Whooping cough

The incubation period (the time between exposure to an infection and the appearance of the first symptoms of the disease) is 7-14 days. The symptoms can be divided into three stages:

• The catarrhal phase
• The paroxysmal stage
• The convalescent phase

1. The Catarrhal Phase

This is the most infectious period and lasts for 1-2 weeks. The initial symptoms of whooping cough are mild and resemble those of a common cold, which include:

• Mild cough
• Nasal congestion
• Sneezing
• Runny nose
• Low fever (below 102 degrees F)

The cough becomes more severe and frequent as the disease progresses. Although the cough may not be typically paroxysmal (sudden outbursts) in the early stages, it tends to be annoying and more frequent at night.

2. Paroxysmal Stage

This stage is characterized by paroxysms—episodes of sudden outbursts or bouts of cough. A thick layer of mucus accumulates inside the airways, causing uncontrollable coughing. The cough is marked by a high-pitched and long rasping indrawn breath at the end. This phase lasts for approximately 2-6 weeks. Prolonged and severe coughing may lead to:

• Vomiting
• Extreme fatigue
• Red or blue face
• High-pitched “whoop” sound with the subsequent breath of air

Not every whooping cough patient develops the characteristic “whoop” sound. In such cases, a persistent cough is considered a symptom of the disease. Intense coughing often results in loss of bladder control, heaviness in the head, headaches, vomiting, and exhaustion. Sudden but common triggers for the uncontrollable cough include yawning, stretching, laughing, yelling, or exercise. It may also occur more frequently at night. The longer it takes to treat the disease, the more frequent cough episodes may be experienced. Infants with whooping cough may not be able to cough and instead may find it very difficult to breathe.

3. Convalescent Phase

The intensity and paroxysms of cough decrease gradually over 1-4 weeks. Vomiting becomes less frequent, and appetite, general condition, and overall health usually improve.

Whooping cough is a bacterial infection caused by Bordetella pertussis, also known as pertussis. It is a highly infectious disease that can be transmitted from one person to another through close contact. If a person suffering from whooping cough sneezes or coughs, the bacteria-laden droplets are sprayed into the air. When inhaled by a healthy person, these droplets can enter their body. Once inside, the bacteria attach to cilia (hair-like extensions) present in the upper respiratory system. After attachment, the bacteria release toxins that damage the cilia, causing airway swelling and discomfort in breathing.

On average, infected individuals are most contagious for up to 2 weeks after the cough begins. According to the World Health Organization (WHO), there are about 20-40 million cases of whooping cough globally. Of these cases, 95% are diagnosed in developing countries. High incidence rates have been observed in young children due to low vaccination coverage. Coughing adults and adolescents are the major reservoir of B. pertussis and are the usual sources of infection in infants and children.

Whooping cough infection can occur at any time of the year, but cases surge during the summer months. Certain individuals are at a higher risk of contracting the infection, and several factors can increase their susceptibility to the disease, including:

• Lack of immunization or vaccination: According to the American Lung Association, individuals who are not vaccinated are at a significant risk for contracting the infection. Pregnant women and infants are particularly vulnerable:
• Pregnancy: Pregnant women nearing the end of their pregnancy should take extra precautions to avoid contact with individuals who may be infected. Unvaccinated women and their babies are at a higher risk of contracting the infection.
• Babies and infants: Babies cannot build their own immunity until they receive vaccinations at two months of age. Infants under one year who have not been vaccinated are especially at risk. If an infant contracts the infection, they may require immediate hospitalization for specialized treatment and care.
• Close contact with an infected person: Individuals who have been in close proximity to someone infected, or who have shared common objects, are at a heightened risk of contracting the infection.
• Adults with asthma: Research indicates that adults with asthma are at an increased risk of developing whooping cough. Those with asthma may experience severe symptoms if they contract the infection. Additionally, having whooping cough in infancy or childhood may increase the likelihood of developing asthma later in life. Therefore, it is highly recommended to stay up to date with vaccination status to ensure safety.

