whooping cough

and Carola Felchner, science journalist

Sophie Matzik is a freelance writer for the medical team.

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Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

Whooping cough (pertussis) is an acute infection of the upper respiratory tract. Typical symptoms are convulsive coughing fits and a wheezing sound when you take a breath. Whooping cough can affect children and adults alike, but it manifests itself somewhat differently. Read here how contagious whooping cough is, how it is treated and why it often goes undetected, especially in adults.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. A37

Brief description: Whooping cough

What is whooping cough exactly? A very contagious bacterial upper respiratory infection.

Symptoms: barking, staccato-like cough with gasping for breath after the attacks

Contagion: via droplet infection when sneezing, coughing, speaking or kissing

Treatment: antibiotics, inhale, drink enough, take care of yourself; High-risk patients such as infants should be treated in the hospital.

Vaccination: from the second month of life; must be refreshed after ten to 20 years at the latest

Prognosis: Whooping cough can last for several weeks or months, but usually heals completely. Dangerous complications are especially possible in young children.

Whooping cough - symptoms

Whooping cough (medical: pertussis) typically has three phases in children:

If you have been infected, it is very likely that you will not notice whooping cough at first. The symptoms in the so-called cold-like phase are still unspecific and - hence the name - are similar to those of a cold. Typical whooping cough symptoms only appear later. Classically, a pertussis infection has three stages, each accompanied by different symptoms.

1. Cold phase (stage catarrhale): It lasts one to two weeks. At this first stage, the whooping cough symptoms are still unspecific. They are therefore seldom correctly interpreted. Most of the time, the symptoms are mistaken for a common cold. Whooping cough symptoms of the first stage are:

cough
Sneeze
Sore throat
runny nose

2. Seizure stage (convulsive stage): This stage lasts up to six weeks. This shows the classic signs of whooping cough: convulsive coughing fits up to shortness of breath (this is why the Voksmund also speaks of "stick cough"). The cough attacks occur mainly at night. After a seizure, patients breathe in with a whooping sound. It is caused by a spasm of the larynx.

A coughing fit often lasts for minutes and can repeat itself up to 50 times a day. It is staccato-like and is therefore also known as a staccato cough. It is often accompanied by vomiting. At the very least, however, many patients choke up tough mucus (sputum).

At this stage of the disease, most patients also have no appetite and can hardly or not at all sleep. Fever, on the other hand, rarely occurs.

3rd stage of recovery (stage decrementi): This last phase of the disease lasts for up to ten weeks. During this time, the coughing fits will gradually decrease and patients will soon feel fitter again.

Whooping cough: "Get vaccinated!"

Three questions for

Michael Conder,
Specialist in internal and general medicine
1
How do I distinguish irritable cough from whooping cough?

Michael Conder
Whooping cough lasts much longer than a common dry cough - colloquially it is also called a 100-day cough. The type of cough does not initially differ. The second stage of whooping cough only occurs after about three weeks. Then convulsive coughing fits with often gasping “gasping for air” after the coughing fit are typical. This stage lasts about six weeks. The disease then subsides in the third stage.
2
Is there anything I can do to help me recover faster?

Michael Conder
In the early stages of the disease, the infection is treated with antibiotics. This prevents complications and also prevents others from becoming infected. If whooping cough is discovered too late, only the symptoms are treated. Drink a lot, such as bronchial tea. Juicy fruits can calm you down after a seizure. Eat light meals when you experience gag reflex. And create cool and moist indoor air. Also important: rest and physical protection.
3
If I am vaccinated, can I still get whooping cough?

Michael Conder
Yes, you can still get sick, but this is much less the case. If adults or children come into contact with the pathogens without a vaccination, 80 percent of them will develop it. Whooping cough is very contagious - and especially dangerous for babies. Emergency treatment may be needed to prevent breathing failure. So: get vaccinated!
Michael Conder,
Specialist in internal and general medicine
Dr. Conder runs his private practice in Ludwigshafen, he is also a lecturer in general medicine at the University of Heidelberg.

