Whooping cough, or pertussis, is a highly contagious respiratory infection caused by the bacterium Bordetella pertussis. This illness is particularly dangerous for infants and young children, making it imperative to seek medical attention immediately if whooping cough is suspected in yourself or a family member. Treatment and management focus on eliminating the bacteria and supporting the body through the prolonged period of severe coughing.
Medical Interventions to Eliminate the Bacteria
Eradication of the Bordetella pertussis bacteria is primarily achieved through antibiotic treatment, with macrolide antibiotics like azithromycin being the preferred choice for most age groups. The effectiveness of this treatment depends on timing. Antibiotics are most beneficial if started during the initial catarrhal stage, which presents with cold-like symptoms before the characteristic violent coughing fits begin.
If treatment is started early, within the first one to two weeks, antibiotics may lessen the severity and duration of the illness. Once the disease progresses to the paroxysmal stage, antibiotics will no longer significantly alter the course of the cough itself because symptoms are caused by toxins already released by the bacteria. However, even at this later stage, antibiotics remain necessary to eliminate the bacteria from the respiratory tract and prevent transmission to others.
Post-exposure prophylaxis (PEP) is recommended for close contacts. Antibiotics are advised for asymptomatic household members and others with intense exposure, especially those at high risk for severe illness, such as infants under 12 months or women in their third trimester of pregnancy. Prophylactic treatment should be initiated as soon as possible, ideally within 21 days of exposure, using the same macrolide regimen as the patient.
Supportive Care for Managing Coughing Fits
Supportive care is the main strategy for managing the intense and prolonged coughing fits. These paroxysms can be so forceful that they lead to complications like vomiting, exhaustion, and difficulty breathing. Minimizing exposure to environmental irritants, such as tobacco smoke, is important, as these can trigger a coughing episode.
Maintaining a humid environment in the home can help soothe irritated airways. Hydration is paramount, especially since violent coughing is often followed by vomiting, which can quickly lead to dehydration. Patients should drink fluids frequently throughout the day to thin the thick mucus that can accompany the cough.
To prevent post-tussive vomiting, patients should consume small, frequent meals rather than large ones. For infants, offering small feeds immediately after a coughing spell can be effective, as they are less likely to cough again right away. Over-the-counter cough suppressants and expectorants are generally considered ineffective for pertussis and are discouraged for children.
Recovery Timeline and When Contagion Ends
The duration of a whooping cough infection is long. The illness typically involves a catarrhal stage lasting one to two weeks, followed by a paroxysmal stage with violent coughing that can last between two and eight weeks. The final convalescent stage can take weeks to months for a full recovery.
An infected person is most contagious in the initial catarrhal stage and during the first two weeks of the paroxysmal stage. If the patient is not treated with antibiotics, they are considered contagious for up to three weeks after the onset of the paroxysmal cough.
The use of appropriate antibiotics drastically shortens the contagious period. A person is no longer considered infectious after completing five full days of an effective antibiotic regimen. The cough itself can linger for months due to damage to the airways, even after the bacteria are eliminated.
Vaccination Strategies for Prevention
The most effective strategy for prevention is comprehensive vaccination. The primary vaccine for infants and young children is DTaP, which protects against diphtheria, tetanus, and acellular pertussis. Children receive a series of five DTaP doses, starting at two months of age.
For adolescents and adults, the Tdap vaccine serves as a booster to maintain protection against pertussis. A single dose of Tdap is recommended for adolescents, ideally at age 11 or 12, and for adults who have not previously received it. Protection from the pertussis component of these vaccines can wane over time, making boosters necessary.
Pregnant women should receive a Tdap dose during the third trimester, between 27 and 36 weeks of gestation. This practice allows the mother to pass protective antibodies to the newborn, which offers temporary protection until the infant is old enough to begin their own DTaP series at two months of age. This maternal vaccination is the best way to prevent severe pertussis in vulnerable newborns.