7 Key Whooping Cough Symptoms You Should Never Ignore

Whooping cough, medically known as pertussis, is a highly contagious respiratory infection caused by the bacterium Bordetella pertussis. This disease is characterized by severe coughing episodes that can last for weeks or even months, earning it the nickname “the 100-day cough.” While whooping cough can affect people of all ages, it poses the greatest risk to infants and young children whose immune systems are still developing.

The name “whooping cough” comes from the distinctive high-pitched “whoop” sound patients make when gasping for air after a coughing fit. Understanding the symptoms of this condition is crucial for early detection and preventing its spread to vulnerable populations. In this comprehensive guide, we’ll explore the seven key symptoms of whooping cough, their progression, and what you need to know about this serious respiratory illness.

1. Mild Cold-Like Symptoms (Catarrhal Stage)

Whooping cough typically begins with symptoms that closely resemble a common cold, making it difficult to diagnose in its early stages. This initial phase, known as the catarrhal stage, usually lasts one to two weeks.

During this period, you may experience:

• Runny or stuffy nose
• Mild fever (typically below 102°F or 38.9°C)
• Occasional mild cough
• Watery eyes
• General feeling of being unwell

This is actually the most contagious stage of whooping cough, even though symptoms appear mild. Many people unknowingly spread the infection during this time because they assume they just have a regular cold. The bacteria multiply rapidly in the respiratory tract, preparing for the more severe symptoms to come. It’s particularly important to be vigilant if you’ve been exposed to someone with confirmed whooping cough, as these seemingly innocent symptoms could indicate the beginning of pertussis infection.

2. Severe, Uncontrollable Coughing Fits (Paroxysmal Stage)

After the initial stage, whooping cough progresses to its most recognizable and severe phase: the paroxysmal stage. This stage typically begins one to two weeks after symptoms first appear and can last anywhere from one to six weeks, sometimes even longer.

The coughing fits during this stage are distinctive and intense:

• Rapid, consecutive coughs occur without time to breathe in between
• Episodes may last for a minute or longer
• Multiple coughing fits can occur back-to-back
• Attacks often happen more frequently at night
• Physical triggers like eating, drinking, laughing, or yawning can provoke coughing

These coughing paroxysms are exhausting and can be frightening to witness. During a fit, the person coughs repeatedly until their lungs are completely empty of air. The severity of these episodes distinguishes whooping cough from other respiratory infections and is often what prompts people to seek medical attention. Between coughing fits, patients may appear completely normal, which can be confusing for both patients and healthcare providers.

3. The Characteristic “Whooping” Sound

The hallmark symptom that gives whooping cough its name is the distinctive high-pitched “whoop” sound made when gasping for air after a coughing fit. This sound occurs because the airway becomes swollen and narrowed, causing the characteristic noise when the person finally inhales deeply.

Important points about the whooping sound:

• Not everyone with pertussis makes this sound, especially adults and adolescents
• Infants under 6 months may not “whoop” at all
• The sound is more common in children than adults
• When present, it’s a strong indicator of whooping cough
• The whoop occurs at the end of a coughing episode when the person desperately inhales

While the whooping sound is considered the signature symptom, its absence doesn’t rule out pertussis. Many patients, particularly older children, teenagers, and adults, may have severe coughing fits without the characteristic whoop. In infants, instead of whooping, you might notice apnea (pauses in breathing) or gasping for air, which can be even more dangerous than the whoop itself.

4. Vomiting After Coughing Episodes

One of the most distressing symptoms of whooping cough is vomiting that occurs during or immediately after severe coughing fits. This happens because the violent coughing episodes trigger the gag reflex and put significant pressure on the stomach.

Key characteristics of cough-induced vomiting:

• Occurs specifically after intense coughing paroxysms
• More common in children than adults
• Can lead to dehydration and weight loss if frequent
• May cause patients to avoid eating or drinking due to fear of vomiting
• Can result in nutritional deficiencies in prolonged cases

The vomiting associated with whooping cough is particularly challenging for young children who may become afraid to eat or drink, knowing that a coughing fit could follow. Parents often report that their children lose weight during the illness because of this cycle. The combination of forceful coughing and vomiting also increases the risk of aspiration, where stomach contents enter the lungs, potentially causing additional complications. It’s important to offer small, frequent meals and ensure adequate hydration between coughing episodes.

5. Extreme Exhaustion and Fatigue

The relentless nature of whooping cough takes a significant toll on the body, resulting in profound exhaustion that affects daily functioning. This fatigue goes beyond normal tiredness and can be debilitating.

Factors contributing to exhaustion include:

• Frequent nighttime coughing fits that prevent restful sleep
• Physical energy expended during violent coughing episodes
• Reduced oxygen intake during coughing paroxysms
• Decreased food and fluid intake due to fear of triggering cough
• The body’s immune system working overtime to fight the infection

Patients often describe feeling completely drained and unable to perform normal activities. Children may be too tired to play or attend school, while adults struggle to maintain work responsibilities. The exhaustion is compounded by sleep deprivation, as coughing fits frequently occur at night, sometimes happening multiple times per hour. This lack of restorative sleep affects mood, cognitive function, and overall recovery. Family members may also experience exhaustion from caring for the sick person and losing sleep themselves. The fatigue typically improves as the coughing episodes become less frequent during the recovery phase.

6. Facial Redness or Bluish Skin Color

The intense physical strain of whooping cough coughing fits can cause visible changes in skin coloration, which can be alarming but are direct results of the respiratory distress.

You may observe:

• Redness (erythema): The face, particularly the cheeks and forehead, may turn bright red or purple during coughing fits due to increased blood pressure and straining
• Cyanosis (bluish tint): The lips, face, or fingernails may develop a blue or grayish color, indicating insufficient oxygen in the blood
• Petechiae: Small red or purple spots may appear on the face, neck, or eyes from broken blood vessels caused by forceful coughing
• Bloodshot eyes: The whites of the eyes may become red from burst capillaries

Cyanosis is particularly concerning as it indicates that oxygen levels are dangerously low. This is more common in infants and young children whose airways are smaller and more easily obstructed. If you notice a bluish tint to the skin, especially around the lips or fingernails, seek immediate medical attention as this suggests severe respiratory compromise. The facial redness typically resolves quickly after the coughing fit ends, but repeated episodes can cause lasting facial petechiae that take days to fade. These visible signs demonstrate the severity of the strain that whooping cough places on the respiratory and cardiovascular systems.

7. Difficulty Breathing and Apnea

Respiratory difficulties are among the most dangerous symptoms of whooping cough, particularly in infants and young children. The inflammation and mucus production in the airways make breathing labored even between coughing episodes.

Breathing problems may include:

• Apnea: Pauses in breathing that last several seconds, most common in infants under 6 months
• Rapid breathing: Breathing faster than normal to compensate for reduced oxygen
• Shallow breathing: Taking small, quick breaths instead of deep ones
• Chest retractions: The skin between the ribs pulling inward with each breath, indicating respiratory distress
• