Key points to remember

• whooping cough causes bouts of coughing. Each bout may last for two or three minutes - 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 three months
• it is a highly contagious (catching) disease - it spreads easily from person to person
• 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 (see whooping cough immunisation on this website)

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 three to five 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. 

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 six 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 vomiting

• It starts with a runny nose and eyes, mild fever and sneezing – just like a virus cold. This lasts one or two weeks.
• Next there is an irritating cough. Over a week or two, 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, debilitating illness. 

Whooping cough may cause a range of other problems. See What are the complications?

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 infectious is whooping cough?

People can catch and spread whooping cough easily - it is highly contagious (catching). 

Whooping cough is most contagious in the first stage (before the typical cough starts). It may still be contagious three or four weeks after the cough starts.

Antibiotics have very little effect on the cough. However, if started early, antibiotics can reduce the amount of time your child is infectious to others from about three weeks to five 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:

• babies
• in children who have a heart, lung or another chronic medical problem

The younger your child, the greater the risk of getting very sick.

The best protection is to have your child fully immunised.

See:

• How can whooping cough be prevented? below

How is whooping cough diagnosed?

Whooping cough is usually diagnosed on your description of your child’s symptoms. Your GP (general practitioner) 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 or contagious).

Your child's infection-fighting (immune) system will help get rid of the bacteria after three or four 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 be admitted to hospital.  See Don't delay - Immunise for whooping cough

• begin immunisation at six weeks of age, and
• complete the first three doses on time to build the maximum protection

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

• are less than one year old
• were premature
• have a heart or lung condition

See:

• whooping cough immunisation on this website

How can I care for my child at home?

What are the complications?

• stopping breathing
• lack of oxygen
• pneumonia (see pneumonia on this website)
• seizures
• 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 rapid deterioration.

• babies under one year of age hospitalised with whooping cough have a one in 10 chance of ending up in the paediatric intensive care unit
• if they end up there, they have a one in six 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 eight weeks old and had been seriously ill in hospital for about six weeks.

When should I seek help?

You should see your GP (general practitioner) if your child:

• is less than one 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 two weeks
• is less than three 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 for urgent medical help 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

Where to go for more information

On this website

In the above video, health professionals talk about how severe whooping cough can be, particularly in young babies, and the importance of immunisation to protect them.

IMAC (Immunisation Advisory Centre) www.immune.org.nz

See the IMAC website for:

• information on whooping cough (pertussis)
• a whooping cough (pertussis) fact sheet for parents and caregivers (at right)

For questions on immunisation, vaccination-preventable diseases or a specific vaccine, you can contact the Immunisation Advisory Centre.
Call free on 0800 IMMUNE (0800 466863), weekdays 9am - 4.30 pm
Email: imac@auckland.ac.nz

 

Ministry of Health www.health.govt.nz

See the Ministry of Health website for:

• information about whooping cough
• parents sharing their experiences of whooping cough
   

HealthEd (NZ Ministry of Health) www.healthed.govt.nz
The HealthEd website houses a searchable catalogue of resources about key public health topics. Health professionals and members of the public can order one or multiple copies of the following whooping cough resources via this website:

• don't delay - immunise now for whooping cough (brochure)
• don't delay - immunise now for whooping cough (poster)