Pertussis

Last Updated 05/07/2020

Authors:Allan Dias, MD; Mary Catelleto, MD, FCCP; Burton Lesnick, MD, FCCP; Chris Carroll, MD, FCCP

About Pertussis (Whooping Cough)

Key facts about Pertussis
  • Pertussis, or whooping cough, is a bacterial infection that affects the lungs.
  • It is very contagious—that is, it’s easily passed from person to person. You can also spread it without knowing you have it.
  • Preschool- and school-aged children most often get pertussis, but anyone can get it. Infants with the disease get sickest and are most likely to die of it.
  • At first, patients may feel like they have a cold. Then, they may have a lasting, harsh cough that makes a “whooping” sound.
  • Pertussis slowly gets better over 3 to 6 months with treatment.
  • Vaccines can prevent pertussis. Your health care provider can give you or your child a shot to help you resist the bacteria.

Pertussis, also known as whooping cough, is caused by the Bordetella pertussis (B. pertussis) bacterium. You can get pertussis all year round, but in North America, it’s most common in summer

About Symptoms Diagnosis Treatment Resources and fall. One frequent symptom is a “whooping” sound a patient often makes after coughing hard. The infection can last for up to 3 to 6 months.

People of all ages can get pertussis, but it’s most common in preschool- and school-age children. Babies with the disease can get very sick and even die.

Pertussis has been far less common and deadly since babies began getting vaccinated for it. However, more adults are catching the disease now, possibly because the vaccine becomes weaker with age.

How Pertussis affects your body

Pertussis usually starts 7 to 10 days after an infected person passes the disease to a healthy person. The first symptoms are often mild and feel like a cold: runny nose, teary eyes, mild cough, and feeling tired. Health care providers often call this the catarrhal phase.

After 1 to 2 weeks, patients with pertussis begin to cough harder and for a longer time. This is called a coughing paroxysm. While coughing, a person’s eyes may bulge, their neck veins may pop out, and their face or mouth may appear blue. The coughing may be violent enough for the person to throw up (vomit). This stage is called the paroxysmal phase. If you are an adult who has been coughing until you vomit for some time, your health care provider may suspect pertussis.

Coughing paroxysms often end with a whooping sound. They can happen several times per hour, or 5 to 10 times a day. They often get worse at night and make sleeping hard. Some older children and adults don’t have coughing paroxysms or make the whooping sound.

The cough slowly goes away over weeks and months. This stage is often called the convalescent phase. If the patient gets a viral infection over the next 6 to 12 months, he or she may have new coughing paroxysms.

How serious is Pertussis?
  • Pertussis is most severe in babies 6 months old or younger, premature babies, and those who haven’t been vaccinated.
  • Babies younger than 3 months of age are the most likely to die of pertussis or go to the hospital with serious problems.
  • Children under 6 months of age more often have breathing problems. They may not make the “whooping” sound and need more time to get better.
  • Preschool children’s symptoms can be exhausting and more severe.

Symptoms of Pertussis

Pertussis is easy to catch. People who haven’t had a pertussis vaccine or who live in the same home with someone who has pertussis have the highest risk of getting it. Older and younger patients can show different symptoms.

The most common symptoms of pertussis are:

  • Cold-like symptoms (runny nose, tearing eyes);
  • Coughing hard for a long time, followed by a whooping sound; and
  • Vomiting after hard coughing.

Patients may cough during the day and night, but coughing can get worse at night. Coughing can be started by yawning, stretching, laughing, yelling, or exercise. Patients can also start coughing after breathing in steam, mist, or other things that can bother your lungs. There is usually no fever.

Teenagers and adults often have less severe symptoms than babies and children. Older patients who had pertussis before may have milder symptoms. Having pertussis once does not make you immune to having it again.

Older patients often have the following symptoms:

  • Coughing over a long time (sometimes this is the only symptom)
  • Coughing up mucus
  • Runny nose
  • Sweating
  • Sore throat

Coughing episodes in older patients are often worse at night and make sleeping hard.

What causes Pertussis?

Pertussis is caused by being infected by the B. pertussis bacterium.

What are risk factors for Pertussis?

Pertussis is highly contagious. Living in the same house with an infected person and not being immunized are two major risk factors. There are two pertussis vaccines: the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine for babies and children and the tetanus, diphtheria, pertussis (Tdap) vaccine for adults. People in the same home as a patient with pertussis who haven’t been vaccinated are 80% to 100% likely to catch pertussis if they’re exposed to it. Immunized people in a home with someone who has the disease are only 20% likely to be infected.

If you have been exposed to someone in the home with pertussis, consider getting antibiotics to prevent infection.

If you have pertussis and show signs of dehydration (having less water in your body than is healthy), contact your health care provider right now. Signs of dehydration include:

  • Dry, sticky mouth;
  • Feeling sleepy or tired;
  • Feeling thirsty;
  • Urinating less often (or fewer wet diapers in babies);
  • Few or no tears when crying;
  • Muscle weakness; and
  • Feeling dizzy or lightheaded

Diagnosing Pertussis

Health care providers usually order tests to confirm pertussis, even if you have every symptom. If the test shows that are infected or were exposed to someone who has pertussis, the provider will order antibiotics. This medication will keep you from spreading pertussis and make the illness less severe. If you’re already coughing violently, antibiotics won’t make the infection last a shorter time.

