Whooping Cough (Pertussis)
Whooping cough (pertussis) is a highly infectious respiratory infection caused mainly by Bordetella pertussis
Causative Agent
Whooping cough is caused by Bordetella pertussis – a Gram-negative coccobacillus
Transmission: [UKHSA]
- Highly infectious
- Spread predominantly by respiratory droplets / close face-to-face contacts (including coughing and sneezing)
- Transmission may occur from 2-4 days before the cough onset until ~21 days after cough onset (if untreated)
Risk Factors
The following patients are at higher risk of severe disease: [UKHSA]
- Young infants (esp. <6 m/o)
- Unvaccinated / incompletely vaccinated infants
- Infants born to mothers who were not appropriately vaccinated against pertussis during pregnancy
Clinical Features
Whooping cough classically presents with 3 stages:
| Stage | Description |
|---|---|
| Stage 1: catarrhal stage [UKHSA] | Initially resembles a mild URTI:
|
| Stage 2: paroxysmal stage (may persist for 2-6 weeks) [UKHSA] | Cough progressively worsens and becomes:
Classic associated features:
Severe coughing may occasionally cause pressure-related complications such as subconjunctival haemorrhage |
| Stage 3: convalescent phase [UKHSA] |
|
Whooping cough in infants may present with: [UKHSA]
- Apnoea
- Cyanosis / blue or grey discolouration
- Breathing difficulty
- Seizures in severe disease
Suspect whooping cough in a patient with new-onset cough with no clear alternative cause PLUS at least 1 of the following: [UKHSA]
- Paroxysms of coughing
- Post-tussive vomiting
- Inspiratory whoop
- Cough lasting ≥14 days
- Apnoeic episodes in infants
Complications
Potential complications include: [UKHSA]
- Pneumonia
- Apnoea
- Seizures
- Encephalopathy / neurological complications in severe disease
- Severe respiratory compromise
Investigation and Diagnosis
Choice of investigation depends largely on the duration of cough at presentation: [UKHSA]
| Days from cough onset | Recommended investigation |
|---|---|
| <21 days | PCR +/- culture (of a nasopharyngeal / pernasal swab) |
| >14 days AND age >1 y/o | Consider serology (if ≥1 year since the last pertussis-containing vaccine) |
Whooping cough can be diagnosed in the presence of compatible clinical features PLUS at least 1 diagnostic test (PCR / culture / serology) [UKHSA]
Management
Active Treatment
| Supportive care [UKHSA] |
Young infants, particularly <6 months, or anyone with significant breathing difficulty may require hospital monitoring / support |
| Antibiotic therapy [UKHSA] | Antibiotics may be given up to 21 days from cough onset
Choice of antibiotics:
Role of antibiotics in whooping cough: The main benefit of antibiotics is to reduce transmission to others If started very early (during the catarrhal phase), antibiotics may also reduce the severity and duration of symptoms. However, whooping cough is rarely diagnosed this early, so this benefit is often limited in practice. |
Public Health and Exclusion
Whooping cough is a notifiable disease in England and Wales [UKHSA]
- All suspected cases should be notified to the local Health Protection Team
- NB laboratory confirmation is NOT required for notification (i.e. clinical suspicion of whooping cough alone is sufficient for notification)
Patients with whooping cough should be excluded from school, nursery, or work until: [UKHSA]
- 48 hours after starting antibiotics, or
- 21 days from cough onset if untreated
Contact management: [UKHSA]
- Prophylactic antibiotics are NOT routinely required for all contacts
- They are considered when there has been close contact with individuals with increased risk of severe pertussis or vulnerable infants
- Management is usually guided by the local Health Protection Team
Pertussis Vaccination
| Vaccination during pregnancy [UKHSA] | ALL pregnant women should be offered a pertussis vaccine between 16-32 weeks of gestation (ideally around the time of the 20-week anomaly scan)
|
| Routine childhood vaccination [UKHSA] |
|