Whooping cough: What you need to know

Whooping cough is a highly contagious disease caused by the bacterium Bordetella pertussis, also known as pertussis. Whooping cough is also known in some countries as the 100 day cough.

The disorder is named after a distinctive hacking cough, accompanied by a high-pitched air gasp that sounds like a “whoop.”

About 157 people per 100,000 had developed whooping cough in the United States prior to vaccination.

Peaks occurred every 2-5 years. They were children under the age of 10 in 93 per cent of cases. Experts claim that the actual occurrence was much higher at that time, since not all cases were registered.

Since mass vaccination was introduced in the 1940s, whooping cough rates fell to below 1 in 100,000 by 1970. It currently primarily affects infants who are too young to have undergone the entire course of vaccines, as well as teenagers whose immunity has waned. Since 1980, however, figures have begun creeping back up.

Important facts about whooping cough

Here are some key points about whooping cough. More detail and supporting information is in the main article.

  • Whooping cough is caused by the Bordetella pertussis bacterium.
  • Children who are not vaccinated are 23 times more likely to develop whooping cough.
  • The bacterium is spread in tiny droplets of water when the patient coughs and sneezes.
  • Infants with whooping cough are usually admitted to hospital for treatment.

Symptoms

Whooping cough image
Whooping cough symptoms start off mild and progress.

Whooping cough symptoms typically occur 6-20 days after the patient has been infected with the Bordetella pertussis bacterium, that is, pertussis has an incubation period of 6-to-20 days.

The disease begins with mild symptoms and then get much worse before it improves. Initial signs and symptoms of pertussis mimic common cold:

Initial symptoms

  • blocked nose
  • dry and irritating cough
  • malaise (general feeling of being unwell)
  • mild feve
  • runny nose
  • sore throat
  • watery eyes
  • diarrhea (sometimes)

For the first week the above signs and symptoms are normal, after which they get more severe.

Later (paroxysmal) symptoms

In the second stage of “paroxysmal” signs include:

Severe bouts of coughing – a bout can last a couple of minutes. Every bout sometimes comes so soon after the last one that the patient has cluster bouts that last for tens of minutes. Typically there’s 10-15 bouts every day.

During a bout of coughing, the patient finally gasps between coughs for air, and often creates a “whoop” sound immediately after the bout is over. This is less common in very young kids and babies-they may gag or gasp, or even temporarily stop breathing.

Young children can turn blue in the face (cyanosis) during a bout of coughing. Even though it’s terrifying for parents, it’s almost never as bad as it looks and breathing will soon resume.

Vomiting can be accompanied by coughing bouts; this is more common in young children and infants.

Whooping cough paroxysmal symptoms are less severe in adults and adolescents than in infants and young children-they are typically close to the bronchitis symptoms.

Whooping cough can in very rare cases cause sudden unexpected death in babies.

Recovery stage

At this point, the patient begins to show signs of recovery. There are less coughing bouts, which are less frequent too. The recovery stage could take 3 months or more. The patient can even experience bouts of intense coughing at this stage.

Causes

Bordetella pertussis is a bacterial infection caused by whoping cough. Infection occurs in the airway lining, especially in the trachea ( windpipe) as well as in the bronchi (airways that branch off the trachea into the lungs).

It multiplies and paralyzes mucus-clearing components of the lining as soon as Bordetella pertussis reaches the lining of the airways, causing mucus to accumulate. As the mucus builds up the patient tries to expel it by coughing; because there is so much mucus, the coughing becomes more intense.

When airway inflammation worsens (they swell up), they become narrower, making it difficult to breathe and causing the “whoop” when the patient attempts to get back their breath after a bout of coughing.

How does whooping cough spread?

People infected with Bordetella pertussis may transmit the infection to others from 6-20 days after the bacterium has entered their body for 3 weeks after the “whooping” cough has begun.

The bacterium is released into the air in tiny droplets of water. Hundreds of droplets of blood are released into the air as the patient coughs and snees.

If some of this moisture is inhaled by people nearby, they are exposed and may become sick.

