What is whooping cough?
Whooping cough or pertussis is a highly infectious bacterial disease that affects the respiratory tract. It mainly occurs in children under the age of five and most cases occur in children under one year. Pertussis is one of the infections that children are vaccinated against when they are babies and vaccination against pertussis has significantly reduced its incidence in the community.

Causes

Whooping cough is caused by a bacterium called bordetella pertussis. Transmission occurs by close contact via droplet infection from the respiratory tract of infected patients, i.e. when a child with the disease coughs, they shoot hundreds of infected droplets into the air. The incubation period is usually seven to ten days.

Symptoms

The early symptoms are similar to a cold, i.e. runny nose, mild cough, raised temperature and pink eyes. This lasts about a week and is the most infectious stage. Then a cough develops, which gradually gets worse and can last for two to three months. The cough usually occurs in spasms and may end with a high-pitched whoop as the child gasps for air. These spasms are usually worse at night. Fever may be absent during this phase of the illness. In young infants, the typical 'whoop' may never develop and the infant may vomit, go blue or even stop breathing for a moment after a coughing spasm.

Complications

Complications of pertussis infection include pneumonia, seizures and death. Complications are most common in children under six months of age.

Diagnosis

Your doctor may be able to diagnose whooping cough by the characteristic cough. In adults and small babies, diagnosis is more difficult and the doctor may take a swab of cells from the throat or nose to test for pertussis.

Treatment

Pertussis is a serious illness and many children are admitted to hospital for treatment. Even with treatment the illness can last for several weeks. Treatment can include:

Antibiotics.

Oxygen and intravenous fluids may also be necessary.
Fluids: encourage your child to drink lots of clear fluids to prevent the mucus in the lungs from becoming sticky and to loosen the mucus in the nose and throat.

Avoidance of cough triggers: keep your children away from things that trigger coughing, such as smoke.

Care of exposed persons: all people in close contact with your child will be asked to take an antibiotic to prevent them from getting sick or passing the infection on to other people. This includes people in your immediate household and any day care contacts.

Is pertussis very infectious?

Whooping cough is an extremely infectious illness. As many as 90% of non-immune household contacts will pick up the infection. The early stage of the illness before the cough starts is the most infectious stage but the patient can remain infectious for several weeks.

Call your doctor if:

• Coughing spasms cause your child's face, hands, or feet to turn blue.
• You hear a 'whoop' when the child breathes in.
• Your child stops breathing with any coughing spells.
• Your child's breathing becomes fast or difficult.
• Your child has a seizure.
• Your child is not responding to you or seems lethargic (sluggish).
• Your child is not drinking.
• Your child develops a fever higher than 104ºF (40ºC).
• Your child looks very sick.
• Your child is less than six months old and has coughing spasms and vomiting.
• Your child has been exposed to someone with whooping cough.
• Your child's cough lasts longer than three weeks.

Prevention

Whooping cough can be prevented by vaccination. Current vaccination against pertussis begins at two months and is given as part of the five-in-one vaccine (this vaccine contains protection against diphtheria, tetanus, pertussis, polio and haemophilus influenzae). Vaccinations are given at two months, four months and six months of age. A booster vaccination is recommended at school entry.

Vaccine safety issues

It must be remembered that pertussis is a very dangerous disease, especially for infants. A newer, safer vaccine for pertussis is now available and the risk of a serious reaction is less than with the previous vaccine. The risk of neurological problems or long-term damage from the vaccine is very low and much lower than the risks from pertussis infection.

Minor side effects (e.g. local redness, swelling) can sometimes occur.

There are very few reasons not to vaccinate your child. A child can still be immunised even if:

The child had soreness, redness, or swelling at the injection site after a previous shot.

The child had a fever of less than 105ºF (40.5ºC) after a previous shot.
The child has/is recovering from a mild illness such as a cold, cough or diarrhoea without a fever.
The child has recently been exposed to an infectious disease.
The child is taking antibiotics.
The child was premature.
The child is breastfeeding.
The child has allergies (unless it is an egg allergy).
The child's family has a history of convulsions or sudden infant death syndrome (SIDS).

Contraindications to vaccination

There are a small number of contraindications to pertussis vaccination:

The child has a history of convulsions
The child has certain neurological problems
The child had a serious anaphylactic (allergic) reaction to pertussis vaccine.
Your doctor may decide not to give pertussis vaccination if, after a previous vaccination containing pertussis:

Your child had a very high temperature within 48 hours of vaccination
Your child had seizures within 72 hours of vaccination.
Your child had a floppy/unresponsive episode within 48 hours of vaccination.
Your child had crying lasting more than three hours within 48 hours of vaccination.