Whooping cough (pertussis) is a serious, contagious, respiratory infection caused by the bacterium Bordetella pertussis. The disease begins like a cold and then the characteristic cough develops. This cough may last up to three months, even after antibiotic treatment is completed and the person is no longer infectious.
The 'whoop' (which is not always obvious) is due to a deep breath at the end of a bout of coughing. Vomiting after coughing is common.
Whooping cough is particularly dangerous for babies less than six months of age. They are affected more seriously by the disease than older children or adults, and are more likely to develop complications.
One in every 200 babies who contract whooping cough under six months of age will die.
Immunisation is the best way to reduce the risk of whooping cough.
Symptoms of whooping cough
Whooping cough begins with symptoms similar to those of a cold. These can rapidly progress to include:
- severe cough – occurs in bouts
- characteristic 'whooping' sound on inhalation
- vomiting at the end of a bout of coughing
- apnoea – the child stops breathing for periods of time and may go blue.
A person with these symptoms may also have poor appetite, fatigue and dehydration. The person may appear normal between bouts of coughing. During the recovery, the cough gradually decreases, but can last up to three months.
Complications of whooping cough
Whooping cough is most serious in babies under 12 months of age. In young babies less than six months of age, the symptoms can be severe or life threatening. Seek urgent medical attention if your child's lips or skin go blue (cyanosis) or if they are having breathing difficulties associated with the coughing.
Some of the complications of whooping cough in young babies include:
- haemorrhage (bleeding)
- apnoea (stopping breathing for periods of time)
- inflammation of the brain
- convulsions (fits) and coma
- permanent brain damage
Causes of whooping cough
The Bordetella pertussis bacterium is spread by airborne droplets from the upper respiratory tract (when the infected person coughs or sneezes) and is highly infectious. The time from infection to appearance of symptoms (incubation period) is between six and 20 days.
A person is infectious for the first 21 days of their cough or until they have had five days of a 10-day course of antibiotics. In countries where immunisation rates are high, the risk of catching whooping cough is low.
In Victoria, most reports of whooping cough currently occur in adults over 20 years of age. Recent research has shown that family members, household contacts and carers are the main source of whooping cough infection in babies.
Diagnosis of whooping cough
Whooping cough needs to be diagnosed and treated immediately. There are a number of tests for whooping cough, but they are not always reliable and the results may take some time. Treatment should not be withheld while waiting for these results.
Tests used to diagnose whooping cough may include:
- medical history including immunisation status
- physical examination
- blood tests
- swabs of the nose and throat for laboratory testing.
Treatment for whooping cough
In its early stages, the symptoms of whooping cough can be reduced by taking antibiotics. If treatment is given in the first 21 days of the illness, the risk of passing the infection to others might be reduced.
Members of the infected person's household are at increased risk of getting the disease and are usually prescribed a strong antibiotic as a preventative measure, even if they are fully immunised.
Immunisation against whooping cough
In Victoria, the whooping cough vaccine is only available in a number of combined vaccines that also contain protection against other serious and potentially fatal diseases. The type of combined vaccine used for immunisation will depend on the person's age group. Children need to follow the full schedule of vaccines to be fully protected.
In Victoria, immunisation against whooping cough is free for:
- children at two (from six weeks), four and six months of age – in the form of a diphtheria, tetanus, whooping cough, hepatitis B, polio and Haemophilus influenzae type b (Hib) vaccine (six-in-one vaccine)
- children at 18 months of age – in the form of a diphtheria, tetanus and whooping cough vaccine (three-in-one vaccine)
- children at four years of age – in the form of a diphtheria, tetanus, whooping cough and polio vaccine (four-in-one vaccine)
- adolescents in Year 7 at secondary school (or age equivalent) – adolescents receive a booster dose of diphtheria, tetanus and whooping cough vaccine (three-in-one vaccine). The dose can also be given by a doctor or at a council community immunisation session
- pregnant women from 20 weeks gestation – during every pregnancy, from 20 weeks gestation, pregnant women receive a dose of diphtheria, tetanus and whooping cough vaccine (three-in-one vaccine)
- partners of women in the third trimester of pregnancy, if the partner has not received a whooping-cough-containing booster in the last ten years
- parents or guardians, if their baby is under six months of age and they have not received a whooping-cough-containing vaccine in the last ten years.
Free catch-up immunisations are also available in Victoria for people who have not been fully vaccinated, including:
- all people aged up to 19 years
- refugees and other humanitarian entrants aged 20 years and over
- vulnerable citizens.
If you are not sure whether you are eligible for immunisation against whooping cough that is free of charge, ask your doctor.
Adult immunisation against whooping cough
The whooping cough vaccine for adults also contains diphtheria and tetanus protection in a combination vaccine.
Adults who should be vaccinated with whooping cough vaccine if they have not had a dose in the last 10 years include:
- childcare workers
- healthcare workers
- pregnant women from 20 weeks gestation, in every pregnancy
- any adult who wants to reduce their likelihood of becoming ill with whooping cough
- family members, grandparents and people in contact with infants less than six months of age, including other household members
- all adults aged 65 years and older
- adults needing a tetanus boost at any time, and at 50 years of age when tetanus boosting is recommended
- people with a history of whooping cough infection – people who have had whooping cough are still recommended to receive whooping cough vaccine as scheduled.
A booster dose of whooping cough vaccine is recommended for people who have not had one in the previous ten years. The vaccine takes about two weeks for immunity to develop after vaccination.
The following people should have a booster dose of whooping cough vaccine every ten years:
- all adults working with infants and young children less than four years of age
- all healthcare workers.
Pregnancy and whooping cough immunisation
A combination vaccine against diphtheria, tetanus and whooping cough is recommended from 20 to 32 weeks gestation in every pregnancy and at any time up to delivery. If the vaccine is given within two weeks of delivery, the newborn may not be adequately protected.
Read more about protecting your baby from whooping cough.
If you would like more information, ask your doctor.
Immunisation and HALO
The immunisations you may need are decided by your health, age, lifestyle and occupation. Together, these factors are referred to as HALO.
Talk to your doctor or immunisation provider if you think you or someone in your care has health, age, lifestyle or occupation factors that could mean immunisation is necessary. You can check your immunisation HALO using the Immunisation for Life infographic.
Where to get help
This page has been produced in consultation with and approved by:
Department of Health and Human Services - RHP&R - Health Protection - Communicable Disease Prevention and Control Unit
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