Menstuff® has information on Whooping Cough (Pertussis):
Symptoms and Sounds
Who catches whooping cough?
How do you catch it and pass it on
Whooping cough printout for doctors
Statistics about whooping cough
Quick self diagnosis
Adolescent and Adult Pertussis Immunization Issues
Worldwide, there are 3050 million pertussis cases and about
300,000 deaths per year. Despite generally high coverage with the DTP
and DTaP vaccines, pertussis is one of the leading causes of
vaccine-preventable deaths world-wide. Most deaths occur in young
infants who are either unvaccinated or incompletely vaccinated; three
doses of the vaccine are necessary for complete protection against
pertussis. Ninety percent of all cases occur in the developing world.
Children tend to catch it more than adults.
Symptoms and Sounds
Fever is usually limited to the first week and is only mild. There may be a runny nose like a cold in the early stages. After the first 2 weeks, the characteristics described below are predominant.
Major Symptoms (usually from 2 weeks onwards). Attacks of a choking cough that lasts from 1 to 2 minutes, often with vomiting, severe facial congestions and a feeling or appearance of suffocation. Between these attacks of coughing the sufferer appears and usually feels perfectly well.These choking attacks of coughing happen as little as twice a day or as many as fifty. Between attacks ('paroxysms' is the technical name) the sufferer may not cough at all.'Whooping' is a noise that comes from the voice box after a paroxysm when the sufferer is suddenly able to take a breath in again.
Only about 50% of whooping cough sufferers 'whoop' but this is where the name comes from. Sometimes the patient stops breathing after a severe bout of coughing, long enough to go blue. Occasionally the patient faints as well. Recovery is usually rapid however, and back to normal within a couple of minutes
Whooping cough lasts at least 3 weeks and can frequently go on for 3 months or even longer. I am told that in China it is called the 100 day cough.
Late symptoms. Whooping cough resolves by a slow reduction in the number of choking attacks. From the time the attacks start to reduce in number, to the time they finish, it may be roughly from 2 weeks to 2 months or more. The average case of whooping cough lasts about 7 weeks. But for people with whooping cough visiting this site, it is likely to last longer, because only more severe cases are likely to get hereImportant points
The crucial point for clinical diagnosis is attacks of severe
choking cough separated by long intervals of NO COUGHING AT ALL.
There is immense variation in severity and duration of the
illness.MOST CASES GO UNDIAGNOSED BECAUSE THE PHYSICIAN NEVER HEARS
THE PATIENT COUGH AND CANNOT BELIEVE IT IS AS SEVERE AS HE/SHE IS
BEING TOLD. AND LISTENING WITH A STETHOSCOPE INDICATES NORMAL LUNGS
IN WHOOPING COUGH!
There are a few exceptions however.
One exception is in those who get severe illness. This is most often infants, particularly those under 3 to 6 months, but it also applies to the frail or very elderly and those debilitated by other illness or malnutrition. In such cases treatment with steroids can reduce the severity and antibiotics might be used to prevent complicating infections. Supportive measures with hydration and oxygenation may be necessary. Such cases would obviously be in hospital. It should be noted that in the developed world one would not expect even 1% of cases to require hospitalization because most cases are mild.
Another exception is when serious complications occur. This is also rare and probably affects about 1 or 2% of cases in the developed world. The most frequent complication is pneumonia which requires standard antibiotic treatment. Some patients get a secondary infection of bacterial tracheo-bronchitis causing increased cough and sputum which may improve with antibiotics, but does not generally cause illness.
For very young babies whooping cough is a dangerous illness and they can die from pneumonia, respiratory failure and encephalopathy. It is to protect babies that we have an immunization program, and it is effective.
Many people with whooping cough are given an antibiotic such as erythromycin. This is to kill any Bordetella pertussis they may still carry so as to make it more difficult to pass it on to others. It does not help the disease because the bugs have already done the damage by the time it is usually diagnosed. If however you have such an antibiotic while you are incubating the disease it is believed it may prevent it developing.
A physiotherapist has emailed me an enecdote that I am inserting below. I would appreciate any feedback about it.
