Whooping cough

Definition

Whooping cough (pertussis) is a highly contagious respiratory tract infection. In advanced stages, it's marked a severe, hacking cough followed by a high-pitched intake of breath that sounds like "whoop."

In the first half of the 20th century, whooping cough was a leading cause of childhood illness and death in the United States. But after the introduction of a vaccine, the number of cases gradually declined, reaching a low in the mid-1970s.

Since then, however, the incidence of whooping cough has been increasing, primarily among children too young to have completed the full course of vaccinations and teenagers and adults whose immunity has faded.

Symptoms

Once you become infected with whooping cough, it takes three to 12 days for signs and symptoms to appear. They're usually mild at first and resemble those of a common cold:

• Runny nose
• Nasal congestion
• Sneezing
• Red, watery eyes
• A mild fever
• Dry cough

After a week or two, signs and symptoms worsen. Severe and prolonged coughing attacks may:

• Bring up thick phlegm
• Provoke vomiting
• Result in a red or blue face
• Cause extreme fatigue
• End with a high-pitched "whoop" sound during the next breath of air

However, many people — particularly infants, adolescents and adults — don't develop the characteristic whoop. Sometimes, a persistent hacking cough is the only sign that an adolescent or adult has whooping cough.

When to see a doctor
Call your doctor if prolonged coughing spells cause you or your child to:

• Vomit
• Turn red or blue
• Inhale with a whooping sound

Causes

Whooping cough is caused by bacteria. When an infected person coughs or sneezes, tiny germ-laden droplets are sprayed into the air and breathed into the lungs of anyone who happens to be nearby.

Once inside your airways, the bacteria multiply and produce toxins that interfere with your respiratory tract's ability to sweep away germs. Thick mucus accumulates inside your airways, causing uncontrollable coughing.

The bacteria also cause inflammation that narrows breathing tubes in your lungs. This narrowing leaves you gasping for air — sucking in air with a high-pitched "whoop" — after a fit of coughing.

Bronchi

Bronchi

Your lungs draw air through your nose, mouth and throat into the tube-shaped trachea (windpipe), which passes into your chest cavity. At the level of your breastbone, your trachea splits into two ...

Risk factors

Whooping cough is thought to be on the rise for two main reasons. The whooping cough vaccine you receive as a child eventually wears off, leaving most teenagers and adults susceptible to the infection during an outbreak — and there continue to be regular outbreaks. In addition, children aren't fully immune to whooping cough until they've received at least three shots, leaving those 6 months and younger at greatest risk of contracting the infection.

Complications

Most people recover from whooping cough with no problems. When complications occur, they tend to be side effects of the strenuous coughing, such as:

• Bruised or cracked ribs
• Abdominal hernias
• Broken blood vessels in the skin or the whites of your eyes

Infants
In infants — especially those under 6 months of age — complications from whooping cough are more severe and may include:

• Ear infections
• Pneumonia
• Slowed or stopped breathing
• Dehydration
• Seizures
• Brain damage

Because infants and toddlers are at greatest risk of complications from whooping cough, they're more likely to need treatment in a hospital. Complications can be life-threatening for infants less than 6 months old.

Preparing for your appointment

If you think you or your child has whooping cough, make an appointment with your family doctor or pediatrician. Severe symptoms may warrant a visit to an urgent care center or a hospital's emergency department.

What you can do
You may want to write a list that includes:

• Detailed descriptions of the signs and symptoms
• Information about past medical problems
• Information about the medical problems of parents or siblings
• Questions you want to ask the doctor

What to expect from your doctor
Your doctor will conduct a physical exam and will use a stethoscope to listen closely to the lungs. Questions your doctor may ask include:

• When did the cough start?
• How long does a coughing spell generally last?
• Does anything trigger the cough?
• Does the cough ever cause gagging or vomiting?
• Has the cough ever resulted in a red or blue face?

Tests and diagnosis

Diagnosing whooping cough in its early stages can be difficult because the signs and symptoms resemble those of other common respiratory illnesses, such as a cold, the flu or bronchitis.

Sometimes, doctors can diagnose whooping cough simply by asking about symptoms and listening to the cough. Medical tests may be needed to confirm the diagnosis. Such tests may include:

• A nose or throat culture and test. Your doctor takes a nose or throat swab or suction sample. The sample is then sent to a lab and cultured or otherwise tested for whooping cough bacteria.
• Blood tests. A blood sample may be drawn and sent to a lab to check for a high white blood cell count. White blood cells help the body fight infections, such as whooping cough. A high white blood cell count typically indicates the presence of infection or inflammation. This is a general test and not specific for whooping cough, however.
• A chest X-ray. Your doctor may order an X-ray to check for the presence of inflammation or fluid in the lungs, which can occur when pneumonia complicates whooping cough and other respiratory infections.

Treatments and drugs

Infants are typically hospitalized for treatment, because whooping cough is more dangerous for that age group. If your child can't keep down liquids or food, intravenous fluids may be necessary. In some cases, prescription sedatives will help your child rest. Your child will also be isolated from others to prevent the infection from spreading.

Treatment for older children and adults usually can be managed at home.

Medications

• Antibiotics. Antibiotics kill the bacteria causing whooping cough and help speed recovery. Family members may be given preventive antibiotics.
• Cough relief. Unfortunately, not much is available to relieve the cough. Over-the-counter cough medicines, for instance, have little effect on whooping cough and are discouraged.

Lifestyle and home remedies

The following tips on dealing with coughing spells apply to anyone being treated for whooping cough at home:

• Get plenty of rest. A cool, quiet and dark bedroom may help you relax and rest better.
• Drink plenty of fluids. Water, juice and soups are good choices. In children, especially, watch for signs of dehydration, such as dry lips, crying without tears and infrequent urination.
• Eat smaller meals. To avoid vomiting after coughing, eat smaller, more-frequent meals rather than large ones.
• Vaporize the room. Use a mist vaporizer to help soothe irritated lungs and to help loosen respiratory secretions. If you use a vaporizer, follow directions for keeping it clean. If you don't have a vaporizer, a warm shower or bath also can temporarily help clear the lungs and ease breathing.
• Clean the air. Keep your home free of irritants that can trigger coughing spells, such as tobacco smoke and fumes from fireplaces.
• Prevent transmission. Cover your cough and wash your hands often; if you must be around others, wear a mask.

Prevention

The best way to prevent whooping cough is with the pertussis vaccine, which doctors often give in combination with vaccines against two other serious diseases, diphtheria and tetanus. Doctors recommend beginning vaccination during infancy.

The vaccine consists of a series of five injections, typically given to children at these ages:

• 2 months
• 4 months
• 6 months
• 12 to 18 months
• 4 to 6 years

Vaccine side effects
Side effects of the vaccine may include fever, crankiness or soreness at the site of the injection. In rare cases, severe side effects may occur, including:

• Persistent crying, lasting more than three hours
• High fever
• Seizures, shock or coma

Booster shots

• Adolescents. Because immunity from the pertussis vaccine tends to wane by age 11, doctors recommend a booster shot at that age to protect against whooping cough (pertussis), diphtheria and tetanus.
• Adults. Some varieties of the every-10-year tetanus and diphtheria vaccine also include protection against whooping cough (pertussis). In addition to protecting you against whooping cough, this vaccine will also reduce the risk of your transmitting whooping cough to infants.