Pertussis, also known as Whooping Cough, is an illness with a name that captures its characteristic symptom—the cough. It’s a sound that can be genuinely frightening, sometimes resembling a person gasping for air, and it just doesn’t seem to let up. The relentless coughing fits can cause severe respiratory distress and, in some cases, lead to failure. Pertussis is a highly contagious respiratory illness caused by the bacterium Bordetella pertussis. Despite the availability of vaccines, we are seeing a rise in cases, with current rates surpassing pre-pandemic levels and cases now four times higher than they were at this time last year. So, who is most at risk? Infants under one year of age, as well as individuals with immunocompromising conditions or asthma, are particularly vulnerable. Babies, especially, are not only more likely to contract the illness but are also at higher risk for severe complications. While pertussis may begin with mild, cold-like symptoms, it can rapidly become much more dangerous—even fatal. The good news is that there’s a vaccine. As healthcare professionals, we have the responsibility to educate patients about the importance of vaccination and promote infection prevention measures to help curb the spread of this serious illness.
Understanding the Progression of Pertussis
Bordetella pertussis is a gram-negative bacterium that spreads via respiratory droplets or contact with airborne droplets. Symptoms typically develop within 5 to 10 days after exposure but can take longer, up to 21 days. Pertussis progresses through three stages: catarrhal, paroxysmal, and convalescent.
Catarrhal Phase: In this initial phase, pertussis appears as a minor respiratory illness with low-grade fever and cough. In infants, however, apnea (temporary cessation of breathing) may occur.
Paroxysmal Phase: This is when respiratory distress escalates. Intense, rapid coughing fits—often occurring at night—lead to the characteristic “whoop” sound at the end of a coughing spell. These attacks can occur up to 15 times a day, causing exhaustion, cyanosis (bluish skin), and vomiting. This stage can last from 1 to 6 weeks.
Convalescent Phase: During this final phase, the cough gradually subsides, though recovery may take weeks or even months.
Vaccinated individuals may experience milder symptoms. While adolescents and adults may experience less severe complications, infants and older adults are more likely to face life-threatening outcomes, such as apnea, pneumonia, encephalopathy, seizures, subdural hematomas, and even death. Infants are particularly susceptible to apnea and pneumonia, the most common complications for that group.
Prevention Strategies: Protecting Your Patients
Preventing pertussis involves three key strategies, according to the CDC: vaccination, post-exposure prophylaxis, and hygiene.
Vaccination: There are two vaccines that protect against pertussis—DTaP and Tdap. DTaP is administered as a five-dose series during infancy and early childhood. Tdap is given once between ages 11 and 12, during each pregnancy between 27-36 weeks, and then as a booster every 10 years for adults.
Post-Exposure Prophylaxis: This involves administering antibiotics to high-risk individuals who have been exposed to pertussis, including household contacts and those at risk of severe complications. Antibiotics, such as azithromycin, erythromycin, clarithromycin, or TMP-SMX, are most effective when given within 21 days of exposure.
Good Hygiene: Practicing proper hand hygiene and cough etiquette can also help limit the spread of pertussis. Reminding patients to wash hands frequently and cover their mouth and nose when coughing or sneezing is vital.
Key Takeaways for Healthcare Workers
Pertussis is a serious and potentially life-threatening illness. As healthcare professionals, it’s crucial to recognize the signs and symptoms and educate patients on the importance of vaccination—especially pregnant women and those in close contact with infants. Encouraging good hygiene and respiratory etiquette can also make a significant impact in preventing the spread of infection. By providing thorough education and clear communication, you can help prevent deadly outcomes. For further information and guidelines, please refer to the links below.
Resource Links
About Whooping Cough | Whooping Cough | CDC
Clinical Features of Pertussis | Pertussis (Whooping Cough) | CDC
Pertussis Vaccination Recommendations | Whooping Cough | CDC
Postexposure Antimicrobial Prophylaxis | Pertussis (Whooping Cough) | CDC
Pertussis infection in adolescents and adults: Treatment and prevention – UpToDate
Pertussis infection in infants and children: Treatment and prevention – UpToDate
Symptoms of Whooping Cough | Whooping Cough | CDC
References
Centers for Disease Control and Prevention. (April 2, 2024). About Whooping Cough. Retrieved from About Whooping Cough | Whooping Cough | CDC.
Centers for Disease Control and Prevention. (April 2, 2024). Clinical Overview of Pertussis. Retrieved from Clinical Overview of Pertussis | Whooping Cough | CDC
Centers for Disease Control and Prevention. (August 2, 2024). Pertussis Vaccination Recommendations. Retrieved from Pertussis Vaccination Recommendations | Whooping Cough | CDC
Centers for Disease Control and Prevention. (April 2, 2024). Post-Exposure Antimicrobial Prophylaxis. Retrieved from Postexposure Antimicrobial Prophylaxis | Pertussis (Whooping Cough) | CDC
Cornia, P. & Lipsky, B. (January 8, 2024). Pertussis infection in adolescents and adults: Treatment and prevention. UpToDate. Retrieved from Pertussis infection in adolescents and adults: Treatment and prevention – UpToDate
Yeh, S. (May 6, 2024). Pertussis infection in adolescents and adults: Treatment and prevention. UpToDate. Retrieved from Pertussis infection in adolescents and adults: Treatment and prevention – UpToDate