Key points to remember
- whooping cough causes bouts of coughing - each bout may last for 2 or 3 minutes and often the face gets very red and there may be vomiting after coughing
- young infants can go blue and stop breathing with bad coughing bouts
- the cough may go on for 3 months
- whooping cough spreads easily from person to person - it is very catching (contagious)
- it can cause serious illness and sometimes death in babies and infants
- it is usually less severe in older children and adults but is still distressing for them
- immunisation reduces the risk of getting whooping cough and makes the illness less severe in those who get it
What is whooping cough?
Whooping cough is an infection that causes a cough that can go on for weeks or months. Its medical name is pertussis. 'Whoop' describes the sound that some children make after coughing (click on this link to listen to someone with whooping cough).
Whooping cough is very easy to catch. Every 3 to 5 years a significant number of young New Zealand children are hospitalised with whooping cough. These outbreaks are called epidemics.
Whooping cough can cause very serious illness in babies and young children. Older children usually get a less severe disease but the cough and vomiting can be very distressing. Adults may just have an irritating cough that goes on much longer than usual.
Parents or older children in the family with whooping cough can easily pass it on to babies who are too young to have fully completed their immunisation course.
In the above video, filmed in 2012 during a whooping cough epidemic, health professionals talk about how severe whooping cough can be, particularly in young babies, and the importance of immunisation to protect them.
What causes whooping cough?
Whooping cough is caused by a type of bacteria called Bordetella pertussis (this is why the illness is sometimes called pertussis). This bacteria damages the lining of the nose, throat and breathing tubes (trachea and bronchi) and causes the coughing. Children get the bacteria from someone who is infected with it. It is spread through the air in droplets, so coughing and contact with spit (saliva) pass it on.
What are the signs and symptoms?
Whooping cough affects children differently depending on their age.
Babies aged less than 6 months old do not usually whoop. They may:
- stop breathing
- appear to have a cold, then cough and have difficulty breathing
- get exhausted from coughing
- not be able to feed because of coughing
- lose weight because of difficulty feeding and because the cough causes vomiting
In older babies and young children, the illness has 3 stages:
- It starts with a runny nose and eyes, mild fever and sneezing – just like a virus cold. This lasts 1 or 2 weeks.
- Next there is an irritating cough. Over a week or 2, the cough gets worse and your child will have bouts of coughing. They gasp for air between each bout of coughing. They get very red in the face. These spells last many minutes and they may vomit food or spit (phlegm) after the coughing. The cough often gets worse with swallowing or eating. It is very distressing for both parent and child.
- The final stage is the long recovery stage. The symptoms get less severe, but the cough continues for weeks.
Older children and adults may get a less severe illness, particularly if they have had whooping cough before, but most have a prolonged irritating cough and some will still get a severe illness.
Whooping cough may cause a range of other problems.
How long does whooping cough last?
Whooping cough can last for weeks or months.
If your child gets an ordinary viral cold in the weeks after they have recovered from whooping cough, bouts of coughing sometimes come back for a while.
Whooping cough usually lasts for a shorter time:
- in adults
- in children who are partially immunised
- in older children if the effect of their infant immunisations is beginning to wear off
How easy is it to catch whooping cough?
People can catch and spread whooping cough easily - it is highly catching (contagious). On average, each person with whooping cough passes the infection on to 12 other people.
Whooping cough is most easily passed on in the first stage (before the typical cough starts). It may still be passed on to others 3 or 4 weeks after the cough starts.
Antibiotics have very little effect on the severity of the coughing illness. However, if started early, antibiotics can reduce the amount of time your child is infectious to others from about 3 weeks to 5 days.
Your child should be kept away from others, especially babies, children and elderly people until they are no longer infectious.
What puts my child at risk of getting whooping cough?
You can get whooping cough at any age. Severe disease and complications are most likely in:
- in children who have a heart, lung or another chronic medical problem
The younger your child, the greater the risk of getting very sick from whooping cough. The best protection is to have your child fully immunised and for you to be immunised against whooping cough if you are pregnant. Getting immunised during pregnancy means you can pass on your immunity to your baby when they're most vulnerable. It helps to protect baby until their first immunisations.
How is whooping cough diagnosed?
Whooping cough is usually diagnosed on your description of your child’s symptoms. Your family doctor will ask some questions, and examine your child. Sometimes whooping cough can be hard to diagnose.
Your doctor may take a sample of mucus ('snot') from your child’s nose. This is sent to a laboratory. It can take days for a result to come back. Your doctor may also ask for a blood test.
