The symptoms of whooping cough can be divided into three stages. The first stage lasts one to two weeks and is similar to a typical upper respiratory infection or cold. The symptoms include runny nose, mild cough, and possibly fever. During this stage, it is almost impossible to distinguish pertussis from the common cold.
The second phase is the most severe and usually the longest, lasting up to 10 weeks. The most characteristic symptom during this phase is the classic paroxysmal cough. The cough is sometimes described as staccato, which is a musical term that refers to notes played abruptly and detached. The short coughs usually come in rapid sequence, one after another after another. The coughing fits are sometimes followed by a high-pitched gasp that makes a “whooping” sound, hence the name of the illness. These coughing episodes can also be associated with vomiting, drooling, ruptured blood vessels in the eye, and sleep disturbance. According to the Centers for Disease Control (CDC), 4% of adults develop rib fracture and one quarter have loss of bladder control as a result of violent coughing. In infants, hospitalization to monitor for or treat complications is not uncommon. Some of these complications include pneumonia, seizure, and apnea (absence of breathing). Pertussis is fatal in 1% of hospitalized infants.
The third and final phase of the illness lasts approximately two to three weeks. The cough improves, but due to inflammation in the respiratory tract, patients are more susceptible to infection with other respiratory pathogens and recurrence of pertussis symptoms. The total time of illness is about 3 months, giving the disease another name, the 100-day cough.
Antibiotics are usually prescribed once the diagnosis of pertussis is made. However, the illness is not typically suspected until the second phase of illness and patients are most contagious during the first phase. By this point, the antibiotics help decrease the spread of infection to others, but do not treat the active symptoms. The spread of the infection is usually to close contacts through respiratory secretions. Parents and siblings are the source of infection in 65% of cases. For these reasons, prevention by vaccination is imperative.
The DTaP (diptheria, tetanus, acellular pertussis) vaccine is recommended for children at 2, 4, and 6 months, with boosters at 12-18 months and 4 years. Delaying or withholding this vaccine puts infants at risk for the complications described previously. Likewise, failing to immunize older siblings or parents puts young infants at risk since they are the source of infection in the majority of cases. The concept of “cocooning” centers on immunizing all of the close contacts of infants – parents, grandparents, siblings, healthcare workers, and childcare workers – in order to provide the unimmunized or partially immunized baby with a bubble of protection. Until the baby is able to receive his or her own vaccines, everyone else can help keep them healthy by getting regular boosters.
In addition to practicing good hand hygiene and covering your cough, talk with your doctor and your baby’s doctor to ensure your family is up to date on the pertussis vaccine. If you are an expectant parent, discuss with your doctor whether you need to get a booster during your gestation. If a close contact is diagnosed with pertussis, call your doctor to determine if you are a candidate for prophylactic antibiotics to prevent transmission of the infection.
Dr. Shanna McGinnis is a pediatrician at the One Health Pediatrics. She is also the mother of 3 children.