Whooping cough in babies and toddlers

The younger a child, the more dangerous whooping cough is. In the first year of life, children have not yet developed full vaccination protection. That is why whooping cough is often severe at this age. In addition, babies and toddlers cannot sit up to cough better.

Another difficulty: infants often show no typical symptoms. Whooping cough attacks are often not very strong and not staccato-like in them. Often you only notice a squeak or a flushed face. The focus is often on pauses in breathing (apneas): the little ones stop breathing for seconds. The shortness of breath can sometimes cause the skin to discolour bluish (cyanosis).

Other possible complications include pneumonia, otitis media, and encephalitis with seizures). Unvaccinated babies under six months of age, premature babies and babies born to very young mothers are particularly susceptible to a severe whooping cough disease.

Whooping cough: symptoms of concomitant diseases

In addition to the typical whooping cough symptoms, other complaints can be added if patients develop an accompanying illness. This happens to about a quarter of all patients. The reason is usually that whooping cough is diagnosed and treated late. The bacteria have often already spread through the body by then. Possible concomitant diseases and symptoms associated with whooping cough are:

Middle ear and pneumonia: They occur when the whooping cough bacteria migrate up the ear canal or down into the lung tissue.
Rib and inguinal hernia: They are caused by particularly strong coughing fits. Often these breaks are not recognized until much later, for example when severe pain occurs during exercise.
severe weight loss: this occurs especially in children. Whooping cough is often associated with a poor appetite.
Incontinence: it is primarily a problem of children and the elderly. With every coughing attack, a lot of pressure is built up in the body. Then some urine may leak uncontrollably. However, incontinence is not a permanent problem. It will go away as soon as the whooping cough symptoms subside.

Whooping cough: risk of contagion and incubation period

Whooping cough is contagious, very contagious! Without vaccination protection, 80 to 90 percent of people who come into contact with the pertussis pathogen become ill. Whooping cough is transmitted via droplet infection: when infected people speak, cough or sneeze, tiny droplets of saliva spread around the area - and do so in a radius of up to one meter. There are whooping cough bacteria in these tiny droplets. If they get on the mucous membrane of a healthy person (e.g. through inhalation), they too will be infected.

Whooping cough infection is also possible through kisses. This also applies if you use the same cutlery as someone who is sick.

Even if you have been vaccinated against whooping cough and do not fall ill yourself, you can become a carrier of the bacteria for a short time. In this way, you can pass the germs on to other people unnoticed.

Bordetella pertussis

The bacterium Bordetella pertussis causes whooping cough.

Whooping cough: incubation period

As with most infectious diseases, whooping cough can take some time before symptoms appear after infection. This so-called incubation period is around seven to 20 days for whooping cough. Those affected are contagious from the onset of the first symptoms (cold phase) and then for another five to six weeks. Exception: treatment with antibiotics shortens the infection phase. A patient is no longer contagious five days after the start of therapy.

The best way to protect yourself from whooping cough is to avoid contact with sick people. If there is illness in the family, you should pay attention to careful hygiene.

Whooping cough in adults

Whooping cough has long been considered a "childhood disease". But it has long since ceased to be. Adolescents and adults are also increasingly suffering from it:

In 2008, the average age of whooping cough patients was given as around 42 years. Ten years earlier it was around 15 years. Two thirds of all whooping cough cases now affect people over the age of 19! According to doctors, this is due to the fact that adults often forget the necessary booster vaccination: Almost all children (95 percent) are vaccinated against whooping cough when they start school. However, this vaccination protection must be refreshed after ten to a maximum of 20 years. If you don't do this, you will catch whooping cough at the next opportunity and very likely get sick.

Whooping cough in adults often takes an atypical course: the symptoms are weaker, the coughing fits less severe and more continuous than attack-like. The risk of suffocation is low.

But that doesn't make the infection less dangerous, on the contrary: Many sick adults simply consider whooping cough to be a particularly persistent but common cough. That's why you don't go to the doctor. Without treatment, the whooping cough pathogens can spread throughout the body. In rare cases, this leads to complications and secondary diseases. For example, pneumonia or otitis media as well as broken ribs are often the result of whooping cough.

