Whooping cough

Causes Of Whooping Cough

Whooping cough is a bacterial infection caused by Bordetella pertussis & hence, also known as “pertussis”. It is a highly infectious disease that can be transmitted from one person to another through close contact. 

If a person suffering from whooping cough sneezes or coughs, the bacteria laden droplets get sprayed into the air, which when inhaled by a healthy person can enter their body. Once inside the body, the bacteria attaches to cilia (hair like extensions) that are present in the upper respiratory system. Post attachment, the bacteria releases toxins which damages the cilia and causes the airway to swell and discomfort in breathing.

On an average, infected people are most contagious for upto 2 weeks after the cough begins. As per the World Health Organization (WHO), there are about 20-40 million cases of whooping cough globally. Of the total cases, 95% have been found to be diagnosed in developing countries.

High incidence rates have been observed in young children due to low vaccination coverage. Coughing adults and adolescents are the major reservoir of B. pertussis and are the usual sources of infection in infants and children.

Symptoms Of Whooping Cough

The incubation period (the time period between exposure to an infection and the appearance of the first symptoms of the disease) is 7-14 days.

The symptoms can be divided into three stages:

1. The catarrhal phase

2. The paroxysmal stage

3. The convalescent phase

1. The catarrhal phase

This is  the most infectious period and lasts for 1-2 weeks.

The initial symptoms of whooping cough are mild and are similar to common cold which includes:

• Mild cough

• Nasal congestion

• Sneezing

• Runny nose

• Low fever (below 102 degrees F)

The cough becomes more severe and frequent as the disease progresses. Though the cough may not be typically paroxysmal (sudden outbursts) in early stages, it tends to be annoying and more frequent at night.

2. Paroxysmal stage

This stage is characterized by paroxysms -- episodes of sudden outburst or bouts of cough. A thick layer of mucus accumulates inside the airways and causes uncontrollable coughing. Cough is marked by high pitched and long rasping indrawn breath at the end. This phase lasts for approximately 2-6 weeks.

Prolonged and severe coughing may lead to:

• Vomiting

• Extreme fatigue

• Red or blue face

• High-pitched “whoop” sound with the subsequent breath of air

Not every whooping cough patient develops the characteristic “whoop” sound. In this case, persistent cough is considered a symptom for the disease. Intense coughing often results in loss of bladder control, heaviness in the head, headaches, vomiting, and exhaustion. Sudden but common triggers for the uncontrollable cough include yawning, stretching, laughing, yelling, or exercise. It may also occur more frequently at night.

The longer it takes to treat the disease, the more frequent cough episodes may be experienced. Infants with whooping cough may not be able to cough and instead may find it very difficult to breathe.

3. Convalescent phase

The intensity and paroxysms of cough decrease gradually over 1-4 weeks. The vomiting becomes less frequent. Appetite, general condition and overall health usually improves.

Risk Factors For Whooping Cough

Whooping cough infection can be caused at any time of the year but cases surge during summers. Certain people are at a higher risk of getting the infection and some factors can increase their susceptibility towards the disease, which includes:

1. Lack of immunization or vaccination

According to the American Lung Association, anyone who is not yet vaccinated is at a major risk for getting the infection. However, pregnant women and infants may experience severities discussed below:

Pregnancy: Pregnant women approaching the end of their pregnancy should take extra care to stay away from people who might be infected. Unvaccinated women and their babies are at a higher risk of getting the infection. 

Babies and infants: Babies are unable to build their own immunity until they are vaccinated when they are two months old. Infants under a year who have not been vaccinated. If an infant gets infected, they may have to be rushed to the hospital for special treatment and care. 

2. Close contact with an infected person

If anyone in your family or community has been in close proximity with an infected person, used or shared common objects, there is a high risk of getting the infection.

3. Adults with asthma

Studies suggest that adults with asthma are at an increased risk of contracting whooping cough. Adults with asthma may develop severe symptoms if they contract the infection. Also, whooping cough in infancy or childhood increases the risk of developing asthma later in life. Therefore, it is highly recommended to stay up to date with the vaccination status to stay safe.

Diagnosis Of Whooping Cough

Whooping cough causes symptoms that are clearly evident but an early diagnosis could be difficult because the symptoms resemble those of a common cold or common respiratory illness. If your symptoms worsen, and the cough persists (longer than 7-10 days) you must visit your doctor.

Often the doctor may ask you questions about the type of cough or symptoms you experience. Based on those answers, your doctor may recommend some medical tests to confirm the presence of the disease such as:

1. Total leucocyte count 

A blood test is a general and not a specific test for whooping cough diagnosis. A blood test will help determine the presence of an infection or inflammation. A blood sample will be drawn and sent to the laboratory to check for white blood cell count. White blood cells (WBCs) are a component of blood that accounts for 1% of your blood. They are responsible for protecting your body from infections and therefore an increase in the number of WBCs will be indicative of an infection or inflammation. 