"We have named the following technique Christabel's method after
my daughter (9) as she noted that by attempting to stop herself from
inspiring reflexively between coughs she could reduce the length and
the violence of the cough and prevent reflux. Simply put she delays
herself breathing in and holds what breath she has left for as long
as possible then tries to breath slowly. This technique may not work
on the first cough of the series but in our experience appears to
slow down subsequent coughs. The techniques requires practice but
does allow the patient some control back in their bodies! As this
method requires the patient to overcome their natural reactions I
suspect this is only suitable for older children and adults."
Who catches whooping cough?
When there is no immunization against whooping cough in a population, most will have had the illness by the time they are five years old and will remain immune for the rest of their lives because the illness builds up good antibody levels, and because these antibodies are being boosted by frequent contact with the organism.
But we now live in an environment where most children are immunized early in life against whooping cough, giving them important protection against it at an age when it would otherwise be so easily spread by them to their newborn unimmunized siblings whom it could kill. We must remember that immunization has drastically reduced the impact of whooping cough on our populations.
So nowadays in developed communities there are five groups of people who are relatively susceptible. (And come to think about it, it is almost everybody)
The bottom line
It used to be children under 5 who caught it before about 1950.
Now it seems to be principally primary school children (5yrs to
11yrs), and mature adults coming a close second. So any age can be
affected, but the pattern will vary from place to place.
How do you catch it and pass it on
Although contacts in the same house are likely to get it, it can also pass easily between friends, especially children. It does not pass so easily between adults, who tend to cough away from people rather than directly over them. It is most infectious in the first 2 weeks when it seems no different from an ordinary cough and cold.
Most people who have whooping cough can identify the person who gave it to them. This is because it is usually somebody you have been in close contact with and because you have heard THEM cough the same unusual choking cough that you now have!
It takes more than the inhalation of one bacterium to cause whooping cough. You probably need to inhale hundreds or thousands unless you are really susceptible (like the newborn). You also need to have no immunity to whooping cough to get it easily. Most people will be partially immune through previous infection or whooping cough immunization (shots).
Immunity doesn't last forever. That is why quite a lot of older children and adults get it.
There are probably other things that make people more vulnerable to catching it from time to time. In my experience I have found that having a viral cold or cough increases the likelihood of catching whooping cough. This can make the diagnosis of whooping cough even more difficult because you have two illnesses in succession. People who suffer from asthma also seem more susceptible to whooping cough, although paradoxically, asthmatics who get whooping cough often find their asthma is improved for the duration of whooping cough and for some time afterwards!
It is possible to be infectious (able to pass the infection to
others) for a maximum of six weeks from when symptoms first start.
For practical purposes, most people agree that after three weeks it
is most unlikely to be passed on. But the main reason for having an
antibiotic is that at whatever stage the disease is at, after five
(possibly three) days after starting the antibiotic, the person can
be considered non-infectious and no danger to others. It is usual,
however, to have an antibiotic for 7 to 14 days.
Unfortunately there is no easy way.
The usual way is to try to detect the causative organism (Bordetella pertussis) in the back of the nose. This usually involves passing a swab on a wire through a nostril to the back of the throat and sending it to a medical lab to culture the material. This may take 5 to 7 days. If Bordetella pertussis or parapertussis grows this is usually taken as proof that it is whooping cough.
Unfortunately the organisms is delicate, killed easily by many antibiotics and has often been eliminated from the body by natural defences by the time the diagnosis is suspected. It is easiest to find it in the first 2 weeks but very unlikely after 3 weeks. But the patient has often had it for 3 weeks before whooping cough is suspected. So it is unusual to get a positive culture in whooping cough. In other words, if a swab is negative, the patient can still have whooping cough.
A better and more modern way of detecting the organism is by detecting its unique DNA pattern by means of polymerase chain reaction (PCR). This also involves getting material from the back of the nose and specialist laboratory testing. A result can be obtained in 24 to 48 hours.
It also depends on the organism being present, which it may no longer be, but since it detects minute quantities of genetic material it is more likely to be positive than culture in cases of whooping cough.
Antibody tests are done by some laboratories on blood samples taken after several weeks of illness. By looking at IgG and IgA antibodies to fimbria, pertussis toxin and filamentous haemagglutinin, it is possible to say whether it is likely the patient has had whooping cough. It is a highly specialized test and you may have difficulty finding a lab able to do it. There are several variations on this theme. Sometimes one specimen about 3 weeks into the illness is required, sometimes two specimens some weeks apart. Some labs do less satisfactory immunological tests. These tests are not always accurate. They sometimes say the patient has had whooping cough when they haven't, and sometimes the other way round. You need to know the reliability of a test before accepting the answer as true.
In the United Kingdom (since 1/4/2002), NHS labs (via the PHLS) can do pertussis toxin ELISA IgG on a single sample at least 3 weeks into the illness and give valuable diagnostic result. They can also arrange PCR in special (usually hospitalised) cases.
The bottom line is that in practice the diagnosis has to be made
on symptoms and course of the illness alone. This too can be wrong of
This is where many published figures are misleading and may lead you to believe that whooping cough has a high rate of complications. Because whooping cough goes unrecognized much of the time official figures tend to exaggerate the severity and underestimate the incidence (the number of cases).
In my published study of 500 consecutive cases in an English village over 20 years, only 1 in 100 developed significant complications (always pneumonia).
The worst complication is death. This is rare except in young babies for whom it is a more exhausting illness than some can stand. In babies it can lead to respiratory failure, convulsions and coma from encephalopathy. It is thought that some very young babies who get it, do not cough at all, but simply get the 'stopping breathing' bit that usually comes after a bout of coughing, with possibly very serious consequences. In the United Kingdom it is estimated that one child in 1500 who gets it under the age of one, dies from it. (Anxious parents should take comfort from this). In older children death is very rare; 1 in 20,000 cases. In the underdeveloped world, the mortality is vastly greater.
There are minor complications that are often described but usually occur only in the most severe. These are; bleeding over the white of the eye (subconjunctival haemorrhage), blood spots in the skin (petechiae), tearing of the ligament at the base of the tongue and umbilical hernia. All these are caused by congestion of blood or the strain of coughing, retching and vomiting.
All these things are described in textbooks and reading them gives the impression they are very common.
I have to tell you that although I know these things do occur. None of my patients (in my family practice) has yet, to my knowledge, developed any of these congestion caused complications.
Some people faint with paroxysms and may make involuntary jerking movements resembling a fit. They may have no recollection of the faint, but unlike a true fit, they will remember the events leading up to it.
Other ill effects
It is suspected that undiagnosed whooping cough could be the cause some pneumonia cases in children and even possibly some cases of sudden infant death syndrome.
Long term complications
It used to be thought that whooping cough led to bronchiectasis, a condition in which the main air passages in the lungs become enlarged and distorted, allowing sputum to accumulate and fester, causing the sufferer to have a chronic productive cough and susceptibility to more severe lung infections and general debility, if severe. Most cases of bronchiectasis have probably not been caused by whooping cough, but by previous pneumonia. I do not know of any good evidence that uncomplicated whooping cough causes bronchiectasis.
More people who have whooping cough have asthma than those who
have not had whooping cough. Whooping cough DOES NOT CAUSE ASTHMA. It
just so happens that people with asthma seem more susceptible to
Whooping cough printout for doctors
If your patient gives you this, it is as a result of my advice to do so, so please indulge me and your patient by giving it some consideration. www.whoopingcough.net exists to help patients with it to get diagnosed by their own doctor.
Whooping cough AS IT REALLY IS in the developed world today.
It is not like the traditional descriptions that you read about in most textbooks, or how you have learnt it. Text book descriptions are of a perceived stereotype illness and have been copied from each other down the years. They do not describe pertussis infection as it usually presents nowadays.
This page is to help inform doctors about whooping cough so they can diagnose and support their patients. Some of them may have been referred to this site by patients who have visited here, found it informative and wish to share the information with their physician.
