Whooping cough (pertussis)

What is whooping cough?

Whooping cough (pertussis) is a highly contagious respiratory disease that is found all over the world. It is caused by the bacterium Bordetella pertussis. Whooping cough is characterised by sudden, severe coughing fits, also known as a staccato cough. These coughing fits occur at irregular intervals, with the patient coughing intensely and in bursts. Furthermore, these fits may also be accompanied by vomiting.

How is whooping cough transmitted?

It is transmitted via droplet infection. This means that when a person coughs, sneezes or speaks, tiny droplets of secretions are released into the air, which can then be inhaled by others. The incubation period for whooping cough is around 6 to 20 days, usually 9–10 days.

How common is whooping cough?

The number of whooping cough cases is on the rise. In Austria, too, there has been an increase in the reported incidence of pertussis in recent years: between 2015 and 2018, the number of reported cases in Austria rose from 579 to almost 2,200. There has been a marked increase in cases among 15–20-year-olds, 40–45-year-olds and 65–70-year-olds, which may be due, amongst other things, to a loss of immunity several years after vaccination or after having had the disease.

What are the symptoms of whooping cough?

Whooping cough progresses in three stages, with the symptoms differing in each stage. Catarrhal stage (initial stage): In the first stage, the symptoms are still non-specific and similar to a cold, with the following symptoms:

• Cough
• Sneezing
• Sore throat
• runny nose

However, those affected are highly contagious. After about two weeks, the cough becomes increasingly severe and the condition progresses to the second stage. Convulsive stage (main stage):

• Severe, repeated coughing fits, up to 50 times a day
• Frequent night-time coughing fits
• Accompanying symptoms: the urge to retch, vomiting, and the production of thick phlegm.

Decrementi stage (recovery phase): The coughing fits and symptoms gradually subside and the illness usually resolves without any further risk of infection. Note: Not all of the symptoms listed need to occur in every person affected. If whooping cough is suspected, seek medical advice.

What are the possible associated conditions and complications?

If whooping cough is not diagnosed at the onset of the illness, various associated conditions and complications may arise. These include, for example:

• pneumonia
• Middle ear infection
• Seizures
• Weight loss
• Inguinal and umbilical hernias
• Haemorrhages into the conjunctiva

In infants: risk of life-threatening breathing stops

What are the risks of whooping cough for children?

The younger a child is, the more dangerous the illness is. This is particularly true for children in their first year of life, as they have not yet built up full immunity through vaccination. In infants under three months of age, due to their small airways and the lack of protective immunity, oxygen deprivation and pneumonia are more common; the typical symptom – paroxysmal coughing fits – is observed less frequently. As a rule, whooping cough heals completely without causing any lasting damage; however, in people with a weaker immune system and without vaccination protection – particularly in newborns and infants – the disease can be fatal if left untreated.

How is whooping cough diagnosed?

The diagnosis of whooping cough begins with taking a medical history, followed by a physical examination. Laboratory tests are carried out to confirm the diagnosis. Various methods are available for this purpose:

• Direct detection of the pathogen: taking a throat swab.
• Polymerase chain reaction (PCR): A highly specific method for detecting the whooping cough pathogen.
• Serological testing: Testing the blood for antibodies against the pathogen.

The choice of tests depends on various factors, such as the stage of the disease, the patient’s age, vaccination status and other individual health considerations. If complications or secondary conditions are suspected, further specific tests and additional investigations may be necessary.

How is whooping cough treated?

Whooping cough is treated with antibiotics, but only during the first three to four weeks. Antibiotic treatment can shorten the period during which the patient is infectious. However, it cannot stop the characteristic cough immediately. This is because the bacterium responsible produces a toxin that damages the mucous membranes and cilia in the lungs. The mucus clears only slowly. Improvement only sets in once the cilia have recovered. Whooping cough used to be known as the ‘100-day cough’, as full recovery can take some time. In addition, there are general measures which can support treatment, depending on the patient’s age and symptoms. Infants with whooping cough should be treated as inpatients; similarly, hospitalisation may be necessary for children and patients with a severe course of the illness. When treating whooping cough, it is advisable to ensure adequate fluid intake. Rest periods, particularly bed rest, can also aid the recovery process. Due to coughing fits and the potential for gagging, it is advisable to plan meals in several small portions spread throughout the day.

Who is at risk from whooping cough?

Regular booster vaccinations are an effective way of preventing whooping cough and indirectly protecting at-risk groups. Those at risk include unvaccinated individuals, particularly infants and children. Adults without adequate vaccination cover are a source of infection for newborns in the first few weeks of life, who cannot yet be vaccinated. Vaccination against pertussis is recommended for everyone, but is particularly important for, amongst others:

• Women planning to have children (before becoming pregnant)
• Pregnant women from the second trimester onwards (preferably in the third trimester), if their last pertussis vaccination was more than two years prior to the due date
• People in close contact with a newborn (parents, grandparents, siblings, babysitters, etc.)
• Healthcare workers
• People working in childcare facilities, schools, hospitals, retirement homes and care homes
• People in professions involving frequent direct contact with others (e.g. beauticians, home helpers)
• People aged 60 and over
• Smokers
• Young people and adults at increased risk due to an underlying medical condition (e.g. asthma, COPD, chronic lung, heart or circulatory diseases, immunosuppression)

Which doctor should I contact if I have symptoms of illness?

If you suspect whooping cough and experience the first symptoms, you should contact:

• a GP
• a hospital outpatient clinic or
• a paediatrician

Important: If you suspect whooping cough, you must inform the doctor by telephone in advance.