Whooping cough causes symptoms that are clearly evident, but early diagnosis can be challenging because the symptoms resemble those of a common cold or respiratory illness. If your symptoms worsen and the cough persists for longer than 7-10 days, you must visit your doctor. Often, the doctor may ask you questions about the type of cough or symptoms you experience. Based on those answers, your doctor may recommend several medical tests to confirm the presence of the disease, such as:

• Total leucocyte count: A blood test that is general and not specific for whooping cough diagnosis. It helps determine the presence of an infection or inflammation by checking the white blood cell count. White blood cells (WBCs) account for 1% of your blood and are responsible for protecting your body from infections. An increase in WBCs indicates an infection or inflammation.
• Differential leucocyte count (DLC): This test detects the percentage of each type of white blood cell present in the blood.
• Nose or throat culture test: A culture test is performed by swabbing the nasopharynx (the area where the nose and throat meet) to check for the presence of the whooping cough bacteria. Your doctor may recommend a laboratory test using the sample.
• Polymerase chain reaction test: This is a highly sensitive rapid laboratory test that can help determine the presence of the bacteria in a biopsy specimen.
• Chest X-ray: A chest X-ray produces images of the heart, lungs, airways, blood vessels, and the bones of the chest and spine. It is commonly one of the first imaging tests recommended by a doctor when they suspect heart or lung disease. A chest X-ray can help confirm the presence of inflammation or fluid in the lungs, which can occur during the disease.

Whooping cough can be prevented by getting vaccinated and staying up-to-date with immunizations. Additionally, certain preventive measures should be practiced to avoid the disease. They include:

Vaccine and Immunization

Vaccination is the most effective way to prevent whooping cough across all age groups, including babies, children, teens, pregnant women, and adults. The Tdap (tetanus-diphtheria-acellular pertussis) and DTaP (diphtheria-tetanus-acellular pertussis) vaccines are the two globally available vaccines that help prevent whooping cough. Both vaccines are effective against diphtheria, tetanus, and pertussis.

Types of Vaccines Available

There are two main types of whooping cough vaccines available:

• Whole cell (wP/DTwP)
• Acellular (aP/DTaP)

Since 1978, India has been using the whole cell (wP/DTwP) vaccine in its national immunization programs, while the acellular vaccines are primarily prescribed by the private sector.

The American Lung Association recommends the following forms of the whooping cough vaccine for specific age groups:

• DTaP for young children:
  • 2, 4, and 6 months
  • 15 through 18 months
  • 4 through 6 years of age
• Tdap for preteens:
  • 11 through 12 years
• Tdap for pregnant women:
  • During the 27th to 36th week of each pregnancy
• Tdap for adults:
  • Including adults with asthma
  • Anytime for those who have never been vaccinated

Chemoprophylaxis

Chemoprophylaxis refers to the use of drugs to prevent disease. Erythromycin is recommended for close family contacts of patients suffering from whooping cough, especially for children under 2 years old.

Additional Preventive Measures

Here are some additional preventive measures that can help prevent the spread of whooping cough:

• Self-isolation of suspected individuals: Suspected cases should self-isolate to avoid spreading the infection to adults and young children.
• Staying up-to-date with vaccination status: Vaccination is key to preventing the disease. Booster doses may be required to ensure immunity is maintained. Booster doses are recommended for all adults aged 19-65 years and adults in contact with babies less than 12 months old.
• Practicing good personal hygiene: Whooping cough is a contagious disease; therefore, maintain good hygiene by washing hands with soap and water regularly. If you come in contact with an infected person, cover your mouth and face with your hand. Practicing personal hygiene is crucial for comfort and for preventing disease transmission to others.

Learn more about 5 simple ways of maintaining hygiene at your workplace.

Whooping cough is a bacterial infection that can be treated with antibiotics. If treatment is initiated at an early stage, it becomes easier to manage the severity of the symptoms. If your doctor confirms the presence of the infection, you will be advised to start antibiotics immediately.

Medication

• Azithromycin
• Clarithromycin
• Erythromycin

If an infant contracts the infection, there is a higher risk of complications. In many cases, infants may require hospitalization. In severe cases, the patient may need intravenous fluids to replace lost fluid levels.

Supportive Measures

General measures include:

• Providing adequate nutrition and hydration
• Avoiding factors that aggravate coughing

Nebulization with salbutamol is effective in reducing bronchospasm (tightening of the muscles that line the airways or bronchi in the lungs) and controlling coughing episodes. If nebulization is not possible, salbutamol may be administered orally.

