Whooping cough (pertussis)

Whooping cough is a disease that is triggered by an infection with the Bordetella species of bacteria. The medical term pertussis derives from Latin: “tussis” means “cough” and “per” means “very”. The English term also indicates the main symptom: severe fits of coughing that are associated with audibly aggravated breathing.  

Whooping cough is a severe illness that occurs especially in infants, children and adolescents. But adults are being increasingly affected by it; the progression of 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. This can involve respiratory arrest and whooping cough should therefore be monitored in hospital as a precaution.

In unvaccinated people with an initial infection, 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, a feeling of weakness and possibly a slight fever occur.

The subsequent characteristic symptoms of the illness – which give it is name – are severe spasmodic bouts of coughing and a whooping or wheezing sound when breathing due to the sick person struggling for air. The tongue usually protrudes during coughing. Those affected often bring up thick phlegm or vomit during the coughing attacks. The face can turn blue in the process.

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 progression with these is mostly milder and shorter.  

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 get onto a person’s mucosa. The bacteria are transmitted very easily. The probability that a sick person will infect other people in the immediate vicinity is about 80-90%. Whooping cough is thus highly contagious. 

Sick 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. 10,300 cases of whooping cough were reported in Germany in 2019. However, the estimated number of undetected cases is much higher. 

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 93% for children starting school in 2018 – 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. 

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, which last for minutes at a time, can occur up to 50 times in 24 hours and are very distressing. Ill people often get up thick phlegm and vomit. 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. While they also have a long-lasting cough, this is often not paroxysmal with wheezing and they do not have to vomit. That is why the illness is often not diagnosed in such cases. 

People who have already had whooping cough can develop it again. But a vaccination does not provide full protection. 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 rectified up into adulthood. 

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

1. vaccination: from the age of two months (eight weeks old)
2. vaccination: from the age of four months
3. vaccination: at the end of the first year of life (11 to 14 months old)

Booster

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 7 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 when:

• 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. 

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