Whooping Cough: Symptoms, Treatments, Medications and Prevention

by topschoolsintheusa · September 14, 2024

Whooping cough, also known as pertussis, is a highly contagious bacterial infection that affects the respiratory system. Caused by the bacterium Bordetella pertussis, it is known for its characteristic severe coughing fits, often followed by a “whooping” sound when the person inhales. While whooping cough can affect individuals of any age, it is especially dangerous for infants and young children, leading to significant morbidity and mortality worldwide. Despite being preventable through vaccination, outbreaks still occur in many regions, making understanding, prevention, and treatment crucial.

What is Whooping Cough?

Overview of Whooping Cough

Whooping cough, or pertussis, is a highly infectious disease caused by the Bordetella pertussis bacterium. It primarily affects the upper respiratory tract, causing severe coughing fits that can last for several weeks or even months. The disease gets its name from the distinctive “whoop” sound made by individuals, particularly children, when they struggle to breathe after a coughing fit. However, not everyone makes this sound, especially very young infants or adults, which can sometimes make diagnosis more challenging.

Pertussis is a dangerous illness, particularly for infants under six months of age who are not fully vaccinated. It can lead to life-threatening complications like pneumonia, seizures, brain damage, and, in some cases, death.

How Whooping Cough Spreads

Pertussis is a highly contagious disease that spreads through respiratory droplets when an infected person coughs, sneezes, or talks. The bacteria can easily be transmitted from one person to another, particularly in close quarters like schools, daycare centers, and households. Individuals infected with whooping cough are most contagious during the early stages of the illness, often before the severe coughing begins, making it difficult to prevent its spread without proper vaccination.

Who is at Risk of Whooping Cough?

High-Risk Populations

Whooping cough can affect people of all ages, but certain groups are more vulnerable to severe forms of the disease or complications.

1. Infants and Young Children

Infants, especially those younger than six months, are at the highest risk for contracting severe whooping cough. Babies are particularly susceptible because their immune systems are not fully developed, and they may not have completed the full course of pertussis vaccinations. Infants are more likely to develop life-threatening complications such as pneumonia, seizures, and even death. Infected infants often do not exhibit the classic “whoop” sound, and their condition can worsen rapidly.

2. Pregnant Women

Pregnant women, especially in their third trimester, are encouraged to get vaccinated to protect both themselves and their unborn child. When a pregnant woman receives the whooping cough vaccine (Tdap), antibodies are passed to the fetus, providing some immunity during the first few months of the infant’s life before they can receive vaccinations.

3. Unvaccinated or Under-Vaccinated Individuals

People who have not received the full series of pertussis vaccinations or who have not had their booster shots are at a higher risk of contracting and spreading the disease. This includes children who have missed vaccinations, as well as adults who have not received a booster dose of the Tdap vaccine.

4. People with Weakened Immune Systems

Individuals with compromised immune systems, such as those undergoing chemotherapy, organ transplant recipients, or people with chronic illnesses, are at a higher risk of severe pertussis infections. Their immune systems may not be strong enough to fight off the infection effectively.

5. Elderly Adults

Older adults, particularly those over the age of 65, are more susceptible to whooping cough. The immunity from childhood vaccinations wanes over time, and without booster shots, elderly individuals are more likely to contract the disease and suffer from prolonged illness.

6. Healthcare Workers and Caregivers

Healthcare workers and caregivers who come into close contact with infants, young children, or immunocompromised individuals are at higher risk of exposure to pertussis. Vaccination is crucial in these populations to prevent transmission to vulnerable individuals.

Geographic and Social Risk Factors

Whooping cough can spread quickly in certain environments due to close contact and shared spaces. Risk factors include:

Schools and Daycare Centers: Children in schools or daycare settings are at higher risk of contracting pertussis due to the close proximity and frequent contact with others.
Unvaccinated Communities: Communities with lower vaccination rates are more vulnerable to outbreaks of whooping cough. This can be due to lack of access to healthcare, vaccine hesitancy, or cultural factors.
Crowded Living Conditions: People living in densely populated areas or overcrowded housing may face an increased risk of whooping cough outbreaks due to the ease of transmission in close quarters.

