Whooping Cough

What is whooping cough?

Whooping cough, also called pertussis, is a highly contagious infection of the airways caused by a bacterium named Bordetella pertussis. The illness gets its name from the high-pitched “whoop” sound that some people make when they gasp for air after a long fit of coughing. Not everyone makes this sound, and its absence does not rule out the infection.

Whooping cough can affect people of any age. Before routine vaccination it was a common childhood illness, and it remains a serious concern worldwide. Infants, especially babies who are too young to have completed their first vaccine doses, are at the highest risk of severe illness and complications. Teenagers and adults can also catch whooping cough, often because protection from earlier vaccination fades over time. In older children and adults the illness is often milder, but it can still last for many weeks and can be passed on to vulnerable babies.

At Acibadem, whooping cough is generally evaluated and managed by the Infectious Diseases Department, working together with pediatric teams when the patient is a child.

Whooping cough symptoms

Whooping cough symptoms usually develop in stages, and the pattern is one of the reasons the illness is sometimes recognized late. The early stage often looks like a common cold, so many people do not suspect whooping cough until the coughing fits begin.

Common whooping cough symptoms include:

• Runny or blocked nose in the first week or two
• Mild fever or no fever at all
• A mild cough that gradually becomes worse
• Sudden, intense bursts of coughing (called paroxysms) that are hard to control
• A “whoop” sound when breathing in after a coughing fit
• Vomiting or gagging after coughing
• Exhaustion after coughing spells
• Red or blue-tinged face during coughing
• Difficulty sleeping because of nighttime coughing

Stages of whooping cough

Doctors often describe three stages. The catarrhal stage (the early, cold-like phase) typically lasts one to two weeks and is the period when a person is most contagious. The paroxysmal stage follows, with the characteristic coughing fits. Between fits the person may seem well, but attacks can happen many times a day and are often worse at night. This stage commonly lasts several weeks. The convalescent stage (recovery phase) brings gradual improvement, though coughing may return with later colds for months. Because of this long course, whooping cough is sometimes known as the “100-day cough.”

How symptoms differ in babies

Infants may not cough in the typical way at all. Instead, they may have pauses in breathing (called apnea), turn blue around the lips, become very tired, or struggle to feed. These signs can be life-threatening and need urgent medical attention. Babies under a few months of age are the group most likely to need hospital care for whooping cough.

Symptoms in teenagers and adults

In vaccinated older children and adults, whooping cough symptoms are often less dramatic. Many have a persistent, nagging cough without the whoop and may assume they have bronchitis or a lingering cold. Even so, the cough can be severe enough to cause broken ribs, fainting, or loss of bladder control during fits, and the person can still spread the bacteria to others.

Causes and risk factors

The direct cause of whooping cough is infection with Bordetella pertussis bacteria. These bacteria attach to the tiny hair-like structures (cilia) that line the upper airways and release toxins. The toxins damage the cilia and cause the airways to swell, which triggers the violent coughing fits.

How whooping cough spreads

Whooping cough causes illness by spreading from person to person through droplets released when an infected person coughs, sneezes, or talks. Close, prolonged contact, such as living in the same household, makes transmission more likely. Symptoms usually begin about a week or two after exposure, though the incubation period can vary. A person is generally contagious from the start of the cold-like symptoms until several weeks into the coughing stage, or until they have completed an appropriate course of antibiotics.

Risk factors

• Being unvaccinated or under-vaccinated, including infants who have not yet received all their early doses
• Waning immunity in teenagers and adults whose childhood vaccination protection has faded
• Close contact with an infected person, especially within a household
• Pregnancy, because infection late in pregnancy can pass to the newborn, and because babies of unvaccinated mothers lack passive protection
• Working with or caring for young children, such as in daycare or health care settings
• Living in an area experiencing an outbreak

It is worth noting that having had whooping cough or being vaccinated does not give lifelong protection. Repeat infections can occur, although they are often milder.

Whooping cough diagnosis

Whooping cough diagnosis can be challenging, particularly in the first stage when the illness resembles an ordinary cold. Doctors combine the patient’s history, a physical examination, and laboratory testing to confirm the infection.

