A unique child health: A guide to ... Whooping Cough

What is whooping cough?

Whooping cough is an infectious disease caused by a bacterium called Bordetella pertussis. Whooping cough causes intense bouts of coughing. It can affect anyone of any age, but is more commonly seen in children under the age of four years.

Whooping cough is now relatively uncommon in the UK because all babies are offered a pertussis vaccine at two, three and four months of age and a booster vaccine between the ages of three and five years. Before the introduction of this vaccine in the 1950s, over 100,000 cases of whooping cough were reported in England and Wales. Last year there were just 150 cases in children under the age of four years. Whooping cough does, however, remain a major cause of illness in children in countries where the vaccine is not routinely offered.

What causes whooping cough?

The pertussis bacteria is easily spread through infected droplets which are produced during coughing, and by close contact with someone who has the disease. The bacterium attaches itself to the cells that line the airways. It then multiplies and causes the symptoms.

Once a person has been exposed to the bacteria, they will usually develop symptoms between seven and 14 days. Whooping cough is most infectious during the early stages of the disease, but people can remain infectious throughout the course of their illness if they are not treated with antibiotics.

What are the signs and symptoms?

The initial symptoms of whooping cough are similar to a cold - a runny nose, sore throat, a mild fever and a dry cough. Within a week or so, the cough gets worse and becomes 'paroxysmal'. This means there are bouts or 'paroxysms' of intense coughing. During an episode of coughing, the coughing will continue until no air is left in the lungs. After this comes a deep intake of breath that can cause the 'whooping' sound that gives rise to the name of the disease.

Each bout of coughing usually lasts one to two minutes and can be very distressing. Some people can stop breathing at the end of a bout of coughing, but usually resumes again quite quickly. It is also not uncommon to vomit after a coughing episode. The number of coughing bouts will vary from person to person - some will only have a few bouts of coughing, others can experience up to 100 bouts a day. Quite often the symptoms are worse at night. Intense periods of coughing can cause nosebleeds and haemorrhaging (bleeding) into the whites of the eyes.

This main coughing stage of the illness usually lasts at least two weeks. It is not usual for a cough to persist for two to three months in some cases.

Complications of whooping cough can include bronchitis, pneumonia, ear infections, seizures, and bronchiectasis, a condition where pockets of infection form in the small airways of the lungs. In babies under six months, whooping cough can be really serious, as it can cause apnoea (the baby stops breathing) and sudden death.

How is whooping cough treated?

The pertussis bacteria can be killed by antibiotics, although the effects of antibiotics are uncertain, because once the bouts of coughing have started, treatment with antibiotics has little effect on the course of the illness. Mild cases of whooping cough can be treated at home with rest and fluids. Some cases, particularly young children, will need to be treated in hospital. Serious illness is less common in older children and adults.

How can whooping cough be prevented?

The pertussis vaccine which is offered to all children in the UK offers excellent protection against whooping cough. The effect of the immunisation is, however, thought to wane over the years, which explains why older children and adults who were immunised as young children still develop the disease. Once someone recovers from whooping cough they are unlikely to get it again, as they develop immunity against the disease.

Caring for a child with whooping cough in a childcare setting

The Health Protection Agency recommends that children should be kept away from a childcare setting for five days after starting antibiotics, or 21 days from the onset of the illness if they have not been prescribed antibiotics. This is because, after five days of antibiotics, they will no longer be infectious, but without antibiotics they will remain infectious for up to three weeks.

FURTHER INFORMATION

You can contact WellChild Helpline on 0808 801 0330, email helpline@wellchild.org.uk or text 0778 147 2599.