Whooping Cough (Pertussis)

Whooping cough, or pertussis, mainly affects infants and young children. Caused by a bacterial infection, it is associated with paroxysms (intense fits or spells) of coughing that end with the characteristic whoop as air is inhaled.

• Whooping cough caused thousands of deaths in the 1930s and 1940s, but, with the advent of the vaccine, the rate of death has declined dramatically.
• Whooping cough usually affects children younger than 1.
• Seventy-five percent of children affected are under age 5.
• Thirty percent of children affected are under age 1.

This disease can be mostly prevented with the pertussis vaccine. This is usually part of the DTaP vaccine (which stands for diphtheria, tetanus, and pertussis). This vaccine is usually given to children at 2, 4, 6, and 15 to 18 months of age, with a booster at 4 to 6 years of age. Unfortunately, some cases of the disease still occur, especially in infants younger than 6 months.

The disease usually takes one to three weeks to fully set in, and your child will usually pass through three stages. While each child may experience symptoms of whooping cough differently, some of the most common symptoms of each stage include:

Catarrhal stage (often lasts one to two weeks):

• Mild cough
• Low-grade fever
• Runny nose

Acute phase (may last for several weeks):

• Cough gets worse and comes in severe fits
• Cough is dry and harsh
• Cough ends with a whoop sound on inspiration (breathing in)
• Your child may vomit with the coughing and appear to be strangling on the vomit
• Cough can be started by many factors, including feeding, crying, or playing

Recovery phase (usually begins around the fourth week):

• Vomiting and the whooping cough cease first
• Cough usually decreases around the sixth week, but may continue on occasion for the next one to two months

Whooping cough can last up to several weeks and can lead to pneumonia.

Whooping cough is caused by a bacteria called Bordetella pertussis. It is spread among children by exposure to infected persons through droplets in the air. Once the bacteria is in the child's airways, swelling of the airways and mucus production begins.

In addition to a complete medical history and physical examination, diagnosis of whooping cough is often confirmed by a culture taken from your child’s nose.

Sometimes oxygen and intravenous (IV) fluids are needed until your child begins to recover, and he may be hospitalized for supportive care and monitoring. Your child's physician may also order a course of antibiotic treatment such clarithromycin (Biaxin), azithromycin (Zithromax), or a similar antibiotic.

Family members and others who have been in close contact with your child may also be started on antibiotic therapy, even if they have received the vaccine in the past.

Other treatment may include the following:

• Keeping your child warm
• Eating small, frequent meals
• Increased fluid intake (giving your child more liquids to drink)
• Reducing stimuli that may provoke coughing

The Division of Pulmonary Medicine at Boston Children’s Hospital is made up of clinical pulmonologists, pulmonary nurse specialists, physical therapists, and social workers who work together to care for our patients. Two physicians are on call 24 hours a day, seven days a week to deal with emergency situations. We have a nursing line to help answer questions and a prescription line to provide prompt medication refills.