Pertussis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Pertussis, literally meaning “a violent cough,” also known as whooping cough or “the cough of 100 days,” was first described in the Paris epidemic of 1578. Bordetella pertussis, the causative organism, was discovered in 1906, and a vaccine was developed in the 1940s. Before the pertussis vaccine was developed, pertussis was a major cause of infant morbidity and mortality. This activity describes the presentation and management of pertussis and highlights the role of the interprofessional team in the treatment of affected patients and families.

Objectives:

• Identify the etiology of pertussis.

• Describe the typical presentation of a patient with pertussis.

• Outline the treatment and management options available for pertussis.

• Summarize interprofessional team strategies for improving care coordination and communication to enhance the care of patients with pertussis and improve patient outcomes.

Access free multiple choice questions on this topic.

Introduction

Pertussis, literally meaning “a violent cough,” also known as whooping cough or “the cough of 100 days,” was first described in the Paris epidemic of 1578. Bordetella pertussis, the causative organism, was discovered in 1906, and a vaccine was developed in the 1940s. Before the pertussis vaccine was developed, pertussis was a major cause of infant morbidity and mortality.[1][2][3] Pertussis is a serious illness with very high morbidity and mortality.

Etiology

The causative organisms of pertussis are Bordetella pertussis and Bordetella parapertussis. Bordetella is spread by airborne droplets and is highly contagious. Pertussis often affects 100% of non-immune household contacts. Immunity wanes to 50% 12 years after completing a vaccination series. Immunocompromised persons can also contract Bordetella bronchiseptica, which typically affects animals and is commonly known as “a kennel cough. ”[4][5][6]

Humans are the sole reservoir for Bordetella; the organism is spread via aerosolized droplets produced during a cough. The organism is highly contagious, with the majority of cases occurring during summer.

Risk factors for acquiring pertussis include:

• Pregnancy

• Epidemic exposure

• Lack of immunization

• Close contact with an infected individual

Epidemiology

Reported pertussis cases are increasing in the United States and worldwide. The prevalence of pertussis in the United States sharply declined from 150,000 to 250,000 cases per year in the prevaccination era to 1010 cases reported in 1976. Since then, pertussis has been on the rise, which is partially attributed to waning adolescent and adult immunity. Although pertussis largely remains a pediatric disease, with 38% of cases occurring in infants younger than 6 months and 71% of cases occurring in children younger than 5 years, adolescents and adults can also contract the disease and are likely contributing to the increasing number of both adult and pediatric cases seen over the past three decades. Worldwide, there are over 24 million cases annually, with greater than 160,000 deaths. The Center for Disease Control and Prevention (CDC) reported over 48,000 cases in the United States in 2012, the most recent year for which this data is available. Due to difficulty in diagnosis, the CDC estimates likely underreporting.[7]

Pathophysiology

Bordetella is a gram-negative coccobacillus that adheres to ciliated respiratory epithelial cells. Local inflammatory changes occur in the mucosal lining of the respiratory tract. Released toxins (pertussis toxin, dermonecrotic toxin, adenylate cyclase toxin, and tracheal cytotoxin) act locally and systemically, although the organism itself does not fully penetrate the respiratory tract, and almost never is found in blood cultures.

History and Physical

After an incubation period of 1 to 3 weeks, pertussis infection typically progresses through three distinct stages: the catarrhal phase, the paroxysmal phase, and the convalescent phase.

The catarrhal phase presents similarly to other upper respiratory tract infections, with fever, fatigue, rhinorrhea, and conjunctival injection. The catarrhal phase lasts 1 to 2 weeks and is the most infectious stage of the disease.

The paroxysmal phase follows the catarrhal phase and is characterized by paroxysms of a staccato cough and the resolution of fever. The patient typically coughs repeatedly, followed by forceful inspiration, which creates the characteristic “whoop.” These episodes may be triggered by cold or noise and are more common at night. Patients are nontoxic-appearing in between paroxysms, but during coughing episodes, may exhibit cyanosis, diaphoresis, or apnea. Immediately following a paroxysm, patients may develop post-tussive emesis, syncope, or apnea.

Finally, during the convalescent phase, a residual cough persists for weeks to months, usually triggered by exposure to another upper respiratory infection or irritant.

Atypical presentations are common in infants, and fever may not occur. Rather, tachypnea, apnea, cyanosis, and episodic bradycardia may be the presenting features.

Increased intrathoracic pressure from coughing may result in petechiae above the nipple line, subconjunctival hemorrhage, and epistaxis.

Breath sounds are variable; auscultation may reveal clear lungs or rhonchi, while rales suggest superimposed pneumonia. The inspiratory whoop or gasp is usually heard in children between 6 months to 5 years.

Evaluation

Testing for pertussis is not readily available in the emergency department. Nasopharyngeal culture and polymerase chain reaction (PCR) may yield laboratory confirmation, but the fastidious and slow-growing Bordetella organisms require specialized media, and cultures are typically not positive for 3 to 7 days. In adults, by the time the diagnosis is suspected, cultures are typically negative (96%), and overall culture sensitivity is only 20% to 40%. PCR is more sensitive and specific than culture, but testing is not widely available. [8][9][10]

In the emergency department, pertussis should be considered in patients with prolonged cough, especially occurring in paroxysms or with whoops or post-tussive emesis. During the late catarrhal and early paroxysmal phases, leukocytosis (often 25,000 to 60,000 per mL) with lymphocytosis may raise suspicion for pertussis. In a study of 100 infants less than 120 days old and admitted to a pediatric intensive care unit, there was a significantly higher leukocytosis in the five fatal cases. Unfortunately, leukocytosis may be the only laboratory finding useful in the emergency department. Chest x-ray findings are nonspecific and may show peribronchial thickening, atelectasis, or infiltrates. The classic association, though not often seen, is a “shaggy” right heart border.

Treatment / Management

Treatment of pertussis is largely supportive, including oxygen, suctioning, hydration, and avoidance of respiratory irritants. Parenteral nutrition may be necessary as the disease tends to have a prolonged course.

