Symptoms, Causes, and Treatment of Pertussis (Whooping Cough)

Pertussis

Pertussis is a bacterial infection characterized initially by cold symptoms and later by coughing fits. Symptoms of pertussis, which can cause serious complications especially in infants under 1 year of age, are attempted to be controlled with certain antibiotics prescribed by doctors in the early stages.

What is Pertussis?

Pertussis, commonly known in medical literature as whooping cough, is a type of upper respiratory tract infection caused by a bacterium called Bordetella pertussis. Although whooping cough, also known colloquially by various names such as the \"100-day cough,\" is thought to be less common than it used to be due to the spread of vaccination programs, unfortunately, its frequency has seen a significant increase with vaccine hesitancy. The disease can easily spread through droplets released into the environment as a result of infected individuals coughing or sneezing. Some studies show that people without immunity against pertussis have a very high risk of contracting the disease upon contact with infected people.

While pertussis was a disease seen in almost all children and leading to serious complications in the pre-vaccination era, today the number of cases is seen to decrease significantly thanks to pertussis vaccination programs. Nevertheless, many factors such as anti-vaccination, global inequalities in vaccine access, or the waning of immunity over time lead to a resurgence of pertussis in many countries. According to current data, more than 24 million pertussis cases are recorded worldwide every year.

What Are the Symptoms of Pertussis?

Pertussis is a highly contagious respiratory disease that can cause serious complications, particularly in young children and infants. Following infection with the bacteria, the incubation period for pertussis generally ranges between 5 and 10 days. However, in some patients, the appearance of symptoms can take up to 3 weeks after contracting the disease. Pertussis is a progressively advancing infectious disease. Symptoms of the disease can vary depending on its stage. Accordingly, the main stages of pertussis are:

Cold phase: The disease initially manifests with symptoms similar to a cold, such as a runny nose, mild fever, and redness in the eyes. The cold phase, which is the period when the infection is most contagious, lasts an average of 1-2 weeks.

Coughing fits: Typical symptoms of pertussis are more pronounced in this phase of the infection. Known as the paroxysmal (severe coughing fits) phase, this stage is characterized by sequential and uncontrolled coughing fits specific to pertussis. Sometimes these fits are so severe that vomiting, cyanosis (bluish discoloration of the skin), shortness of breath, and even temporary cessation of breathing can be observed in patients. Following the coughing fits, a high-pitched whooping sound is heard. The paroxysmal phase usually lasts 1-6 weeks. However, in some patients, whooping cough fits can extend up to 10 weeks.

Convalescent phase: In the later stages of the disease, the frequency of coughing fits begins to gradually decrease. Although pertussis symptoms lessen during this period, people may become susceptible to other respiratory infections due to a weakened immune system.

The pertussis-type cough followed by a high-pitched whooping sound is the characteristic symptom of whooping cough. In some adults, pertussis symptoms may be mild and this sound may never occur. Conversely, whooping cough can also cause health problems such as migraine attacks, otitis media (middle ear infection), and urinary incontinence in adults. However, the whooping cough sound is more common in infants and young children aged between 6 months and 5 years. If this is accompanied by symptoms such as nutritional deficiency due to vomiting and bluish discoloration of the skin due to oxygen deprivation, it is important to consult a specialist doctor without delay.

What Causes Pertussis?

Being infected with the bacterium called Bordetella pertussis, also known as the pertussis bacterium, is the primary cause of pertussis. The pertussis bacterium can easily spread from an infected person to healthy people via droplets dispersed into the air through coughing or sneezing. When Bordetella pertussis enters the respiratory tract, it attaches to ciliated (hair-like) cells in the airways and begins to secrete toxins. These toxins, also known as pertussis toxin, cause inflammation in the airways and trigger the cough reflex.

How is Pertussis Diagnosed?

Diagnosing pertussis based solely on a physical examination can be difficult because it shows similar symptoms to other respiratory infections in the early stages of the disease. Especially in the early phase, since the symptoms of the disease resemble other respiratory diseases such as the common cold, flu, or bronchitis, relying only on physical examination can lead to misdiagnosis in patients. Therefore, it is important to utilize laboratory tests during the pertussis diagnostic process to rule out other infectious diseases.

