Whooping Cough

Whooping cough, also called pertussis, is a highly contagious infection of the lungs and airways caused by bacteria. It is best known for the long bouts of coughing it causes, which can be followed by a sharp intake of breath that makes a 'whoop' sound, especially in children.

While it can affect people of any age, it is most dangerous for young babies, particularly those under 6 months who are too young to be fully protected by vaccination. The illness can last for many weeks, which is why it is sometimes called the '100-day cough'.

Whooping cough usually begins like a common cold, with a runny nose, sneezing, a mild cough and sometimes a slight fever, for about a week or two. After this, the coughing becomes much worse and comes in long bouts that can last for minutes at a time. These fits are often worse at night, and a child may go red in the face, bring up thick mucus or vomit afterwards, and gasp for breath with a 'whoop' between coughs.

The cough can carry on for many weeks, gradually easing over time. It is important to know that young babies may not whoop at all; instead they may have pauses in their breathing (apnoea), brief spells where they turn blue or grey, or simply look very unwell. Some people, including older children and adults, may have a milder, lingering cough without the classic whoop.

Whooping cough is caused by bacteria that infect the lining of the airways. It spreads very easily when an infected person coughs or sneezes and others breathe in the droplets, or through close contact.

A person is usually contagious from the early, cold-like stage and for some time into the coughing stage. Antibiotics taken early can shorten the time a person can pass the infection to others, which is especially important for protecting vulnerable babies.

A doctor may suspect whooping cough from the typical pattern of a cough that comes in long bouts, especially with a whoop, vomiting after coughing, or known contact with someone who has it. The history of how the cough has changed over time is an important clue.

To confirm the diagnosis, a doctor can take a sample from the nose or throat, or sometimes a blood test, depending on how long the cough has been present. Diagnosis can be harder later in the illness, so testing and treatment decisions are often based on the overall picture as well as test results.

If whooping cough is diagnosed early, usually within the first few weeks of the cough, antibiotics may be prescribed. Antibiotics are given mainly to reduce the spread of infection to others, particularly vulnerable babies; once the coughing stage is well established, they may do little to ease an individual's own symptoms. Close contacts, especially newborns and pregnant women, are sometimes offered antibiotics to protect them.

At home, rest, plenty of fluids and a calm, smoke-free environment help. Coughing fits can be exhausting, so smaller, more frequent feeds or meals can be easier to manage. Cough medicines are not recommended for young children and do not help with this cough. Young babies and anyone who is seriously unwell are often treated in hospital, where they can be monitored and supported with their breathing and feeding.

Call emergency services or go to the nearest emergency department immediately if a baby or child has long pauses in their breathing, stops breathing, struggles to breathe, or their skin, lips or tongue look blue or grey. These are signs that a baby needs help straight away and are particularly important in infants, who may have these spells instead of a whoop.

Also seek prompt medical advice if your child has repeated, severe coughing fits, brings up a lot of mucus or vomits often after coughing, becomes very tired, is not feeding well, or you think a young baby may have whooping cough. Babies under 6 months should always be assessed because they are at the highest risk of complications such as dehydration, breathing problems, pneumonia and seizures.

Vaccination is the most effective way to prevent whooping cough. Routine childhood vaccines protect babies and children, and a pre-school booster helps maintain protection. Because young babies are most at risk before they can be fully vaccinated, vaccination during pregnancy is recommended in many countries, as it passes protection to the baby for the vulnerable first weeks of life.

Good hygiene also helps reduce spread: cover coughs and sneezes, dispose of tissues, and wash hands often. Keeping unwell people, and anyone with a cough, away from young babies is an important extra precaution.

Most older children and adults recover fully, although the cough can be tiring and may last for many weeks before it finally settles. Complications are less common in this age group.

Babies under 6 months can become seriously unwell and are the most likely to need hospital care, so they are watched especially closely. Early recognition, vaccination and prompt treatment of complications give the best outcomes, and most children who receive timely care recover well.