When should you see your health care provider?

Contact your provider if you have:

  • Long-lasting, severe cough over several days (see a provider immediately);
  • Cold-like symptoms after exposure to an infected person; or
  • Signs of dehydration (lack of fluids).

What to expect from a Pertussis diagnosis

Health care providers usually don’t diagnose pertussis before patients begin coughing hard, typically because the disease looks like the common cold at first. Teenagers and adults can take even longer to be diagnosed because sometimes the only symptom they have is a long-lasting cough.

Treatments for babies can help them have fewer serious symptoms. If these treatments are not started in school-aged children, adolescents, and adults, they may still have all the usual symptoms.

How is Pertussis diagnosed?

Your health care provider will collect a sample from the back of your nose or throat (called a culture or PCR test). The provider will place a small tube deep into your nose or use a special swab in your throat. The PCR test provides results within a day. The culture from the swab takes longer. Cultures are less useful in teenagers and adults because they can have symptoms for several weeks before pertussis is suspected. Patients who have been coughing for more than 4 weeks may only be diagnosed with a special blood test.

Treating Pertussis

Most people with the infection are treated with antibiotics. Antibiotics must be started early to make the disease go away faster and reduce its severity. Starting a patient on antibiotics who has been sick for 3 weeks won’t help because the bacteria are typically gone by then, even if the person still feels symptoms. The symptoms last because the bacteria have already damaged the body.

The antibiotics most often used for pertussis are azithromycin, clarithromycin, and erythromycin. Cough medicines usually don’t help with pertussis cough.

Pertussis can sometimes be serious and require a hospital stay. Babies have the greatest risk of severe complications, including pneumonia, heart failure, a collapsed lung, bleeding in the brain, and death.

Living with Pertussis

Although pertussis eventually goes away, it can be debilitating—that is, it can seriously weaken you—and last up to 6 months.

In babies, the illness can be severe or fatal. Babies with pertussis often stop breathing briefly (called apnea), gasp for breath, or gag while coughing.

School-aged children will often have the classic symptoms discussed earlier. Older children and adults often cough for many days. Some may also feel dizzy, sleep poorly, and even fracture their ribs while coughing.

Managing Pertussis

If pertussis is discovered before the harsh paroxysmal phase, early treatment can make the disease shorter and milder. If it’s discovered later, you will be given medicine to feel better while the disease goes away on its own. Cough medicine is not recommended and likely won’t be helpful.

The following tips can help you manage pertussis and reduce the risk of spreading it:

  • Take antibiotics exactly as your health care provider has prescribed.
  • Keep your home free of irritants that can make you cough, such as smoke, dust, and chemical fumes.
  • Use a clean, cool-mist vaporizer to help loosen mucus and soothe the cough.
  • Wash your hands well.
  • Drink plenty of fluids, including water, juices, and soups, and eat fruits to prevent dehydration.
  • If you vomit after coughing, eat small, frequent meals to help prevent it.

Preventing Pertussis

By having all infants and children vaccinated, you can reduce their risk of catching pertussis and passing it to others in the community. Because it is so easy to catch pertussis from someone else in the home, your health care provider will prescribe antibiotics to limit the spread.

The Tdap vaccine can help protect teenagers and adults against 3 diseases: tetanus, diphtheria, and pertussis. Because the childhood vaccine becomes weaker over time, a “booster” vaccine is recommended for all adults aged 19 to 65 years and for older adults who will be in contact with babies younger than 12 months of age.

Resources

Your health care provider can tell you what symptoms to look out for in case the illness gets worse. If you’re too weak to go to work or school, your health care provider may give you a letter to explain that you need to work less or from home. Many people with pertussis can still go to work or school once they can no longer spread the disease.

The American Lung Association recommends that patients and caregivers join its Living With Lung Disease support community to connect with others facing this infection. To talk to a trained lung professional, call the American Lung Association’s Lung Helpline at 1-800-LUNGUSA. They can help answer your questions and connect you with additional support.

Questions to ask your health care provider

Making notes before your visit and taking along a trusted family member or friend can help you through the first appointment.

If you’re pregnant or someone in your family or household is pregnant, ask if you should have a Tdap booster.

You will probably be calling your provider about a long-term or severe cough. If the cough has lasted longer than 2 to 4 weeks, has been debilitating, is causing whooping sounds, or makes you vomit, you may want to ask about pertussis.

You can ask your health care provider questions such as the following:

  • Could this cough mean that I have pertussis?
  • If yes, how much longer will the cough last?
  • What symptoms or changes in symptoms should cause me to call you? What symptoms should cause me to go to the emergency department?
  • Am I or my child still contagious? If so, when will we no longer be contagious?
  • What treatment do you suggest, based on how long I’ve been sick (such as antibiotics or the vaccine)? What are the potential side effects?
  • How can household members or other contacts avoid catching the disease?
  • If I’m pregnant or someone in my family or household is pregnant, should I get a Tdap booster?