Vaccines and Your Immune System

Whooping Cough

What Is Whooping Cough? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Holly Pevzner
By Medically Reviewed by 
Reviewed:
Medically Reviewed

Whooping cough (pertussis) is a very contagious respiratory disease caused by the bacteria Bordetella pertussis. When this bacteria infects the linings of the lungs, it causes significant inflammation and swollen airways. The result is intense, uncontrollable coughing.

While the whooping cough vaccine has significantly reduced the infection’s occurrence, there were still more than 15,600 reported cases of whooping cough in the United States in 2019, according to the Centers for Disease Control and Prevention (CDC).

Signs and Symptoms of Whooping Cough

Whether a child or an adult is infected, whooping cough often seems like a regular cold at first, marked by a runny nose, sneezing, or a low-grade fever, according to Kid's Health.

While experiencing a mild cough is also an early symptom, for babies, the cough is often minimal or even absent. (Babies may also experience apnea, which is a temporary pause in breathing, as an early symptom.) These early symptoms can last for up to two weeks, notes the CDC.

Once whooping cough progresses, the following symptoms may appear:

  • Shortness of Breath
  • Tearing and Drooling (in Babies)
  • Vomiting This may occur during or after coughing fits.
  • Choking Spells (in Babies)
  • Skin Turning Blue While Coughing Lips, the tongue, and nail beds may also turn blue.
  • Extremely Rapid Coughing This is often followed by a high-pitched “whoop” sound. Coughing worsens as the illness progresses, often peaking at night. Note that milder versions of the disease mean teenagers and adults might not experience the “whoop.”

Causes and Risk Factors of Whooping Cough

Whooping cough is easily spread through the air when an infected person sneezes, coughs, laughs, or even talks near another. Sharing the same household with an infected person and not being vaccinated against whooping cough are the biggest risk factors for becoming infected, according to the American Lung Association.

Children and adults in the same home who have not received the vaccinations for whooping cough are 80 to 100 percent likely to be infected with exposure.

Here’s what you need to know about who’s at risk:

  • Infants Under 2 Months Old The youngest babies are also the most vulnerable to whooping cough and its complications. Not only are their immune systems still developing, but young babies cannot start receiving their whooping cough vaccinations until they’re 2 months old. Until then, they only have their mother’s antibodies to project them. (This, of course, is only if mom got her whooping cough vaccine during pregnancy.)
  • Babies Under 6 Months Old These children are at high risk for complications from whooping cough, including pneumonia, notes the CDC.

  • Babies Under 12 Months Old According to the CDC, about half of babies younger than 1 year old who contract whooping cough end up hospitalized.

  • Kids Under 6 Years Old Children don’t receive their final whooping cough vaccine booster shot until somewhere between the ages of 4 and 6, says the CDC.

  • Teenagers and Adults The whooping cough vaccine administered in childhood eventually wears off, leaving teenagers and adults susceptible during an outbreak.
A whooping cough infection can occur any time of the year, but tends to surge in the summer and fall months. If there’s an outbreak in your community, it’s important to be vigilant about early signs and symptoms of whooping cough.

How Is Whooping Cough Diagnosed?

Because whooping cough mimics the common cold, the flu, and bronchitis, it can be tricky to diagnose whooping cough early. But healthcare providers may be able to diagnose whooping cough by conducting an exam, asking specific questions regarding symptoms, and by simply listening to the cough. At times, medical tests are needed to confirm diagnosis. These include:

  • Nose or Throat Culture Here, a healthcare professional takes a sample of mucus from the back of the nose or throat to examine under a microscope. Results can take up to seven days. In most cases, this test is very effective, but often fails to detect whooping cough after several weeks of illness.

  • Polymerase Chain Reaction (PCR) Testing Here, mucus samples are retrieved from the back of the nose or throat. PCR testing zeroes in on the presence of specific DNA, notes the CDC.

  • Blood Tests A physician may order a white blood cell (cells that help the body fight infection) count to help determine if an infection or inflammation is present, notes the Mayo Clinic.