I will tell you who I am, as you will not necessarily want to scrutinize the whole site. My name is Doug Jenkinson. I am a family doctor in Nottingham, England. I have made a special study of whooping cough in the community in which I work (11,000 patients) over the last 25 years. I have meticulously studied every case of whooping cough that has occurred in this time (over 700), and built up a good working knowledge of the disease as it affects individuals. I have published extensively on the subject. (most relevantly 'Natural course of 500 consecutive cases of whooping cough: a general practice population study. Jenkinson D. Br Med J 1995;310,299-302.')
The issue with whooping cough is the extreme difficulty of making a diagnosis. There is little doubt that most cases go undiagnosed by doctors. Some of these patients find the diagnosis for themselves with the aid of a site like this, but then usually have the diagnosis rejected by their doctor.
The reasons for the difficulty are simple. There are four difficulties and misconceptions
1. Most doctors are not familiar with the unique character of the sound of a whooping cough paroxysm because they have never heard one or had the opportunity to hear one.
2. Doctors believe that whooping cough is a severe and serious illness causing frequent coughing and that they could not possibly miss such a diagnosis if their patient had it. In fact, most patients feel and look perfectly well with whooping cough and usually go for many hours at a time between paroxysms. So you are most unlikely to hear a patient with whooping cough who coughs at all. And we are all so used to patients exaggerating the severity of their symptoms, that a patient with whooping cough describing their cough accurately sounds just like a patient with an ordinary cough using a bit of poetic license.
3. Doctors think it is rare. Wrong. It is far more common than we think. Because it is unrecognized, few cases are officially notified. This reinforces the idea of rarity. Research from several different sources confirms that may be roughly 50 times more common than is recognized.
4. Doctors think it has been immunized out of existence. Wrong. The effect of immunization only lasts a few years. Adolescents and adults become vulnerable once again. Adults can now get it and pass it to their children. (A recent concern)
How do you diagnose it?
First you need a high index of suspicion.
Second, you need to know that when it occurs it still tends to be in small outbreaks in a school or church community. You should find several cases. Such clusters are strongly in favor of pertussis as the cause.
Thirdly, outbreaks tend to occur every 4 to 6 years. The intervals are variable and probably reflect the underlying immunization rate.
Fourth is the history, and is without doubt the most important factor in diagnosis. Most patients, or parents of children with whooping cough do not give a history spontaneously that allows the diagnosis to be made. That is why a high index of suspicion is the first requirement. However, when it occurs in clusters, as it usually does, some of them will give you a classical history if you can recognize it. So when you have found your first case you can assume there are others about and start asking the right questions. You do not need me to tell you how to elicit a correct history for this sort of illness, but the symptoms you are looking for that make it whooping cough are as follows.
It can start in one of two ways generally. The most common is a very sore throat, slight malaise and sometimes a mild feverishness, that after 3 or 4 days turns into an unremarkable dry cough and after 10 days from the very start of symptoms starts to become paroxysmal. In the third week and for the next 4 to 24 (roughly) weeks the cough generally is almost exclusively paroxysmal. Thus after 2 weeks from the start of the illness the diagnosis is made from the existence of paroxysms of coughing that continue for at least 2 weeks. A typical paroxysm comes unexpectedly (but may be precipitated by a change in temperature, or peculiar things such as a particular food). It is a succession of dryish coughs that follow each other without any inspiration so that the lungs become empty of air and the patient obviously develops severe facial congestion. There sometimes follows a brief period of a feeling of suffocation, and cyanosis may occur. Then sometimes (about 50% of patients) will occasionally, when inspiration suddenly comes back with a rush, make an inspiratory stridulous 'whoop'. The paroxysm may be repeated several times leaving the patient exhausted. There then follows a long period before the next paroxysm. Children tend to have about 10 paroxysmal a day at their worst, but adults will commonly only have 2 or 3 a day. It usually causes onlookers as much distress as the patient! (another useful history point). Paroxysms are commonly associated with coughing up sticky mucus and reflex copious salivation. Most patients will retch after a paroxysm as a matter of course. About 50% vomit at some time.
