Whooping Cough

whooping cough

Whooping cough is a bacterial infection, which can affect anyone of any age. As the name suggests the symptoms comprises of severe bouts of intense coughing followed by symptom free periods. Whooping cough is still common in rural India, however due to the immunisation the incidence has gone down.

What is whooping cough?

Whooping cough is an infection caused by a bacterium (germ) called Bordetella pertussis. The spread of this bacteria occurs by 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.

What is the presentation of whooping cough?

The illness typically follows a pattern.

  • Early stage (catarrhal phase)- At this stage the patients presents with sore throat, which within a period of one day develops into mild, dry ordinary cough which is followed by mild fever, running nose and then develops into a productive cough with sputum (phlegm)- but at first it still seems to be an ordinary cough.
  • Main coughing stage (paroxysmal phase)- After as many as 10-14 days of illness, the cough gets worse and becomes paroxysmal (i.e., there are bouts of intense coughing). They are sometimes called choking coughs.

During this bout of coughing, the face often goes red and the body becomes tense, there is a desperate attempt to breathe in, which may cause a whooping sound.  Whooping sound at the end of a bout of coughing is not seen in about half of cases. There is loss of breathing at the end of a bout of coughing and go blue for a short time, this generally looks worse than it actually is, as breathing usually quickly resumes. The coughing typically lasts 1-2 minutes. People commonly vomit at the end of a bout of coughing. A person may 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)- After three months or more, the bouts of coughing ease gradually.

Who are prone to get whooping cough?

Anybody of any age can get whooping cough.

  • Children- with the availability of immunisation the incidence of whooping cough has drastically decreased.
  • Adults and older children can also get whooping cough. Adults who were not immunised or whose immunistaion status has waned away, can also get whooping cough.

Is whooping cough infectious and how much?

It is a very infectious disease, which may be transmitted to most household members who are not immunised (or who have not previously had whooping cough). Symptoms develop within 7-14 days after being infected.

How long should you stay away after whooping cough?

If you have whooping cough you should stay away from others either:

  • until you have finished a five-day course of antibiotics ; OR
  • if you do not have antibiotics, for three weeks after symptoms of the paroxysms (bouts) of coughing start. After this, although you will probably still have bouts of coughing, you are not likely to be infectious.

How does one diagnose whooping cough?

The doctor generally diagnosis whooping cough by the symptoms the patients present with.By sending samples of throat and mucus, one can diagnose the condition, however, in many cases of 'cough for several weeks', the bacterium that causes whooping cough will have gone but the cough usually continues for several further weeks. Therefore, a negative test, with no bacteria found, does not rule out the diagnosis of whooping cough in someone who has been coughing for several weeks.

A blood test that can detect antibodies to the whooping cough bacterium has been available since 2001 and is being increasingly used, especially in adults.

What complications can happen?

 Complications are most common in babies under the age of six months. These include:

  • Pneumonia (lung infection).  Secondary infection with bacteria over whooping cough can cause pneumonia. Pneumonia is suspected in a baby or child if they become more ill, have a high temperature, breathe fast, or have difficulty breathing between bouts of coughing.
  • Pressure effects of the severe coughing can, rarely, cause blood vessels to burst and cause nosebleeds, coughing up blood, or skin bruises. The increase of pressure in the abdomen during bouts of coughing may cause a hernia.
  • Rarely, brain damage occurs.

How whooping cough can be treated?

  • Antibiotics are given to treat whooping cough. However, once the bouts of coughing have started, treatment with antibiotics makes little impact on the course of the illness. In effect, the bacteria will have done what they need to do to the airways to set off the bouts of coughing for the next few weeks.However, a course of antibiotics is still usually given if the disease is diagnosed in the first few weeks of the illness. This is because after five days of antibiotics you are no longer infectious. Without antibiotics, you can remain infectious for about three weeks after the bouts of coughing start.
  • General measures include:
    • General comforting. Being nursed in a sitting position seems to give some relief to babies.
    • Clearing away any mucus and vomit during bouts of coughing to prevent them from being inhaled by the child.
    • Looking out for complications such as pneumonia, which should be treated with antibiotics.
    • Making sure an ill child is getting enough food and drink.

 How do you prevent whooping cough?

  • Antibiotics course can be given to non-immunised people who have come into contact with a person with whooping cough. This may prevent the illness from developing.
  • Immunisation against whooping cough is routinely offered to all children. It is part of the triple vaccine. Three doses are usually given at ages 2, 3 and 4 months and then a preschool booster at ages 3-5 years. Immunisation is good but not 100%. This is why some immunised children still get whooping cough. Also, as mentioned above, the effect of the immunisation may wane over the years. This is the reason why some older children and adults who were immunised as a young child develop whooping cough.

How is the general outlook?

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

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