Adults who develop pertussis are also often a danger to others. They are considered a serious source of infection for infants and the elderly. With these, whooping cough can be severe and dangerous.

Whooping Cough & Pregnancy

Whooping cough disease during pregnancy does not endanger the child. However, violent coughing fits can trigger labor prematurely. In addition, the infection weakens the expectant mother.

Women who want to have children should therefore be vaccinated against whooping cough up to three months before pregnancy if possible. If this is no longer possible, a whooping cough vaccination should definitely be made up in the first few days after the birth. It also means a certain protection for the baby if the mother cannot get whooping cough.

Pregnant women who are not vaccinated should avoid any contact with sick people. If you suspect infection, the doctor can prescribe an antibiotic (erythromycin) as a precaution. This alleviates whooping cough symptoms that occur.

Whooping cough bacteria are very unlikely to be passed from an infected pregnant woman to the unborn child.

Whooping cough: causes and risk factors

The cause of whooping cough is the bacterium Bordetella pertussis. It affects the nose, throat, windpipe and lungs and irritates the mucous membranes. This triggers the convulsive coughing fits.

The bacterium also secretes various toxins. On the one hand, these damage the surrounding tissue (especially the cilia of the mucous membranes in the airways). On the other hand, they weaken the immune system. As a result, the body can no longer adequately defend itself against the bacteria. The germs can multiply in this way undisturbed. If left untreated, whooping cough can cause serious complications and even be fatal.

Infection and course of disease

In whooping cough, bacteria enter the upper respiratory tract via microdroplets. They destroy the mucous membrane and thus trigger convulsive coughing fits.

In addition to Bordetella pertussis, related species can very rarely cause whooping cough-like disease. These are Bordetella parapertussis and Bordetella holmesii. Usually an infection with these pathogens is shorter and less severe.

Whooping cough: examinations and diagnosis

In order to clarify the suspicion of whooping cough, the doctor will first take the patient's medical history (anamnesis). He talks to the patient or - in the case of small children - with the parents about the symptoms that may arise. Typical questions are:

How long has the cough been going on?
Is mucus coughed up or is the cough rather dry?
Do you have problems breathing after the cough attacks?
Are there any other complaints (fever, sore throat, chest pain, etc.)?

The doctor will also physically examine the patient. This includes tapping the chest and listening to the lungs. He also takes a look down the throat. If he presses the tongue with the spatula, it triggers the characteristic coughing fits of whooping cough.

If the typical whooping cough symptoms (in children) are present, this makes the diagnosis easier. Laboratory tests should be performed to confirm this (see below).

Such laboratory tests are even more important if whooping cough is untypical. This is mostly the case with infants, but also adolescents and adults. The latter are now the most common age group among whooping cough patients.

Laboratory tests

The type of laboratory tests that are used depends on the stage of the disease.

In the first two to three weeks after the start of a cough, an attempt is made to detect the whooping cough pathogen directly. To do this, the doctor either takes a swab from the deep throat or sucks off some bronchial mucus, which is transported upwards when you cough.

In the laboratory, the sample can be applied to a nutrient medium in order to grow the germs (bacterial culture) and then to determine them. Alternatively, the genetic material of germs contained in the sample can be reproduced using the polymerase chain reaction (PCR) and then identified. The whooping cough pathogen - if present - can also be detected in this way.

Another option besides direct pathogen detection is so-called serum diagnostics. The patient's blood serum is examined for antibodies against the whooping cough pathogen. However, this method is only possible in advanced stages of the disease: Such specific antibodies can only be detected about three weeks after the start of the cough.

If the doctor suspects complications or secondary diseases of whooping cough (such as middle ear infection or pneumonia), appropriate further examinations are necessary.

Whooping cough is notifiable

Since 2013 there has been an obligation to report whooping cough in Germany: If whooping cough is suspected and the disease is proven, the doctor must inform the responsible health authority of the patient's name. Death from pertussis must also be reported.

