Whooping cough

Whooping cough is caused by a type of bacteria called Bordetella pertussis (this is why the illness is sometimes called pertussis). This bacteria damages the lining of your nose, throat and breathing tubes (trachea and bronchi) and causes the coughing. The cough can go on for weeks or months. ‘Whoop’ describes the sound that some children make after coughing.

Whooping cough can be very serious in babies, young children and older adults. Older children are usually less unwell but the cough and vomiting can be distressing. Adults may just have an irritating cough that goes on much longer than usual.

Whooping cough – a baby in Starship's Intensive Care

(KidsHealth NZ, 2012)

Whooping cough is very easy to catch. It is passed from person to person by coughing and sneezing. On average, each person with whooping cough passes the infection on to 12 other people.

A person with whooping cough is likely to be infectious from the week before they start coughing to 3 weeks after the cough begins. Parents or older children in the family with whooping cough can easily pass it on to babies who are too young to have fully completed their course of vaccinations.

Whooping cough is not under control in Aotearoa New Zealand. Every 3–5 years there are outbreaks with several thousand people (mostly young children) affected.

More than half of babies under 1 year of age who get whooping cough will need to be treated in hospital, and 1 or 2 of every 100 hospitalised babies will die. 

Having whooping cough can lead to other complications such as pneumonia, seizures, paralysis, deafness and blindness.

Whooping cough affects you differently depending on your age.

Babies under 6 months

Whooping cough in young babies is unpredictable and can get worse very quickly. Babies aged less than 6 months old do not usually whoop.

They may:

• stop breathing
• go blue with bad coughing bouts
• appear to have a cold, then cough and have difficulty breathing
• get exhausted from coughing
• not be able to feed because of coughing
• lose weight because of difficulty feeding and because the cough causes vomiting (being sick).

Older babies and young children

In older babies and young children, the illness has 3 stages:

The early stage

It starts with a runny nose and eyes, mild fever and sneezing – just like a cold. This lasts 1 or 2 weeks.

The second stage

Next, there is an irritating cough. Over a week or two, the cough gets worse and your child will have bouts of coughing. They gasp for air between each bout of coughing. They get very red in the face. These spells last many minutes and they may vomit food or spit (phlegm) after the coughing. The cough often gets worse with swallowing or eating. It is very distressing for both parent and child.

The final stage

The final stage is the long recovery stage. The symptoms gradually get milder, but the cough continues for weeks.

Older children and adults

Older children and adults usually get a milder illness, particularly if they have had whooping cough before. But most have a long-lasting irritating cough and some still get a severe illness.

Whooping cough can last for weeks or months. If you or your child get a cold in the weeks after you have recovered from whooping cough, bouts of coughing sometimes can come back for a while.

If you think you or your child may have whooping cough, get an assessment by your healthcare provider as soon as possible. Make sure you tell the receptionist about the cough when you phone to book an appointment as you will need to be kept separate from other people in the surgery. Older children and adults will need to wear a mask.

Your doctor may be able to diagnose whooping cough after asking questions about your symptoms and doing an examination. They may take a nose and throat swab and send it to the laboratory to check for pertussis bacteria and/or test for COVID-19.  A whooping cough swab will only show up positive in the early stages of the disease. Your doctor may sometimes ask for a blood test.

Antibiotics may help reduce the severity of the illness if started very early 

If whooping cough is diagnosed during the first 3 weeks of the infection, your doctor may prescribe a course of antibiotics. This helps to prevent the bacteria from spreading to other people. If started early, antibiotics can reduce the amount of time you are infectious to others from about 3 weeks to 5 days.

Antibiotics may help make the illness less severe if they are taken very early in your illness, before the cough starts. Even then, they may make only a small difference. 

There is no medicine that will stop the cough once it has started

Your immune system will get rid of the bacteria after 3 or 4 weeks without any treatment but the damage caused to your breathing tubes takes longer to repair. There is no medicine that will stop the cough once it has started. Cough medicine will not ease the coughing and is not recommended in young children.

