Whooping Cough (Pertussis)

DOHMH Health Alert # 29: Pertussis in New York City (PDF)
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What is pertussis?

Pertussis, also known as whooping cough, is a highly contagious bacterial illness. It causes a cough that can last several weeks, even months.

Who gets pertussis?

People can get pertussis at any age. Children who are too young to be fully vaccinated and those who have not received all vaccinations are at highest risk for severe illness. Since the 1980s, the number of reported pertussis cases has gradually increased in the United States. In 2014, over 28,000 pertussis U.S. cases were reported, the highest number since 1959. In New York City, between 2008 and 2014, around 200 cases were reported to the Health Department each year.

How is pertussis spread?

Pertussis is usually spread when an infected person coughs or sneezes, exposing others to infected mucus or droplets.

What are the symptoms?

Pertussis usually starts with cold-like symptoms. These early symptoms can last for one to two weeks and usually include:

  • Runny nose
  • Low-grade fever
  • Mild, occasional cough (may be minimal or absent in infants)
  • Apnea — a pause in breathing (in infants)

Later, the traditional symptoms of pertussis appear. Those include:

  • Paroxysms (fits) of many, rapid coughs, which empty the lungs, followed by a high-pitched "whoop" when inhaling afterwards
  • Vomiting (throwing up)
  • Exhaustion after coughing fits

The coughing fits can go on for up to 10 weeks or more. For teens and adults, especially those who were vaccinated, the "whoop" is often not there, and the infection is generally less severe.

How soon after infection do symptoms appear?

Symptoms usually appear seven to 10 days after exposure to an infected person, but can appear as late as six weeks afterwards.

When and for how long is a person able to spread pertussis?

People are most contagious during the early, "cold-like" stage. A person is contagious for up to three weeks after the onset of cough or until five days after antibiotic treatment has begun.

Does past infection with pertussis make a person immune?

No—neither vaccination nor a past infection with pertussis guarantees lifelong immunity. Since immunity drops after about five years after the last pertussis vaccine dose, older children, teens and adults may need additional vaccine doses.

What are the complications associated with pertussis?

Complications of pertussis are most common in young infants and can include pneumonia, ear infections, seizures, problems of the nervous system and brain, and death. About half of infants younger than age 1 who get the disease are hospitalized.

What is the vaccine for pertussis?

The vaccine for pertussis is given together with the vaccines for diphtheria and tetanus. There are two vaccines to protect against pertussis: one for children under 7 years old (diphtheria-tetanus-acellular pertussis vaccine, or DTaP), and another for people aged 7 and older (tetanus-diphtheria-acellular pertussis vaccine, or Tdap).

Infants should get DTaP doses at 2, 4 and 6 months and a fourth dose between 15 and 18 months. Children should get a fifth “booster” dose between 4 and 6 years, before starting school. If a 7- to 10-year-old child has not received all of the recommended DTaP vaccine doses, a dose of Tdap should be given before the 11- to 12-year-old checkup.

Teens attending sixth through twelfth grades are required to receive a Tdap booster dose to start school.

Adults should also get the Tdap vaccine; it is especially important for those in close contact with infants under 1 year old, such as parents, caregivers and health care workers. Pregnant women should also get Tdap vaccine, preferably during the late second or third trimester (after 20 weeks gestation and preferably between 27 and 36 weeks). Vaccination during pregnancy helps protect the baby before he or she is old enough to get vaccinated. If a mother didn’t get Tdap while pregnant, she should get it right after giving birth.

What can be done to prevent pertussis from spreading?

The single most effective way to prevent pertussis is by ensuring that as many people as possible in the community are vaccinated.

Antibiotics can shorten the time people are contagious. People who have pertussis should stay away from young children and infants until they have been treated. People in close contact with an infected person may need antibiotics (post-exposure prophylaxis) to prevent them from becoming ill and spreading the disease.

For more information on where you or your child can be vaccinated, call 311.