Whooping cough (pertussis) is an infectious disease caused by the Gram-negative bacterium Bordetella pertussis. It typically presents in children. There are around 1,000 cases are reported each year in the UK.

Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:

• Paroxysmal cough.
• Inspiratory whoop.
• Post-tussive vomiting.
• Undiagnosed apnoeic attacks in young infants.

The typical clinical findings include 2-3 days of coryza precede onset of:

• coughing bouts
  • usually worse at night and after feeding
  • may be ended by vomiting
  • central cyanosis may occasionally be seen
• inspiratory whoop
  • not always present
  • caused by forced inspiration against a closed glottis
• infants may have spells of apnoea
• persistent coughing may cause subconjunctival haemorrhages or even anoxia leading to syncope & seizures
• symptoms may last 10-14 weeks and tend to be more severe in infants

Diagnosis

• per nasal swab culture for Bordetella pertussis - may take several days or weeks to come back
• PCR and serology are now increasingly used as their availability becomes more widespread

If bloods are done a marked lymphocytosis is often seen.

Management

• infants under 6 months with suspect pertussis should be admitted
• in the UK pertussis is a notifiable disease
• an oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread
• household contacts should be offered antibiotic prophylaxis
• antibiotic therapy has not been shown to alter the course of the illness
• school exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )

Complications

• subconjunctival haemorrhage
• pneumonia
• bronchiectasis
• seizures

Routine immunisation

• infants are routinely immunised at 2, 3, 4 months and 3-5 years. Newborn infants are particularly vulnerable, which is why the vaccination campaign for pregnant women was introduced
• neither infection nor immunisation results in lifelong protection - hence adolescents and adults may develop whooping cough despite having had their routine immunisations

Vaccination of pregnant women

In 2012 there was an outbreak of whooping cough (pertussis) which resulted in the death of 14 newborn children. As a temporary measure, a vaccination programme was introduced in 2012 for pregnant women. This has successfully reduced the number of cases of whooping cough (the vaccine is thought to be more than 90% effective in preventing newborns developing whooping cough). It was however decided in 2014 to extend the whooping cough vaccination programme for pregnant women. This decision was taken as there was a 'great deal of uncertainty' about the timing of future outbreaks.

Women who are between 20-32 weeks pregnant will be offered the vaccine.