Symptoms of Whooping Cough and How It Is Diagnosed

The symptoms of whooping cough typically develop in stages, beginning with mild cold-like symptoms and progressing to severe coughing fits. Because the early symptoms can resemble those of other respiratory illnesses, such as the common cold or flu, pertussis is often misdiagnosed in its initial phase.

Stages and Symptoms of Whooping Cough

1. Catarrhal Stage (1-2 Weeks)

The first stage of whooping cough, known as the catarrhal stage, is characterized by symptoms similar to a mild respiratory infection. This stage lasts one to two weeks and is the most contagious period of the illness.

Runny nose
Mild cough
Low-grade fever
Sneezing
Mild fatigue

During this phase, the symptoms are usually not severe, making it easy to mistake the illness for a cold or minor respiratory infection. However, pertussis bacteria are highly contagious during this time, and infected individuals can easily spread the disease to others.

2. Paroxysmal Stage (1-6 Weeks or Longer)

As the disease progresses to the paroxysmal stage, the hallmark severe coughing fits develop. This stage can last anywhere from one to six weeks or longer, depending on the individual’s health and age. The coughing fits, or paroxysms, are violent and uncontrollable, often leaving the person gasping for air afterward, leading to the characteristic “whooping” sound.

Severe, forceful coughing fits: These bouts of coughing can last for several minutes and may occur multiple times a day.
Whooping sound: The high-pitched “whoop” occurs when the person inhales sharply after a coughing fit. Infants may not exhibit this symptom.
Vomiting: The forceful coughing can trigger vomiting, especially in young children.
Exhaustion: The frequent and intense coughing fits leave the individual feeling fatigued and weak.
Red or blue face: During coughing fits, the person’s face may become flushed or blue due to lack of oxygen.

3. Convalescent Stage (Weeks to Months)

The final stage, known as the convalescent stage, marks the gradual recovery from whooping cough. During this period, the severity and frequency of coughing fits decrease, but milder symptoms can linger for weeks or even months. Some individuals may experience recurrent coughing fits if they catch another respiratory infection during recovery.

Coughing gradually decreases: While the severe coughing fits subside, a persistent cough may linger for weeks.
Gradual return to normal: Energy levels improve, and symptoms become less intense.

Complications of Whooping Cough

Whooping cough can lead to severe complications, particularly in infants and vulnerable populations. Some of the most common complications include:

Pneumonia: Pertussis can cause secondary bacterial pneumonia, a leading cause of hospitalization and death in infants.
Seizures: Severe coughing fits can lead to a lack of oxygen in the brain, causing seizures.
Apnea: Infants may experience periods where they stop breathing (apnea), especially during severe coughing spells.
Brain damage: Prolonged lack of oxygen can result in neurological complications, including brain damage.
Dehydration and weight loss: Vomiting after coughing fits can lead to dehydration and difficulty maintaining proper nutrition, especially in young children.

Diagnosis of Whooping Cough

Accurate and timely diagnosis of whooping cough is crucial for initiating treatment and preventing the spread of the disease. However, early symptoms often resemble those of other respiratory illnesses, making it difficult to diagnose during the catarrhal stage.

1. Medical History and Physical Examination

The first step in diagnosing whooping cough is taking a detailed medical history, including vaccination status and potential exposure to others with pertussis. During a physical examination, the doctor may listen to the characteristic coughing fits or “whoop” sound.

2. Laboratory Tests

Several laboratory tests are used to confirm a diagnosis of pertussis:

Nasopharyngeal swab or aspirate: A sample of mucus is collected from the back of the nose or throat and tested for the presence of Bordetella pertussis bacteria. This is the most common diagnostic test for pertussis.
Polymerase chain reaction (PCR) testing: PCR is a molecular test that detects the DNA of the pertussis bacteria in the mucus sample. It is highly sensitive and provides rapid results.
Blood tests: In some cases, blood tests may be used to measure antibodies against pertussis bacteria, especially if the diagnosis is made later in the course of the illness.
Chest X-ray: If pneumonia or other complications are suspected, a chest X-ray may be performed to assess lung function and detect any secondary infections.