Common symptoms of whooping cough include cough, runny nose, fever, and nasal congestion. Some home care tips for whooping cough include:

• Do not give your child over-the-counter cough medications unless prescribed by a doctor.
• Avoid contact with anyone in the household or outside until you have fully recovered from the infection to help prevent its spread.
• Flu-like symptoms can be best managed with medications prescribed by a doctor and by getting plenty of rest. Ensure you relax and take rest until your symptoms have completely resolved.
• Keep your surroundings free from triggers such as smoke, dust, and chemical fumes to avoid coughing and sneezing.
• Practice good hand hygiene by washing hands frequently and properly using soap.
• Drink plenty of fluids, such as juices, water, and soups, to stay hydrated and prevent dehydration. Especially for children, watch for symptoms such as dry lips, lack of tears while crying, and infrequent urination.
• Use a cool mist vaporizer to help loosen mucus and soothe the lungs.
• Eat small meals at short intervals to aid digestion and reduce the chances of vomiting.
• Avoid close contact with others by keeping your mouth covered with a mask.

Whooping cough, if left untreated, can cause serious complications in different age groups, especially in babies and young children. They are at a higher risk for complications due to lack of vaccination and protection.

Infants: Complications of Whooping Cough

According to the Centers for Disease Control and Prevention (CDC), about half of the babies younger than 1 year old who contract whooping cough require hospitalization. Of those babies treated in the hospital:

• 1 out of 4 (23%) develop pneumonia (lung infection)
• 1 out of 100 (1.1%) experience convulsions (violent, uncontrolled shaking)
• 3 out of 5 (61%) suffer from apnea (slowed or stopped breathing)
• 1 out of 300 (0.3%) may develop encephalopathy (disease of the brain)
• 1 out of 100 (1%) may die

Teens and Adults: Complications of Whooping Cough

Teens and adults who are vaccinated tend to experience fewer complications compared to those who are unvaccinated. Commonly reported complications of whooping cough include:

• Pneumonia: Lung health can be compromised, leading to pneumonia if whooping cough becomes severe. This can result in acute respiratory distress and may require emergency medical attention.
• Seizures: Sudden, uncontrolled electrical disturbances in the brain that can cause changes in behavior, movements, feelings, and levels of consciousness.
• Encephalopathy: A group of brain disorders that can be harmful if left untreated.
• Hernia: A condition where an area of an organ or tissue pushes through a weakened layer of muscle, usually in the groin or abdomen. Severe whooping cough can lead to a hernia due to persistent and prolonged coughing.
• Damaged or collapsed lungs: Persistent coughing can exert pressure on the lungs, potentially resulting in collapsed lungs.
• Tuberculosis: Whooping cough can trigger flare-ups of tuberculosis infection.
• Malnutrition: This may occur due to persistent vomiting and avoidance of eating due to fear of coughing.

Whooping cough is a bacterial disease that can be treated with antibiotics. However, in some cases, it can become severe and lead to complications. Here are some tips to prevent and manage whooping cough effectively:

• Stay up-to-date with your vaccination status: Vaccines for bacterial diseases like whooping cough require booster doses at scheduled intervals. The immunity developed from the vaccine tends to diminish over time, so ensure you receive your booster doses as scheduled.
• Get plenty of rest: Make sure to rest until your symptoms resolve completely. If complications arise, follow up with your doctor regularly.
• Keep your surroundings free from triggers: Common cough triggers include smoke, dust, and chemical fumes. Maintain a clean and tidy living environment.
• Practice good hygiene: Wash your hands frequently with soap to reduce the risk of reinfection or spreading the disease.
• Keep yourself hydrated: Bacterial infections can lead to fluid loss. Drink plenty of fluids such as water, juices, and soups to stay hydrated.
• Use mist vaporizers: If you experience discomfort due to the infection, vaporizers can help loosen mucus and soothe the lungs.
• Eat small meals at short intervals: Bacterial infections can cause digestive difficulties. It is advisable to consume small, easily digestible meals at regular intervals and avoid large meals.
• Avoid cough medications for children: It is highly recommended to avoid cough medications for children infected with whooping cough, as they may not effectively clear the airway.
• Watch for signs of dehydration: Children with whooping cough may become dehydrated. Be alert for signs such as dry lips and decreased urination frequency.

In cases of severe infection, ensure you follow up with your doctor. Proper medication under a doctor's guidance will help manage the disease.