Whooping cough

January 2017

Whooping cough is a very contagious bacterial infection caused by a bacterium called Bordetella pertussis. This very contagious disease affects children and babies, in particular those who are not vaccinated. Whooping cough can affect adults and older children, in particular those who did not receive a vaccination booster. Upper respiratory tract infection often precedes the onset of whooping cough.


Symptoms


Diagnosing whooping cough can be difficult because the symptoms can be similar to bronchitis for example. Children, especially oder children infected with whooping cough can have symptoms for several weeks before they present themselves at their GP when it is diagnosed

Incubation lasts approximately 7 to 14 days. Upper respiratory tract infection often precedes the appearance of the first symptoms of whooping cough.

Coughing fits


Coughing fits characterise whooping cough. Whooping cough begins with a cough which gradually becomes increasingly frequent and manifests in violent fits of coughing.

The coughing fits are repetitive, short, bursts. The coughing fit ends in noisy breathing which is often compared to cock's crowing known as an inspiratory whoop. These coughing fits, can reach as many as 20 per day, and are exhausting.

Children may vomit thick mucus or food after each coughing episode. Between two coughing fits, the child breathes in deeply and noisily. Whooping cough in a child can lead to severe respiratory complications. The coughing fits can last approximately 2 to 4 weeks.

Episodes of dry cough worsened by effort, cold or tobacco can last beyond the period of fits.

Diagnosis


The diagnosis of whooping cough is often difficult to make.
  • A nasopharyngeal swab is taken.
  • A blood test searching for the bacterium.

Treatment


Whooping cough is a bacterial disease and antibiotics are essential for treatment, however they do not alter course of the disease, but do curtail the period of infectivity.

Antibiotics


The antibiotic treatment is advised in the first 3 weeks of development of the illness. Antibiotic treatment reduces the contagiousness of the disease. The most frequently used antibiotic is erythromycin. It is prescribed orally as syrup or a tablet for a period of approximately 2 weeks. Beta lactam (penicillins, cephalosporines) are ineffective.

Prevention of spread of infection


Patients must be isolated in order to avoid spreading the infection. Exclusion should be for 5 days from starting the antibiotics.

If a person has been in contact with an infectious person then prophylactic antibiotics are of value.

Other drugs


Bronchodilating and steroid drugs are given to the very young with severe symptoms.

Cough syrups and suppressants are ineffective

Respiratory complications


In severe cases steroids are used to help reduce the intensity of the coughing fits.

Asphyxiating coughing fits require a hospitalisation

Vaccination


The current uptake of the vaccine in the UK is over 90% and the prevalence of the disease is low. The vaccine against Whooping cough must be given at the age of 2 months, 3 months and 4 months and a booster given at 3 -4 years.

A minimum of four doses is recommended as part of the childhood immunisation programme and individuals who are immuno-compromised such as HIV postive people are advised to have booster doses

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