Paediatrics

Whooping Cough (Pertussis)

Pertussis is a highly contagious Bordetella pertussis infection causing prolonged paroxysmal cough; young infants may present with apnoea or cyanosis rather than a whoop and are at greatest risk of severe disease.

In a nutshell

Pertussis is a notifiable, highly contagious infection with coryza followed by paroxysmal cough, whoop or post-tussive vomiting. Young infants may present with apnoea, cyanosis or poor feeding without a whoop and are at greatest risk. Stabilise high-risk infants, test using the current UKHSA pathway without delaying treatment, consider a macrolide within 21 days of cough onset, apply 48-hour/21-day exclusion, and protect vulnerable contacts.

Classic presentation

A child develops coryza followed by recurrent coughing fits with post-tussive vomiting or a whoop, or a young infant presents with apnoea, colour change and poor feeding after a household exposure.

Key points

The whoop is not required: young infants and vaccinated people may not whoop.
Apnoea, cyanosis, bradycardia, poor feeding or exhaustion in a young infant are emergency features.
Use current UKHSA testing guidance; do not delay treatment or public-health action for a result.
Consider antibiotic treatment as soon as possible and up to 21 days after cough onset; use BNF/local prescribing details.
Exclude for 48 hours after starting antibiotics, or 21 days from cough onset if untreated.
Chemoprophylaxis is risk-assessed, with priority given to contacts of vulnerable infants and people who may transmit to them.
Maternal vaccination from 16 weeks and timely infant immunisation protect the highest-risk group.

First-line investigation

Clinical severity assessment plus an appropriately timed respiratory sample through the current UKHSA testing pathway; notify the local health protection team.

Management

Recognise infant danger

Apnoea, cyanosis, bradycardia, poor feeding, dehydration or exhaustion require urgent paediatric assessment; a young infant may not whoop.^1,2

Test and treat promptly

Use the current UKHSA respiratory testing pathway without delaying treatment, notification or infection-control action.¹
Consider a current BNF macrolide as soon as possible and up to 21 days after cough onset; the main benefit is reducing transmission.^1,3

Protect vulnerable contacts

Notify the health protection team, exclude for 48 hours after antibiotics or 21 days untreated, and risk-assess contact prophylaxis for vulnerable infants and those who may transmit to them.¹

Close the prevention gap

Complete the current infant and childhood schedule and offer pertussis vaccination in every pregnancy from 16 weeks, ideally around 20 weeks.^4,5

Exam traps

A young infant may have apnoea or cyanosis without a whoop.
Pertussis can occur after vaccination, especially as a prolonged cough in older children or adults.
Antibiotics late in the course usually do not abolish the cough, but they still matter for transmission control.
Do not use the older 14-day untreated exclusion rule; current UKHSA guidance uses 21 days.
Do not give chemoprophylaxis automatically to every asymptomatic contact; use current UKHSA risk assessment.
Do not delay public-health action while waiting for PCR, culture, serology or oral-fluid results.

Illustrations

Subconjunctival haemorrhage after forceful coughingA sharply demarcated bright-red subconjunctival haemorrhage beneath the bulbar conjunctiva, shown as a possible consequence of forceful coughing rather than a diagnostic feature.Doc James, Wikimedia Commons · CC-BY-SA-4.0

Key sources

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.