Whooping cough (pertussis)

Whooping cough is a disease that is mainly triggered by an infection with Bordetella pertussis bacteria. The medical term pertussis derives from Latin: “tussis” means “cough” and “per” means “very”. This refers to the main symptom – violent fits of coughing that are associated with audibly aggravated breathing.  

Whooping cough is a severe illness that mainly occurs in infants, children and adolescents. Adults may also be affected, although the disease is often milder for them.   

The disease can drag on over many weeks or even months. Very severe disease progressions may cause death, but whooping cough fatalities are very rare. Newborns and infants aged up to six months have an increased risk of a severe disease progression. To enable fast action in the event that breathing should stop, newborn babies and infants with whooping cough should be kept under close monitoring in hospital. 

In unvaccinated people who contract an infection for the first time, the illness typically progresses in three phases. You can find more detailed information about this in the Outlook section. 

At first, flu-like symptoms such as slight coughing, rhinitis (sneezing, itchiness and a blocked or running nose), a feeling of weakness and possibly a slight fever occur.

This is typically followed by a phase of violent coughing fits, which give the disease its name. After coughing, it is difficult to catch a breath while inhaling – this is what causes the characteristic wheezing or whooping sound. Shortness of breath may cause the face to turn blue, especially in newborn babies and infants. The tongue usually protrudes during coughing. Those affected often bring up thick phlegm or vomit during the coughing attacks. 

The main pathogen of whooping cough is the bacterium Bordetella pertussis. While an infection with the bacterium Bordetella parapertussis and the bacterium Bordetella holmesii can also lead to an illness, the symptoms are mostly milder and don’t last as long.  

The bacteria are transmitted by air, for example when someone is talking, sneezing or coughing. This is referred to as a droplet infection, because droplets containing bacteria find their way to the mucous membrane lining the respiratory tract. The bacteria are transmitted very easily. There is a very high likelihood of catching the disease through close contact with someone who is already infected. 

People can be infectious for up to three weeks and are at their most infectious during the first two weeks of the illness. If patients are treated with antibiotics, the infectiousness is reduced by up to seven days after the start of therapy.

Whooping cough is one of the world’s most prevalent infectious diseases in children, but adolescents and adults can also get sick from it. During the COVID-19 pandemic, there was a sharp drop in case numbers in Germany between 2020 and 2022. Since the end of 2022, however, the number of whooping cough cases reported has begun to rise again. 810 cases were reported in 2021. This figure rose to 1,741 in 2022. 

Whooping cough occurs year-round, but is somewhat more common in autumn and winter. While the vaccination rate is high for infants and small children – it was about 92 percent for children starting school in 2020 – vaccine protection only lasts for a limited time. This means that after both an illness recovery and a vaccination, it is possible to be reinfected and get sick from whooping cough due to decreasing immunity. As adults were often vaccinated when they were much younger, their immunity against the disease is reduced. The number of adults to catch whooping cough is therefore on the rise.

The progression of the illness essentially depends on the vaccine protection. 

In unvaccinated people, an initial infection with the illness typically progresses in three phases. At the start, the symptoms resemble a normal cold: the patients have a runny nose and slight cough. A mild fever may appear. This phase lasts 1 to 2 weeks. 

As the illness progresses further, the cough intensifies and changes into severe spasmodic coughing attacks (“staccato cough”) with a wheezing sound when breathing. These fits of coughing can occur up to 50 times in 24 hours, and are particularly frequent at night. They may last several minutes and are very distressing. People often get up thick phlegm and vomit while having a coughing fit. Fever is seldom or only slightly pronounced, but patients have little appetite and are weakened. This phase can last 4 to 6 weeks overall.  

During the subsequent 6 to 10 weeks, the symptoms subside and the patients recover. 

In adolescents, adults and many vaccinated children, a whooping cough illness has a less severe and less typical progression. In many untypical cases, no coughing fits, wheezing or vomiting occurs. That is why the illness is often not diagnosed in such cases. 

Even people who have been vaccinated or had a previous infection with whooping cough can catch the disease again. Because the illness has a much milder progression in vaccinated people, the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends a whooping cough vaccination for all age groups.  

Initial immunization

Immunization is particularly recommended for infants. The first shots are referred to as initial immunization. If this initial immunization in childhood is unsuccessful, it can be repeated at a later stage, including in adulthood. 

The initial immunization comprises three vaccine doses that are recommended at the following stages:  

1. First vaccination from the age of two months (eight weeks old)
2. Second vaccination from the age of four months
3. Third vaccination from the age of 11 months

Booster vaccine

In childhood and adolescence, vaccine protection should be boosted twice with a combination vaccine for whooping cough, tetanus and diphtheria: 

• at the age of 5 to 6 years
• at the age of 9 to 17 years  

Once it is more than ten years since the last whooping cough vaccination, physicians recommend a one-time booster shot to all adults (as a combination vaccine). They should also do this if they have been vaccinated for whooping cough as a child or adolescent.

People in health professions like midwives and medical staff as well as people who work in community facilities like kindergartens or retirement homes are advised to get a whooping cough vaccine every ten years. 

Close contacts of an infant like grandparents, babysitters or nannies should get a booster four weeks before the birth at the latest. Only adults who have already been immunized against whooping cough in the last ten years do not need this booster. 

The vaccine is not available individually, but is available in the form of various combination vaccines. Depending on their “combo package”, these vaccinations protect against other diseases like tetanus, diphtheria, polio, type B influenza and hepatitis B.

You will find answers to the questions most frequently asked about the whooping cough vaccine on the Robert Koch Institute website.

Children are usually diagnosed based on the typical symptoms. Doctors can trigger the typical coughing with specific pressure on the tongue.  

Because whooping cough is easily confused with a normal cold in adults, older children and adolescents, with them only a laboratory test can give an indication on the causes of a longer-lasting cough. This can include both blood tests and examinations of nasopharyngeal swabs. 

For patients with coughing, laboratory diagnostics should always be carried out if:

• they had contact with a person who had a confirmed case of whooping cough
• there are coughing attacks with wheezing or vomiting
• the coughing has occurred for longer than 14 days
• infants and small children show typical whooping cough symptoms, especially spasmodic coughing and shortness of breath

Antibacterial drugs known as antibiotics can reduce the duration of the coughing attacks and lower their intensity. However, they are only effective if they are taken at the start of the coughing illness or in the first one or two weeks after coughing begins. To disrupt infection chains, treatment up to three weeks at most after the start of coughing is still a good idea. 

Cough syrup seldom brings about any improvement. Thick and stuck phlegm can be coughed up better with the aid of expectorants. 

With severe progressions, inhaling cortisone is also possible, but this usually has no effect. Newborns and young infants with whooping cough should always be monitored in hospital, because they are not yet able to independently cough up phlegm that is forming, and there is a high risk of respiratory arrest.

To prevent a lack of fluid due to vomiting, patients with whooping cough should drink a lot. Liquid or mushy foods can replace normal and mostly heavier fare during the illness. If there are severe coughing fits followed by vomiting, eating smaller, more frequent meals is recommended. 

While physical exertion can make coughing fits more likely and should be avoided, walks in the fresh air occasionally have a soothing effect.