Hospitalization is indicated for patients with superimposed pneumonia, hypoxia, central nervous system (CNS) complications, or who are unable to tolerate nutrition and hydration by mouth. Patients less than 1-year-old are not fully vaccinated and carry the greatest risk of morbidity and mortality; they should be hospitalized regardless of symptoms. Neonates should be admitted to an intensive care setting as life-threatening cardiopulmonary complications and arrest can occur unexpectedly.

Antibiotic effect on the duration or severity of the disease is minimal when started in the catarrhal phase and not proven effective when started in the paroxysmal phase. Rather, the primary goal of antibiotic treatment is to decrease the carriage and spread of disease. Erythromycin (40 to 50 mg/kg per day, maximum 2 g per day, in 2 to 3 divided doses) is the first-line treatment for pertussis. Azithromycin (10 mg/kg per day on day 1 followed by 5 mg/kg on days 2 to 5) and clarithromycin (15 mg/kg per day in two divided doses) are alternative treatments. Trimethoprim-sulfamethoxazole (8 mg/kg per day of trimethoprim) has been used as an alternative in macrolide-allergic patients, but its efficacy has not been proven.

The macrolides are not recommended for infants less than 4 weeks old for fear that this may lead to infantile hypertrophic pyloric stenosis.

Strict isolation is important while the patient remains infectious. Pertussis is contagious throughout the catarrhal phase and for 3 weeks after the onset of the paroxysmal phase. In patients treated with antibiotics, isolation should be continued for at least 5 days after treatment is initiated. Postexposure prophylaxis with erythromycin is recommended for all household contacts.

Corticosteroids have not shown definite benefit in reducing the severity and course of illness but are sometimes given to critically ill infants. Beta2-agonists, pertussis immune globulin, cough suppressants, and antihistamines are not effective. Exchange blood transfusion therapy for leukocytosis with lymphocytosis may be considered.

Close contacts should be treated with azithromycin or erythromycin.

Vaccination is recommended with the acellular vaccine at ages 2,4,6, 15-18 months, and at ages 4 to 6 years. In addition, the CDC recommends a single dose of Tdap for all adults to reduce transmission to children. Adverse effects of the vaccine include crying and febrile seizures, but severe neurological effects are rare. The vaccine can also be administered during the third trimester to pregnant women without causing harm to the fetus. 

DTaP is approved during the last 3 months of pregnancy to prevent pertussis in infants under 2 months old.

Differential Diagnosis

Pertussis initially presents similarly to other respiratory infections, such as viral upper respiratory infection, bronchiolitis, pneumonia, and tuberculosis. Key differentiating factors of pertussis include typical progression through the three phases and persistent cough without fever. Foreign body aspiration should be considered in younger patients, and exacerbation of chronic obstructive pulmonary disease should be considered in older patients with the appropriate history. The striking leukocytosis may also be confused with leukemia.

Prognosis

Most people infected with pertussis will fully recover, albeit usually after a prolonged illness of months. Infants and older adults tend to have the highest mortality and morbidity, respectively. The infant death rate is about 2% of cases and accounts for 96% of deaths related to pertussis. Older adults tend to have increased morbidity due to other chronic medical conditions, as well as an increased rate of complications, such as pneumonia.[11][12][13]

Secondary complications like pneumonia, seizures, and encephalopathy may occur in some patients.

Complications

Secondary pneumonia or otitis media may occur. Superimposed pneumonia is a major cause of mortality in infants and young children and may be caused by aspiration of gastric contents during paroxysms of cough or because of decreased respiratory clearance of pathogens. Fever should subside during the catarrhal phase, and its presence during the paroxysmal phase should raise suspicion for pneumonia. The most common causes of secondary bacterial pneumonia are Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, and Staphylococcus aureus; although viral infections with the respiratory syncytial virus, cytomegalovirus, and adenovirus superinfections are also common.

Rarely (less than 2% of cases), CNS complications such as seizures and encephalopathy can occur, likely secondary to hypoxia, hypoglycemia, toxins, secondary infections, or cerebral bleeding from increased pressure during coughing. Sudden increases in intrathoracic and intraabdominal pressures can also result in periorbital edema, pneumothorax, pneumomediastinum, subcutaneous emphysema, diaphragmatic rupture, umbilical and inguinal hernias, and rectal prolapse.

Pertussis toxin also causes histamine hypersensitivity and increased insulin secretion.

Infants are particularly prone to bradycardia, hypotension, and cardiac arrest from pertussis. The development of pulmonary hypertension has been increasingly recognized as a factor contributing to infantile mortality, as it may lead to worsening systemic hypotension and hypoxia.

Deterrence and Patient Education

Pertussis vaccine exists in both whole-cell (DPT) and acellular (DTaP) forms. In 1991, the acellular formulation largely replaced the whole-cell vaccine, which had been associated with acute encephalopathy and prolonged seizures. The acellular form has fewer adverse effects and is as effective as the whole-cell formulation. As a result, the whole-cell preparation is only recommended when the acellular form is not available. Common adverse effects are mild and include fever, irritability, behavioral changes, and pain at the injection site. Less commonly, moderately severe reactions, including fever over 40 C, persistent and high-pitched crying, and seizures may occur. A recent study of over 50,000 patients vaccinated from 1981 to 2016 did not detect any new or unexpected adverse effects.

Pearls and Other Issues

Laboratory and radiographic confirmation of pertussis is a challenge in the emergency department setting. It is important to maintain a low threshold of suspicion for pertussis in any patient presenting with prolonged cough, regardless of immunization status. A complete blood count with attention to leukocytosis and lymphocytosis may be the best diagnostic screening tool in the emergency department.

Enhancing Healthcare Team Outcomes

The management of pertussis is best done with an interprofessional team that includes the pharmacist and nurses. With a strong anti-vaccine movement, patient education is key. Parents and caregivers have to be informed that the adverse effects of the vaccine are rare. In an era of anti-vaccination sentiments, clinicians should educate the public that the vaccine is safe and effective.