Medical history and examination

Your doctor will ask about how long the cough has lasted, whether it comes in fits, whether there is a whoop or vomiting afterward, and whether anyone around you has had a similar illness. Vaccination history is important. A cough lasting two weeks or more with coughing fits, whooping, or post-cough vomiting raises strong suspicion. Listening to the chest may be normal between coughing episodes, which is one reason a clinical impression alone is often not enough.

Laboratory tests

• Nasopharyngeal swab or aspirate: a sample is taken from the back of the nose and throat. This sample can be tested in two ways.
• PCR test (polymerase chain reaction, a test that detects the bacterium’s genetic material): this is widely used because it is fast and sensitive, and is most useful in the first few weeks of illness.
• Bacterial culture: growing the bacteria in the laboratory. It is considered very specific but takes longer and becomes less likely to be positive as the illness progresses or after antibiotics have started.
• Blood tests (serology): measuring antibodies against the bacteria may help when the cough has been present for several weeks and swab tests are less reliable.
• Complete blood count: in infants, a very high white blood cell count, particularly of lymphocytes, can support the diagnosis and may indicate more severe disease.

Imaging

A chest X-ray is not needed to diagnose whooping cough itself, but a doctor may order one to check for complications such as pneumonia (lung infection), particularly in infants or in anyone with breathing difficulty.

Because whooping cough is a notifiable disease in many countries, a confirmed diagnosis is usually reported to public health authorities so that close contacts can be identified and protected.

Whooping cough treatment options

Whooping cough treatment options depend on the age of the patient, how far the illness has progressed, and how severe the symptoms are. There is no treatment that instantly stops the cough once the paroxysmal stage is established, so care focuses on limiting spread, preventing complications, and supporting the patient through recovery.

Antibiotics

Antibiotics are the main medical treatment. Doctors most often prescribe a class of antibiotics called macrolides (for example azithromycin, clarithromycin, or erythromycin). Alternatives may be used for people who cannot take macrolides. Antibiotics work best when started early, ideally during the cold-like stage or the first weeks of coughing. Started early, they may reduce the severity and length of illness. Started later, they may not change the cough much, but they still shorten the time a person is contagious, which protects others. Because of this, your doctor may recommend antibiotics even several weeks into the illness, especially if there are infants or pregnant women in the household.

Preventive antibiotics for close contacts

People who have been in close contact with someone diagnosed with whooping cough are often offered a course of antibiotics to prevent infection, regardless of their vaccination status. This is particularly important for infants, pregnant women in their later trimester, and anyone who cares for babies.

Supportive care at home

Most older children and adults recover at home. Measures that may help include resting, drinking enough fluids, eating small frequent meals to reduce vomiting after coughing, and keeping the air free of smoke, dust, and strong fumes that can trigger fits. A cool-mist humidifier may soothe the airways for some people. Over-the-counter cough medicines are generally not recommended, because they have not been shown to help with whooping cough and can be harmful to young children. Your doctor can advise on managing fever and discomfort.

Hospital care

Infants, especially those under a few months old, are frequently admitted to hospital for observation because breathing can stop suddenly during or after a coughing fit. Hospital care may include monitoring of oxygen levels and heart rate, suctioning of thick mucus from the airways, supplemental oxygen, and fluids or feeding support if the baby cannot feed normally. In severe cases, intensive care and breathing support may be needed. Older children and adults are usually hospitalized only if complications such as pneumonia develop.

What treatment does not involve

There is no surgery for whooping cough, and no procedure that removes the infection. Steroids, bronchodilators (inhalers that open the airways), and antihistamines have been studied, but evidence does not clearly show they shorten or ease the cough, so they are not routinely recommended. Rehabilitation is not typically required, although recovery of energy and normal sleep may take time.

Living with whooping cough and outlook

For most otherwise healthy older children, teenagers, and adults, the outlook is good, and full recovery is expected. However, the illness is often longer and more tiring than people anticipate. Coughing fits commonly continue for several weeks and may flare again with any new respiratory infection for months afterward. Sleep disruption, sore chest muscles, and fatigue are common during this time.

During the illness, it is usually advised to stay home from work, school, or daycare until a doctor confirms you are no longer contagious, which is generally after completing the recommended antibiotic course or after enough time has passed since the cough began. This helps protect infants and other vulnerable people.

