Pertussis (whooping cough)

Caused by the bacteria Bordetella pertussis, this disease is highly infectious and most serious in babies.

The disease is spread through droplets in the air and it can develop from upper respiratory tract (windpipe) infections into pertussis pneumonia (lung infection).

Symptoms include coughing and ‘whooping’, which can continue for a few months.

Complications of the disease include hypoxic encephalopathy (lack of oxygen to the brain) leading to brain damage and possibly death.

Pertussis (whooping cough) is a disease which can be prevented by vaccination.

Vaccination recommended for routine childhood immunisation is listed on the National Immunisation Program (NIP) Schedule and funded for children under the Immunise Australia Program.

People in high risk occupations, such as health and child care workers, should consider receiving a booster against pertussis. Contact your doctor or State or Territory Health Department for more details. Currently, there is a Government Funded Programme to give the booster to parents and grandparents of new babies.

Who is most at risk?

• Any one who is not protected (by recent immunisation or by having had the infection before) can get whooping cough, including older children and adults.

• Most people who get the infection in Australia are adults or young people over about 11 years of age – even if they have been immunised as a baby.

• Babies are at most risk of having severe health problems from whooping cough. About 1 in 200 babies who get whooping cough before they are 6 months old will die from the infection.

How long does it take to develop?

A child or adult who catches whooping cough will usually start to be unwell about 7 to 10 days after being exposed to the infection.

Signs and symptoms of whooping cough

• After several days the long spells of coughing start, causing difficulty breathing during the spells. The child will have many quick coughs in one spell. There can be several spells of coughing each hour (with an average of 25 coughing spells per day).

• Young children often have a whoop after the coughing spell (when they can finally breathe in). They might vomit any food or drink that they have recently swallowed, during the cough or soon afterwards.

• Adults and older children may not whoop, but they will have coughing spells and they may feel tired (the coughing can interfere with sleeping), and generally unwell. It can be many weeks before it is recognised that the older child or adult has whooping cough.

• Finally, after several weeks or more, the coughing spells start happening less often and they stop happening about 2 to 3 weeks later. If the person gets a cold soon after having whooping cough, the coughing can start again for a while (much shorter than the original illness).

Diagnosis of whooping cough

• During an outbreak of whooping cough it is usually possible to diagnose whooping cough from the symptoms.

• Blood tests and tests on mucous from the nose or throat can be done to confirm that the illness is whooping cough. Xrays may be done to check how well the lungs are working.

What you can do

• Be sure you and your children have up to date protection by vaccination.

• It is important to check often that the child is eating and drinking enough.

• It seems that feeding a young child immediately after a coughing spell may mean the food and drink stays down. Feeding seems to trigger a coughing spell if the child has not coughed recently, but soon after a coughing spell, food and drink usually do not trigger another coughing spell.

• Children who are coughing often will be tired and uncomfortable (coughing can cause tummy pain from overused muscles). Some paracetamol or ibuprofen may help with aching muscles.

Immunisation

• Routine childhood vaccination covers whooping cough at 2,4,6 months and 4 years

• Immunisation of older children also protects babies under 2 months (when whooping cough can be very severe) because there will be fewer children in the community who can spread the infection to babies (babies are not protected by antibodies from their mother).

• There is now a vaccine to protect children over 10 years and adults.  This booster works if the person had a full set of immunisation as a baby.

Immunisation is recommended to be given with tetanus and diphtheria at the age of 15-17 years (one injection with three vaccines). This immunisation is provided free in Australia.

Preventing the spread of whooping cough

• Any person with whooping cough should be excluded from child care, kindergarten and school until 5 days after starting treatment, or if not treated, for 3 weeks from the start of symptoms.

Children who are unwell should not be at child care, kindergarten or school even if they are no longer infectious.  The teachers are not able to provide the care that sick children need.

• Any children under the age of 7 years who have not been immunised and have been in contact with someone with whooping cough should be excluded from child care, kindergarten or school for 14 days after the contact, or until they have been on antibiotic treatment for at least 5 days.

• The National Health and Medical Research Council in Australia recommends that anyone who has been exposed to whooping cough in the household or other close contacts (such as child care) should receive antibiotics for 10 days even if they have been immunised (see your doctor).

• Whooping cough is a notifiable disease in Australia. The State Government health service will be notified of proven cases of whooping cough so that they can assist in stopping the spread of the infection.

Questions often asked about immunisation against pertussis

Q: Does pertussis immunisation cause permanent brain damage?
A: No, it does not, and many studies have been done to show that there is no risk. A few babies become “floppy” for several hours after the injection. They always recover fully. However children who get ill with pertussis (especially babies) can have brain damage, and might die.

Q: Does the pertussis part of the vaccine (combined with tetanus, diphtheria, and in South Australia Hepatitis B vaccines) cause reactions such as fever and a sore spot where the injection was given?
A: The type of pertussis vaccine has been changed. Since this new vaccine (a-cellular pertussis) has been used, there have been many fewer children who get a fever or sore injection sites, but they get the same amount of protection.

Q: Do children still need to be immunised against whooping cough?
A: Yes, there have been regular outbreaks of whooping cough in Australia even in the last few years, and babies in Australia still die from whooping cough. In some countries where many children are not immunised against whooping cough, the numbers of children getting sick (and dying) with whooping cough is much higher than in Australia.

Q: How long does the protection from whooping cough last after immunisation?
A: For some people, the protection against whooping cough starts to get lower around the age of 12 years. A booster at 15 to 17 years is recommended and provided free of charge in Australia.

Q: Is it better to wait until my child is a bit older before having the whooping cough immunisation?
A: No. Waiting until your child is older is not recommended because it is when they are less than 12 months old that babies are most at risk. Many of the children over 5 months old who get whooping cough have either not been immunised or the immunisations have not been given at the recommended time.