Pertussis immunity wanes significantly about seven years after vaccination and about 15 years after natural infection. As a result, the CDC Advisory Committee on Immunization Practices recommends routine booster immunization, starting at ages 11 to 18 years. A study of almost 70,000 patients showed no significant adverse effects for patients receiving Tdap instead of Td as a tetanus booster; in patients requiring a tetanus booster in the emergency department, adding the acellular pertussis component could be considered, especially in pregnant women. Mothers are often identified as the source of pertussis infection in newborns who have not completed their vaccination series, and preliminary data suggest that infants of mothers vaccinated against both influenza and pertussis may be at lower risk for contracting pertussis.

Pertussis is a reportable infection in the US, and even one case must be reported immediately, and control measures to prevent transmission should be in place. Open communication between the interprofessional team is vital to ensure that patients are treated with optimal care and that vaccination protocols are in place.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Leong RNF, Wood JG, Turner RM, Newall AT. Estimating seasonal variation in Australian pertussis notifications from 1991 to 2016: evidence of spring to summer peaks. Epidemiol Infect. 2019 Jan;147:e155. [PMC free article: PMC6518527] [PubMed: 31063086]

2.

Hotez PJ. Immunizations and vaccines: a decade of successes and reversals, and a call for ‘vaccine diplomacy’. Int Health. 2019 Sep 02;11(5):331-333. [PubMed: 31034023]

3.

Xu J, Liu S, Liu Q, Rong R, Tang W, Wang Q, Kuang S, Zhou C. The effectiveness and safety of pertussis booster vaccination for adolescents and adults: A systematic review and meta-analysis. Medicine (Baltimore). 2019 Apr;98(16):e15281. [PMC free article: PMC6494346] [PubMed: 31008974]

4.

Dou M, Macias N, Shen F, Bard JD, Domínguez DC, Li X. Rapid and Accurate Diagnosis of the Respiratory Disease Pertussis on a Point-of-Care Biochip. EClinicalMedicine. 2019 Feb;8:72-77. [PMC free article: PMC6469871] [PubMed: 31008450]

5.

Dou M, Sanchez J, Tavakoli H, Gonzalez JE, Sun J, Dien Bard J, Li X. A low-cost microfluidic platform for rapid and instrument-free detection of whooping cough. Anal Chim Acta. 2019 Aug 13;1065:71-78. [PMC free article: PMC6481316] [PubMed: 31005153]

6.

Etskovitz H, Anastasio N, Green E, May M. Role of Evolutionary Selection Acting on Vaccine Antigens in the Re-Emergence of Bordetella Pertussis. Diseases. 2019 Apr 16;7(2) [PMC free article: PMC6630436] [PubMed: 30995764]

7.

Jenkinson D. Pertussis (whooping cough) is common in teens and adults. BMJ. 2019 Apr 09;365:l1623. [PubMed: 30967372]

8.

Toubiana J, Azarnoush S, Bouchez V, Landier A, Guillot S, Matczak S, Bonacorsi S, Brisse S. Bordetella parapertussis Bacteremia: Clinical Expression and Bacterial Genomics. Open Forum Infect Dis. 2019 Apr;6(4):ofz122. [PMC free article: PMC6453521] [PubMed: 30976607]

9.

Kandeil W, Atanasov P, Avramioti D, Fu J, Demarteau N, Li X. The burden of pertussis in older adults: what is the role of vaccination? A systematic literature review. Expert Rev Vaccines. 2019 May;18(5):439-455. [PubMed: 30887849]

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Argondizo-Correia C, Rodrigues AKS, de Brito CA. Neonatal Immunity to Bordetella pertussis Infection and Current Prevention Strategies. J Immunol Res. 2019;2019:7134168. [PMC free article: PMC6387735] [PubMed: 30882004]

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Forsyth KD, Tan T, von König CW, Heininger U, Chitkara AJ, Plotkin S. Recommendations to control pertussis prioritized relative to economies: A Global Pertussis Initiative update. Vaccine. 2018 Nov 19;36(48):7270-7275. [PubMed: 30337176]

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Campbell H, Gupta S, Dolan GP, Kapadia SJ, Kumar Singh A, Andrews N, Amirthalingam G. Review of vaccination in pregnancy to prevent pertussis in early infancy. J Med Microbiol. 2018 Oct;67(10):1426-1456. [PubMed: 30222536]

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Lumbreras Areta M, Martinez De Tejada B. [Preventing whooping cough in infants : vaccinated mother, protected newborn]. Rev Med Suisse. 2018 Oct 24;14(624):1884-1886. [PubMed: 30375788]

Disclosure: Ashley Lauria declares no relevant financial relationships with ineligible companies.

Disclosure: Christopher Zabbo declares no relevant financial relationships with ineligible companies.

Whooping Cough | Pertussis | 3 Stages, Severity, & Spread

1. Infection & Disease

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2. Whooping Cough

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Language:

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Written by

Laura Henry, MD.

Resident in the Department of Otolaryngology-Head & Neck Surgery at the University of Pennsylvania

Medically reviewed by

Jeffrey M. Rothschild, MD, MPH.

Associate Professor of Medicine, Brigham and Women’s Hospital

Last updated May 23, 2023

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What is whooping cough?

Symptoms

Causes

Treatment & prevention

When to see a doctor

References

Table of Contents

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Written by

Laura Henry, MD.

Resident in the Department of Otolaryngology-Head & Neck Surgery at the University of Pennsylvania

Medically reviewed by

Jeffrey M. Rothschild, MD, MPH.

Associate Professor of Medicine, Brigham and Women’s Hospital

Last updated May 23, 2023

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This article will discuss the respiratory illness whooping cough that can occur in children, adolescents, and adults. Symptoms include fatigue and malaise, a low-grade fever, excessive tearing, red eyes, severe coughing, a “whooping” sound on inspiration, and vomiting after coughing.

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What is whooping cough?

Whooping cough is caused by the bacteria Bordetella pertussis, which affects the respiratory systems of children, adolescents, and adults. Whooping cough has also been called the “100-day cough” because of its extended time course. The symptoms classically associated with whooping cough are a sudden, uncontrollable coughing spell (“paroxysmal cough”), a “whooping” sound on inspiration, and throwing up after a coughing fit. The course of the condition is generally divided up into three phases — catarrhal, paroxysmal, and convalescent phases. The symptoms of the condition generally change over the course of these phases. Whooping cough is highly contagious and generally spread through respiratory droplets. The DTaP or Tdap vaccines are used to prevent the spread of whooping cough.

