Brief overview
- Symptoms: Barking, staccato cough, wheezing breathing sound when taking a breath after the attacks, less typical symptoms in adults.
- Course of disease and prognosis: Symptoms often persist for several weeks, usually whooping cough heals without consequences. Complications are possible; in babies, severe and life-threatening courses are possible.
- Causes and risk factors: Bacterial infection with Bordetella pertussis, less commonly related bacterial strains. Transmission by droplet infection, unvaccinated persons almost always fall ill after contact with the pathogen.
- Treatment: Antibiotics, inhalation, sufficient drinking, rest; inpatient treatment of high-risk patients such as infants.
- Examinations and diagnosis: Physical examination, depending on the stage of the disease, detection of the pathogen, smear, bacterial culture, PCR detection, antibody detection in the blood.
- Prevention: pertussis vaccination
What is whooping cough?
Whooping cough (technical term: pertussis) is a contagious, bacterial infectious disease. The main pathogen is called Bordetella pertussis. Babies and children often become infected with whooping cough, but infection is also possible in adolescents and adults, especially if they are unvaccinated or their vaccination protection has waned.
Whooping cough is very contagious. It is usually transmitted by droplet infection. In the course of infection, the triggering bacteria form a toxin (bacterial toxin) that damages the mucous membranes of the respiratory tract. The toxin continues to have a damaging effect even when there are no more bordetellae in the body.
Risk of infection and incubation period
These small droplets contain pertussis bacteria. If they get onto the mucous membrane of a healthy person (e.g. by inhalation), the latter becomes infected.
Whooping cough can also be contracted through kissing. This also applies if you use the same cutlery or drinking vessel as a person with the disease.
Even if you have been vaccinated against whooping cough and do not fall ill yourself, there is a risk that you will become a carrier of the bacteria for a short time. In this way, you pass the germs on to other people unnoticed.
Incubation period
As with most infectious diseases, it takes a certain time for pertussis symptoms to appear after infection. This so-called incubation period is about seven to 20 days for whooping cough.
The best way to protect yourself from whooping cough is to avoid contact with people who have the disease. If there is a family history of illness, it is advisable to maintain careful hygiene.
Whooping cough in adults
Whooping cough was long considered a “children’s disease.” However, this is not true. Increasingly, adolescents and adults are also contracting it:
In 2008, the average age of whooping cough patients was reported to be about 42. Ten years earlier, it was still around 15 years. Now, two-thirds of all whooping cough cases affect people older than 19.
This is because adults often forget to get the necessary booster vaccination: Almost all children are vaccinated against pertussis when they start school. However, the vaccination does not leave lifelong immunity and must be boostered. Those who do not do so risk whooping cough infection if they come into contact with the vaccine.
What are the symptoms of whooping cough?
Classically, a pertussis infection progresses in three stages, each accompanied by different symptoms:
1. cold phase (stage catarrhale): it lasts one to two weeks. In this first stage, pertussis symptoms are still non-specific. They are therefore rarely interpreted correctly. In most cases, those affected think the symptoms are a trivial cold. Whooping cough symptoms of the first stage are:
- Cough
- Sneezing
- Sore throat
- Runny nose
2nd seizure stage (stage convulsivum): This stage lasts up to six weeks. Classic signs of whooping cough appear: convulsive coughing fits up to shortness of breath (also called “stick cough”), especially at night. After an attack, patients inhale through a spasm in the larynx with a whooping sound.
At this stage of the disease, most patients have no appetite and little or no sleep. Fever rarely occurs.
3rd recovery stage (stage decrementi): This final stage of illness lasts up to ten weeks. During this time, the coughing attacks gradually become weaker, and patients soon feel fitter again.
Whooping cough in adults
Whooping cough in adults often takes an atypical course: Symptoms are weaker, coughing attacks are less severe and continuous rather than attack-like. The risk of suffocation is low.
However, this does not make the infection any less dangerous; on the contrary, many ill adults simply think whooping cough is a particularly persistent but common cough. They therefore often do not go to the doctor.