2. Differential leucocyte count (DLC)

Differential leucocyte count (DLC) detects the percentage of each type of white blood cell present in blood.

3. Nose or throat culture test

A culture test is performed by swabbing the nasopharynx (the area where the nose and throat meet). A culture test is performed to check for the presence of the whooping cough bacteria. Your doctor may recommend performing a laboratory test to check for the presence of the bacteria using the sample.

4. Polymerase chain reaction test

Polymerase chain reaction test is a highly sensitive rapid laboratory test that can help determine the presence of the bacteria in a biopsy specimen. 

5. Chest X-ray

A chest X-ray helps to produce images of the heart, lungs, airways, blood vessels and the bones of the chest and spine. It is a common and usually one of the first imaging tests recommended by a doctor when they suspect a heart or lung disease. A chest X- ray will help confirm the presence of an inflammation or fluid in the lungs which can occur during the disease.

Prevention Of Whooping Cough

Whooping cough can be prevented by getting vaccinated and staying up-to-date with the immunization. Alongside one must practice certain preventive measures to prevent the disease. They are:

Vaccine and immunization

Vaccination is the best way to prevent whooping cough across age groups including babies, children, teens, pregnant women, and adults. Tdap (tetanus-diphtheria-acellular pertussis) and DTaP (diphtheria-tetanus-acellular pertussis) vaccines are the two globally available vaccines which helps to prevent whooping cough. Both these vaccines are effective against diphtheria, tetanus and pertussis.

Types of vaccines available
Broadly, two types of whooping cough vaccines are available:

• Whole cell (wP/DTwP)
• Acellular (aP/DTaP)

Since 1978, India has been employing the whole cell (wP/DTwP) vaccine in their national immunization programs. Whereas, the acellular ones are mainly prescribed by the private sector.

The American Lung Association recommends the following form of the whooping cough vaccine for the respective age groups:

1. DTaP for young children

• 2,4 and 6 months
• 15 through 18 months
• 4 through 6 years of age

2. Tdap for preteens

• 11 through 12 years

3. Tdap for pregnant women

• During the 27-36th week of each pregnancy

4. Tdap for adults

• Including adults with asthma
• Anytime for those who have never been vaccinated

Chemoprophylaxis

It refers to the use of drugs to prevent disease. Erythromycin is recommended for close family contacts of patients suffering from whooping cough, especially children <2 years old.

Additional preventive measures

Here are some additional preventive measures that can help to prevent the spread of whooping cough.

1. Self-isolation of suspected individuals
Suspected cases should self-isolate to avoid the spread of the infection to adults and young children. 

2. Staying up-to-date with your vaccination status
Vaccination is the key to prevent the disease. You may require booster doses to ensure the immunity is maintained. Booster doses are recommended for all adults 19-65 years and adults in contact with babies less than 12 months old.

3. Practicing good personal hygiene
Whooping cough is a contagious disease therefore make sure you maintain good hygiene by washing your hands with soap and water at regular intervals. Especially, if you come in contact with an infected person, make sure to cover your mouth and face with your hand.

Practicing personal hygiene is extremely important. Someone who gives importance to self-hygiene not only feels comfortable in his/her skin but also prevents transmission of diseases to others.

Learn more about 5 simple ways of maintaining hygiene at your workplace.
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Specialist To Visit

Symptoms of whooping cough mimic common cold and therefore diagnosis can often be difficult. However, persistent and prolonged cough can cause:

• Vomiting after coughing

• Turn your face or lips red, purple or blue

• Difficulty in breathing

• Whooping sound after the cough

• Sluggishness

If symptoms of whooping cough do not resolve, and get worse you must book an appointment with your doctor to confirm the presence of the disease. 

To manage and treat the disease, you can consult the following specialists:

• General physician

• Pediatrician (in case of children)

• Infectious disease specialist

• Pulmonologist or a lung specialist

If your cough fails to subside or if you have any other symptoms along with cough, it is wise to book a consultation with our doctors. 
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Treatment Of Whooping Cough

Whooping cough is a bacterial infection and therefore can be treated with antibiotics. If the treatment of whooping cough is initiated at an early stage, it becomes easy to manage the severity of the symptoms. If your doctor confirms the presence of the infection, you will be recommended to start antibiotics right away. 

Medication

Commonly recommended antibiotics include:

• Azithromycin 

• Clarithromycin

• Erythromycin

If an infant gets the infection, there is a higher chance of complication and risk. In most cases, infants may even need hospitalization. In a complicated and severe case, the patient may require intravenous fluids to replace the lost liquid levels. 

Supportive measures

General measures include providing adequate nutrition and hydration and avoiding factors aggravating cough. Nebulization with salbutamol is effective in reducing bronchospasm (tightening of the muscles that line the airways or bronchi in the lungs) and controlling bouts of cough. If nebulization is not possible, salbutamol may be given orally.