You should visit your primary care physician within the next 24 hours. This disease is managed with prescription antibiotics, and it is important to get treated as soon as possible to avoid spreading the infection to others.

Whooping cough symptoms

Main symptoms

While whooping cough predominantly affects the respiratory system, the symptoms vary throughout the course of the illness. As previously discussed, the condition is generally divided into the catarrhal, paroxysmal, and convalescent stages. The catarrhal stage is the earliest and usually lasts one to two weeks. The paroxysmal stage is the longest portion, lasting about two months. The convalescent stage is when the condition is resolving and usually lasts one to two weeks. Symptoms of whooping cough are listed below.

• Fatigue and malaise: These begin within the first one to two weeks of the condition in the catarrhal phase.
• Low-grade fever: This often develops as the bacteria infect the individual and occurs during the catarrhal phase.
• Excessive tearing
• Red eyes
• Severe, uncontrollable coughing: This is the hallmark symptom of whooping cough. It begins during the paroxysmal phase.
• “Whooping” sound on inspiration: This sound, giving the condition its name, is generally heard after episodes of intense coughing fits as an individual forcefully breathes in. This sound is heard during the paroxysmal phase and is even more prominent in children with whooping cough due to the small size of their windpipes.
• Vomiting after coughing: Also known as post-tussive emesis, this can occur due to the forceful nature of the coughing fits. The intense contraction of the muscles of the thorax (the part of the body where the lungs are found) and the abdomen can cause you to vomit after a coughing fit.

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Other symptoms

Other symptoms seen in whooping cough are not directly caused by the pertussis bacteria but by the extended period of time you experience intense coughing fits:

• Subconjunctival hemorrhage: “Subconjunctival” describes the source of the bleeding, located beneath the conjunctiva, the thin membrane covering the surface of the eye. The increased force during coughing fits can lead to rupture of the very small, delicate blood vessels of the eye and cause this symptom.
• Development or worsening of an abdominal hernia: The contraction of abdominal muscles used in coughing increases the overall pressure within the abdomen. This increase in intra-abdominal pressure can force movement of organs through membranes within the abdomen. Hernias can be seen around the belly button, lower abdomen, or groin regions.
• Urinary incontinence: Involuntary leakage of urine may occur as the abdominal muscles are contracting during coughing fits. This contraction puts stress on the bladder which can cause the release of urine. This occurs when the force from coughing overcomes the force of the pelvic floor muscles and urinary sphincters working to keep urine from expelling.

Diagnosis

It is important to make the diagnosis of whooping cough as early as possible to help you manage your symptoms as well as prevent the spread of infection. According to the CDC, whooping cough can be diagnosed clinically by the presence of a cough not explained by another condition that lasts at least two weeks along with the presence of one of the following: coughing fits, throwing up after coughing fits, or a “whooping” sound on inspiration. Other laboratory tests can also be used for the definitive diagnosis depending on what point of the illness you are experiencing:

• Respiratory culture: Respiratory secretions may be swabbed and cultured to look for the presence of the Bordetella bacteria during the first two weeks of the cough.
• Polymerase Chain Reaction: Also called PCR, this test is used alongside a culture from the respiratory system if the cough has been present for two to four weeks.
• Serology: Serology is a blood test used to detect antibodies, or the body’s natural defense mechanism, to the bacteria causing the infection. This test is used if the cough has been present for greater than four weeks.

Whooping cough causes

Whooping cough is caused by the bacteria Bordetella pertussis. The bacteria multiply in the respiratory tract over the course of seven to 10 days after the bug has lodged itself on the throat and nasal mucosa. This infection is highly contagious and is spread from person-to-person through the respiratory droplets expelled with the vigorous coughing spells that are characteristic of the condition. Prior to the introduction of vaccination in the 1940s, whooping cough often leads to death, especially among infants with the infection. The vaccine has significantly decreased the incidence and severity of pertussis in the U.S.

Treatment options and prevention for whooping cough

Treatment

Despite having the name “100-day cough,” studies show that most people with whooping cough experience a resolution of the infection in three to six weeks without any treatment. The CDC has provided recommendations with regards to administering antibiotics for people with whooping cough. These recommendations state that any person presenting with whooping cough within three weeks of the onset of the cough should receive treatment with antibiotics. The CDC also states that pregnant women, healthcare workers, and individuals with close contact to infants should receive antibiotic treatment if they present with cough suspicious for whooping cough. The preferred antibiotics for treatment are azithromycin or clarithromycin, both in the macrolide class of drugs.

Prevention

The most significant intervention for the prevention of whooping cough is the vaccine. The modern-day form of the vaccine, called the “acellular” vaccine, was introduced in 1991. This form of the vaccine is given along with immunity for tetanus in diphtheria in the vaccine Tdap (tetanus, diphtheria, acellular pertussis). Most people do not have any side effects from this vaccine, however, 25 percent of children will experience redness where the shot was given or a short course of fever.

• Infants/children and vaccination: The vaccine schedule for Tdap starts at age 2 months and a total of 5 vaccines given in total and ending around age 6.
• Adolescents and vaccination: Adolescents 11 to 18 years of age should receive a booster vaccine for Tdap.
• Pregnant women and vaccination: Pregnant women should also receive the vaccination at 27 to 36 weeks as this immunity can be transferred to the developing baby.

Even if an individual has been vaccinated against whooping cough, he or she should receive prophylactic antibiotics after coming in direct contact with someone who has an active pertussis vaccine.

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When to seek further consultation for whooping cough

An important aspect of preventing the spread of whooping cough is early detection. Any individual who is experiencing a persistent cough, fever, or a whooping sound on inspiration should consult his or her healthcare provider as soon as possible. Infants and elderly are particularly at risk of complications from the condition and should be under the careful care of a physician.

Questions your doctor may ask to determine whooping cough

• How severe is your fever?
• Has your cough gotten better or worse?
• Is your cough constant or come-and-go?
• How severe is your cough?
• How long has your cough been going on?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

Jeffrey M. Rothschild, MD, MPH.