Methods used for the definitive diagnosis of pertussis include a culture test or a polymerase chain reaction (PCR) test using a nasal or throat swab. However, detecting the disease with culture tests is not always easy. The ability to capture the bacterium in a culture usually disappears in the early stages, before symptoms have even appeared. Therefore, when pertussis symptoms are noticed in adults, even if a culture test is performed, it may yield a negative result up to 90% of the time. The pertussis PCR test is more sensitive than the culture test. Even if several weeks have passed since the infection, non-viable organisms can be detected.

In addition, when necessary, blood tests—though not specific to pertussis—can examine antibody levels developed against the infection. Especially in young children, if there is a suspicion of complications, secondary infections such as pneumonia can be investigated with a chest X-ray.

How is Pertussis Treated?

The primary goal in the treatment of pertussis is to alleviate the severity of symptoms and prevent the spread of the disease. Antibiotic treatment started in the early phase can help alleviate symptoms and reduce contagiousness. On the other hand, antibiotics cannot prevent coughing fits. Therefore, pertussis treatment is generally based on supportive care. Getting plenty of fluids, resting, and staying away from triggers that will provoke coughing fits are important for the treatment of whooping cough.

Treating the disease is not always easy. In particular, the treatment of infants may need to be carried out in a healthcare facility. Therefore, rather than treatment, it is important to prevent contracting the disease. There are various vaccines known to provide protection against pertussis since the 1940s. However, immunity gained through vaccination can wane over years.

Furthermore, today, the pertussis vaccine is included alongside vaccines such as tetanus and diphtheria that are recommended to be administered during pregnancy. The pertussis vaccine during pregnancy is planned to be completed by the 36th week of gestation. Administering the pertussis vaccine during pregnancy does not cause any harm to the baby and can provide the baby with immunity against the infection. Nevertheless, for full protection in infants and children, it is recommended to administer 5 doses of the vaccine: one dose at 2, 4, and 6 months, one dose at 15-18 months, and one dose at 4-6 years of age.

Frequently Asked Questions

Although pertussis can be seen in all age groups, infants and young children whose immune systems have not yet fully developed are at a higher risk. Pertussis can also be seen in adults whose immunity to the bacteria has decreased over time. Pertussis is a highly contagious infectious disease starting from the first phase when cold-like symptoms are observed. Especially among unvaccinated individuals living in the same household, the transmission rate can rise up to 80-90%. Although the pertussis vaccine provides a high rate of protection, it may not provide complete immunity. The vaccine can significantly reduce the risk of severe disease and death, in particular. However, pertussis immunity can wane over time. Therefore, it is beneficial to administer pertussis vaccine booster doses at intervals recommended by doctors. Whooping cough is typically characterized by consecutive, unstoppable coughing fits. At the end of each coughing fit, a high-pitched whooping sound may be heard, especially in children, accompanied by the effort to breathe. The cough is usually more severe at night. Additionally, complications such as vomiting, shortness of breath, and bluish discoloration of the skin may be observed following the fits. The first phase of the disease, where cold-like symptoms are seen, usually lasts 1-2 weeks. The second stage, where coughing fits occur, lasts an average of 1-6 weeks. However, in some patients, coughing fits can continue for up to 10 weeks. The third phase, the convalescent phase where the severity of the cough decreases, can also last up to 6 weeks. In other words, complete recovery from pertussis can take up to 3 months. This is the main reason why the disease is colloquially known as the \"100-day disease.\" The only known treatment method for pertussis is antibiotic treatment started in the early period. However, while antibiotics help alleviate symptoms and prevent the person from transmitting the infection to others, they cannot make the cough disappear completely. Pertussis can cause life-threatening complications in some people. The highest risk group consists of infants under 12 months of age, especially those under two months who have not yet been vaccinated. This risk may be higher in infants whose mothers did not get vaccinated during pregnancy. In addition, in individuals whose immune systems are suppressed for any reason, who have severe asthma, or who have any chronic health condition, pertussis can cause serious complications such as pneumonia, respiratory failure, and brain damage. According to experts, immunity against pertussis varies between 4 and 20 years. Therefore, someone who has had pertussis is at risk of catching it again. Due to the waning of immunity gained through vaccination or the disease over time, pertussis can also be seen in adults. It is important for those in contact with an infected person to consult a specialist doctor and receive preventive treatment. Prophylactic antibiotics can generally be started for contact persons. In addition, it is important for contact persons to stay away from crowded environments until pertussis symptoms develop.

Pertussis can lead to serious health problems when not diagnosed in the early period. If you think you or your child has symptoms of pertussis, you can make an appointment with our specialist doctors without delay. Take a step for your health right now!