Overview

Whooping cough, also known as pertussis, is a highly contagious bacterial infection that affects the respiratory tract, including the throat, airways, and lungs. The disease is named for the "whooping" sound individuals often make when gasping for air after severe coughing fits. Caused by the Bordetella pertussis bacterium, whooping cough can affect people of all ages, but it is particularly dangerous for infants and young children, especially those who have not been fully vaccinated.

Each year, thousands of cases are reported globally, and although effective vaccines exist, pertussis continues to circulate, particularly in areas with lower vaccination rates.

Stages of the Illness

Whooping cough progresses in three distinct phases, each with unique symptoms and durations.

Catarrhal Stage

This initial stage usually lasts 1 to 2 weeks and presents with symptoms that resemble the common cold. During this period, the disease is at its most contagious.

  • Runny or stuffy nose

  • Mild coughing

  • Sneezing

  • Low-grade fever

  • Fatigue or malaise

  • Brief episodes of apnea in infants

Because the symptoms mimic mild respiratory illnesses, diagnosis at this stage can be difficult without targeted testing.

Paroxysmal Stage

The second stage can last from 1 to 6 weeks and is characterized by:

  • Severe coughing fits that are rapid and difficult to control

  • Vomiting after coughing

  • A high-pitched "whoop" sound during inhalation

  • Exhaustion following coughing episodes

This is the most severe phase and can be frightening, especially in children. Some may cough so violently that they struggle to breathe, and others may even turn blue due to oxygen deprivation.

Convalescent Stage

The final stage usually lasts 2 to 3 weeks. Symptoms begin to decrease, but the person may still experience a lingering, milder cough. In some cases, this cough can persist for months. During recovery, individuals may be more susceptible to other respiratory illnesses.

Causes and Transmission

Whooping cough is caused by Bordetella pertussis, a bacterium that spreads through airborne droplets when an infected person coughs, sneezes, laughs, or even breathes close to others.

  • Transmission is most likely during the catarrhal stage.

  • The bacterium can also be transmitted through contaminated surfaces followed by touching the nose or mouth.

  • Infected individuals remain contagious for up to two weeks after coughing begins.

Diagnosis

Diagnosis typically involves a combination of:

  • Reviewing medical history and symptom progression

  • Physical examination

  • A throat or nose swab to test for Bordetella pertussis

  • Blood tests or chest X-rays in more severe or complicated cases

Early diagnosis is crucial for prompt treatment and reducing the spread of the disease.

Treatment

Treatment depends on the stage and severity of the disease, as well as the age and overall health of the individual.

1. Antibiotics

  • Azithromycin (Zithromax)

  • Erythromycin (EryPed)

  • Clarithromycin (Klaricid)

These antibiotics are most effective if administered during the early stages.

2. Supportive Care

  • Rest

  • Hydration with clear fluids

  • Small, frequent meals to reduce vomiting

  • Avoiding environmental triggers like smoke or allergens

In severe cases, particularly in infants, hospitalization may be required for oxygen support, IV fluids, or close monitoring.

Complications

Complications vary by age and immune response, but infants are at highest risk.

In Babies and Children:

  • Apnea (temporary cessation of breathing)

  • Pneumonia

  • Seizures

  • Encephalopathy (brain swelling due to lack of oxygen)

In Teens and Adults:

  • Fractured ribs from intense coughing

  • Hernias

  • Urinary incontinence

  • Fainting or passing out

Without treatment, whooping cough can lead to serious illness or death, especially in infants under 12 months.

Prevention

Vaccination remains the most effective way to prevent whooping cough.

1. DTaP Vaccine (Children)

  • Administered at 2, 4, 6, 15–18 months, and 4–6 years

2. Tdap Booster (Adolescents and Adults)

  • A booster is recommended for preteens at age 11–12 and during each pregnancy

3. Cocooning Strategy

  • Vaccinating close contacts of infants (parents, siblings, grandparents, caregivers) to form a protective "cocoon"

4. Post-Exposure Prophylaxis

  • In some cases, antibiotics may be given to close contacts to prevent infection after exposure

Long-Term Outlook

With prompt and proper treatment, most individuals recover fully from whooping cough. However, the cough may persist for weeks or months. Regular vaccination, good hygiene practices, and early medical intervention are key to controlling the disease.

For high-risk groups like infants and immunocompromised individuals, minimizing exposure and ensuring timely vaccinations are critical steps in prevention.