Associate Professor of Medicine, Brigham and Women’s Hospital

Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP…

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References

1. Pertussis (whooping cough). Centers for Disease Control and Prevention. Updated July 11, 2018. CDC Link
2. Loeffelholz MJ, Thompson CJ, Long KS, Gilchrist MJ. Comparison of PCR, culture, and direct fluorescent-antibody testing for detection of Bordetella pertussis. J Clin Microbiol. 1999;37(9):2872-6. NCBI Link
3. Centers for Disease Control and Prevention (CDC). Pertussis–United States, 1997-2000. MMWR Morb Mortal Wkly Rep. 2002;51(4):73-6. PubMed Link
4. Kwantes W, Joynson DH, Williams WO. Bordetella pertussis isolation in general practice: 1977-79 whooping cough epidemic in West Glamorgan. J Hyg (Lond). 1983;90(2):149-158. PubMed Link
5. Whooping cough (Pertussis). Centers for Disease Control and Prevention. Updated August 14, 2015. CDC Link

full description, symptoms and causes

The hallmark of whooping cough is a strong hacking cough, followed by a breath, accompanied by a sound that sometimes resembles a scream. Previously, this disease was one of the main causes of infant mortality. Currently, it is rare, as mass vaccination is carried out.

In the modern world, whooping cough is not completely defeated. For example, in Russia in 2019, doctors identified 14,409 patients, including 13,537 children. And in 2021, 6,069 were diagnosedcases, among them in children – 5691. Perhaps the incidence has decreased due to “coronavirus” restrictions. In the world, more than 24 million cases of whooping cough are diagnosed per year, more than 160 thousand patients die. Now most of the patients are young children who did not have time to complete the vaccination course, as well as adolescents and adults, whose immunity began to “forget” the pathogen after vaccination due to a decrease in antibody titer.

Exciter characteristic

So, the causative agent of whooping cough is whooping cough, or Bordetella pertussis. There is another less common pathogen – Bordetella parapertussis. It causes disease in a milder form. The bacterium Bordetella bronchiseptica can also cause infection.

Bordetella pertussis are rod-shaped bacteria. They are immobile, do not form capsules, spores, and rather quickly die in the external environment. Man is their only reservoir. Infection occurs by airborne droplets: bacteria are released from the respiratory tract of the patient during a conversation, coughing. Whooping cough is highly contagious. If a susceptible (i.e., unvaccinated and not previously affected) person comes into contact with a sick person, then he will become infected with a probability of 80–90%.

The whooping cough produces a range of toxins. Getting into the respiratory tract, it multiplies on the surface of their mucous membrane, from the nasopharynx to the bronchi and bronchioles, and produces toxins. Because of this, a mucopurulent and bloody exudate is released in the airways, which leads to coughing and other symptoms.

Bacteremia in whooping cough is not typical – bacteria do not enter the bloodstream. Therefore, blood cultures in case of illness give a negative result.

Stages of development

The pathogenesis of diseases is divided into three stages:

1. Adhesion – attachment of bacteria to the mucous membrane after they have entered the respiratory tract.

2. Local lesions of the mucous membrane.

3. Systemic lesions – due to the fact that bacterial toxins spread in the body.

In the clinical picture of whooping cough in children, three stages are also distinguished (we will talk about the symptoms in more detail below):

1. Catarrhal period – when exudate is secreted in the airways, and the manifestations resemble SARS.

2. Paroxysmal stage (spastic cough stage) – when a spasmodic (convulsive) cough appears.

3. The resolution period is a gradual decrease in symptoms and recovery.

Whooping cough symptoms

At the first stage (catarrhal period), the symptoms of whooping cough in children resemble the manifestations of SARS. Thus, at first, the disease cannot be distinguished from the common cold. Within 1-2 weeks, symptoms such as:

• nasal congestion, discharge
• sneeze
• redness of the conjunctiva of the eyes
• temperature increase – usually not more than 38° C
• cough – barking or simply dry
• Young children may experience episodes of apnea (life-threatening pauses in breathing) and cyanosis (blueness of the skin)

After 1-2 weeks from the onset of the first symptoms, the paroxysmal stage begins. Its characteristic manifestation is a paroxysmal persistent cough, when during one exhalation a series of cough shocks occurs, and then the patient inhales sharply and deeply. This noisy breath can resemble a scream, it is called a reprise. A coughing fit may last a minute or more. It may be accompanied by vomiting, redness of the face, shortness of breath, petechial (pinpoint) hemorrhages on the face and upper body, under the conjunctiva of the eye. Sleep apnea may occur in young children. In between attacks, the child feels tired and fearful. Over time, seizures get worse. They can last up to 3 months or longer. At the same time, the course of the disease can no longer be influenced.

In older children and adults, the disease is usually milder than in infants.

At the resolution stage, coughing fits gradually become weaker and less frequent. They can disappear and then reappear, for example, when a child gets sick with SARS. Sometimes they return a few months after recovery.

Diagnosis

During the appointment, the doctor examines the child, evaluates his symptoms, asks parents about the course of the disease, contacts with sick people, examines the throat, listens to the lungs with a phonendoscope (performs auscultation). For a more accurate diagnosis of whooping cough, laboratory tests can be prescribed:

• complete blood count with leukocyte count
• determination of pathogen DNA by PCR (polymerase chain reaction) in throat swabs – carried out up to 4-5 weeks of illness
• determination of the level of antibodies to the pathogen in the blood – if the child coughs for more than 2-3 weeks
• bacteriological examination of sputum – carried out if the cough persists for no more than 14-21 days
• if the course of the disease is atypical, or if treatment does not help, conduct tests for pathogens of other SARS

In some cases, instrumental diagnostic methods can be assigned :

• if pneumonia is suspected, chest X-ray, pulse oximetry
• in severe disease and risk of heart damage – ECG, echocardiography
• in the event of neurological symptoms, seizures, signs of cerebral edema – neurosonography (ultrasound examination of the brain – in children under one year old), electroencephalography
• with extensive and long-lasting atelectasis (falling and loss of lung tissue from breathing) – bronchoscopy

Possible complications

Whooping cough is not only highly contagious, but also a very dangerous disease. In some cases, it can lead to serious complications and even death of the patient.

