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The Return of Whooping Cough


Updated February 09, 2011

Although there has been a vaccine available against the Bordetella pertussis bacteria that causes pertussis or whooping cough, pertussis remains a big problem, especially for newborns and young infants.

Unlike most other vaccine preventable illnesses, the rates of pertussis have been increasing in the United States during the last few decades, hitting a peak in 2000, when 7867 cases were reported. Pertussis infections were most common in children aged 10-19 (36%), infants less than 7 months of age (24%) and adults (20%).

Adolescents and adults typically just get a chronic cough that lasts for weeks or months when they get pertussis, but young children can have major complications, which, according to the Centers for Disease Control and Prevention, can include "hypoxia, apnea, pneumonia, seizures, encephalopathy, and malnutrition." It can also cause death, with reports of 5-10 young infants dying from pertussis each year in the US. However, in 2000, there were 17 deaths, all in infants who began having symptoms of pertussis before they were 4 months old.

Cases of pertussis continue to increase, with 550 reported cases in August 2002, which surpassed historical levels. So far, in 2002, states with the most reported cases of pertussis include Arkansas (429 cases), California (383), Colorado (245), Ohio (297), Massachusettes (277), Texas (786), and Washington (324).

Keeping things in perspective, the current increases in whooping cough cases are still much less than they were in the 1930s, before routine vaccination against pertussis began, when one year, there were over 250,000 cases.

Symptoms of Pertussis

Pertussis usually begins with a catarrhal stage, about 6-20 days after being exposed to someone with pertussis (incubation period), with symptoms similar to a typical viral upper respiratory infection, including a low grade fever, runny nose and cough. It is during this stage, which usually lasts 1-2 weeks, that a person is most contagious to others.

The disease then may worsen during the paroxysmal stage, which lasts 2-4 weeks, with children getting severe spells or paroxysms of coughing, which may be followed by a whoop and vomiting. While not all children make the characteristic whooping sound, the posttussive vomiting and coughing spells are very commonly seen in children with pertussis.

These coughing spells then slowly improve and become less frequent during the next convalescent stage, which lasts another 1-2 weeks.

All together, symptoms might last for 3-10 weeks.

Pertussis Treatments

Although children can recover from pertussis without antibiotics, treatment, especially if started early during the catarrhal stage, may help them to get better faster and be less contagious to others. The antibiotic of choice for treating pertussis is erythromycin for 14 days. Alternatives may include Clarithomycin (Biaxin) for 7 days1, azithromycin (Zithromax) for 5 days, and Bactrim for 14 days.

While most children should not have any of the major complications discussed above and can be treated safely at home, younger infants, especially those born prematurely, may need to be hospitalized.

Children with pertussis are usually excluded from school or daycare until they have been on antibiotics for at least 5 days.

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