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

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.

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.

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 pertussis are the biggest risk factors for becoming infected.

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.

Babies Under 12 Months Old?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.

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

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:

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.
At least 90 percent of kids are fully protected after getting all five doses of DTaP.
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.
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.
Doing so lowers the risk of contracting whooping cough by about 91 percent during the first two months of baby's life, according to a report.

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. 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 report 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. One study 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.

For example, as of June 2021, 42.3 percent of the U.S. population was fully vaccinated against the coronavirus, but only 19.7 percent of Black Americans were, per a report. The authors cite mistrust in the healthcare system and providers, the government, and vaccine safety itself.

The disparity continues when it comes to which children receive their DTaP. 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.

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.

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

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 a study.

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.

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

2019 Final Pertussis Surveillance Report. Centers for Disease Control and Prevention.
Whooping Cough (Pertussis). Nemours Kids Health.
Pertussis (Whooping Cough): Signs and Symptoms. Centers for Disease Control and Prevention.
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Whooping Cough Is Deadly for Babies. Centers for Disease Control and Prevention.
Pertussis (Whooping Cough): Signs and Symptoms. Centers for Disease Control and Prevention.
Babies Need Whooping Cough Vaccines on Time. Centers for Disease Control and Prevention.
Pertussis (Whooping Cough). Merck Manual.
Best Practices for Healthcare Professionals on the Use of Polymerase Chain Reaction (PCR) for Diagnosing Pertussis. Centers for Disease Control and Prevention.
Whooping Cough: Diagnosis and Treatment. Mayo Clinic.
Pertussis (Whooping Cough): Signs and Symptoms. Centers for Disease Control and Prevention.
Pertussis (Whooping Cough): Treatment. Centers for Disease Control and Prevention.
Whooping Cough (Pertussis). U.S. Department of Health and Human Services.
Pertussis (Whooping Cough). Centers for Disease Control and Prevention.
Pertussis: Summary of Vaccine Recommendations. Centers for Disease Control and Prevention.
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Effectiveness of Vaccination During Pregnancy to Prevent Infant Pertussis. Pediatrics.
Pertussis (Whooping Cough): Postexposure Antimicrobial Prophylaxis. Centers for Disease Control and Prevention.
Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2020. Centers for Disease Control and Prevention.
Can Routine Offering of Influenza Vaccination in Office-Based Settings Reduce Racial and Ethnic Disparities in Adult Influenza Vaccination? Journal of General Internal Medicine.
KFF — The Undefeated Survey on Race and Health. Kaiser Family Foundation.
Black Americans Cite Low Vaccine Confidence, Mistrust, and Limited Access as Barriers to COVID-19 Vaccination. RAND Health Care.
Disparities Details by Race and Ethnicity for 2018. Office of Disease Prevention and Health Promotion.
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Acellular Pertussis Vaccine Effectiveness Over Time. Pediatrics.
Pertussis. National Organization for Rare Disorders.

Resources

2019 Final Pertussis Surveillance Report.?Centers for Disease Control and Prevention. May 2021.
Whooping Cough (Pertussis).?KidsHealth.?March 2023.
Pertussis (Whooping Cough): Signs and Symptoms.?Centers for Disease Control and Prevention.?August 4, 2022.
Pertussis (Whooping Cough).?Merck Manual. September 2022.
Five Things to Know About Whooping Cough.?American Lung Association. November 17, 2022.
Whooping Cough Is Deadly for Babies.?Centers for Disease Control and Prevention. December 1, 2022.
Babies Need Whooping Cough Vaccines on Time.?Centers for Disease Control and Prevention.?December 1, 2022.
Best Practices for Healthcare Professionals on the Use of Polymerase Chain Reaction (PCR) for Diagnosing Pertussis.?Centers for Disease Control and Prevention. August 4, 2022.
Whooping Cough: Diagnosis and Treatment.?Mayo Clinic.?February 11, 2022.
Pertussis (Whooping Cough): Treatment.?Centers for Disease Control and Prevention.?August 4, 2022.
Pertussis (Whooping Cough): Diagnosis and Treatment.?Centers for Disease Control and Prevention.?August 4, 2022.
Whooping Cough (Pertussis). U.S. Department of Health and Human Services. April 29, 2021.
Get a Whooping Cough Vaccine During Each Pregnancy.?Centers for Disease Control and Prevention.?December 1, 2022.
Baxter R, Bartlett J, Fireman B, et al.?Effectiveness of Vaccination During Pregnancy to Prevent Infant Pertussis.?Pediatrics.?May 2017.
Pertussis (Whooping Cough): Postexposure Antimicrobial Prophylaxis.?Centers for Disease Control and Prevention.?August 4, 2022.
Razzaghi H, Kahn KE, Black CL, et al. Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2020.?Centers for Disease Control and Prevention.?October 2, 2020.
Disparities Details by Race and Ethnicity for 2018.?Office of Disease Prevention and Health Promotion. December 28, 2021.
Zerbo O, Bartlett J, Goddard K, et al. Acellular Pertussis Vaccine Effectiveness Over Time.?Pediatrics. July 2019.
Pertussis.?National Organization for Rare Disorders. April 10, 2009.
Pertussis (Whooping Cough).?Centers for Disease Control and Prevention. August 8, 2022.
5 Things to Know About Whooping Cough.?Centers for Disease Control and Prevention. August 4, 2022.
Pertussis: Summary of Vaccine Recommendations.?Centers for Disease Control and Prevention. January 22, 2020.
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Pertussis (Whooping Cough): Causes and How It Spreads.?Centers for Disease Control and Prevention.?August 4, 2022.
Whooping Cough: What Parents Need to Know.?HealthyChildren.org. December 10, 2021.
Whooping Cough: Symptoms and Causes.?Mayo Clinic. February 11, 2022.
Resources to Encourage Routine Childhood Vaccinations: Resources for Parents. Centers for Disease Control and Prevention. March 21, 2023.
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Jane Yoon Scott, MD

Medical Reviewer

Jane Yoon Scott, MD, is an infectious disease physician and an assistant professor of medicine at Emory University?in Atlanta. Dr. Scott enjoys connecting with her patients, empowering them to understand and take ownership of their health, and encouraging them to ask questions so that they can make informed and thoughtful decisions.

She graduated with the highest honors from the Georgia Institute of Technology, then received her MD from the Medical College of Georgia. She completed her internal medicine residency training and chief residency at Temple University Hospital, as well as a fellowship in infectious diseases at Emory University. She is board-certified in both internal medicine and infectious diseases.

When she is not seeing patients, Dr. Scott works with neighboring health departments to promote public health, especially to communities that have been historically underserved. She also teaches medical trainees and lectures medical students at the Emory University School of Medicine.

In her free time, Dr. Scott appreciates a good coffee shop, weekend hikes, playing guitar, strolling through cities, sampling restaurants, and traveling to new places.

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Holly Pevzner is a writer who specializes in health, nutrition, parenting, and pregnancy. She is currently a staff writer at Happiest Baby. Her work, including essays, columns, features, and more, spans a variety of publications, websites, and brands, such as EatingWell, Family Circle, Fisher-Price, Parents, Real Simple, and The Bump. Pevzner has written several monthly health columns, including for First for Women and Prevention?magazines. She previously held senior staff positions at Prevention, Fitness, and Self magazines, covering medical health and psychology. She was also a contributing editor at Scholastic's Parent & Child magazine.

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