Pertussis (whooping cough) notifications continue to rise in Victoria, particularly among school-aged children. Approximately 40% of cases are in children aged 10 to 15, while 23% involve those under 10. Notifications in 2024 have surged to over 12 times last year’s figures, with 36% of cases reported in southeast Melbourne.
Pertussis is a vaccine-preventable respiratory illness caused by Bordetella pertussis bacteria. Infants, especially those too young to be fully vaccinated, face the highest risk of severe illness, hospitalization, or death.
Recommendations
- Early diagnosis, isolation, and treatment are essential to prevent the spread and protect vulnerable infants.
- Vaccination is strongly recommended for both infants and pregnant women to lower the risk of infection and complications.
- Ensure infants receive their vaccinations on time and that all pregnant women are vaccinated between 20 and 32 weeks.
To help prevent pertussis (whooping cough), follow these key steps:
- Get Vaccinated: Ensure that you and your family are current on vaccinations. The DTaP vaccine is given to infants and children, while the Tdap booster is recommended for adolescents, adults, and pregnant women (between 20-32 weeks).
- Vaccinate Pregnant Women: Pregnant women should receive the Tdap vaccine during every pregnancy to protect high-risk newborns.
- Ensure Timely Vaccination for Infants: Ensure infants are vaccinated according to the recommended schedule. They should receive the DTaP series starting at two months of age.
- Stay Isolated When Sick: If you or your child have symptoms of pertussis, stay home and avoid contact with others, especially infants, to prevent spreading the illness.
- Practice Good Hygiene: Wash your hands regularly, cover your mouth and nose when coughing or sneezing, and use hand sanitiser to reduce the spread of germs.
- Prompt Diagnosis and Treatment: If you suspect pertussis, seek medical attention early for diagnosis and treatment to reduce transmission.
These actions help protect you and vulnerable individuals, especially infants too young to be fully immunized.
The symptoms of pertussis (whooping cough) typically develop in stages:
- Early Symptoms (Catarrhal Stage, 1-2 weeks):
- Runny nose
- Mild fever
- A mild, occasional cough
- Sneezing
- Apnea (a pause in breathing), especially in infants
These early symptoms are often mistaken for a common cold.
- Later Symptoms (Paroxysmal Stage, 1-6 weeks or longer):
- Severe coughing fits (paroxysms)
- A “whooping” sound when breathing in after coughing (more common in children)
- Vomiting after coughing fits
- Exhaustion after coughing episodes
These coughing fits can be intense and occur more frequently at night.
- Recovery Stage (Convalescent Stage, several weeks):
- Coughing becomes less severe and gradually subsides but may persist for weeks.
Infants may not have the classic “whooping” sound but can experience dangerous pauses in breathing or difficulty feeding. If you notice these symptoms, seek medical attention immediately.
Pertussis (whooping cough) is typically treated with antibiotics, which help reduce the symptoms’ severity and prevent the spread of the infection. The sooner treatment begins, the more effective it is, especially in reducing transmission to others. Here’s how pertussis is treated:
- Antibiotics:
- Macrolides, such as azithromycin, clarithromycin, or erythromycin, are the most commonly prescribed antibiotics for pertussis.
- Antibiotics are most effective in the early stages of the illness but can still help reduce contagiousness later on.
- Supportive Care:
- Hydration: Ensure that the person drinks fluids to prevent dehydration, especially after coughing fits.
- Rest: Adequate rest is essential to help the body recover.
- Smaller, frequent meals: In severe cases, vomiting can occur after coughing fits, so smaller meals can help avoid discomfort.
- Hospitalization:
- Infants, particularly those under six months, are at high risk of complications like pneumonia and may require hospitalization for close monitoring, oxygen support, or intravenous fluids.
- Cough Medications:
- Over-the-counter cough suppressants usually don’t help with pertussis and are not recommended, especially for young children.
- Isolation:
- To prevent the spread of the disease, individuals with pertussis should stay away from others, particularly infants, for at least five days after starting antibiotics.
Early treatment can make a significant difference, so seeking medical care promptly is important if you or someone close to you shows symptoms.
