Pertussis (whooping cough) is a lung infection that causes non-stop coughing. It is often deadly for babies. The pertussis vaccine has greatly reduced the risk, but outbreaks are becoming more common in the United States.
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Table of Contents for Pertussis
How do you get pertussis?
How many people get pertussis every year?
What are the symptoms of pertussis?
How soon do symptoms appear?
Can pertussis cause death?
What are complications of pertussis?
Is pertussis contagious?
How is pertussis treated?
Why do we use DTaP instead of DTP for pertussis?
How effective is the pertussis vaccine?
What is the immunization schedule for pertussis?
Do I need a booster shot?
What are pertussis vaccine names?
Pertussis (whooping cough) is a highly-contagious bacterial disease. It is caused by an infection with Bordetella pertussis. This bacteria attaches to the lining of the airways and releases toxins that cause severe lung inflammation and swelling. Pertussis causes weeks of violent non-stop coughing and it can be deadly, especially in babies.
People with pertussis can spread the disease by coughing, sneezing, or breathing while in close contact with other people. The bacteria is found in fluids from the mouth and nose of someone with the disease.
In 2014, pertussis caused about 30,000 illnesses in the United States. Some years are worse than others. For example, nearly 50,000 cases were reported in 2012. Many more cases are never reported.
Pertussis symptoms begin like a common cold, but progressively worsen until they are far more severe. These early symptoms may include:
- Runny nose
- Mild cough
- Low-grade fever
- Red, watery eyes
- Pause in breathing in infants (apnea)
After 1-2 weeks of cold-like symptoms, the next stage of pertussis begins. The coughing fits become very severe and uncontrollable. Each coughing fit may last for over a minute. Infants may even stop breathing.
The late-stage symptoms usually last 1-6 weeks, but they can last 10 weeks. The symptoms may include:
- Coughing violently non-stop
- Coughing up thick phlegm (mucous)
- Gasping for air after coughing
- Making a “whooping” noise while struggling to breathe
- Problems breathing, eating, drinking, talking, or sleeping due to coughing
- More frequent coughing at night
- Turning blue from coughing due to lack of oxygen
- Vomiting after coughing fits
- Generally feeling sick or unwell
- Fatigue from coughing so much
The incubation period of pertussis is usually 7-10 days, but symptoms may appear as early as 4 days or as long as 21 days after exposure. Nearly all non-immune people will get sick if they are exposed to it.
Yes. Pertussis is deadly in 20% of children under 5 years old and adults over 40 years old. In the United States, there were 277 deaths from pertussis from 2000 to 2014. Almost all of the deaths (87%) were in babies under 3 months old who were too young to be vaccinated. Before the DTaP vaccine was routinely given to infants, pertussis caused about 8,000 deaths every year in the United States.
- Pneumonia (severe lung infection)
- Seizures (jerking or staring)
- Brain damage
Yes. Pertussis is extremely contagious. An infected person can spread pertussis by coughing, sneezing, or breathing. They are contagious as soon as cold-like symptoms appear and for at least 2 weeks after coughing starts.
Pertussis is usually treated with an antibiotic called erythromycin. This antibiotic will stop the person from being contagious after 5 days of treatment. It is also given to people who were in close contact with the sick person, regardless of age and immunization status.
The first pertussis vaccine was developed in the 1930s, but it did not go mainstream until the 1940s when it was combined with vaccines against diphtheria and tetanus toxoids to make the DTP vaccine.
Pertussis vaccines are made by chemically treating pertussis toxins to make them non-toxic but still capable of causing an immune response in the vaccinated person. The vaccines are “inactivated” because they do not contain live viruses. This is why multiple doses are necessary.
The DTP vaccine is no longer used in the United States. Instead, we use the following vaccines in children and adults:
- DTaP Vaccine: Diphtheria, tetanus, and acellular pertussis vaccine for children between the ages of 6 weeks and 6 years old. DTaP is given in 5 separate shots at specific ages.
- Tdap Vaccine: Diphtheria, tetanus, and acellular pertussis vaccine for children over 7 years old, children, and adults. It is usually as a single dose booster shot.
The DTP vaccine contains whole-cell pertussis. While the DTP vaccine was very effective at preventing pertussis, up to half of children developed side effects where the shot was given.
In 1991, safety concerns led to the development of the DTaP vaccine, which contains acellular pertussis (“a” in DTaP) and has fewer side effects. DTaP has replaced DTP vaccines in the United States.
Full immunization with DTaP or Tdap are estimated to be 80-85% effective at preventing pertussis, but outbreaks are becoming more common in fully-vaccinated people. One explanation is that the pertussis vaccine wears off too quickly. In 2005, a study found that immunity against pertussis only lasts for 4-12 years after vaccination.
The pertussis vaccine for children under 7 years old is called DTaP. The immunization schedule is a series of 5 shots at these ages:
- 2 months
- 4 months
- 6 months
- 15-18 months
- 4-6 years old
Yes. Tdap is the pertussis booster shot for everyone 11 years and older. One dose of Tdap is recommended for teenagers when they are 11 or 12 years old. Anyone who did not get Tdap at that age should still get one dose of Tdap. Pregnant women should also get a dose of Tdap between the 27th and 36th week of each pregnancy.
- Daptacel® (DTaP)
- Infanrix® (DTaP)
- Kinrix® (DTaP-Polio)
- Pediarix® (DTaP-HepB-Polio)
- Pentacel® (DTaP-Polio-Hib)
- Boostrix® (Tdap)
- Adacel® (Tdap)
Yes. Immunization against pertussis is much safer than getting whooping cough, but like any medicine, vaccines can have severe side effects. The risk of serious injury or death is very small.
The most common side effects from the DTaP vaccine include:
- Redness, swelling, soreness, tenderness where the shot was given
- Swelling (sometimes the entire arm or leg for 1-7 days)
- Poor appetite
Pertussis vaccines can’t cause whooping cough. Severe side effects are extremely rare, but vaccines do sometimes cause life-threatening or permanent complications.
The risk depends on the type of vaccine and the dose number, but severe reactions generally include:
- Allergic reactions
- Behavior changes
- Brain damage
- Brachial neuritis
- Crying non-stop for 3 hours or more
- Fever over 105ºF
- Long-term seizure disorders (epilepsy)
- Lowered consciousness
- Nerve damage
- Nervous system diseases
- Shoulder Injury Related to Vaccine Administration (SIRVA)
- Vasovagal syncope
- Weakness or numbness