Whooping cough: treatment

As with other diseases, the same applies to pertussis: Therapy and healing process depend on the stage and severity of the disease.

Whooping cough therapy in children

Whooping cough in children can usually be treated at home if the disease progresses easily. In severe cases, hospital treatment is advisable. The same applies if a child has previous heart or lung diseases.

Infants with whooping cough should always be hospitalized. In the clinic, the bronchial mucus can be aspirated - babies are unable to cough up the mucus. In addition, it is possible to act quickly and professionally if breathing pauses threaten or occur.

Sick children should generally receive a lot of attention and affection. Strict bed rest is not necessary for whooping cough. It is enough to take care of yourself physically. Walks in the fresh air and quiet play are permitted and can even be good for you. But pay attention to a low-irritant environment.

Soothe the child if they have coughing attacks. It can also be helpful to put it on or carry it around. Inhaling over a bowl of hot water and sea salt can help relieve discomfort in older children.There are inhalation devices in the pharmacy for small children with which they cannot scald themselves.

Warm chest wraps with lemon juice before bed can also provide some relief from whooping cough symptoms.

The room air should not be too dry. For example, you can ventilate the room regularly or hang damp cloths over the heater. This increases the humidity.

Patients should drink enough. Preferably prepare liquid or pulpy dishes. Several small meals spread over the day are more advisable than a few large meals. Children with whooping cough are prone to gagging and vomiting.

Make sure that your child does not come into contact with other children or the elderly during the period of infection. These are particularly susceptible to infection and potentially severe courses and complications.

Antibiotics can help reduce the duration and severity of coughing attacks in whooping cough. However, this only works if they are administered as early as possible, that is: before or in the first one to two weeks after the start of the cough.

Under certain circumstances, antibiotic treatment can still be useful afterwards: The symptoms can then hardly be influenced. However, antibiotics can be used to break the chain of infection: about five days after starting the intake, patients are no longer contagious. They are then allowed to visit community facilities such as school and kindergarten again.

Antibiotics used are for example erythromycin and clarithromycin. They are taken for a few days to two weeks, depending on the active ingredient.

Cough syrup usually does little or no help with whooping cough. If the mucus that forms in the bronchi is very thick, expectorant medication can sometimes help.

Whooping cough therapy in adults

Whooping cough in adults is treated similarly to that in children. Antibiotics are preferred in the early stages of the disease. In later stages, they serve to reduce the risk of infection for other people. This is particularly important in adolescent and adult patients. Often it is they who infect babies. And whooping cough can be life-threatening for them.

In addition to antibiotics, general measures support the treatment of whooping cough. These include inhalations, chest compresses, adequate fluid intake and humidified room air.

Employees of community facilities (such as teachers, educators, nursing staff, etc.) are only allowed to go back to work if the treating doctor allows it. Only he can judge whether the patient can still transmit whooping cough pathogens to others or not.

Whooping cough vaccination

You can protect yourself against whooping cough with a vaccination. The whooping cough vaccination is recommended in early childhood. It can be given from the age of two months. Regular booster vaccinations maintain vaccination protection against whooping cough, even in adulthood. The following groups of people in particular should be vaccinated against whooping cough:

Women of childbearing age
close contact persons of pregnant women in the same household and carers (e.g. child minders, parents, siblings) if possible four weeks before the birth of the child
Caring parents of a child with whooping cough
Employees in the health service and in community facilities

You can read more about this in the article Whooping Cough - Vaccination.

Whooping cough: course and prognosis

Whooping cough can last for weeks to months. In some patients the disease is relatively mild, in others it is severe. As a rule, however, pertussis heals completely without permanent damage.

However, complications develop in around every fourth whooping cough patient. These include, above all, pneumonia and otitis media. Children are more often affected than adults.

Whooping cough can be very dangerous, especially for babies under six months of age. The pauses in breathing can cause a severe lack of oxygen that damages the brain. Possible consequences are permanent damage such as paralysis, visual or hearing impairments and mental disorders. Very rarely do the little patients even die. Therefore, as a precaution, infants with whooping cough should always be treated in hospital.