What is whooping cough?

Whooping cough (also known as 'pertussis') is a highly infectious infection of the lungs and airways. It is caused by bacteria.

The disease is most serious in babies under the age of 12 months, particularly in the first few months of life. It can be life threatening for young babies. They have soft airways that can be damaged from the severe coughing bouts. They may not yet have had their whooping cough vaccinations, which make the disease less severe.

Older children and adults, including those who have been vaccinated, can still get whooping cough. While it is not as critically dangerous as it is in small babies, whooping cough can still be a distressing condition, with the cough lasting up to 3 months. Whooping cough has been called the ‘100-day cough’.

What are the symptoms of whooping cough?

Whooping cough tends to develop in stages, with mild symptoms starting 7 to 10 days after infection, followed by a period of more severe symptoms, before improvement begins.

Early symptoms

The early symptoms of whooping cough are often similar to those of a common cold and may include:

• runny or blocked nose
• sneezing
• watering eyes
• dry, irritating cough
• sore throat
• slightly raised temperature
• feeling generally unwell

These early symptoms of whooping cough can last for 1 to 2 weeks before becoming more severe.

Paroxysmal symptoms

The second stage of whooping cough is often called the paroxysmal stage and involves intense bouts of coughing. The bouts are sometimes referred to as ‘paroxysms’ of coughing.

Paroxysmal symptoms of whooping cough may include:

• intense bouts of coughing, which bring up thick phlegm
• a ‘whoop’ sound with each sharp intake of breath after coughing. This doesn’t happen to everyone — adolescents and adults usually don’t have a whoop
• vomiting after coughing, especially in infants and young children
• fainting after coughing
• coughing hard enough to break a rib

Each bout of coughing usually lasts between 1 and 2 minutes, but several bouts may occur in quick succession and last several minutes. The number of coughing bouts experienced each day varies. The coughing can be worse at night.

The paroxysmal symptoms of whooping cough usually last at least 2 weeks but can last up to 10 weeks, even after treatment. This is because the cough continues even after the bacteria has been cleared from the body.

A milder cough can last for several months.

Symptoms in babies

Babies might have a bad cough but some do not cough at all. Other symptoms in babies include:

• pauses in breathing
• turning blue
• trouble feeding
• choking or gagging

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When should I see my doctor?

See your doctor as soon as possible if you think you or your child may have whooping cough.

If a young baby has suspected whooping cough, they need to be tested for it straight away. Your doctor may refer them to hospital. This is because the disease can be severe in babies.

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What causes whooping cough?

Whooping cough is caused by the Bordetella pertussis bacteria. It is passed on through close personal contact with someone who has whooping cough, sneezing and coughing.

The bacteria infect the lining of the airways, mainly the windpipe (trachea) and the 2 airways that branch off from it to the lungs (the bronchi). There is a build-up of thick mucus. This mucus causes the intense bouts of coughing as the body tries to cough it up.

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

How is whooping cough diagnosed?

The doctor will first discuss the symptoms. They will confirm the diagnosis by taking a swab from the back of the nose or throat and often a blood test as well.

Some people may need a chest x-ray to see if they also have developed pneumonia.

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How is whooping cough treated?

If whooping cough is diagnosed during the first few weeks of the infection, a course of antibiotics may be given to prevent the infection spreading further.

Antibiotics will stop someone being infectious after 5 days of taking them. However, without antibiotics, they may still be infectious until 3 weeks after the intense bouts of coughing start.

If whooping cough is not diagnosed until the later stages of the infection, antibiotics may not be prescribed. This is because the bacteria that cause whooping cough have already gone by this time, so the person is no longer infectious. Antibiotics will make no difference to the symptoms at this stage.

Treating babies and young children

If your child is admitted to hospital 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.

If your child is admitted to hospital 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 or steroids intravenously (straight into a vein through a drip).

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.

If an antibiotic is given, the infectious period will continue for up to 5 days after starting treatment.

Can whooping cough be prevented?

Immunisation against whooping cough is normally effective in preventing the disease. Sometimes it is still possible to catch whooping cough, but if someone has been immunised the cough is usually less severe. Vaccination is recommended as part of routine childhood immunisation.

Immunity can wear off several years after vaccination. To have your child immunised against whooping cough, you can visit your local doctor or child health nurse.

Added protection for infants

It is now recommended that all pregnant women receive a pertussis (whooping cough) vaccination when they are 20 to 32 weeks pregnant. A combination of antibodies being passed through the mother’s bloodstream and the reduced risk of the mother catching the disease makes this an ideal time to administer the vaccine. Pertussis vaccine is available free of charge to eligible people under the National Immunisation Program. Speak to your doctor or antenatal care provider to schedule an appointment.

Fathers, grandparents and anyone else who is likely to come into contact with newborns should see their doctor to get a pertussis booster at least 2 weeks before the baby is born.

Whooping cough vaccine

Vaccination is your best protection against whooping cough. This table explains how the vaccine is given, who should get it, and whether it is on the National Immunisation Program Schedule. Some diseases can be prevented with different vaccines, so talk to your doctor about which one is appropriate for you.

What age is it recommended?	Children at 2 months, 4 months, 6 months, 18 months, 4 years, and between 10 and 15 years. Pregnant women at 20 to 32 weeks. Healthcare workers, if they have not had a whooping cough vaccine in the past 10 years. People working in early childhood education and care, if they haven’t had a whooping cough vaccine in the past 10 years. Adult household contacts and carers of babies under 6 months old. People who are travelling overseas, if they haven’t had a whooping cough vaccine in the past 10 years. Adults of any age who need a tetanus, diphtheria or polio dose (you can get a combination vaccine that includes whooping cough to increase protection). People aged 50 years, at the same time as they get their recommended tetanus and diphtheria vaccine. People aged 65 or over, if they have not had a whooping cough vaccine in the past 10 years.
How many doses are required?	6 doses, then boosters every 10 years.
How is it administered?	Injection
Is it free?	Free for anyone under age 20. Free for pregnant women. Free for humanitarian entrants of any age. For everyone else, there is a cost for this vaccine. Find out more on the Department of Health website and the National Immunisation Program Schedule, and ask your doctor if you are eligible for additional free vaccines based on your situation or location.
Common side effects	The vaccine is very safe. Side effects may include redness, swelling or hardness where the needle went in.

Complications of whooping cough

Infants

Babies and young children can be especially susceptible to complications of whooping cough. These include:

• pneumonia
• apnoea (stopping breathing for an extended period of time)
• choking
• becoming blue in the face (cyanosis)
• damage to the airway’s tubes
• vomiting
• seizures
• dehydration
• weight loss
• brain damage

Though very rare, it is possible for whooping cough to cause sudden unexpected death in infants.

Adults are less likely to develop complications. However, older people may develop problems due to persistent coughing, including incontinence, hernia, fractured ribs, fainting, a brain bleed and disturbed sleep.