very unlikely to get it again.