Adults who contract pertussis are also often a danger to others. They are considered a serious source of infection for infants and the elderly. Pertussis is sometimes severe in these groups of people.
Whooping cough in babies and young children
The younger a child is, the more dangerous whooping cough is. In the first year of life, children have not yet built up complete vaccination protection. Therefore, whooping cough is often severe at this age. In addition, babies and toddlers are often not yet able to sit up to cough on their own.
Infants often do not show typical symptoms. Pertussis attacks in them are often not very severe or staccato. Often, all that is noticed is a beeping sound or a reddened face. However, there are often cessations of breathing (apneas) for several seconds. An indication of this is the sometimes bluish skin coloration (cyanosis).
Symptoms of concomitant diseases
The typical whooping cough symptoms may be joined by other symptoms if patients develop a concomitant disease. This happens in about a quarter of all patients. The reason is usually that whooping cough is diagnosed and treated late.
By then, the bacteria have often already spread throughout the body. Possible concomitant diseases as well as secondary symptoms of whooping cough are:
- Middle ear and pneumonia: These occur when the pertussis bacteria travel up the ear canal or down into the lung tissue.
- Rib hernia and inguinal hernia: They are caused by particularly severe coughing fits. Often these hernias are not recognized until much later, for example when severe pain occurs during sports.
- Severe weight loss: This occurs mainly in children. Whooping cough is often accompanied by a lack of appetite.
What is the course of whooping cough?
Whooping cough sometimes lasts for weeks to months. In some patients, the course of the disease is relatively mild, while in others it is severe. As a rule, however, pertussis heals completely without any lasting late effects.
Complications develop in about one in four pertussis patients. These include, above all, pneumonia and middle ear infection. Children are affected more frequently than adults.
Whooping cough is particularly dangerous for infants under six months of age. In extreme cases, the breathing stops cause a considerable lack of oxygen, which damages the brain. Possible consequential damage includes permanent paralysis, visual or hearing impairment, and mental disorders.
Deaths from whooping cough in babies are possible, but very rare. So that babies with whooping cough are closely monitored medically, hospital treatment is recommended.
What is the course of whooping cough in pregnancy?
Experts currently recommend that pregnant women receive the whooping cough vaccination at the beginning of the last trimester of pregnancy (from the 28th week of pregnancy), or as early as the second trimester if there is a risk of premature birth.
As a result of the vaccination, the expectant mother forms antibodies against the pertussis pathogens, which she passes on to the unborn child. In this way, the baby receives nest protection against pertussis during the first weeks of life.
The recommendation also applies to any new pregnancy and regardless of whether a woman has already been vaccinated against pertussis before becoming pregnant.
It is also advisable that the pregnant woman’s environment, such as partners, children or grandparents are vaccinated against pertussis.
It is very unlikely that pertussis bacteria will be passed from an infected pregnant woman to her unborn child.
What is the cause of whooping cough?
The bacterium also secretes various poisons (toxins). These damage the surrounding tissue, especially the cilia of the mucous membranes in the respiratory tract. In addition, they weaken the local defenses. As a result, the germs multiply more easily.
If left untreated, pertussis sometimes causes serious complications. In newborns, pertussis is sometimes life-threatening.
In addition to Bordetella pertussis, there are rarely other related Bordetella species, such as Bordetella parapertussis and Bordetella holmesii. However, infection with these pathogens is usually shorter and less severe.
What treatment is required?
As with other diseases, the following applies to pertussis: therapy and the course of healing of whooping cough depend on the stage and severity of the disease.
Whooping cough therapy in children
For babies with whooping cough, inpatient treatment is always advisable. In the clinic, the bronchial mucus can be aspirated – babies are not able to cough up the mucus. In addition, doctors and nurses act quickly and professionally when breathing stops are threatened or occur.
For sick children, lots of attention and affection is generally important. Strict bed rest is not necessary for whooping cough. It is sufficient to take it easy physically. Walks in the fresh air and quiet play are allowed and even do most children good. However, make sure the environment is low in irritants.