The outlook is more guarded for young infants. Complications in babies can include pneumonia, seizures, dehydration, brain injury from lack of oxygen, and, in some cases, death. This is why any suspicion of whooping cough in an infant is treated as urgent. In older people, complications are less common but can include rib fractures, hernias, fainting, and bacterial pneumonia.

Having whooping cough does not guarantee protection against future infection. Doctors generally still recommend keeping vaccinations up to date after recovery.

Prevention through vaccination

Vaccination is the most effective way to reduce the risk of whooping cough and to make illness milder if it does occur. Children typically receive a combined vaccine that protects against diphtheria, tetanus, and pertussis, given as a series of doses starting in early infancy, with boosters in later childhood and adolescence. Adults may receive a booster dose, and vaccination during pregnancy is widely recommended because it passes protective antibodies to the baby before birth, covering the most dangerous early months. Protection from vaccination decreases over time, which is why booster doses are part of most national schedules.

Frequently asked questions

What is whooping cough and how serious is it?

Whooping cough is a bacterial infection of the airways that causes prolonged, violent coughing fits. In older children and adults it is usually unpleasant rather than dangerous, though the cough can last for months. In infants, particularly those too young to be fully vaccinated, it can be very serious and sometimes life-threatening, which is why it is treated as a medical priority in this age group.

What are the first whooping cough symptoms?

The first whooping cough symptoms often look like a mild cold: a runny nose, mild cough, sneezing, and perhaps a low fever. These early signs typically last one to two weeks before the more recognizable coughing fits begin. Because the early stage is so ordinary, whooping cough is frequently not suspected until the cough has become severe.

What are the main whooping cough causes?

The single cause is infection with the bacterium Bordetella pertussis, which spreads through respiratory droplets from an infected person. Lack of vaccination, fading immunity from earlier vaccination, and close contact with someone who is infected are the main factors that increase the chance of catching it.

How is whooping cough diagnosis confirmed?

Whooping cough diagnosis usually involves a swab from the back of the nose tested by PCR or culture, sometimes supported by blood antibody tests later in the illness. Doctors also rely on the pattern of symptoms, especially a cough lasting two weeks or more with fits, whooping, or vomiting. A chest X-ray may be used to check for complications rather than to confirm the infection itself.

What are the whooping cough treatment options for adults?

For adults, whooping cough treatment options center on a course of antibiotics, most often a macrolide, together with rest, fluids, and avoiding cough triggers such as smoke. Antibiotics started early may lessen the illness; started later they mainly reduce the risk of spreading the infection. Cough suppressants are not usually recommended. Your doctor may also suggest antibiotics for people you live with.

How long is whooping cough contagious?

A person is generally most contagious during the early cold-like stage and remains able to spread the bacteria for several weeks into the coughing stage if untreated. After completing an appropriate antibiotic course, contagiousness ends much sooner, usually within days. Your doctor or public health authority can advise when it is safe to return to school or work.

Can you get whooping cough if you have been vaccinated?

Yes. Vaccination greatly reduces the risk and usually makes any illness milder, but protection is not complete and fades over time. This is why booster doses are recommended for adolescents, adults, and pregnant women, and why vaccinated people with a persistent cough should still consider whooping cough as a possibility.

When to see a doctor

Contact a doctor if you or your child have a cough that has lasted more than two weeks, comes in intense fits, or is followed by a whooping sound or vomiting, especially if you know of whooping cough in your community or household. Early assessment allows treatment to start when it is most useful and helps protect others.

Seek emergency care immediately if any of the following occur:

• A baby or child stops breathing, has pauses in breathing, or turns blue or gray around the lips or face
• Difficulty breathing or rapid, labored breathing between coughing fits
• Signs of dehydration, such as very little urine, dry mouth, no tears, or unusual drowsiness
• A seizure or fit
• Extreme exhaustion, limpness, or unresponsiveness after coughing
• Chest pain, coughing up blood, or high fever that does not settle
• Any cough with fits or whooping in an infant under one year of age, even if the baby seems well between episodes

Infants with suspected whooping cough should be evaluated urgently rather than observed at home, because their condition can worsen quickly and without warning.