Whooping cough (pertussis)
Whooping cough is a bacterial infection of the airways, spread through the air by coughing and talking, and it is extraordinarily contagious.
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Medicines commonly prescribed for Whooping cough (pertussis)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 1000 mgActive substance: azithromycinManufacturer: Pfizer S.L.Prescription requiredDosage form: TABLET, 500 mgActive substance: azithromycinManufacturer: Tarbis Farma S.L.Prescription requiredDosage form: TABLET, 500 mg clarithromycinActive substance: clarithromycinManufacturer: Laboratorios Alter S.A.Prescription required
Whooping cough is a bacterial infection of the airways, spread through the air by coughing and talking, and it is extraordinarily contagious. An adult usually gets an exhausting cough that drags on for weeks — unpleasant, but not much more than that. For a baby in the first months of life it is lethal, and it is lethal partly because it does not look the way people expect: not bouts of coughing with a whoop at the end, but pauses in breathing and a baby turning blue. That gap between "a cough that will not go away in an adult" and "a threat to life in an infant" is the central fact about this illness.
It starts as a cold
Roughly a week to ten days pass between catching the infection and the first signs, sometimes as long as three weeks. The first phase is indistinguishable from an ordinary cold: runny nose, sneezing, a scratchy throat, a mild cough, and a temperature that is normal or barely raised. This lasts a week or two, and nobody is thinking about whooping cough during it. Yet this is exactly when the person is most infectious and exactly when an antibiotic would do the most good — that is the central trap of the disease.
A cough you cannot mistake for anything else
Then the cough changes. It comes in bouts: a run of coughs one after another with no chance to draw breath between them, the face reddening or turning purple, the eyes streaming, the veins in the neck standing out. When air finally forces its way through the narrowed airways it produces that sharp whistling gasp on breathing in — the whoop that gives the illness its English name. A bout often ends with vomiting of thick mucus, and afterwards the person needs several minutes to recover, drained. Between bouts they can look completely well, which is thoroughly misleading. Bouts are commoner at night and are set off by laughing, crying, eating, cold air and exertion. The whoop is not universal: in teenagers and adults it is often absent altogether, leaving only a punishing cough that ends in vomiting or in running out of air — which is why in that age group whooping cough is so often put down to a bronchitis that has overstayed.
The third phase is a long fade. The bouts gradually thin out, but the cough stays for many more weeks and sometimes several months; in some languages the illness is called "the hundred-day cough". Any subsequent cold can bring the bouts back briefly, and that does not mean the infection has not been treated. The cough itself extracts a price: in adults it causes cracked ribs, hernias, leaking of urine, bleeding into the white of the eye, fainting after a particularly violent bout, and complete exhaustion.
Why it is so dangerous for babies
Babies in the first months are not yet protected by vaccines of their own, and their airways are narrow, so the illness hits them hardest. It also looks different in them.
In a young baby whooping cough may show itself not as a cough but as pauses in breathing. The baby goes still, stops breathing for a few seconds or longer, and turns blue or grey — the lips, the tongue, the face; on darker skin this is easier to see on the palms and the soles. There may be no coughing bout at all. Other signs should raise alarm too: feeding weakly or refusing feeds, unusual sleepiness, fast shallow breathing, and the spaces between the ribs and the hollow at the base of the neck pulling in with each breath. The complications are worse as well: pneumonia, dehydration, seizures, brain damage from lack of oxygen. Babies in the first months are almost always admitted to hospital, where breathing can be watched around the clock.
From this comes a practical rule for a household: if there is a baby under six months in the home, any prolonged coughing-in-bouts in an adult or an older child is a reason to see a doctor straight away, not to wait for it to pass. Infants nearly always catch it at home, most often from parents and older siblings who are convinced they merely have a lingering cold.
When to call an ambulance
Call an ambulance immediately — in Spain, Italy, Portugal, Poland and Ukraine the single European number is 112 — if a child or an adult has:
- stopped breathing, or pauses in breathing during or after a coughing bout;
- lips, tongue, face or skin turning blue or grey;
- fast, shallow breathing with the spaces between the ribs drawing in, or obvious difficulty breathing;
- a seizure;
- a child who is floppy, not responding as usual, or hard to wake;
- chest pain that worsens on breathing in or coughing — this may be pneumonia.
Do not drive the child yourself: during a bout help may be needed that cannot be given from behind the wheel. The same day, but without an ambulance, a doctor should see coughing bouts in a baby, in a pregnant woman, or in anyone with lung disease or reduced immunity, and also a cough that ends in vomiting and has lasted more than two weeks, or any cough after contact with a confirmed case.
What antibiotics do and do not do
This is where disappointment usually sets in, and it helps to know in advance how it works. Whooping cough is treated with macrolide antibiotics, and the main point of that treatment is not to ease the cough but to stop the person being infectious. After a few days of tablets they stop shedding the bacterium and are no longer a danger to those around them, babies above all.