It can also start with coryzal upper respiratory symptoms and a more moist cough before it turns into the typical paroxysms. This is in fact the usual textbook description, which in my experience only occurs in about a third. (My theory is that pertussis pure and simple, causes only the sore throat and dry cough start, but that is commonly invades a respiratory tract previously made vulnerable by inflammation by a virus, asthma or whatever, and that the early symptoms are frequently a combination of pertussis and the underlying inflammatory cause). That is why the physical findings, that are described next, can also suggest an alternative (and more sometimes desirable) diagnosis.
There are very often no abnormal physical signs. Sometimes there are added sounds in the chest. Sometimes a few wheezes (particularly if the patient has asthma, but usually asthmatics have a reduction in their level of wheeze when they get whooping cough). Sometimes there are a few crackles. None of these adventitious sounds or their absence are a help in diagnosing whooping cough but they obviously raise differential diagnoses that will inevitably be difficult to verify if it is actually whooping cough (back to getting a good history). Sometimes there is secondary bacterial infection which might give some signs. There may concomitant respiratory infections to confuse the picture in whooping cough ( the history will stand a chance of sorting it).
If you diagnose all the cases of whooping cough that occur the average duration from start to finish is about six weeks. If you only diagnose the more severe cases the duration is more likely to be 3 months. With all grades in between of course.
Proof of whooping cough is very difficult. A positive per nasal swab is wonderful when it happens but by the time most cases are recognized the bugs have gone. Serology is done differently in different parts of the world, and some tests give too many false positives and false negatives. In some places (UK for example since 1/4/2002), NHS labs can do pertussis toxin ELISA IgG on a single sample at least 3 weeks into the illness and give valuable diagnostic result. Just send a serum sample requesting 'pertussis antibodies'. It is all usually down to the history and a clinical diagnosis. But if you swab contacts with early symptoms you may be lucky, and once you have confirmed a case you can be much more confident about your clinical diagnosis.
What about treatment? There isn't any really. Sick infants need hospitalization for assessment quite often, and if severe may benefit from antibiotics, steroids and oxygen. Others generally just need erythromycin or azithromycin to kill Bordetella organisms to stop infectivity. If the same is given during incubation the disease may be aborted. Management involves checking for complications such as pneumonia and supporting the parents of children in their coping with what is an exhausting experience for all the family. Pernasal swabs or blood specimens may be tested according to the advice of your laboratory. Negative tests do not exclude whooping cough as a diagnosis. The key is the sound of whooping cough, which you can hear from recordings on this site.
Thank you for reading this. www.whoopingcough.net
The following is an email from a patient with typical difficulty getting a doctor to diagnose whooping cough. It is worth reading.
We live in Massachusetts, USA and after three weeks, including one hospital trip, four doctors visits, and many, many nights of constantly interrupted sleep, we finally got a diagnosis of whooping cough for my 12 year old twin boys.
What made this particularly frustrating was the fact that I had brought up the idea of the disease to the doctors over a week ago, and my kids were not immunized against it, and the dr's knew that - but they just didn't believe me when I described the severity of the symptoms. The boys were not very "sick" when we visited the doctors. In the last three weeks the boys were tested for strep (negative) and diagnosed with allergies (dog and pollen), sinus infections and "cough" (what the heck does that mean!). They were given an Albuterol inhaler, a Flovent inhaler, Singulair pills, Robitussin cough syrup, codeine cough syrup, over-the-counter Sudafed (decongestant), Rhinocort nasal spray and a pill called Hydrocodone to knock them out at night to help them sleep. We also tried homeopathic Phosphorus 30C pills. And we went out and got an air-purifier! I am sure you are not surprised that nothing worked - not even the Hydrocodone.
Then the school nurse called (for the umpteenth time) and really encouraged me to look into whooping cough again. I found your site and got the courage to go back to the dr's. I told the nurse and dr that we were NOT GOING TO LEAVE the office until they heard one of my kids have a "whooping session". Well, after about 35 minutes one of them launched into a particularly dramatic spasm with the coughing, whooping, red face, loss of breath, sticky foamy saliva, vomit and all. They almost couldn't believe it, because otherwise, my child just looked and sounded a bit under the weather. I said "See, I told you! This is what has been keeping us up at night for weeks! This is why I have been afraid to leave their side because I thought he would choke and die!"
