WHOOPING COUGH (PERTUSSIS)

What is whooping cough?

Whooping cough, also known as pertussis, is a highly infectious condition caused by bacterial infection. Whooping cough causes a very severe, uncontrollable cough and can be passed from person to person very quickly. The condition gets its name from the sound of inhaling after coughing and is usually considered a childhood disease; however, it can affect people of all ages.

In the UK, all children are invited to attend vaccination clinics and one of the conditions vaccinated against is whooping cough. As a result of the immunisation programme, the number of cases of whooping cough has fallen from 120,00 cases per year, before the vaccination was introduced, to under 600 cases in England and Wales in 2005.

What causes whooping cough?

Whooping cough is caused by a strain of bacteria known as Bordetella pertussis, which infects the lining of the airways in the trachea (windpipe) and the bronchi, causing thick, sticky mucus to collect. The body then tries to dislodge and get rid of this mucus by coughing. Whooping cough also makes it difficult to breathe, as the airways become inflamed and this causes the whooping sound after coughing.

Whooping cough is highly infectious and can be passed from one person to another very quickly and easily through droplets, which are expelled when you cough or sneeze. If you do have a cough it is best to cover your mouth and throw away tissues as soon as you have used them. People who have whooping cough should try to stay away from others until they have completed a course of antibiotics to prevent spreading the infection.

Symptoms of whooping cough

The main symptom of whooping cough is a severe cough followed by a whooping noise when you try to take a breath, but this does not usually appear until 2 weeks after infection with the Bordetella pertussis bacteria. Symptoms of whooping cough often take time to develop (between 1 and 2 weeks) after infection and usually the first symptoms to appear are similar to a common cold.

Early signs of whooping cough include:

• Runny nose.
• Slightly raised temperature.
• Generally feeling ill.
• Watery eyes.
• Sneezing.
• Sore throat.

Later symptoms

Symptoms that develop after the initial infection period include coughing (episodes of coughing are referred to as paroxysms and these symptoms are therefore known as paroxysmal symptoms).

Paroxysmal symptoms include:

• A violent cough, with bouts of uncontrollable episodes of coughing.
• Coughing up phlegm.
• Vomiting after coughing (this is more common in children).
• A whooping sound, which occurs when you take a sharp intake of breath after coughing.
• Tiredness.
• Red face.

Usually bouts of coughing last between 1 and 2 minutes, but episodes usually follow on from one another and some people can experience more than 15 bouts of coughing per day.

Infants may not make the whooping sound but they can find it very difficult to breathe after coughing and in rare cases whooping cough can be fatal. Sometimes infants with whooping cough start to go blue after a bout of coughing, which is called cyanosis. Although this can be very scary for parents the baby will soon start to breathe normally again.

It can take up to three months for an individual to recover from whooping cough and symptoms are usually much more severe in young children than adults.

How is whooping cough diagnosed?

If you or your child have any of the symptoms listed above, you should see your GP. Your GP will carry out an examination and confirm a diagnosis by listening to your chest, checking your symptoms and conducting a blood test, which will be analysed for bacteria. A sample of mucus can also be taken. Babies may need to be hospitalised if whooping cough is suspected, as the infection can be very severe in infants.

Treatment for whooping cough

Whooping cough can usually be treated very effectively with antibiotics and the vast majority of people make a full recovery. Babies may be admitted to hospital if whooping cough is suspected, as the infection can be very serious and potentially fatal. Young children may also need ventilation to make it easier to breathe and intravenous medication. If a child has a very severe case, they may be prescribed corticosteroid medication in addition to antibiotics. These drugs contain steroids, which help to reduce inflammation in the airways and make it easier for the baby to breathe. Doctors may also give babies additional oxygen through a mask.

Self-help

In addition to taking antibiotics, doctors also recommend:

• Getting plenty of rest.
• Taking in plenty of fluid.
• Clearing excess mucus.
• Staying away from others to prevent the infection spreading.

Preventing whooping cough

Whooping cough is now rare in the UK because all children are given vaccinations against the infection. The whooping cough vaccination is given as part of the 5-in-1 immunisation, which children are given at the age of 2- 4 months old. This vaccine also protects against tetanus, diphtheria, polio and Hib (this is short for haemophilus influenzae type b). Children are also given a pre-school booster vaccine at the age of 3 years and 4 months. Vaccines work by causing the body to make antibodies, which will help to fight the infection if the body is infected by the strain of bacteria. The vaccine is very safe and all children should have it.

In some cases, the vaccine can cause mild side-effects.

These may include:

• Raised temperature.
• Crying and being more emotional and clingy than usual.
• Swelling and redness at the site of the injection.

If you do have whooping cough, you should avoid going near other people until you have completed your course of antibiotics. It is also important to cover your mouth when you cough or sneeze and to throw tissues away once you have blown your nose, as this will help to prevent the infection spreading to other people.