The following may provide some relief:

• sipping warm drinks
• reducing dry air, by using a humidifier in the bedroom
• using saline nose drops to help remove thick mucus
• drinking lots of clear fluids
• avoiding coughing triggers, such as cigarette smoke, perfumes or pollutants.

Sometimes hospital treatment is needed

Young children and older adults who are very unwell with whooping cough may need to stay in hospital. Sometimes whooping cough may make it hard to breathe and drink, so hospital treatment may include:

• oxygen by a nasal tube during or after the coughing bouts
• fluids by an intravenous drip (into a vein), or by nasogastric feeding (feeding through a tube passed through the nose or mouth into your stomach).

Mild cases of whooping cough can be treated at home. Stay at home and away from people who are not in your family/whānau bubble (especially babies and children) for 3 weeks. This is to stop the infection spreading.

If you are taking antibiotics, this isolation time goes down to 5 days from the day the antibiotics were started.

Make sure you and your child get as much rest as you can. Caring for your child with whooping cough is hard work, and the cough is often worse at night. Encourage small healthy meals and plenty of fluids.

If the cough is painful you can use paracetamol for pain relief. Make sure you follow directions and measure children's doses accurately. Never give more than the recommended dose. If unsure, ask your healthcare provider or pharmacist for advice.

Vaccination is the best way to protect against whooping cough

In New Zealand, the pertussis vaccine for whooping cough is part of the NZ Immunisation Schedule. It is a course of 3 injections that are given at ages 6 weeks, 3 months and 5 months. Two booster doses are then given at ages 4 years and 11 years. These vaccinations are all free.

Most cases of whooping cough in babies are passed on by family/whānau  members, as you can be infectious and pass it on without realising. People who are around pregnant mums and babies should have a whooping cough vaccination. This includes people in the household and other close family members such as grandparents. These people could be at risk of passing whooping cough onto your baby and vaccination is the best way to prevent this. 

The protection you get from vaccination does reduce over time, so check with your healthcare provider if you are not sure whether you might need a booster injection. Read more about the pertussis vaccine for whooping cough.

The best protection for babies is for their mother to be vaccinated during pregnancy and then for the baby to have their vaccinations on time at 6 weeks, 3 months and 5 months. A booster dose of the pertussis vaccine is recommended for every pregnancy and is free during the second or third trimester. It is available from your general practice and through some pharmacies. To find a local vaccine provider go to Healthpoint(external link) then enter Diphtheria/ Tetanus/ Pertussis into the search bar, and your region into the location box. 
 
If you are vaccinated during pregnancy against whooping cough, your body makes antibodies that pass through the placenta. This protects your baby from severe whooping cough for the first few months of life, until they have had their own 3 doses of vaccine and can make their own longer-term protection. Breastfeeding alone does not provide effective protection against whooping cough. Read more about pregnancy and immunisation.

If you or your child has whooping cough:

Isolate

To reduce the risk of infecting others, stay at home until you are feeling well AND you have either:

• taken 5 days of antibiotics or
• 3 weeks have passed since the start of the coughing bouts or
• been advised by your healthcare provider that you are no longer infectious.

During the stay at home (isolation) time, you must stay away from early childhood centres, kohanga reo, school, work, community gatherings and people outside of your family/whānau bubble.

Tell your close contacts

Anyone who you have been in face-to-face contact with for more than 1 hour is at risk of catching whooping cough. Tell these people that you have whooping cough and that they need to get advice from their healthcare provider.

Cover coughs and sneezes

Follow good hygiene practice for covering coughs and sneezes. 

Wash your hands often

Follow good hygiene practice for hand washing.

If you or your child come in close contact with whooping cough

Contact your healthcare provider if anyone in your family comes into contact with someone with whooping cough. Antibiotics may help prevent or reduce the severity of whooping cough if given early enough.

It's very important to see get advice quickly if your baby has been in contact with whooping cough and they:

• are less than 1 year old
• were premature
• have a heart or lung condition.

The following links provide more information on whooping cough.