Home-care For Whooping Cough 

Common symptoms of whooping cough include cough, runny nose, fever and nasal congestion. Some home care tips and tricks for whooping cough include:

• Do not give your child over the counter cough medications, unless prescribed by the doctor. 

• Avoid contact with anyone in the household or outside till the time you don't recover completely from the infection. This will help prevent the spread. 

• Flu-like symptoms can best be resolved with medications prescribed by the doctor and getting plenty of rest. Make sure you relax and take rest till the time your symptoms don't resolve completely. 

• Keep your surroundings free from triggers such as smoke, dust and chemical fumes to avoid coughing and sneezing. 

• Practice good hand hygiene by washing hands frequently and properly using soap. 

• Drink plenty of fluids in the form of juices, water and soups to stay hydrated and avoid loss of water. Especially for children, be watchful for symptoms such as dry lips, lack of tears while crying and infrequent urination. 

• Use of cool mist vaporizer that could help to loosen the mucus and soothe the lungs

• Eat small meals in short intervals. This will help to digest the food and avoid chances of vomiting. 

• Avoid close contact with others by keeping your mouth covered with a mask.

Complications Of Whooping Cough

Whooping cough, if left untreated, can cause serious complications in different age groups, especially babies and young children. They are at a higher risk for complications because of not being vaccinated and protected. 

Infants: Complications of whooping cough

According to the Centers for Disease Prevention and Control (CDC), about half of the babies younger than 1 year old who get the whooping cough infection do need hospitalization. Of those babies who are treated in the hospital with whooping cough:

• 1 out of 4 (23%) get pneumonia (lung infection)

• 1 out of 100 (1.1%) will have convulsions (violent, uncontrolled shaking)

• 3 out of 5 (61%) will have apnea (slowed or stopped breathing)

• 1 out of 300 (0.3%) will have encephalopathy (disease of the brain)

• 1 out of 100 (1%) will die

Teens and adults: Complications of whooping cough

Teens and adults who are vaccinated tend to face less complications compared to those not vaccinated at all. Some of the commonly reported complications of whooping cough include:

• Pneumonia: Lung health can be compromised and lead to pneumonia if whooping cough gets severe. Pneumonia can lead to acute respiratory distress and cause a medical emergency sometimes. 

• Seizures: It is a sudden, uncontrolled electrical disturbance in the brain that causes changes in your behavior, movements or feelings, and in levels of consciousness.

• Encephalopathy: It is a group of brain disorders that can be harmful if left untreated. 

• Hernia: It is a condition when an area of an organ or tissue pushes through a weakened layer of muscle, usually in your groin or abdomen. Severe whooping cough can often lead to a hernia due to persistent and prolonged coughing. 

• Damaged or collapsed lungs: Persistent coughing can cause pressure on the lungs and therefore can lead to collapsed lungs. 

• Tuberculosis: It can lead to flare ups of tuberculosis infection. 

• Malnutrition: This could be due to persistent vomiting and avoiding eating because of fear of cough.

Living With Whooping Cough

Whooping cough is a bacterial disease and it can be cured with medications such as antibiotics. However, in some cases it can get severe and cause complications. 

Here are some tips to prevent and manage whooping cough effectively:

• Stay up-to-date with your vaccination status: Vaccines for bacterial diseases such as whooping cough require booster doses after an interval of time. The immunity developed due to the dose tends to drop over the time. Therefore, make sure you get your booster dose as and when scheduled for. 

• Get plenty of rest: Make sure you relax and take rest till the time your symptoms don't resolve completely. In case of complications, follow up with your doctor on a regular basis. 

• Keep your surroundings free from triggers: Common triggers for cough include smoke, dust and chemical fumes. Make sure to keep your living surroundings clean and tidy. 

• Practice good hygiene: Wash your hands frequently using soap to eliminate chances of a reinfection or spread of the disease. 

• Keep yourself hydrated: Often bacterial infections can cause loss of fluids in the body. Drink plenty of fluids in the form of juices, water and soups to stay hydrated and avoid loss of water. 

• Use mist vaporizers: If you experience discomfort due to the bacterial infection, use vaporizers that can help to loosen the mucus and soothe the lungs.

• Eat small meals in short intervals: A bacterial infection can often cause difficulty in digesting food. It is recommended to consume small meals that are easy to digest in short intervals. Stay away from large meals. 

• Avoid cough medications for children: It is highly recommended to avoid cough medications if your child is infected with the disease. They fail to clear the airway when used for children. 

• Watch for signs of dehydration: Children with whooping cough may get dehydrated. Be watchful for signs of dehydration such as dry lips, and decreased frequency of urination.

In case of severity of infection, make sure to follow up with your doctor. Taking proper medications under the advice of your doctor will help manage the disease.