Anyway, that's our story. Thanks for the informative site. It was clear, interesting and put my mind at ease. I am sure we have many more weeks of whooping - but the boys were put on Zithromax and the school is going to let them go on their BIG 6th grade overnight field trip next week. And our doctor assured me that they won't stop breathing!
PLEASE MAKE SURE PEOPLE KNOW THAT THE KIDS CAN SEEM "WELL" IN-BETWEEN BOUTS!
I know you cover this on the site, but it cannot be reiterated too strongly. This has been a truly amazing experience...with the irony that it took a school nurse and a Mom to get the doctors to listen.
I am going to take a nap!
For about fifty years vaccine against whooping cough has been used effectively to drastically reduce the number of infants who would otherwise die of whooping cough.
The traditional vaccine is prepared from killed Bordetella pertussis organisms and given in combination with diphtheria and tetanus toxoids in the first year of life. Some programs give three doses over about three months and others five over 5 years. There are many different programs in different countries.
The main effect of the vaccine is to greatly reduces the number of whooping cough cases in children. Although the children given direct protection in this way are not especially at risk from the disease (in the developed world) this protection indirectly stops their infant brothers and sisters (who are too young to be immunized) getting the illness and possibly dying from it.
In recent years a purer form of vaccine has become available and is gradually replacing the traditional type. It is known as acellular pertussis vaccine because it consists, not of whole cells, but various combinations of the several antigens known to play a part in natural immunity.
The new vaccine, as one might expect, is equally effective but causes fewer reactions when given. It is quite common for children not to complete a course of traditional pertussis vaccine because of severe swelling at the injection site, or fever and irritability for several hours afterwards.
For the vaccine to be effective at reducing the incidence in
children sufficient to protect infants, about 80% to 90% of children
need to be fully immunized.
Statistics about whooping cough
In the United States in 1998 there were 7,405 reported cases. There were 5 reported deaths. In 1999 there were 7,288 cases. In 2000 there were 7,867. The provisional number of deaths for 2000 is 12. only 82% of children in the US are fully immunized against pertussis (2000).
The CDC has an excellent website with up to date information and recommendations on the treatment and prevention of whooping cough (pertussis). Link is in submenu on the right.
In England and Wales about 3 deaths per year are recorded. In 2004 there were 504 notifications. I believe the number of cases occurring is probably 50 times greater.
Bordetella pertussis genome
If you want to get really intimate with Bordetella pertussis visit The Sanger Centre and download the whole DNA sequence. See submenu on right.
It is my opinion, based on my research, that the actual
number of cases that occur is at least 10 times the number reported.
This is based on the fact that I have studied every case of whooping
cough that I have detected in the community in which I work since
1977. This is in Keyworth, England, a community of 11,000. In England
communities like this are often served by a single medical practice,
making it possible to study such things accurately. Dr. Doug
am building up information in this area bit by bit. Most of the information I have at present relates to England and Wales because this is where I do my research.
How many cases are notified in England and Wales?
Graph of notified cases in England & Wales (pop. approx 50 million) 1977 to 1999
Graph of notified cases in England & Wales (pop. approx 50 million) 1956 to 1999
To what degree are cases under-notified in England and Wales?
You can see a histogram of how the number of whooping cough cases
I have counted compares with the number notified in England and Wales
for every year since 1977, after adjustment for population size. The
number of cases I detect varies from about 4 times the official
notification rate to about 100 times! More information about this on
the Keyworth study
Source: www.whoopingcough.net/statistics%20deeper.htm :
Quick self diagnosis
Are you aged between 0 and 120 years?
Have you had attacks of coughing lasting at least a minute for at least 3 weeks, that come without warning, make you cough and cough and cough until you feel as if you are choking and unable to get a breath, making you red in the face, nauseous, and frightening anyone who observes you?
Do you go for hours or more feeling fine without any cough at all?
Have you ever had a cough like this before?
If you answered "yes" to all the first 3 questions and "no" to the
4th, there is a high probability you have whooping cough. If in
addition, you know other people who have or have had an identical
cough, and you have been in contact with them, or you have been in
contact with known whooping cough cases, then the probability that
you have it is even stronger.