Whooping Cough: What You Need to Know About Pertussis

Parents, have you heard of the term whooping cough? Find out what it means and what you can do to prevent it.

What is pertussis?

Pertussis (commonly known as whooping cough) is an acute and infectious disease of the respiratory tract, caused by the bacteria, Bordetella pertussis. It is characterised by severe coughing spells that end in a “whooping” sound when the person breathes in.

Pertussis is characterised by uncontrollable, forceful coughing that often makes breathing difficult. Pertussis patients frequently need to take long breaths after coughing fits, which results in a “whooping” sound. Pertussis can affect people of all ages, but it can be devastating for babies under a year old.

Pertussis is an important cause of infant death worldwide and continues to be a public health concern even in countries with high vaccination coverage.  Getting vaccinated is the greatest strategy to protect against pertussis.

Is pertussis contagious? How is it transmitted?

Pertussis is spread by coughing or sneezing while in close contact with others, who then breathe in the bacteria. As pertussis is highly contagious, it can be easily spread between family members and people in close contact with an infected person.³

Many infants who get pertussis are infected by older siblings, parents or caregivers who might not even know they have the disease.³

Whooping cough in children

Most pertussis cases occur in children under five years of age, with children less than one-year-old being the most seriously affected. Infants, 6 months of age and below, who have not received the full dose (at least three shots) of the pertussis vaccine are vulnerable to getting pertussis. 

The whooping cough vaccine you receive as a child fades off over time. This makes most teenagers and adults vulnerable to infection during an outbreak, which occurs on a regular basis.

Infants under the age of 12 months who are unvaccinated or have not received the entire set of recommended immunisations are at the greatest risk of serious problems and death.

Outbreaks of pertussis occur in most teenagers and adults whose immunity against the bacteria from previous pertussis vaccination has worn off because protection from immunisation only lasts 5 to 10 years after the last dose. ¹

What are the signs and symptoms of pertussis?

Symptoms start between an average of 7 to 10 days after exposure to the bacteria. It can start off like an ordinary cold (runny nose, sneezing, cough, fever) for 7 to 14 days, but tends to worsen with periods of uncontrolled coughing that can last 1 to 2 months. An infected individual has cough episodes that may end in vomiting or a “whoop” sound when he tries to breathe in. 

Many people, however, do not develop the characteristic whoop. A persistent hacking cough is sometimes the only indicator that an adolescent or adult has whooping cough. The “whoop” sound may not be heard from an adult who has pertussis, as an adult’s airway is wider. ¹

Symptoms may manifest differently in each child. Coughing might be difficult to hear in babies. Instead of coughing, infants may experience a halt in breathing (apnea). Babies may not cough at all. Instead, individuals may struggle to breathe or even cease breathing for a short period of time. If you observe this, contact your child’s doctor or transport him or her to the hospital right soon.

The symptoms of whooping cough can be similar to those of other illnesses, so it’s best to make an appointment for your child to see a doctor for a diagnosis.

Call your doctor if you or your kid experience the following symptoms as a result of persistent coughing spells:

• Vomiting
• Skin turning red or blue
• Seem to be struggling to breathe or have noticeable pauses in breathing
• Inhaling with a whooping sound

How is a child’s whooping cough diagnosed?

Your child’s symptoms and medical history will be discussed with the healthcare provider. Your child will also be examined physically. The bacteria can be examined in a sample of nasal fluid or cough mucus. This is frequently done to confirm a diagnosis.

What are the possible complications of pertussis?

In babies, pertussis can be very serious and can even be fatal, with unvaccinated and partially vaccinated babies at particular risk.³

Pertussis, when severe, can lead to pneumonia, fits, dehydration, weight loss due to feeding difficulties, slowed or stopped breathing, seizures, brain damage and in rare cases, even death. Most hospitalisations and deaths from pertussis occur in babies under 12 months of age.⁴

Because infants and toddlers are most vulnerable to whooping cough problems, they are more likely to require hospitalisation. Complications can be fatal in newborns under the age of six months.

In older children and adults, pertussis is generally milder; however, they can still experience prolonged bouts of coughing for many weeks, resulting in sleep disturbances and in rare cases, pneumonia, rib fracture and seizures.⁵

What is the treatment for pertussis?