  • Chest X-Ray This can detect inflammation or fluid in the lungs, which can point to pneumonia, a complication of whooping cough.

Duration of Whooping Cough

Symptoms of whooping cough generally develop within 5 to 10 days after exposure, but it can take as long as three weeks to surface. After that, the signature coughing fits tied to whooping cough can last for up to 10 weeks or more.

Usually, whooping cough is no longer contagious after the third week of infection — or until five days after the start of treatment, according to the CDC.

Treatment and Medication Options for Whooping Cough

Your healthcare provider will likely prescribe an antibiotic treatment of erythromycin (EryPed 200), clarithromycin (Biaxin), or azithromycin (Zithromax) to kill the bacteria that causes whooping cough. The earlier antibiotics are used to treat whooping cough, the better. In fact, the CDC strongly encourages healthcare providers to consider treating suspected cases of whooping cough before a positive test result comes back.

This is especially so for individuals who are at risk for a severe case or complications.

If an infant has a severe case of the illness, hospitalization may be required. In the hospital, an IV may be administered to replace lost fluids, and the throat may need to be suctioned to clear away excess mucus.

Alternative and Complementary Therapies

Antibiotics can stop the spread of the whooping cough infection, but they can’t prevent or treat the cough itself. Experts discourage use of over-the-counter cough medicines, but the following steps may help aid recovery, per the CDC:

  • Using a cool-mist vaporizer to help loosen mucus and soothe irritated lungs and cough
  • Eating small, frequent meals to help prevent vomiting
  • Drinking plenty of water to avoid dehydration
  • Keeping your home free from irritants like smoke, dust, or chemical fumes that irritate the lungs

Prevention of Whooping Cough

Getting vaccinated is the number one way to prevent whooping cough. According to the CDC, children who haven’t received their DTaP vaccines are at least 8 times more likely to get sick than those who’ve received all five doses of that vaccine. (DTaP vaccines prevent against diphtheria, tetanus, and pertussis.)

Right now, there are two available vaccines that do the job in the United States: DTaP for children under 7 years old and Tdap for adolescents and adults. (Tdap is the name for the one-shot vaccine against tetanus, diphtheria and pertussis that’s given to people 11 years and older.)

Here’s who should get shots and when:

  • Infants and Young Children Babies should receive their first whooping cough vaccination at 2 months old, followed by a second and third dose at 4 months and 6 months. The fourth vaccination should be administered between 15 and 18 months, followed by the fifth and final shot between 4 and 6 years old, according to the U.S. Department of Health and Human Services.

    At least 90 percent of kids are fully protected after getting all five doses of DTaP, per the CDC.

  • Preteens and Teens DTaP’s ability to prevent whooping cough slowly decreases over time. For instance, if a child received her last DTaP at age 6, by the age of 11, that child’s chance of being fully protected hovers at 70 percent. As such, the CDC recommends that all children between the ages of 11 and 12 get a booster shot of the Tdap vaccine.

  • Adults 19 and Older Didn’t get the Tdap booster as a teen? You’ll want to make sure you get it now. In addition, a single Tdap dose should be given to adults who are in contact with infants as well as healthcare workers, according to the CDC.

  • Pregnant Women The CDC recommends that all pregnant women get a Tdap shot between the 27th and 36th week of each pregnancy. This way, you create protective antibodies to pass onto the baby before birth, helping to provide short-term protection against whooping cough and the related complications, notes the CDC.

    Doing so lowers the risk of contracting whooping cough by about 91 percent during the first two months of baby's life, according to the 2017 report in the journal Pediatrics.

No vaccine is 100 percent effective, but it is the very best protection available. Plus, if an individual does contract whooping cough after getting the vaccines, they are less likely to experience a serious infection.