Information for people with whooping cough (pertussis)(external link) Auckland Regional Public Health Service, NZ
Information for contacts of people with whooping cough(external link)  Auckland Regional Public Health Service, NZ
Whooping cough fact sheet(external link)  Auckland Regional Public Health Service, NZ
Whooping cough(external link) Ministry of Health, NZ
Pertussis(external link) The Immunisation Advisory Centre, NZ
Immunisation during pregnancy(external link) The Immunisation Advisory Centre, NZ
Immunise during pregnancy(external link) HealthEd, NZ

(external link)Immunise during pregnancy Health Ed, NZ, 2020 Available in Chinese Simplified, (external link)Chinese Traditional(external link), Hindi(external link), Māori(external link), Sāmoan(external link), Tongan(external link)
Pertussis (Whooping Cough) – factsheet NSW Multicultural Health Communication Service, Australia. Available in Arabic(external link), Chinese (traditional)(external link), English(external link), Farsi(external link), Khmer(external link), Korean(external link), Thai, (external link)Vietnamese(external link), More languages(external link)
Childhood immunisation booklet(external link) Ministry of Health, NZ, 2019
Don't delay – immunise now for whooping cough(external link) Immunisation Advisory Centre and Ministry of Health, NZ, 2013

Pertussis vaccine
Childhood immunisation
Cough in children

1. Pertussis (whooping cough)(external link) (Immunisation Handbook 2020(external link)) Ministry of Health, NZ
2. Pertussis: halting the epidemic by protecting infants(external link) BPAC, NZ, 2013
3. News update – pertussis vaccine now subsidised for all pregnant women(external link) BPAC, NZ, 2015

Te Whatu Ora clinical reminder: 9 March 2023

Te Whatu Ora is encouraging healthcare providers and professionals to be alert to the symptoms of pertussis/whooping cough and to encourage immunisation due to concerns about potential underlying community spread.

This comes following the recent tragic deaths of two people from whooping cough.

Pertussis is serious in very young children – during the last outbreak from October 2017 to May 2019, 50% of children with pertussis, who were aged under 1 year old, required hospitalisation.

Healthcare providers should consider pertussis as a possible alternative diagnosis, particularly in babies under 3 months with respiratory illness who may not present with the characteristic whoop. Be aware of the red flags of a seriously ill infant:

• apnoea
• dehydration
• lethargy
• cyanosis or O2 saturations <92%
• fever ≥ 38 degrees C.

And also consider early admission to hospital if any concerning clinical features:

• Poor feeding, with or without reduced urine output. 
• History of prematurity.
• Infants aged < 3 months. 
• Children with a history of chronic respiratory disease, cardiac disease, neuromuscular disease, or immune deficiency.
• Reduced alertness and responsiveness.
• Repeat presentations in this illness.

Any child less than 3 months of age with respiratory symptoms, whose caregiver has presented them for triage (via phone) should have a low threshold for offering an in-person assessment.

Free antenatal pertussis vaccination, with Boostrix, is available from general practice and also through many pharmacies across New Zealand. It can be given from the second trimester of every pregnancy and is recommended to have from 16 weeks, but at least 2 weeks before birth.

The whooping cough (pertussis) vaccination is free for:

• all children and young people aged under 18 years
• pregnant people for every pregnancy
• all adults at 45 and 65 years of age as immunity reduces (same vaccine as the tetanus booster)
• some groups at higher risk of becoming very unwell if they catch whooping cough (eg, chronic respiratory conditions, congenital heart disease or immunocompromised).

View the whooping cough pathway on your local HealthPathways site for information. Immunisation resources are available to download here(external link).

Practice notes

• Pertussis is a notifiable disease. Clinically suspected or laboratory confirmed cases must be notified to the Medical Officer of Health.
• Patients should be advised to avoid contact with others, especially infants and children, until at least 5 days of antibiotic treatment has been taken (2 days if azithromycin is used).
• Children with pertussis can deteriorate rapidly and may require hospitalisation.