Possible complications of whooping cough:

• Apnea – respiratory arrest that can lead to death
• Cerebral edema – accumulation of fluid in the brain cells and intercellular space, accompanied by an increase in intracranial pressure. This causes symptoms such as nausea and vomiting, severe headache, impaired consciousness
• Hemorrhages in the brain.
• Pertussis encephalopathy – this term combines conditions characterized by brain damage and the development of neurological symptoms
• Pneumonia – pneumonia
• Dehydration
• Convulsions

Most often, these complications occur in children under 6 months of age. According to American statistics, 69% of young children need hospitalization, and mortality in this age group is 1-3%.

Which doctor should I contact?

Whooping cough is diagnosed and treated by pediatricians and infectious disease doctors. Any pediatrician should be able to suspect him in the presence of characteristic symptoms and course. It is necessary to consult a doctor (and if the child feels very unwell, call an ambulance) if the following symptoms occur:

• ARVI that occurs with uncharacteristic, unusual manifestations
• Signs of SARS in a child, if it is known that shortly before that he was in contact with a sick whooping cough
• Characteristic attacks of obsessive coughing with reprisals
• Vomiting after coughing fit
• Redness, blueness of the face
• Pauses in breathing

Treatment. How to deal with whooping cough in a child at home?

The treatment of whooping cough has three goals: the fight against the pathogen, the elimination of whooping cough attacks and the prevention of complications (or the fight against complications that have already developed). First of all, the patient must be isolated for 25 days from the onset of the disease so that he does not transmit the infection to others. The sick person is contagious throughout the catarrhal stage and for 3 weeks from the onset of the paroxysmal stage. If the patient is diagnosed with pneumonia, hypoxia (oxygen deficiency), damage to the central nervous system, or he cannot eat / drink on his own, then he must be placed in a hospital. Also, hospitalization is indicated for all sick children under one year old, because they have an increased risk of severe disease and complications.

The effectiveness of antibiotics for whooping cough is not very high, and it is only in cases where treatment is prescribed in the catarrhal stage. If the paroxysmal stage has already begun, then the severity and course of the disease cannot be influenced. Here, antibacterial drugs can only help reduce the bacterial load and the risk of infecting others. People who have been in contact with the patient may be given prophylaxis with the antibacterial drug erythromycin.

Corticosteroids – drugs of the adrenal cortex that suppress the inflammatory process – have not shown an effect on the severity and course of the disease in scientific studies. But sometimes they are prescribed to infants with a severe course of the disease.

Antitussives, beta2-agonists (drugs used to treat asthma attacks), pertussis immunoglobulin, and antihistamines (anti-allergic) drugs are ineffective.

We wrote in detail about the ineffectiveness of interferon preparations in this article.

Thus, in most cases, treatment is exclusively symptomatic. This includes drinking plenty of fluids, removing mucus from the airways (eg, with special suction), avoiding airway irritants (eg, tobacco smoke), and sometimes oxygen therapy.

Feeding a child with whooping cough

Children with whooping cough often have feeding problems. Quite often, coughing fits occur after eating, and against its background, vomiting begins with everything that the child has eaten. Therefore, portions should not be large: it is better to feed the child little by little, but more often. Under no circumstances should you force yourself to eat. It is necessary to offer the child dishes that he loves, but do not forget that the food should be balanced and complete.

More rarely, there are situations when, due to strong and frequent seizures, the child is afraid of meals. The mere mention of food can provoke another attack in him. In this case, you need to consult a doctor. You may need hospitalization and nutritional support in a hospital setting.

Prophylaxis

The only effective way to prevent whooping cough is vaccination.

But first, let’s talk about some other general measures. First of all, the same methods that are used to prevent SARS help here. This is the avoidance of crowded places during seasonal epidemics, wearing masks, limiting contact with sick people. If a child or adult is diagnosed with whooping cough, they should be isolated immediately so as not to infect others. And contact persons can be prescribed antibiotics for prevention – but in no case should they be taken without a doctor’s prescription.

Whooping cough vaccination

Vaccination against whooping cough is provided for in the National Calendar of Preventive Immunizations in Russia and calendars of other countries. There are two variants of the pertussis component in the composition of complex vaccines:

• Whole cell is whole bacteria killed
• Acellular (cell-free) represented by wall fragments of killed bacteria

The whole cell component causes the most persistent and long-lasting response from the immune system – for example, it is part of DTP. Doctors at the Nashe Vremya clinic recommend the use of complex (multicomponent) vaccines: they allow you to vaccinate a child against several infections at once and eliminate stress due to several injections.

As part of routine vaccination , we recommend using:

• Inactivated vaccine for the prevention of whooping cough, diphtheria, tetanus, poliomyelitis, Haemophilus influenzae type B conjugated Pentaxim – up to 6 years.
• Vaccine for the prevention of whooping cough, diphtheria, tetanus, inactivated poliomyelitis, hepatitis B combined, Haemophilus influenzae type B conjugated, adsorbed “Infanrix-hexa” – up to 36 months.

Domestic analogues of vaccines for immunization against pertussis:

• Adsorbed pertussis-diphtheria-tetanus vaccine “DTP” – up to 4 years.
• Diphtheria, tetanus, pertussis and recombinant hepatitis B vaccine (absorbed) “Bubo-kok” – up to 4 years.

Vaccines used in catch-up vaccination :

• Adsorbed acellular pertussis-diphtheria-tetanus vaccine “Infanrix” – up to 7 years.
• Vaccine for the prevention of diphtheria (with a reduced content of antigen), whooping cough (acellular) and tetanus combined adsorbed “Adasel” – for children over 4 years of age and adults.

According to the recommendations of the CDC, in order to reduce the incidence of whooping cough, children should be vaccinated with a pertussis component instead of ADS as a 5th booster dose. Also, vaccination is absolutely necessary for pregnant women in the 3rd trimester of each pregnancy to protect the baby in the first 3 months of life.

