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Whooping cough (pertussis)

whoop; whooping; cough; pertussis; immunisation; immunization; vaccine; vaccination; mucous; erythromycin; infection; Bordetella;

Whooping cough (also called pertussis) is an infection of the nose, throat and lungs which causes long bursts of coughing (up to several minutes long). In young children the coughing spell often ends in a 'whooping' noise when the child can finally take a breath in.

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Children can have several coughing spells each hour, including while they are sleeping. They can also go on having coughing spells for many weeks (up to about 3 months for some).

Older children and adults can have whooping cough without the 'whooping' sound. They have coughing spells lasting a minute or more, followed by several minutes of not coughing.

Whooping cough can be life threatening for babies. Newborns are not immune and they often get extremely sick. Babies who get whooping cough often get it from others in their family, including their parents.

It is now recommended that parents and others who will be close to a baby get a whooping cough booster even if they have been immunised before. This includes grandparents, older children in the family, other adults who live in the house, child care workers and health care workers. Women can get the booster when they are planning a pregnancy or as soon as their baby is born. Other family members can be immunised during the pregnancy.

The vaccine for babies and young children, and children aged 10 to 15 years, is free in Australia, but not free for adults.

What is whooping cough?

Whooping cough is an infection caused by a bacterium, Bordetella pertussis. Outbreaks of whooping cough were first described in the 16th Century.

Pertussis kills about 250,000 children worldwide each year. 18 deaths were recorded in Australia between 1993 and 2004, of whom all but 2 were children under 12 months old.

In Australia, there are epidemics of whooping cough about every 3 to 5 years, with the most recent peaks in South Australia in 2009 and 2010.

How does it spread?

The infection spreads by droplets that are coughed or sneezed out during the first 3 weeks of the illness. These droplets can be breathed in or they can be carried to the nose by hands which come in contact with the droplets (eg through handling used tissues or by touching surfaces which have the droplets on them).

Whooping cough is very easy to catch. 70% to 100% of people living in the same house as someone with whooping cough will get the infection unless they have been immunised in the last 11 years, or have had the infection.

Who is most at risk?

Any one who is not protected (by recent immunisation or by having had the infection before) can get whooping cough, including older children and adults. Most people who get the infection in Australia are adults or young people over about 11 years of age - even if they have been immunised as a baby.

Babies are at most risk of having severe health problems from whooping cough. About 1 in 200 babies who get whooping cough before they are 6 months old will die from the infection.

How long does it take to develop?

A child or adult who catches whooping cough will usually start to be unwell about 7 to 10 days after being exposed to the infection.

How long is it infectious?

A person with whooping cough is highly infectious in the first few days (when they seem to only have a 'cold').

Without treatment with an effective antibiotic, a person will go on being infectious for about 3 weeks.

If the illness is treated with an effective antibiotic (often erythromycin), a person will usually stop being infectious within 5 days.

It can take a while for adults with whooping cough to be diagnosed correctly, because they usually do not whoop. If their cough is treated with some commonly used antibiotics the bacteria may not be killed, and they can go on being infectious for about 3 weeks.

Signs and symptoms of whooping cough

The illness usually starts like a 'cold' with runny nose and a cough which is not like the spells of coughing later in the illness.

After several days the long spells of coughing start, causing difficulty breathing during the spells. The child will have many quick coughs in one spell. There can be several spells of coughing each hour.

Young children often have a whoop after the coughing spell (when they can finally breathe in). During the cough or soon afterwards they might vomit any food or drink that they have recently swallowed.

Very young babies may not cough, but they may just stop breathing for a minute or longer many times per day. If they cough there might not be the whoop.

Adults and older children may not whoop, but they will have coughing spells and they may feel tired (the coughing can interfere with sleeping), and generally unwell. Also the coughing can cause muscle pain in chest and abdomen (tummy).

It can be many weeks before it is recognised that the older child or adult has whooping cough.

Finally, after several weeks or more, the coughing spells start happening less often and they stop happening about 2 to 3 weeks after this. If the person gets a cold soon after having whooping cough, the coughing can start again for a while (much shorter than the original illness).

Diagnosis of whooping cough

During an outbreak of whooping cough it is usually possible to diagnose whooping cough from the symptoms.

Blood tests and tests on mucous from the nose or throat can be done to confirm that the illness is whooping cough. Xrays may be done to check how well the lungs are working.

Treatment

If your child has been exposed to whooping cough, see your doctor, as your child might need an antibiotic to protect him from becoming infected.

When it is recognised that a child or adult has whooping cough, an antibiotic, (often erythromycin), is prescribed. It will kill the bacteria but it does not stop the coughing which may go on for many weeks, unless the antibiotic is given very early in the illness.