The pertussis (whooping cough) vaccine is effective, though no vaccine offers 100% protection. Here’s what you need to know about its effectiveness:
- Effectiveness in Children:
- The DTaP vaccine, given to infants and young children, effectively prevents pertussis. After the full series of doses, it offers about 85-90% protection.
- However, the immunity from the vaccine can weaken over time, which is why booster shots are important as children grow older.
- Effectiveness in Adolescents and Adults:
- The Tdap booster, recommended for older children, adolescents, and adults, helps maintain protection. Its effectiveness can range between 70% and 85%.
- Immunity also wanes over time, so repeated vaccinations, especially during pregnancy, are recommended to protect infants.
- Protecting Infants:
- Vaccinating pregnant women between 20 and 32 weeks of pregnancy is highly effective at protecting newborns by passing antibodies to them before they can be vaccinated.
- Infants too young to complete their vaccine series rely on maternal protection and herd immunity from others vaccinated.
While the vaccine doesn’t always completely prevent infection, vaccinated individuals typically experience a milder illness if they contract pertussis. The vaccine plays a key role in reducing the severity and spread of the disease.
The recovery time from pertussis (whooping cough) can vary, but it generally takes several weeks to months to fully recover. Pertussis progresses through three stages, and the duration of each stage affects the overall recovery:
- Catarrhal Stage (1-2 weeks):
- This is the early stage with cold-like symptoms. The illness is not as easily recognizable as pertussis, and recovery hasn’t started.
- Paroxysmal Stage (1-6 weeks or longer):
- This stage is characterized by severe coughing fits. It is the most intense and can last for several weeks.
- Coughing episodes may become less frequent over time, but even during this stage, recovery can feel slow.
- Convalescent Stage (2-3 weeks or longer):
- During this recovery phase, the coughing gradually decreases in severity and frequency.
- Full recovery may take several weeks, but in some cases, the lingering cough can persist for up to 3 months or more, even as other symptoms subside.
The recovery time from the onset of symptoms can range from 6 to 12 weeks or longer. While the person may feel better, the cough can continue to be a nuisance for some time.
Recovery is typically longer in infants, young children, and individuals with weakened immune systems, so monitoring and supportive care during recovery are important.
Certain groups are at higher risk of contracting pertussis (whooping cough) and experiencing severe complications. These include:
- Infants (especially under six months):
- Infants are at the highest risk because they are too young to be fully vaccinated. They are more likely to suffer from severe complications, including pneumonia, seizures, brain damage, and even death. Hospitalization is often required for infants with pertussis.
- Pregnant Women:
- Pregnant women who contract pertussis are at risk of transmitting the infection to their especially vulnerable newborns. To reduce this risk, vaccination is recommended during pregnancy.
- Children under five years old:
- Young children who are not fully vaccinated or have missed doses are at risk of severe disease. Even vaccinated children may contract pertussis as their immunity wanes over time.
- Unvaccinated or Partially Vaccinated Individuals:
- Those who have not received the full series of pertussis vaccinations are at higher risk of getting the disease and spreading it to others.
- Adolescents and Adults with Waning Immunity:
- Immunity from childhood vaccines fades over time, making adolescents and adults susceptible to pertussis, especially if they have not received booster shots (Tdap). They can also unknowingly spread the disease to more vulnerable populations.
- People with Chronic Respiratory Conditions:
- Individuals with asthma, COPD, or other chronic respiratory conditions may experience more severe symptoms and complications if they contract pertussis.
- Healthcare Workers and Caregivers:
- People who work in healthcare settings or care for young children, infants, or the elderly are at higher risk of exposure to pertussis and spreading it to vulnerable populations.
These groups should take extra precautions, including staying up to date with vaccinations and seeking prompt medical care if exposed to pertussis.
A person with pertussis (whooping cough) is contagious for a specific period, depending on whether they have started antibiotic treatment:
- Without Antibiotics:
- Individuals are most contagious in the early stages, typically during the first two weeks after the cough begins.
- They remain contagious for about three weeks after the onset of the severe coughing fits (paroxysmal stage), even though the symptoms may persist longer.
- With Antibiotics:
- If treated with antibiotics, particularly during the early stages, a person is generally no longer contagious after five days of antibiotic treatment.
During the contagious period, avoiding close contact with others, especially infants, pregnant women, and individuals with weakened immune systems, is crucial to prevent the disease from spreading.
