In babies younger than 12 months old, Pertussis is taken seriously, although some babies will develop only mild cases. Infants under 12 months old are at the greatest risk of morbidity. Infants are more likely to require hospitalization, and to have complications—including apnea (the stopping of breathing), pneumonia, seizures, and weight loss secondary to feeding difficulties and vomiting from coughing so hard. Most deaths from Pertussis occur in infants younger than 6 months of age, who are too young to have finished their first three vaccinations.
For infants, the concerns are:
The severity of illness, duration of illness, and risk of complications are generally lower in children who have been vaccinated. Most Pertussis cases occur in unvaccinated children under the age of 10, but it can also occur in vaccinated children and adults. The second most commonly affected group is children in the 10-18 year age range, where cases are both less common and less serious, but can still cause significant concern.
Pertussis is a respiratory disease, marked by its distinctive coughing spells and developing “whoop” sounds near the end of the spells, when the patient becomes more breathless. It is worth noting that the "whoop" sound is heard on inspiration (breath in) when the breathing in occurs suddenly between coughs (stridor). The offending cause of the illness is the Bordetella Pertussis bacteria. Infected individuals are contagious, and the disease is most often contracted through exposure to infected droplets from nearby coughing or sneezing. Locating the source of infection isn’t always easy, as the illness may incubate from 7-21 days before symptoms start to appear.
Infants younger than 12 months (usually under 6 months who have not yet been vaccinated against pertussis), children who have skipped the vaccine, or older children whose immunity had waned over time.
Adults can also get pertussis, though many don’t get a formal diagnosis and recover with at-home conservative care. Many children become infected from adults or older children who are unknowingly sick with the infection.
For those who aren’t vaccinated, pertussis is considered highly contagious. Whooping Cough is considered most contagious within the early part of infection, which can last 2 weeks or more.
Those given a course of antibiotics as treatment are unable to pass on the illness after 5 full days of taking the antibiotics.
The distinctive “whooping” sound is the hallmark symptom of the illness that many, but not all, may experience in the latter stages of the progression of infection. Earlier, it looks more like a common cold. Doctors have identified 3 unique stages of illness progression with pertussis.
Pertussis can look like a common cold. What differs between pertussis and a common cold is that the cough in pertussis gradually worsens instead of improving.
Fever generally doesn’t occur yet, but if it does it is low grade (<101 °F)
Mild loss of appetite
In stage 2, signs and symptoms worsen. Severe coughing fits, with long series of coughs between which there is little or no inspiratory effort, often producing the “whooping” sound when they breathe in between coughs. The child may gag, turn slightly blue, or appear to be struggling to breathe while these coughing fits occur.
Coughing spells increase
May or may not have fever
Loss of appetite
Possible change in skin color in severe coughing fits
Sweating may occur between coughing fits
The path to recovery is gradual and may be slow. Coughing fits begin to decrease in duration, intensity, and frequency. Episodic coughing may recur or worsen with other common colds that can occur during this time.
Fits begin to decrease in duration intensity and frequency
Often a milder cough may remain
Color and appetite returns to normal
If symptoms that first appear as a mild cold continue to worsen beyond 1-2 weeks instead of getting better, whether they have a fever or not, you should contact your primary care provider. Although testing is not necessary to diagnose Whooping Cough, testing can be performed if needed. Speak with your primary care provider to perform an examination. They can decide whether a test for pertussis is necessary.
To test for this, your doctor will typically perform a nasopharyngeal swab. This is where a swab is inserted into the nostril and goes back towards the top of the throat. The test will then be sent off for either a culture or a test called a PCR test. Test results may take between 1-5 days to return, depending on the type of test done. In cases where an infection is strongly suspected, or known contact with another infected person has occurred, your provider may prescribe an antibiotic while awaiting the lab results.
Chest X-rays or blood tests may also be ordered if the diagnosis is uncertain or if they are assessing for other causes or complications. This occurs less commonly.
Once pertussis is diagnosed and an appropriate antibiotics course has begun, your medical provider will likely want to remain in contact in order to monitor symptoms from home. At-home treatment for the caregiver will likely focus on a few key areas:
If your child shows no signs of recovery after 5 days of antibiotic treatment, or the symptoms worsen, reach out to your medical provider immediately.
Whooping cough has a way of hanging around. Even when a child or adult is on the path to recovery, it may be slow. Some find that coughing and energy loss remain for over a month after the initial onset of symptoms.
Because it can be so contagious, patients need to be kept out of school or daycare until the 5 days of antibiotics are completed. If no antibiotics were used, they will need to stay out of school or daycare for 21 days after onset of symptoms.
Dr. Chelsea Roberts was born and raised in the Portland area, and enjoys being able to practice medicine in the community she was raised. After attending Linfield College, she went on to Oregon Health & Sciences University where she received her Masters in Physician Assistant Studies. She then received her Doctor of Medical Science degree at the University of Lynchburg. She is NCCPA certified and has over 13 years of experience as a pediatric medical provider. When not at work, she enjoys traveling, kayaking, camping, and exploring the outdoors with her husband, 2 daughters, and their rambunctious Australian Labradoodle.