Whooping cough (pertussis) is a highly contagious bacterial respiratory infection. In recent years, many countries have seen surges in cases, sometimes reaching levels not seen in decades. Older children and adults may just have a persistent cough, but for young babies, pertussis can be life-threatening, causing pauses in breathing, pneumonia, seizures and death. Most deaths occur in infants too young to be fully vaccinated.
How it presents
- Catarrhal stage (1–2 weeks): runny nose, mild cough, low fever. Looks like a cold. Most contagious at this stage.
- Paroxysmal stage (weeks): bouts of intense coughing, often followed by a high-pitched “whoop” as the child breathes in; vomiting after coughing; exhaustion. Coughing is often worse at night.
- Convalescent stage: gradual recovery, but cough can last weeks to months (“the 100-day cough”).
In young babies
Babies may not whoop. Instead they may have:
- Apnoea (pauses in breathing) or cyanosis (turning blue).
- Gagging, choking, feeding difficulties.
- Very high white cell count in severe cases.
Infants under about 6 months with suspected pertussis often need hospital admission for monitoring.
Nursing care
- Droplet precautions and isolation until 5 days of appropriate antibiotics (per local policy).
- Apnoea and SpO₂ monitoring for infants.
- During coughing spells: stay with the child, position upright or on their side, gently suction secretions if needed, give oxygen if desaturating, and record frequency and severity of spells.
- Small, frequent feeds; consider feeding after a coughing bout; monitor hydration and weight.
- Minimise triggers: crying, smoke, cold air.
- Support exhausted parents.
Treatment
- Macrolide antibiotics (e.g. azithromycin) reduce transmission and may shorten illness if given early. In very young infants, azithromycin is preferred over erythromycin due to a lower risk of pyloric stenosis.
- Antibiotic prophylaxis for close contacts, especially households with infants or pregnant women, as advised by public health.
- Notify public health according to local rules.
Prevention
- Vaccinate in pregnancy: many countries offer pertussis-containing vaccine to pregnant women (commonly from about 16–32 weeks, per national schedules). Antibodies cross the placenta and protect the baby in the first weeks of life, before their own vaccines.
- Timely infant vaccination: pertussis-containing vaccines in the routine schedule (e.g. pentavalent or hexavalent vaccine at 6, 10, 14 weeks in many countries, or 8, 12, 16 weeks in others).
- Boosters for children, and for health workers in some countries.
- Keep coughing people away from newborns.
Related: Bronchiolitis and croup · Diphtheria
Based on WHO pertussis position paper, UKHSA guidance on pertussis and national immunisation schedules. Educational content: follow national guidelines.