On the cough itself an antibiotic only has an effect if started early — in the first weeks of the illness, and ideally during that "cold" phase when nobody is yet thinking of whooping cough. Later the bacterium clears by itself while the cough carries on, sustained by the damage already done to the lining of the airways. There is nothing left to kill at that point, so the cough will not disappear when the course finishes and will run on for weeks. That does not mean the treatment failed or that a different drug is needed.
A course that has been started is finished, even once you feel better. Separately, a doctor may prescribe an antibiotic for healthy people living with the patient, above all where the household includes a baby, a woman late in pregnancy or someone with severe lung disease: that is not treatment but a way of breaking the chain of transmission. The diagnosis is confirmed with a swab from the back of the nose, and where the cough has gone on for some time, with a blood test for antibodies. Cough syrups and expectorants do not work in whooping cough, and many of them are contraindicated in small children anyway.
Getting through these weeks
While the cough runs its course, the job is to cut down the number of bouts and stop the person becoming exhausted.
- Rest and sleep. Bouts get worse with tiredness, and broken nights wear out the whole household. Resting during the day is sensible, not self-indulgent.
- Drinks and small, frequent meals. Vomiting after bouts leads to dehydration quickly, particularly in children. Feed little and often, straight after a bout rather than before one. Watch for signs of dehydration: dry mouth, passing little urine, listlessness and, in a baby, a sunken fontanelle and fewer wet nappies.
- A calm room and clean air. Tobacco smoke, strong smells, aerosols, dust, cold dry air and boisterous play all trigger bouts. Air the room and do not smoke indoors.
- Position. During a bout it is easier sitting up and leaning forward; a baby is held upright. Afterwards, allow a few quiet minutes to get the breath back.
- Pain relief. For headache and sore muscles and ribs, paracetamol or ibuprofen at the appropriate dose for age. Aspirin is not given to children and adolescents.
- Watching the breathing. If the patient is a small child being looked after at home, they should sleep in the same room as an adult.
Infectiousness and the people around
A person is infectious from the very first "cold" days and stays so for about three weeks from the start of the cough if no antibiotic is taken; on treatment the infectiousness ends within a few days. So for that period it is sensible to stay away from school, nursery and work, and the rule counts double for anyone who works with babies, pregnant women or seriously ill patients. Everyone in close contact should know the risk: if they develop a cough, they need to tell the doctor about the contact, or whooping cough will be missed all over again.
Vaccination: what protects a newborn
The most important thing about prevention fits into one sentence. A vaccine given during pregnancy protects the newborn through the first months of life, until the age at which the baby can be vaccinated directly. The mother's antibodies cross the placenta, and it is those antibodies that cover the child through exactly the stretch when the illness is most dangerous to them. It is the single most effective way of keeping a baby safe from whooping cough, and it works regardless of whether the woman was vaccinated years earlier: the vaccine is given afresh in every pregnancy. The point within the pregnancy is set by the national schedule of the country you live in.
After that the child receives the first doses during the first year of life and boosters later on; the exact timing and the make-up of the vaccine are likewise set by the national schedule. The general rule is simple: start as early as possible and do not put it off, because every missed dose leaves the child unprotected at precisely the most vulnerable age.
There is a second point that is less widely known. Protection from the whooping cough vaccine fades over time — over years, not for good. That is why teenagers and adults vaccinated in childhood do still catch it; the illness is usually milder in them, but they are just as infectious, and they are the ones who most often carry it home to a baby. For the same reason, having had whooping cough does not confer lifelong immunity: it can be caught again. Boosters for adults, especially those expecting a child or living with a newborn, are a question for the doctor and for the national schedule.
Online consultation
Whooping cough is exactly the sort of subject where a conversation at a distance settles a great deal, because the diagnosis rests largely on the account given. The doctor will ask how it began, how many days the cough has lasted, what the bouts look like, whether there is vomiting and a whoop, what sets them off, whether there has been contact with anyone coughing, and which vaccinations have been given and when. A bout can be recorded on video, which tells a doctor a great deal. Out of that comes whether this looks like whooping cough, which swab or test is worth doing, and whether there is still a window in which an antibiotic will help.
The things that worry a family most can also be worked through online: what to do if there is a baby in the house, which household members need preventive treatment, how many days to stay away from work and nursery, what to expect from treatment, and when the cough will finally start to ease. The limits of a remote appointment are clear: a child cannot be examined, the chest cannot be listened to and breathing cannot be assessed except in person, and a pause in breathing, a blue colour, a seizure or obvious difficulty breathing calls for an ambulance rather than an appointment.
This material is for information only and does not replace medical advice.
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