Main

• Whooping cough is a highly contagious respiratory infection
• The causative agent of infection is the bacterium Bordetella pertussis, much less often Bordetella parapertussis and Bordetella bronchiseptica
• In the modern world, the disease is rare – mainly in unvaccinated children, as well as in adolescents and adults who have decreased antibody titer
• Infection occurs by airborne droplets through contact with a sick person
• At the onset of the disease, the symptoms are usually indistinguishable from normal SARS
• After 1–2 weeks, a characteristic symptom occurs – attacks of severe obsessive coughing with reprises
• Whooping cough is diagnosed on the basis of history, clinical presentation and laboratory tests. If complications are suspected, instrumental studies may be prescribed.
• Treatment is symptomatic. Antibiotics help only at the very beginning of the disease, at the catarrhal stage, and their effectiveness is low. When characteristic seizures appear, it is no longer possible to influence the course of the disease.
• In most cases, there is a complete recovery. But sometimes whooping cough leads to serious complications and can cause death of the patient. The risk is highest in children under 6 months of age.
• The only effective method of prevention is vaccination. It is provided by the National calendar of preventive vaccinations.

sources ki :

https://nv-clinic.ru/disease/koklyush/
https://www.mayoclinic.org/diseases-conditions/whooping-cough/symptoms-causes/syc-20378973
https://www.cdc.gov/pertussis/about/signs-symptoms.html
https://kidshealth.org/en/parents/whooping-cough.html
https://www. webmd.com/children/whooping-cough-symptoms-treatment
https://www.ncbi.nlm.nih.gov/books /NBK519008/
https://emedicine.medscape.com/article/967268-overview#a1
http://niidi.ru/dotAsset/81b423f4-54db-46be-ab61-eba09a97e09f.pdf
https://www.vedomosti.ru/society/articles/2022/ 05/29/924145-meningitom-koklyushem-snizilas
https://dgb8.ru/vrachi-sovetuyut/koklyush-profilaktika-i-lechenie/

Whooping cough. What is whooping cough?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Whooping cough is an acute infectious disease of a bacterial nature, which manifests itself in the form of attacks of spasmodic cough that accompanies catarrhal symptoms. Infection with whooping cough occurs by aerosol through close contact with a sick person. The incubation period is 3-14 days. The catarrhal period of whooping cough resembles the symptoms of acute pharyngitis, then characteristic bouts of spasmodic cough develop. In vaccinated people, an erased clinical picture of whooping cough is more often observed. Diagnosis is based on the detection of whooping cough in throat swabs and sputum. In relation to whooping cough, antibacterial therapy (aminoglycosides, macrolides), antihistamines with a sedative effect, and inhalations are effective.

ICD-10

A37 Pertussis

• Exciter characteristic
• Whooping cough pathogenesis
• Whooping cough symptoms
• Whooping cough diagnostics
• Complications of whooping cough
• Whooping cough treatment
• Prophylaxis
  • Specific prophylaxis
  • Non-specific prophylaxis
• Prices for treatment

General information

Whooping cough is an acute infectious disease of a bacterial nature, which manifests itself in the form of spasmodic cough attacks that accompany catarrhal symptoms.

Characteristics of the causative agent

Whooping cough is caused by Bordetella pertussis, a small, non-motile, aerobic, Gram-negative coccus (although traditionally the bacterium is called “pertussis bacillus”). The microorganism is similar in its morphological features to the causative agent of parapertussis (an infection with similar but less pronounced symptoms) – Bordetella parapertussis. Pertussis produces thermolabile dermatonecrotoxin, thermostable endotoxin, and tracheal cytotoxin. The microorganism is not very resistant to the influence of the external environment, remains viable under the action of direct sunlight for no more than 1 hour, dies after 15-30 minutes at a temperature of 56 ° C, and is easily destroyed by disinfectants. They remain viable for several hours in dry sputum.

The reservoir and source of pertussis infection is a sick person. The contagious period includes the last days of incubation and 5-6 days after the onset of the disease. The peak of infectivity occurs at the time of the most pronounced clinic. Epidemiological danger is represented by persons suffering from erased, clinically mild forms of infection. Whooping cough does not last long and is not epidemiologically significant.

Whooping cough is transmitted by an aerosol mechanism, predominantly by airborne droplets. Abundant excretion of the pathogen occurs when coughing and sneezing. Due to its specificity, the aerosol with the pathogen spreads over a short distance (no more than 2 meters), so infection is possible only in case of close contact with the patient. Since the pathogen does not persist in the external environment for a long time, the contact route of transmission is not realized.

People are highly susceptible to whooping cough. Most often, children get sick (whooping cough is classified as a childhood infection). After the transfer of the infection, a stable lifelong immunity is formed, however, the antibodies received by the child from the mother transplacentally do not provide sufficient immune protection. In old age, cases of recurrence of whooping cough are sometimes noted.

Pertussis pathogenesis

Pertussis bacillus enters the mucous membrane of the upper respiratory tract and colonizes the ciliated epithelium covering the larynx and bronchi. Bacteria do not penetrate into deep tissues and do not spread throughout the body. Bacterial toxins provoke a local inflammatory reaction.

After the death of the bacteria, endotoxin is released, which causes the spasmodic cough characteristic of whooping cough. With progression, cough acquires a central genesis – a focus of excitation is formed in the respiratory center of the medulla oblongata. Cough reflexively occurs in response to various stimuli (touch, pain, laughter, conversation, etc.). Excitation of the nerve center can contribute to the initiation of similar processes in neighboring areas of the medulla oblongata, causing reflex vomiting, vascular dystonia (increased blood pressure, vascular spasm) after a coughing fit. Children may have seizures (tonic or clonic).

Pertussis endotoxin together with the enzyme produced by bacteria – adenylate cyclase helps to reduce the protective properties of the body, which increases the likelihood of developing a secondary infection, as well as the spread of the pathogen, and in some cases – long-term carriage.