Beyond vaccinations, antibiotics may help act as prevention after whooping cough exposure. This is called postexposure antimicrobial prophylaxis (PEP). The CDC suggests giving PEP to all members of a household where one member has been diagnosed with whooping cough. Per the CDC, other PEP candidates include those who:

  • Are immunocompromised
  • Have moderate to severe asthma
  • Work in neonatal intensive care units, childcare settings, maternity wards
  • Are infants younger than a year, particularly those who are younger than 4 months
  • Women in the third trimester of pregnancy

Black and Hispanic Americans and Whooping Cough

Research suggests that Black and Hispanic women, and Black children in particular, may not have the same access to whooping cough vaccines as other American women and children.

A CDC Morbidity and Mortality Weekly Report published in October 2020 noted that white women are far more likely to receive the Tdap vaccination during pregnancy than Black and Hispanic women.

According to the report, 65 percent of white women received the vaccine from 2018 to 2019, but only 35.8 percent of Hispanic women and 38.8 percent of Black women did. Moreover, where 81 percent of white women reported being offered the protective whooping cough vaccine by their healthcare provider, only 55.7 percent of Black women and 66.6 percent of Hispanic women reported the same.
This kind of "missed opportunity" carries over to other vaccines as well. An August 2014 report published in the Journal of General Internal Medicine found that people of color were more likely to remain unvaccinated for the flu compared with white adults — even when they had at least one healthcare visit during the flu season and indicated that they'd be willing to get vaccinated.

Further adding to the vaccination disparity is a lack of trust in the healthcare system among Black Americans, according to a recent survey from the Kaiser Family Foundation.

For example, about half of Black adults reported that they would not want to get a coronavirus vaccine, even if it was deemed safe by scientists and freely available, noting a lack of trust and safety concerns as the top reasons for refusal.
The disparity continues when it comes to which children receive their DTaP. The latest numbers from the Office of Disease Prevention and Health Promotion found that 88 percent of Asian children, 87.8 percent of Native Hawaiian or Pacific Islander children, and 86 percent of white children in the United States received four doses of the DTaP by age 36. Black or African American babies had the lowest rates of completed schedules, with 78.2 percent receiving all four doses.

Complications of Whooping Cough

Whooping cough can cause serious complications, especially in babies and young children who haven’t received all recommended whooping cough vaccine doses. But teens and adults can suffer complications, too. According to the National Organization for Rare Disorders, these include:

  • Pneumonia (babies and children)
  • Seizures (babies and children)
  • Encephalopathy (inflammation of the brain)
  • Hernia
  • Collapsed lung

Research and Statistics

There were 48,277 diagnosed cases of whooping cough in the United States in 2012. That was the largest number of cases reported in the United States since 1955’s 62,786 reported cases, according to the CDC.

In 2019, there were 15,662 reported cases of whooping cough in the United States, notes the CDC.

The risk of getting whooping cough is 13 times higher for children who never received DTaP than for children who were fully vaccinated, according to study published in July 2019 in the journal Pediatrics.

Children who received at least one DTaP dose, but were behind schedule are almost twice as likely to develop whooping cough than fully vaccinated children.

Related Conditions of Whooping Cough

Acute Bronchitis In acute bronchitis, inflammation of the bronchi and bronchial tubes bronchitis symptoms leads to persistent, mucus-filled cough, fever, or back pain.

Influenza The flu is another highly contagious respiratory tract infection caused by a virus. Symptoms may include sore throat, cough, fever, excessive mucus, fever, weakness, or muscle pain.

Resources We Love

Centers for Disease Control and Prevention (CDC)

Here you’ll find all the vetted and trusted info on whooping cough that you could possibly need. The CDC is also a great place to learn about all childhood vaccinations, with helpful videos and schedules that can help you stay on schedule for these potentially life-saving shots.

American Academy of Pediatrics (AAP)

There are 67,000 pediatricians who are members of the AAP, a leading national voice on children’s health. The parent-forward version of their website, called HealthyChildren.org, is a superb resource on all early childhood conditions, including chronic cough, whooping cough, and similar infections. There’s also the Symptom Checker, where parents can plug in various symptoms (like cough) to get specific tips about how to help and when to call the doctor.

Editorial Sources and Fact-Checking

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