In short
In older children and adults it is a miserable cough that lasts for weeks. In young babies it may not cause a cough at all, only pauses in breathing — which is why vaccination in pregnancy matters so much.
Emergency if: Pauses in breathing in a baby, blue or grey lips or skin, shallow or difficult breathing, chest pain on breathing, or a seizure — call emergency services now.
On your report
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On this page
01
How it starts
Whooping cough, or pertussis, is a bacterial infection of the airways. Symptoms usually appear five to ten days after exposure, though occasionally not for up to three weeks. The first stage looks like an ordinary cold — a runny or blocked nose, a sore throat, a mild occasional cough — and a high temperature is uncommon.
That early stage lasts one to two weeks and is when the infection spreads most easily, precisely because nobody suspects anything more than a cold. It is also the stage when antibiotics can make the most difference to the illness itself.
02
The coughing fits
After about a week the cough changes into fits of many rapid coughs in a row, often followed by a sharp gasp for breath — the whoop. The fits can bring up thick mucus and end in vomiting, and the face may go very red. People are often exhausted afterwards but seem well between episodes, and the fits tend to be worse at night.
Not everyone whoops. Babies under about three months and some adults may never make the sound, so the absence of a whoop does not rule the illness out. Coughing fits usually last one to six weeks and can run to ten, and the cough overall can go on for weeks or months, fading slowly and sometimes returning with the next cold.
03
Why babies are different
Babies under a year are at greatest risk of catching whooping cough and of serious complications. Many do not cough at all. Instead they may have apnoea — pauses in breathing — and in the youngest infants that can be the only sign, which is why whooping cough in a baby is easy to miss and dangerous to miss.
About one in three babies under a year who catch it needs hospital care. Among those admitted, around two in three have pauses in breathing, about one in five develops pneumonia, and about one in a hundred dies. Babies under six months also face dehydration, breathing difficulties and seizures. Older children and adults are far less severely affected, though the coughing can cause sore or cracked ribs, a hernia, ear infections and leaking urine.
04
Antibiotics, and how long it is catching
If whooping cough is diagnosed within about three weeks of the cough starting, antibiotics are given — mainly to stop it spreading to others. They may not reduce symptoms, because by the time the coughing fits begin the damage to the airways is already done; treatment started in the early cold-like stage is the version that can lessen the illness.
Someone with whooping cough is contagious for up to three weeks after the coughing starts. The usual advice is to stay off school, work or nursery until 48 hours after starting antibiotics, or three weeks after the cough began if no antibiotics were taken. Some guidance counts infectiousness as lasting a few days longer after starting treatment, so follow the specific advice you are given, especially around babies.
05
Vaccination, including in pregnancy
Childhood vaccination against whooping cough is given as part of the routine combined infant vaccines in the first months of life, with booster doses later in childhood; schedules differ by country, so follow your local programme. Protection works well but fades over time, which is why boosters matter and why adults can still catch it.
Vaccination during pregnancy is the single most effective way to protect a newborn, because the baby is too young for its own vaccines in the first weeks of life. The mother's antibodies cross the placenta and protect the baby until it can be vaccinated. The vaccine is recommended in every pregnancy, usually in the middle to later part of pregnancy — ask your midwife or doctor if you have not been offered it.
06
When to get help
Get urgent medical advice for any baby under six months with symptoms of whooping cough, for a cough that is very bad and getting worse, and if you are pregnant and have been in contact with someone who has it. Hospital treatment is usually needed for severe illness and for babies under six months.
Call emergency services if lips, tongue, face or skin turn blue or grey, if breathing is shallow or difficult, if there is chest pain that worsens with breathing or coughing, or if a child has a seizure. In a baby, any pause in breathing is an emergency. Do not give aspirin to anyone under sixteen.
When to act
Routine — see a doctor
A lingering cough in a vaccinated older child or adult with no breathing difficulty: see a doctor, since early antibiotics reduce spread to babies and others.
Same-day — call promptly
Any baby under six months with a cough or cold symptoms and possible exposure, a cough that is getting worse, or contact with whooping cough during pregnancy.
Emergency — act now
Pauses in breathing in a baby, blue or grey lips or skin, shallow or difficult breathing, chest pain on breathing, or a seizure — call emergency services now.
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Sources
- Whooping Cough — NHSnhs.uk
- Whooping Cough — MedlinePlusmedlineplus.gov
- Symptoms of Whooping Cough — CDCcdc.gov
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