Treatments of Whooping Cough

Whooping cough is treated with a combination of antibiotics and supportive care to reduce symptoms and prevent the spread of the disease. Early treatment is crucial for improving outcomes and minimizing complications, particularly in vulnerable populations like infants and the elderly.

1. Antibiotic Therapy

Antibiotics are the main treatment for whooping cough. They work by eliminating the Bordetella pertussis bacteria from the respiratory tract and preventing further spread of the infection. While antibiotics cannot reverse the damage caused by the bacterial toxins or stop the severe coughing fits once they have started, they can reduce the duration of contagiousness.

Macrolide antibiotics: The most commonly prescribed antibiotics for whooping cough are macrolides, which include:
- Azithromycin
- Clarithromycin
- Erythromycin

These antibiotics are effective at killing the bacteria and are typically prescribed for a 5- to 7-day course. Infants younger than one month are often treated with azithromycin because it is considered safer for this age group.

2. Supportive Care

Since antibiotics do not directly alleviate the symptoms of whooping cough, supportive care is an important aspect of treatment. Supportive care focuses on managing the symptoms and ensuring the patient’s comfort and recovery.

1. Hydration

Ensuring proper hydration is essential, especially for infants and young children who may struggle with dehydration due to vomiting or difficulty feeding. Frequent small feedings and oral rehydration solutions can help prevent dehydration.

2. Rest

Pertussis can cause significant exhaustion due to the violent coughing fits. Adequate rest is necessary for the body to recover and regain strength.

3. Humidified Air

Humidified air can help ease breathing and reduce throat irritation caused by coughing. Using a humidifier in the room where the patient sleeps or taking steamy showers can provide relief.

4. Oxygen Therapy

In severe cases where the patient is struggling to breathe or experiencing apnea, oxygen therapy may be administered in a hospital setting. Infants are especially vulnerable to respiratory distress and may require close monitoring.

5. Hospitalization

Infants, particularly those under six months, are at high risk of severe complications from pertussis and may require hospitalization. Hospital care may include intravenous fluids, respiratory support, and monitoring for apnea or pneumonia.

3. Treatment of Complications

In cases where whooping cough leads to complications such as pneumonia or seizures, additional medical interventions may be necessary.

Pneumonia treatment: Secondary bacterial pneumonia is treated with antibiotics, often requiring hospitalization and possibly mechanical ventilation for severe cases.
Seizure management: Seizures caused by lack of oxygen may require anticonvulsant medications and close monitoring in a hospital.

Most Common Medications for Whooping Cough

The treatment of whooping cough relies primarily on antibiotics to eliminate the bacteria and supportive medications to manage symptoms. While antibiotics are effective in reducing the contagious period of the illness, they do not fully resolve the symptoms once the disease has progressed to the paroxysmal stage.

1. Azithromycin

Azithromycin is the preferred antibiotic for treating whooping cough in infants, young children, and pregnant women. It is a macrolide antibiotic that is safe for use in infants younger than one month, making it the drug of choice for this age group. Azithromycin is typically given in a 5-day course and works by stopping the growth of the pertussis bacteria.

2. Clarithromycin

Clarithromycin is another macrolide antibiotic used to treat pertussis. It is commonly prescribed for children and adults and is effective in eliminating the bacteria from the respiratory tract. A typical course of clarithromycin lasts 7 days.

3. Erythromycin

Erythromycin was historically the most commonly used antibiotic for whooping cough, but it is now less frequently prescribed due to its association with gastrointestinal side effects. It is still effective against Bordetella pertussis, and the standard course of treatment lasts 14 days.

4. Trimethoprim-Sulfamethoxazole (TMP-SMX)

Trimethoprim-sulfamethoxazole is an alternative antibiotic for patients who cannot tolerate macrolides or who have a history of allergic reactions to them. TMP-SMX is effective in treating whooping cough in both adults and children.