Young babies with whooping cough are often so ill that they need hospital treatment. Feeding can be a problem because they often vomit after coughing. A baby may need tube feeding. Some babies need intensive care including ventilation.

Cough suppressing medicines may be helpful for adults but should not be used for young children unless you have been advised to use them by a doctor. Part of the reason for coughing is that there is sticky mucous in the airways which needs to be coughed up. Always check with your doctor before giving a child a cough suppressing medicine.

What you can do

It is important to check often that the child is eating and drinking enough.

It seems that feeding a young child immediately after a coughing spell may mean the food and drink stays down. Feeding seems to trigger a coughing spell if the child has not coughed recently, but soon after a coughing spell, food and drink usually do not trigger another coughing spell.

Children who are coughing often will be tired and uncomfortable (coughing can cause tummy pain from overused muscles). Some paracetamol or ibuprofen may help with aching muscles.

The topic 'Feeling sick' has more ideas.

Immunisation

Immunisation of babies against whooping cough protects most children completely, although a small number of immunised children may have a milder illness with whooping cough.

The immunisation is given at the same time as immunising them against tetanus, diphtheria and polio (at 6 weeks, 4 and 6 months and 3½ - 4 years). It is very important for protecting babies against whooping cough that they are immunised as soon as possible according to the immunisation schedule. 

Immunisation of older children also protects babies under 2 months (when whooping cough can be very severe) because there will be fewer children in the community who can spread the infection to babies (babies are not protected by antibodies from their mother).

There is now a vaccine to protect children over 10 years and adults.  This booster works if the person had a full set of immunisation as a baby. 

Immunisation is recommended to be given with tetanus and diphtheria in Year 8 (one injection with three vaccines). This immunisation is provided free in Australia.

Immunisation is also recommended for

  • adults before planning a pregnancy
  • parents of newborn babies and other family members 
  • adults working with young children
  • adults at age 50 years (when combined tetanus, diphtheria and pertussis [whooping cough] vaccine can be used instead of diphtheria-tetanus). 

However - the vaccine is not free at these times.

Preventing the spread of whooping cough

Any person with whooping cough should be excluded from child care, kindergarten, school and work until 5 days after starting treatment, or if not treated, for 3 weeks from the start of symptoms.

Children who are unwell should not be at child care, kindergarten or school even if they are no longer infectious.  The teachers are not able to provide the care that sick children need.

Any children who have not been immunised and have been in contact with someone with whooping cough should be excluded from child care, kindergarten or school for 14 days after the contact, or until they have been on antibiotic treatment for at least 5 days.

The National Health and Medical Research Council in Australia recommends that anyone who has been exposed to whooping cough in the household or other close contacts (such as child care) should receive antibiotics for 10 days even if they have been immunised (see your doctor).

Whooping cough is a notifiable disease in Australia. The State Government health service will be notified of proven cases of whooping cough so that they can assist in stopping the spread of the infection.

Department of Health, South Australia Exclusion from childcare, preschool, school and work

Questions often asked about immunisation against pertussis

Q: Does pertussis immunisation cause permanent brain damage?
A: No, it does not, and many studies have been done to show that there is no risk. A few babies become "floppy" for several hours after the injection. They always recover fully. However children who get ill with pertussis (especially babies) can have brain damage, and might die.

Q: Does the pertussis part of the vaccine (combined with tetanus, diphtheria, and in South Australia Hepatitis B vaccines) cause reactions such as fever and a sore spot where the injection was given?
A: The type of pertussis vaccine has been changed. Since this new vaccine (a-cellular pertussis) has been used, there have been many fewer children who get a fever or sore injection sites, but they get the same amount of protection.

Q: Do children still need to be immunised against whooping cough?
A: Yes, there have been regular outbreaks of whooping cough in Australia even in the last few years, and babies in Australia still die from whooping cough. In some countries where many children are not immunised against whooping cough, the numbers of children getting sick (and dying) with whooping cough is much higher than in Australia.

Q: How long does the protection from whooping cough last after immunisation?
A: For some people, the protection against whooping cough starts to get lower around the age of 12 years. A booster in Year 8 recommended and provided free of charge in Australia.

Q: Is it better to wait until my child is a bit older before having the whooping cough immunisation?
A: No. Waiting until your child is older is not recommended because it is when they are less than 12 months old that babies are most at risk. Many of the children over 5 months old who get whooping cough have either not been immunised or the immunisations have not been given at the recommended time.

Resources

South Australia

Australia

References

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    The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

    This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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