Reassure the child during coughing attacks. It is helpful to then sit the child up or carry him in an upright position. Inhaling with hot water and sea salt sometimes relieves discomfort in older children. For young children, there are inhalers available at the pharmacy that do not pose a risk of scalding.
Home remedies have their limits. If the symptoms persist for a long time, do not improve or even get worse, you should always consult a doctor.
The air in the room should be sufficiently humid. This can be achieved, for example, by regular shock ventilation or damp cloths over the heating. This increases the humidity.
It is important that patients drink enough. Preferably prepare liquid or pulpy meals. Several small meals spread throughout the day are more advisable than a few large meals. Children with whooping cough are prone to retching and vomiting.
Make sure that your child does not get together with other children or older people during the infection period. These are particularly susceptible to infection and possible severe courses and complications.
However, antibiotic treatment may still be useful afterwards, as it breaks the chain of infection: about five days after starting antibiotics, patients are no longer infectious. They are then allowed to attend community facilities such as school and kindergarten again.
Antibiotics used include erythromycin, azithromycin and clarithromycin. They are taken for a few days to two weeks, depending on the active ingredient.
Cough syrup usually helps little or not at all with whooping cough. If the mucus formed in the bronchial tubes is very tough, mucolytic medicines sometimes help.
Whooping cough therapy in adults
Treatment for whooping cough in adults is similar to that for children. Antibiotics are given preferentially in early stages of the disease. In later stages, they are used to reduce the risk of infection to other people, especially infants. For them, whooping cough is sometimes life-threatening.
Employees of community institutions (such as teachers, educators, nursing staff, etc.) may not return to work until the attending physician permits it. He or she uses examination and laboratory findings to assess whether or not the patient is still excreting pertussis pathogens.
How does the doctor make the diagnosis?
In order to clarify the suspicion of whooping cough, the physician will first take the patient’s medical history (anamnesis). To do this, he talks to the patient or – in the case of young children – to the parents about the symptoms that are occurring. Typical questions are:
- How long has the cough been present?
- Is mucus coughed up or is the cough more dry?
- Are there problems with breathing after the coughing attacks?
- Are there any other complaints (fever, sore throat, chest pain, etc.)?
If the typical pertussis symptoms are present (in children), this facilitates diagnosis. Laboratory tests are performed to confirm this. Some blood values are sometimes elevated in pertussis, such as the white blood cell count. This indicates inflammation, but is not a specific indication of pertussis.
Laboratory tests are especially important when pertussis is atypical. This is especially the case in infants, but is also more common in adolescents and adults. The latter now represent the most common age group among whooping cough patients.
Laboratory examinations and whooping cough tests
The type of laboratory tests that are used depends on the stage of the disease.
During the first two to three weeks after the onset of coughing, an attempt is made to detect the pertussis pathogen directly. To do this, the physician either takes a swab from the deep throat or aspirates some bronchial mucus that is carried upward when the patient coughs.
Another possibility is the so-called serum diagnostics. This involves testing the patient’s blood serum for antibodies to the pertussis pathogens. This method is only possible in advanced stages of the disease: such specific antibodies can only be detected about three weeks after the onset of coughing.
If the physician suspects complications or secondary diseases of whooping cough (such as middle ear infection or pneumonia), appropriate further examinations are necessary.
Whooping cough is notifiable
Since 2013, there has been a reporting requirement for pertussis in Germany: if pertussis is suspected and the disease is proven, the physician must report the patient’s name to the responsible health office. Death from pertussis is also reportable.
Whooping cough vaccination
Especially the following groups of people are recommended to be vaccinated against pertussis:
- Women of childbearing age
- Close contacts of pregnant women in the same household and caregivers (e.g., daycare providers, parents, siblings) preferably four weeks before the child’s birth
- Caring parents of a child with pertussis
- Employees in the health service as well as in community facilities
Read more in the article pertussis vaccination.
