Whooping cough (pertussis) is a severe respiratory disease caused by the bacterium Bordetella pertussis, which releases toxins primarily responsible for the symptoms of the illness. These toxins damage the respiratory epithelium, initiating the production of thick, sticky mucus and impairing the mechanisms responsible for clearing the airway.
Pertussis is often called the "100-day disease" because of the prolonged coughing spells.
The infection spreads very easily from person to person via droplets, mainly through close contact with an infected individual. Regardless of their immune system's condition, about 80% of people in household contact become infected. Close contact is defined as staying in the same room with the sick person for about 60 minutes or within one meter for at least 30 minutes.
The incubation period (time before symptoms appear) lasts from 5 to 21 days, most commonly between 7 and 10 days. The disease progresses through three distinct phases, which vary significantly across different age groups.
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Phase one in older children is usually mild, resembling a common cold with a watery runny nose, mild cough, tearing eyes, and mild or no fever. In infants up to 3 months old, this phase is short and may not be recognized as illness.
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Phase two involves intense, paroxysmal coughing fits, with a high-pitched inspiratory "whooping" sound caused by difficulty inhaling, often ending with vomiting. In infants, this phase can be very severe, with breathing difficulties, blueness of the face, and apneas. Coughing attacks can be triggered by various stimuli such as sounds, sights, or routine activities like feeding, changing, playing, or bathing.
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Phase three is the gradual resolution of the cough. It lasts long—up to 6 months in older children and even over a year in young infants. This prolonged, exhausting cough is related to airway hyperreactivity, likely due to persistent nerve endings responding to toxins from Bordetella pertussis.
In adolescents and adults, whooping cough often presents in a milder form with weaker cough episodes and occasional "whooping" sounds. However, coughing can last from one to two months. It is often accompanied by additional symptoms such as shortness of breath, excessive sweating, fainting, headaches, or general weakness.
Infants under 6 months, young children, and elderly individuals with coexisting conditions typically require hospitalization, possibly with intensive care.
Complications from pertussis include bronchitis, pneumonia, pneumothorax, rib fractures, nosebleeds, subconjunctival hemorrhages, urinary incontinence, or weight loss. In very young children, complications can also include seizures and encephalopathy due to oxygen deprivation during coughing attacks, which can be fatal.
In older individuals, death from pertussis is rare but occurs mainly in those with other health problems, especially neurological, muscular, or cardiovascular conditions.
Infected persons are most infectious during the catarrhal (first) phase and the first two weeks of the cough (second phase). The length of infectiousness depends on age, prior exposure, immune status, and early antibiotic treatment. For example, unvaccinated infants can be infectious for 1-2 months, while vaccinated, untreated adolescents can transmit for up to two weeks.
Administering antibiotics reduces infectiousness to about 5-6 days.
Early antibiotic treatment can lessen the severity of the disease, but after coughing fits begin, antibiotics do not significantly affect disease progression. They are still recommended to prevent spread to others and reduce the chance of reinfection. Unfortunately, it is possible to get pertussis multiple times because neither infection nor vaccination provides lifelong immunity.
The waning of vaccine-induced immunity during childhood contributes to increased cases in later years. Therefore, booster vaccinations against pertussis are recommended every 10 years.
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