5. Antipyretics and Analgesics

Over-the-counter medications such as acetaminophen or ibuprofen may be used to reduce fever and relieve pain or discomfort associated with whooping cough. These medications do not treat the infection but can help alleviate symptoms like sore throat or muscle aches caused by prolonged coughing.

Where is Whooping Cough Most Prevalent?

While whooping cough has been largely controlled in many parts of the world due to widespread vaccination, outbreaks still occur, particularly in areas with declining immunization rates or incomplete vaccine coverage.

1. Developed Countries

In many developed countries, such as the United States, Canada, Australia, and much of Europe, whooping cough cases have significantly decreased due to routine childhood immunization programs. However, periodic outbreaks still occur, particularly among:

Unvaccinated individuals: Areas with lower vaccination rates, often due to vaccine hesitancy or misinformation, are at higher risk for pertussis outbreaks.
Waning immunity: Adolescents and adults who have not received booster vaccines may experience waning immunity, contributing to the spread of the disease in these populations.

2. Developing Countries

In low- and middle-income countries, particularly in regions of Africa, Asia, and parts of Latin America, pertussis remains a significant public health issue. In these regions, barriers to healthcare access, low vaccination coverage, and poor sanitation contribute to higher rates of whooping cough.

Countries such as India, Nigeria, and Pakistan report large numbers of pertussis cases, particularly in rural areas where access to vaccinations is limited. Efforts to expand immunization coverage in these regions are crucial to reducing the global burden of pertussis.

3. Refugee Camps and Conflict Zones

In regions affected by conflict, such as Syria, Yemen, and parts of Sub-Saharan Africa, healthcare systems are often disrupted, leading to decreased vaccination rates and outbreaks of preventable diseases like whooping cough. Refugee camps and displaced populations are particularly vulnerable to pertussis outbreaks due to overcrowded living conditions and limited access to healthcare services.

Prevention of Whooping Cough

The most effective way to prevent whooping cough is through vaccination. Immunization programs, public health education, and booster doses for older children and adults are critical components of whooping cough prevention.

1. Vaccination

The pertussis vaccine is administered as part of the combination vaccine known as DTaP (diphtheria, tetanus, and acellular pertussis) for children and Tdap (tetanus, diphtheria, and acellular pertussis) for adolescents and adults. Vaccination is the primary method of preventing whooping cough and reducing its spread within communities.

DTaP Vaccine

For infants and young children: The DTaP vaccine is given in a series of five doses at 2, 4, 6, and 15-18 months of age, with a booster shot at 4-6 years old. These vaccinations provide immunity against diphtheria, tetanus, and pertussis.

Tdap Booster

For adolescents and adults: Adolescents receive a Tdap booster shot at 11-12 years of age. Adults, particularly pregnant women and those in close contact with infants, should receive a Tdap booster to ensure continued immunity.
Pregnant women: It is recommended that pregnant women receive the Tdap vaccine during the third trimester of each pregnancy to protect both the mother and the newborn from pertussis. The antibodies passed from mother to baby provide early protection before the infant can be vaccinated.

2. Herd Immunity

Herd immunity occurs when a large portion of the population is vaccinated, reducing the overall spread of the disease and protecting those who cannot be vaccinated, such as infants, immunocompromised individuals, and people with allergies to vaccine components. Maintaining high vaccination rates in the community is essential to preventing whooping cough outbreaks.

3. Good Hygiene Practices

In addition to vaccination, practicing good hygiene can help reduce the spread of whooping cough, especially during outbreaks.

Covering the mouth and nose: Covering the mouth and nose with a tissue or elbow when coughing or sneezing helps prevent the spread of respiratory droplets that can contain pertussis bacteria.
Frequent handwashing: Regular handwashing with soap and water or using hand sanitizer can help reduce the spread of bacteria and viruses.
Isolating infected individuals: People with whooping cough should stay away from others, particularly infants and vulnerable populations, until they have completed at least five days of antibiotic treatment to reduce the risk of transmission.