Whooping cough

Also known as pertussis

Key points about whooping cough

  • Whooping cough (pertussis) causes bouts of intense coughing and trouble breathing.
  • Each bout may last for 2 or 3 minutes. The cough may go on for 3 months.
  • It can cause serious illness and sometimes death in babies, young children and older adults.
  • Whooping cough spreads very easily from person to person.
  • Vaccination makes you less likely to get whooping cough and makes the illness milder if you do get it. 
  • There's been a recent increase in cases of whooping cough in New Zealand (May 2024) so watch out for signs. If you are a hapū māmā (pregnant person) it's important you get a free vaccination. 

 

Boy coughing into elbow
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Whooping cough is currently in Aotearoa New Zealand and is affecting people of all ages. It's very infectious (easily caught), so it's important that as many people as possible are protected from catching it. Young children (less than a year old) are particularly at risk of severe illness and hospitalisation with whooping cough and it's recommended that they get vaccinated against whooping cough. Read more about the free childhood immunisation programme in Aotearoa New Zealand,  what's available and when they should be given. 

If you're pregnant you can get a free Boostrix vaccination from 16 weeks. Others in your whānau are advised to get vaccinated against whooping cough as well but not everyone is eligible for a free vaccination. Read more about who is eligible and where you can get vaccinated

When should I seek help? 

Complications of whooping cough are most likely to happen in babies and young children. 

See your healthcare provider if your child:

  • is less than 1 year old and they've had contact with someone with whooping cough
  • has a cough that goes on for a long time without any pauses, or has a cough that ends in vomiting (being sick)
  • has had a daily cough that lasts longer than 2 weeks
  • is less than 3 months old and has a cough.

Dial 111 for urgent medical help if your baby:

  • goes blue when coughing
  • stops breathing
  • has a seizure
  • is becoming very sleepy and not easy to rouse (wake up).

Whooping cough is an infection caused by a bacteria called Bordetella pertussis. This is why the illness is sometimes called pertussis. The cough can go on for weeks or months which is why it's sometimes called 'the hundred day cough'. A ‘whoop’ is the sound you sometimes make when you breathe in deeply after coughing. Sometimes you can vomit after a bout of 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.

Video: Protect tamariki from whooping cough

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(KidsHealth NZ, 2023)

Video: What is That Sound? Whooping Cough

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(US Food and Drug Administration, 2022)

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 don't usually whoop.

They may:

  • stop breathing
  • go blue with bad coughing bouts
  • seem 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 trouble feeding and because the cough makes them vomit (be sick).

Older babies and young children

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

The early stage

It starts with a sore throat, runny nose, 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 comes in bouts. Children gasp for air between each bout of coughing. They get very red in the face. These spells last 1–3 minutes and they may vomit food or spit (phlegm) after the coughing. The cough often gets worse with swallowing or eating. In between bouts your child is likely to be well. 

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 mostly have a long-lasting irritating cough and some still get a severe illness. 

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

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

More than half of babies under 1 year of age who get whooping cough need to be treated in hospital, and 1 or 2 of every 100 hospitalised babies will die. Having whooping cough can lead to pneumonia, seizures, paralysis, permanent brain damage, deafness and blindness.

Bordetella pertussis bacteria infect the lining of your nose, throat and breathing tubes. 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.

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 healthcare provider 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 healthcare provider may ask for a blood test, but not usually.

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's no medicine that will stop the cough once it has started. Cough medicine won't ease the coughing and isn't recommended for young children.

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're 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 them to have 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 you're not sure how much to give them, ask your healthcare provider or pharmacist for advice.

These things may help them feel more comfortable:

  • 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, like cigarette smoke, perfumes or car fumes.

See your healthcare provider if your child:

  • is less than 1 year old and they have had contact with someone with whooping cough
  • has a cough that goes on for a long time without any pauses, or has a cough that ends in vomiting (being sick)
  • is less than 3 months old and has a cough.

Dial 111 for urgent medical help if your baby:

  • goes blue when coughing
  • stops breathing
  • has a seizure
  • is becoming very sleepy and not easy to wake up.