How is whooping cough treated?
Whooping cough is caused by bacteria, but antibiotics are not effective in stopping the cough once it has started. Antibiotics may help reduce the severity of the illness but only if they are given very early in the illness. They need to be given before the cough starts and, even then, may make only a small difference. They do, however, reduce the chance that the illness is passed on to others (they make the disease less catching).
Your child's infection-fighting (immune) system will help get rid of the bacteria after 3 or 4 weeks without any treatment but the damage caused to the breathing tubes takes longer to repair. There is no medicine that will stop the cough once it has started. Cough medicines (cough suppressants) are not effective and may have side-effects so they are not recommended.
If your child is very young or very unwell with whooping cough, or they have any complications, they may need to stay in hospital. Sometimes whooping cough may make it hard for a young child to get enough oxygen. If your child has any signs of this, they will need to be given oxygen in hospital. This is usually given through nasal prongs (small soft plastic tubes) that fit into your child's nose and carry a flow of oxygen.
If your young child is not drinking enough, they may need to be given fluid by:
- an intravenous drip (into a vein), or
- by nasogastric feeding (feeding via a tube that is passed through the nose or mouth into the stomach)
How can whooping cough be prevented?
Immunisation is the best way of preventing whooping cough. If your child is immunised against whooping cough, they are much less likely to catch it, and if they do catch it, they are less likely to be severely affected. Immunisation is effective at preventing your child dying from whooping cough, or needing to go to hospital.
Young infants are most at risk of getting very sick from whooping cough so it is important to:
- begin immunisation at 6 weeks of age, and
- complete the first 3 doses on time to build the maximum protection
- be immunised during pregnancy - this helps protect young infants against whooping cough until they are old enough to be immunised themselves. The vaccine itself doesn't get passed on to your baby, but your immunity to whooping cough does
Immunity from both the disease and the vaccine lessens over time so booster doses are needed for longer-term protection and to minimise the spread to vulnerable babies who are too young to be fully vaccinated. Booster doses are given to children at the following ages:
- 4 years
- 11 years
There is also a whooping cough vaccine available for older children and adults who are at higher risk of catching the disease or in contact with young infants or other children at high risk. Ask your family doctor about this.
If your child has had close contact with someone with whooping cough (like their brother or sister), antibiotics can be given and this may help prevent them catching it.
See your doctor for advice about antibiotic treatment if your baby has been in contact with whooping cough and they:
- are less than 1 year old
- were premature
- have a heart or lung condition
How can I care for my child at home?
Your child with whooping cough should stay away from people outside of the family (especially other children) for 3 weeks. This is to stop the infection spreading. If your child is given antibiotics, this time goes down to 5 days.
If antibiotics have been prescribed, make sure your child takes all the doses.
If the coughing is hurting your child, you can give paracetamol to make them more comfortable. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose.
Your child will need rest at the beginning, when the bouts of coughing are causing them most trouble.
Encourage them to drink fluids and eat healthy small meals.
What are the complications?
Complications of whooping cough are most likely to happen in babies and young children. Complications are less likely in older children and adults.
Serious complications include:
- stopping breathing
- lack of oxygen
- bleeding into the brain, which can cause brain damage
- weight loss as babies and young children cannot keep enough food down
Whooping cough in very young infants is unpredictable with the potential for getting worse very quickly.
- babies under 1 year of age hospitalised with whooping cough have a 1 in 10 chance of ending up in the paediatric intensive care unit
- if they end up there, they have a 1 in 6 chance of either dying or being left with brain damage or lung damage
In the above video, a doctor at Starship Children's Health talks about a baby with whooping cough in Starship's Intensive Care Unit. At the time of filming, this baby was 8 weeks old and had been seriously ill in hospital for about 6 weeks.
When should I seek help?
You should see your family doctor if your child:
- is less than 1 year old and they have had contact with someone with whooping cough
- has a cough that goes on for a long time without any pauses, or has a cough that ends in vomiting
- has had a persistent daily cough that lasts longer than 2 weeks
- is less than 3 months old and has a cough
You should see a doctor urgently if your child of any age:
- goes blue when coughing, or stops breathing at the end of the cough, or appears frightened by the cough
- has breathing difficulty
- looks unwell and you are worried
Dial 111 within New Zealand for urgent medical help (use the appropriate emergency number in other countries) if your child:
- stops breathing
- has a convulsion
- needs oxygen -the signs of shortage of oxygen are looking very pale, going blue in the tongue and lips and becoming very sleepy and not easy to rouse