Pertussis is generally treated with antibiotics. Early treatment is very important. Treatment may make the infection less severe if it is started early before coughing fits begin. Treatment can also help prevent spreading the disease to close contacts (people who have spent a lot of time around the infected person). ³

What is the treatment for whooping cough in children?

The treatment will be determined by your child’s symptoms, age, and overall health. It will also depend on the severity of the problem.

In some situations, your child may require hospitalisation. This is for monitoring and supportive care. Your child may require oxygen and IV (intravenous) fluids until he or she begins to heal.

Your child may also be given antibiotics. Antibiotics may not hasten your child’s recovery. They will, however, prevent the spread of infection to others. Anyone who has had close contact with a child infected with whooping cough is routinely given antibiotics. This is true even if the person has had the pertussis vaccine.

Home treatment may include:

• Keeping your kid warm and comfortable
• Feeding your kid small meals on a regular basis
• Providing enough fluids to your youngster
• Avoiding common coughing triggers, such as smoke or dust

Discuss the risks, benefits, and potential adverse effects of any medications with your child’s healthcare professional.

How do I prevent pertussis?

Is there a way to prevent pertussis in children?

The pertussis vaccination, which is commonly given in conjunction with shots against two other deadly diseases — diphtheria and tetanus — is the most effective strategy to avoid whooping cough. Vaccination should begin from infancy, according to doctors. Vaccination can protect against pertussis.³

In Singapore, the pertussis vaccination is given routinely together with vaccinations for diphtheria, tetanus, and HiB (Haemophilus Influenzae type B) to infants in one injection called DPT/HiB.¹

The vaccine consists of five shots, which are commonly given to children of these ages:

• 2 months
• 4 months
• 6 months
• 15 to 18 months
• 4 to 6 years

However, immunisation in adults helps reduce the risk of transmission of infection to babies who are too young to be fully immunised themselves. ³

Adults, particularly parents, are an important source of pertussis infection for young babies.⁶ New parents, adults planning to have a baby, grandparents and those caring for young babies should speak to their doctors about early protection against pertussis.⁷

Whooping cough vaccine

Side effects of the vaccine are usually mild and may include a fever, crankiness, headache, fatigue or soreness at the site of the injection.

Tdap Vaccination Common Side Effects

The majority of Tdap vaccination adverse effects, including vaccination during pregnancy, are mild to moderate and self-resolving. The most common side effects are as follows:

• Injection site erythema, edoema, discomfort, and tenderness
• Body-ache
• Fatigue
• Fever

Severe adverse effects are relatively uncommon, particularly in adults.

Booster shots

• Adolescents: Doctors prescribe a booster dose at age 11 to protect against whooping cough (pertussis), diphtheria, and tetanus since immunity from the pertussis vaccine tends to diminish.
• Adults: Some versions of every-ten-year tetanus and diphtheria vaccine also provide whooping cough protection (pertussis). This vaccine will also minimise your chances of passing on whooping cough to infants.
• Pregnant women: Pertussis vaccination is now recommended for pregnant women between the ages of 27 and 36 weeks. This may also provide some protection to the baby during his or her first few months of life.

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Whooping cough vaccine in pregnancy

The CDC and the American College of Obstetricians and Gynecologists (ACOG) believe that the benefits of Tdap vaccination in multiple pregnancies outweigh the theoretical risk of severe hypersensitivity due to more frequent administration of the tetanus component of the Tdap vaccine.

Those who received two tetanus shots in a short period of time (within two years) were no more likely to experience serious side effects than adults who received their first Tdap vaccine.

Manufacturers are now producing these vaccines with lower tetanus component doses than previous tetanus vaccines. This adjustment, according to researchers, likely reduced the probability of severe local reactions.

Breastfeeding Safety Following the Tdap Vaccination

Breastfeeding is not a contraindication to receiving Tdap vaccine and is completely compatible with it. Tdap vaccine can and should be given to pregnant women who intend to breastfeed.

Preventive medications

If you’ve been exposed to someone with whooping cough, your doctor may advise you to take medicines to prevent infection if you:

• Are a health care provider
• Are pregnant
• Are younger than age 12 months
• Have a medical condition, such as a compromised immune system or asthma, that puts you at risk of serious sickness or consequences.• Share a home with someone who has whooping cough.
• Share a residence with someone who is at high risk of acquiring a severe sickness or complications from a whooping cough infection.

If you need more information on pertussis and how to protect yourself and your family from the disease, do not hesitate to speak to your doctor.

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