Whooping Cough

Definition: Whooping cough (pertussis) is a highly infectious disease caused by the bacterium Bordetella pertussis. The name comes from the characteristic 'whoops' that occur in children during bout of paroxysmal cough. The incubation period is approximately 7-10 days. A person is consider infectious from onset of symptoms until 48 hours of appropriate antibiotic therapy or for 21 days from onset of symptom if antibiotic therapy is not completed.

Three phases of Whooping Cough

The Catarrhal Phase

The Paroxysmal Phase

The convalescent phase

Clinical Diagnosis

Differential Diagnosis:

Notifiable disease

Management: Admission Required

Management: Admission not required

Management: Close Contacts


  • Occurs around 1 week after catarrhal phase and last between one and six weeks.
  • Between coughing fits (paroxysms) the person is usually well has undisturbed sleep.
  • Paroxysmal episodes consist of short expiratory burst followed by inspiratory gasp, causing the 'whoop' sound. Sound is less common in adults and children younger than 3 months.
  • Paroxysmal episodes are more common at night and may be triggered by external stimuli, may be up to 30 in 24 hours.
  • Thick mucous plugs or water secretions may be present, however usually no other chest signs seen.
  • May be severe enough to cause cyanosis in children. Frequently post-tussive vomiting. Adults may experience sweating attacks with facial flushing and rarely cough syncope.
  • Lasts between one and two weeks.
  • Rarely diagnosed in this time unless there has been known contact with someone infected
  • Symptoms similar to upper respiratory tract infections: nasal discharge, conjunctivitis, malaise, sore throat, low-grade fever, dry unproductive cough.
  • Lasts up to 3 months
  • Gradual improvement in cough frequency and severity
  • Paroxysms can recur with subsequent respiratory tract infections for many months following initial infection
  • Suspect in acute cough for 14 days or more without another apparent cause with one or more of the following:
  • Paroxysmal cough
  • Inspiratory whoop
  • Post-tussive vomiting
  • Undiagnosed apnoeic attacks in young infants
  • Not fully immunized, or contact with confirmed/suspected case should raise clinical suspicion
  • Consider alternative diagnosis is symptoms are atypical
  • Other infectious causes of cough
  • Respiratory syncytial virus
  • Asthma
  • Post-infectious cough
  • Upper airway cough syndrome
  • Gastro-oesophageal reflux disease
  • Underlying lung malignancy

If any suspicion of infection due to clinical features a notification form should be completed and sent to Public Health.

Public health will advise on appropriate test for confirmation and surveillance depending on age, duration of symptoms and local laboratory facillities.

6 months or younger and acutely unwell

Significant breathing difficulties (apnoea episodes, severe paroxysms, cyanosis)

Significant complications

Inform hospital prior to admission for appropriate isolation to be arranged

Offer antibiotic to close contacts of the 'index case' with suspected/confirmed pertussis.

If symptoms within the previous 21 days and the close contact is within a priority group offer antibiotic

Group 1 infants at increased risk of developing complications

Group 2: People at increased risk of transmitting infection to infants in group 1 and who have not received a pertussis-containing vaccine more than 1 week and less than 5 years ago

Advise exclusion from nursery, school or work for asymptomatic contacts is not required

Offered immunization to all people offered antibiotic prophylaxis

Prescribe antibiotic if the onset of the cough is within the last 21 days (macrolide is preferred first line)

Less than 1 month: Clarithromycin, Children > 1 month and non pregnant adults: Azithromycin/Clarithromycin, Pregnant Women: Erythromycin

Offer information on obtaining rest, fluid intake, use of paracetamol/ibuprofen

Advise even with antibiotics likely to still cause non-infectious cough which may take several weeks to resolve

Advise to seek help if any complications occur

Advise on infectious period and should stay off school/work until this has passed

When acute illness passed arrange for any outstanding vaccinations to be completed