Whooping cough symptoms

The incubation period for whooping cough can be anywhere from 3 days to two weeks. The disease proceeds with a successive change of the following periods: catarrhal, spasmodic cough and resolution. The catarrhal period begins gradually, a moderate dry cough and runny nose appear (in children, rhinorrhea can be quite pronounced). Rhinitis is accompanied by a viscous discharge of a mucous nature. Intoxication and fever are usually absent, body temperature can rise to subfebrile values, the general condition of patients is considered satisfactory. Over time, the cough becomes frequent, persistent, its attacks may be noted (especially at night). This period can last from several days to two weeks. In children, it is usually short-lived.

Gradually, the catarrhal period passes into a period of spasmodic cough (otherwise – convulsive). Coughing attacks become more frequent, become more intense, the cough acquires a convulsive spastic character. Patients may notice the harbingers of an attack – sore throat, chest discomfort, anxiety. Because of the spastic narrowing of the glottis, a whistling sound (reprise) is noted before inhalation. A coughing fit is an alternation of such whistling breaths and, in fact, coughing shocks. The severity of whooping cough is determined by the frequency and duration of coughing fits.

Seizures become more frequent at night and in the morning. Frequent tension contributes to the fact that the patient’s face becomes hyperemic, edematous, there may be small hemorrhages on the skin of the face and mucous membrane of the oropharynx, conjunctiva. Body temperature remains within normal limits. Whooping cough fever is a sign of a secondary infection.

The period of spasmodic cough lasts from three weeks to a month, after which the disease enters a phase of recovery (resolution): when coughing, mucous sputum begins to be expectorated, the attacks become less frequent, lose their spasmodic character and gradually stop. The duration of the resolution period can take from several days to several months (despite the subsidence of the main symptoms, nervous irritability, coughing and general asthenia can be observed in patients for a long time).

Erased form of whooping cough is sometimes observed in vaccinated individuals. At the same time, spasmodic attacks are less pronounced, but the cough can be longer and difficult to treat. Reprises, vomiting, vascular spasms are absent. The subclinical form is sometimes found in the focus of pertussis infection when examining contact persons. Subjectively, patients do not notice any pathological symptoms, but periodic coughing can often be noted. The abortive form is characterized by the cessation of the disease at the stage of catarrhal symptoms or in the first days of the convulsive period and the rapid regression of the clinic.

Diagnosis of whooping cough

Specific diagnosis of whooping cough is carried out by bacteriological methods: isolation of the pathogen from sputum and smears of the mucous membrane of the upper respiratory tract (bakposev on a nutrient medium). Pertussis is sown on Borde-Jangu medium. Serological diagnosis using RA, RSK, RNHA is performed to confirm the clinical diagnosis, since the reactions become positive no earlier than the second week of the convulsive period of the disease (and in some cases they can give a negative result at a later date).

Non-specific diagnostic methods note signs of infection (lymphocytic leukocytosis in the blood), a slight increase in ESR is characteristic. With the development of complications from the respiratory system, patients with whooping cough are recommended to consult a pulmonologist and conduct x-rays of the lungs.

Complications of whooping cough

Whooping cough most often causes complications associated with the addition of a secondary infection, especially diseases of the respiratory system: bronchitis, pneumonia, pleurisy. As a result of the destructive activity of pertussis bacteria, the development of emphysema is possible. Severe course in rare cases leads to atelectasis of the lungs, pneumothorax. In addition, whooping cough can contribute to the occurrence of purulent otitis media. There is a possibility (with frequent intense attacks) of a stroke, rupture of the muscles of the abdominal wall, eardrums, prolapse of the rectum, hemorrhoids. In young children, whooping cough can contribute to the development of bronchiectasis.

Treatment of whooping cough

Whooping cough is treated on an outpatient basis, it is desirable for patients to breathe humidified air, rich in oxygen, at room temperature. Nutrition is recommended full, fractional (often in small portions). It is recommended to limit the impact on the nervous system (intense visual, auditory impressions). If the temperature remains within the normal range, it is advisable to walk more in the fresh air (however, at an air temperature of at least -10 ° C).

In the catarrhal period, it is effective to prescribe antibiotics (macrolides, aminoglycosides, ampicillin or levomycetin) in average therapeutic dosages for courses of 6-7 days. In combination with antibiotics in the first days, the administration of a specific anti-pertussis gamma globulin is often prescribed. As a pathogenetic agent, patients are prescribed antihistamines with a sedative effect (promethazine, mebhydrolin). In the convulsive period, antispasmodics can be prescribed to relieve seizures, in severe cases, antipsychotics.

Antitussives, expectorants and mucolytics for whooping cough are ineffective, antitussives with a central mechanism of action are contraindicated. Patients are recommended oxygen therapy, a good effect is observed with oxygen barotherapy. Physiotherapeutic methods, inhalations of proteolytic enzymes are successfully used.

The prognosis is favorable. It ends fatally in exceptional cases in elderly people. With the development of complications, it is possible to preserve long-term consequences, chronic lung diseases.

Prophylaxis

Specific prophylaxis

Vaccination against whooping cough in the absence of medical contraindications is given to children at the age of 3 months; the second time – at 4.5 months; the third – at 6 months. The first revaccination is carried out at 1.5 years; the second and third – at 6-7 and 14 years old; thereafter every 10 years.

Vaccines DTP, ADS, ADS-M (Russia), Pentaxim (France), Infanrix and Infanrix Hexa (Belgium), Tetraxim (France) are allowed. For revaccination of older children, adults, pregnant women in the 3rd trimester of pregnancy, the Adasel vaccine (Canada) can be used. Family members of a pregnant woman should also be vaccinated before the baby is born.

Non-specific prophylaxis

General preventive measures include early detection of patients and control over the health of contact persons, preventive examination of children in organized children’s groups, as well as adults working in medical and prophylactic institutions and in preschool institutions and schools, if a prolonged cough (more than 5-7 days) is detected.

Children (and adults from the above groups) with whooping cough are isolated for 25 days from the onset of the disease, contact persons are suspended from work and visiting the children’s team for 14 days from the moment of contact, undergoing a double bacteriological test. In the focus of infection, thorough disinfection is carried out, appropriate quarantine measures are taken. Emergency prophylaxis is carried out with the help of the introduction of immunoglobulin. It is received by children of the first year of life, as well as unvaccinated persons who have had contact with sick whooping cough.