Yes, pertussis (whooping cough) can recur, although uncommon. Here’s why and how it can happen:
- Waning Immunity:
- Immunity from either the pertussis vaccine or a previous infection decreases over time. The protection from the DTaP vaccine typically lasts about 4-6 years, and the Tdap booster protects for about 5-10 years. As immunity wanes, individuals can become susceptible to pertussis again, even if they’ve had it before.
- Booster Vaccines:
- Because immunity diminishes, booster shots (Tdap) are recommended for adolescents, adults, and pregnant women. This helps maintain protection and reduce the chances of recurrence.
- Milder Symptoms Upon Recurrence:
- If a person contracts pertussis again, the symptoms may be milder than the first time, especially if a previous vaccination or infection has partially protected them. However, they can still spread the infection to others.
- Importance of Vaccination:
- Staying up to date with pertussis vaccines is crucial to minimizing the risk of recurrence, especially for adults who may have had their last vaccine years ago.
While a recurrence is possible, maintaining immunity through booster shots helps reduce the likelihood and severity of repeat infections.
While most people recover from pertussis (whooping cough) without long-term effects, some individuals, especially infants and those with severe cases, can experience lasting complications. Here are some potential long-term effects:
- Prolonged Cough:
- The coughing fits associated with pertussis can persist for several weeks or months, sometimes called “the 100-day cough.” This is one of the most common long-term effects but usually resolves over time.
- Rib Fractures:
- Severe and repeated coughing can lead to rib fractures, especially in adults. This is more likely in older adults or those with underlying health conditions.
- Breathing Issues:
- In some cases, pertussis can lead to chronic respiratory issues, such as prolonged shortness of breath, particularly in individuals with pre-existing respiratory conditions like asthma or COPD.
- Complications in Infants:
- Brain damage: Severe cases of pertussis in infants can lead to oxygen deprivation during intense coughing fits, which in rare cases can result in seizures or brain damage.
- Developmental delays: Infants who experience serious complications, such as encephalopathy (swelling of the brain), may suffer from long-term developmental delays.
- Pneumonia:
- Pertussis can cause secondary infections, like pneumonia, which can have long-term consequences, especially in those with weakened immune systems or chronic health issues.
- Hernias:
- Severe coughing can lead to abdominal pressure, potentially causing inguinal or abdominal hernias.
- Weight Loss and Fatigue:
- Prolonged coughing fits can interfere with eating and sleeping, leading to significant weight loss and fatigue that may take time to recover fully.
While these complications are more common in infants and older adults, they can occur in any age group. Preventive measures like vaccination reduce the risk of severe cases and long-term effects.
Yes, pertussis (whooping cough) can be fatal, particularly for vulnerable groups such as infants, the elderly, and individuals with weakened immune systems. Here’s how pertussis can become life-threatening:
- Infants at Highest Risk:
- Infants under six months are at the greatest risk of severe complications and death from pertussis because they are too young to be fully vaccinated. Many infant deaths from pertussis occur due to breathing difficulties, pneumonia, or lack of oxygen during coughing fits.
- Apnea, where infants temporarily stop breathing during coughing episodes, is particularly dangerous.
- Severe Complications:
- Pneumonia: The most common complication of pertussis, especially in infants, which can be life-threatening if not treated promptly.
- Seizures and Brain Damage: Intense coughing can reduce oxygen supply, leading to seizures or brain damage, both of which can result in fatal outcomes if severe enough.
- Dehydration and Malnutrition: Prolonged coughing can interfere with feeding, leading to significant malnutrition or dehydration, particularly in infants.
- Adults and Vulnerable Individuals:
- While deaths from pertussis are rare in healthy adults, older adults, people with chronic conditions, and those with weakened immune systems are also at risk of life-threatening complications like pneumonia or respiratory failure.
- Global Impact:
- Before vaccines became widely available, pertussis was a leading cause of death among children. While vaccinations have dramatically reduced the number of fatalities, deaths from pertussis still occur, particularly in areas with low vaccination coverage.
Early vaccination of infants, booster shots for adults, and vaccination during pregnancy are essential to reduce the risk of fatal outcomes. Prompt medical treatment and supportive care can also help prevent pertussis from becoming life-threatening.