Prevention and vaccines

Prevention of whooping cough is key. If a family member is sick, other family members will be advised to be treated with antibiotics.

The pertussis vaccine

The pertussis vaccine prevents whooping cough.
The pertussis vaccine prevents whooping cough.

The pertussis vaccine is required for the general public to avoid the condition; the DTaP vaccine protects against diphtheria, tetanus , and pertussis.

It is administered to babies and children in a sequence of five injections as part of the prescribed immunization schedule.

It is important that pregnant mothers are vaccinated against pertussis, as well as others that are in close contact with infants (newborns and babies up to 12 months of age.

Whooping cough affects about 48.5 million people per year, 295,000 of whom will die. Pertussis is one of the leading causes of vaccine-preventable deaths worldwide, according to WHO (World Health Organisation). Most cases occur in low- and middle-income countries (over 90 per cent).

Children of parents who would not authorize them to be vaccinated are 23 times more likely than completely immunized children to develop whooping cough, researchers reported in the journal Pediatrics.

Diagnosis and tests

Misdiagnosis is normal during its early stages, as the signs and symptoms are close to those seen in other respiratory diseases such as bronchitis, flu and common cold.

Typically, doctors can diagnose whooping cough by asking questions about symptoms and listening to cough (the sound of whooping cough is notable).

The following diagnostic tests may be ordered:

  • A throat or nose culture test – the doctor or nurse takes a swab or suction sample, which is sent to the lab and checked for the presence of the Bordetella pertussis bacterium.
  • Blood tests – the doctor may want to know what the white blood cell count is. If it is high, it means there is probably some kind of infection.
  • Chest X-ray – the doctor may want to see whether there is any inflammation or fluid in the lungs.

If whooping cough is suspected in an infant, they may need to be diagnosed in a hospital.

Treatment

Infants are usually treated for treatment in hospital because pertussis is more likely to lead to complications for that age group. Intravenous infusions may be appropriate if the child is unable to hold down any fluids or food. The baby is placed in an isolation ward to ensure the disease is not spreading.

Older children, teens and adults will normally be handled at home.

Drugs

Antibiotics are provided to destroy the Bordetella pertussis bacterium, and to help the patient heal more quickly. Antibiotics may be prescribed even for members of the family. Antibiotics can also protect the patient from being contagious within 5 days of their taking.

If pertussis is not detected until the later stages, antibiotics will not be given, because the bacteria have gone away by then.

Corticosteroids – administered when the child has serious symptoms; these are given along with antibiotics. Corticosteroids are strong hormones (steroids) that minimize inflammation in the airways very efficiently, making it easier for the child to breathe.

Oxygen – can be provided via a facemask when additional breathing assistance is needed. It is also possible to use a bulb syringe to absorb mucus that has built up in the airways.

Cough treatment – OTC (over-the-counter) cough medicines are unsuccessful in alleviating the symptoms of whooping cough and doctors warn against its use. Sadly, there’s not much that can be done with cough. Coughing tends to cough up phlegm that builds up in the airways.

Measures you can take at home

Typically the effects are less severe for older children and adults. The health care provider may advise the patient to:

  • Plenty of rest.
  • Consume plenty of fluids to prevent dehydration.
  • Try to keep excess mucus and vomit cleared from the airways and the back of the throat to prevent choking.
  • Tylenol (acetimophen, paracetamol) or ibuprofen to relieve sore throat and reduce a fever. Do not give aspirin to children under 16.

Complications

Older children and adults-with no complications or problems, most patients recover from pertussis. Complications are caused so much and so intensely by the strain of coughing, and can include:

  • a swollen face
  • abdominal hernias
  • broken blood vessels in the sclera (whites of the eyes)
  • cracked or bruised ribs
  • mouth and tongue ulcers
  • nosebleeds
  • otitis media (middle-ear infection)

Infants and young children are much more susceptible to serious complications from whooping cough, including:

Temporary breathing pause – there is a risk of brain damage due to oxygen deprivation (extremely rare) if the breathing difficulties are severe.

Pregnant mothers, people with a reduced immune system and those with diabetes are at higher risk of complications.

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