There's no medicine that will stop the cough once it has started.

Antibiotics

Antibiotics may make whooping cough less serious if started very early, before the coughing starts. This is only useful if you've been in contact with a known case of whooping cough and you're at high risk of severe disease – contact your healthcare provider if you think this might be you.

If whooping cough is diagnosed during the first 3 weeks of the infection, your doctor may prescribe 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 2- 5 days.

Hospital treatment

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

  • oxygen by a tube under your nose
  • fluids by an intravenous drip (into a vein), or by nasogastric feeding (feeding through a tube passed through your nose or mouth into your stomach).

Vaccination is the best way to protect against whooping cough

In Aotearoa New Zealand, the pertussis vaccine for whooping cough is part of the NZ Immunisation Schedule. It's 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, including catch ups for missed doses for young people up to the age of 18 years.

Poster promoting vaccination in pregnancy to protect newborn babies from 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. A booster dose of the pertussis vaccine is recommended for every pregnancy and is free during the second or third trimester. It's 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. 
 
When you're vaccinated during pregnancy, 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 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.

Most cases of whooping cough in babies are passed on by 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 whānau members such as grandparents.

The protection you get from vaccination reduces over time, so check with your healthcare provider if you don't know if you might need a booster injection. This is funded at 45 and 65 years.  Read more about the the pertussis vaccine for whooping cough.

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
  • you've been advised by your healthcare provider that you're no longer infectious.

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

Tell your close contacts: Anyone you've spent more than 1 hour with at closer than 2 metres distance 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. They may need to have a vaccine, stay at home or take a preventative antibiotic.

Cover coughs and sneezes: Follow good hygiene practice for covering coughs and sneezes

Wash your hands often: Follow good hygiene practice for hand washing.

Information for people with whooping cough (pertussis)(external link) National Public Health Service – Northern Region
Information for contacts of people with whooping cough(external link) National Public Health Service – Northern Region
Whooping cough fact sheet(external link) National Public Health Service – Northern Region
Pertussis(external link) The Immunisation Advisory Centre, NZ
Immunisation during pregnancy(external link) The Immunisation Advisory Centre, NZ

Brochures

Immunise during pregnancy Health Ed, NZ. Available in Chinese Simplified(external link), Chinese Traditional(external link)Hindi(external link), te reo 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) HealthEd, NZ
Don't delay – immunise now for whooping cough(external link) Immunisation Advisory Centre and Ministry of Health, NZ

References

  1. Pertussis (whooping cough)(external link) (Immunisation Handbook 2020(external link)) Ministry of Health, NZ
  2. Pertussis(external link) Immunisation Advisory Centre, NZ
  3. Pertussis(external link) Auckland Regional HealthPathways, NZ
  4. Whooping cough(external link) KidsHealth, NZ

National Public Health Service – Northern Region (24 May 2024)

There has been a significant increase in pertussis cases across multiple regions of New Zealand recently. While the Auckland region’s case numbers are currently at baseline, future increases are anticipated given current immunisation rates.

  • Please remain alert to pertussis symptoms. Babies with pertussis illness(external link) may not present with characteristic whoop. Have a low threshold for in-person assessment.
  • If considering pertussis please confirm diagnosis using nasopharyngeal PCR swab. This should be taken with the purple-top Copan PCR swab in viral transport medium (see attached photo and guidance). Confirming diagnosis is important at this point in our epidemiology.
  • Continue encouraging free pertussis vaccination, especially for Māori and Pasifika hapū māmā (in every pregnancy) and pēpē, plus self-funded vaccine for caregivers and those with regular contact with babies. See Pertussis Vaccination in Pregnancy(external link).

For more information see Auckland Region HealthPathways: Pertussis (Whooping Cough). More information links are provided below.(external link)

Public health alert –(external link) Pertussis (whooping cough) awareness Health New Zealand | Te Whatu Ora, NZ, 2024
Copan PCR swab image(external link) 
Microbiology swabs and collection tubes(external link) Medinz, NZ, 2023

 

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.

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Emma Dunning, Clinical Editor and Advisor

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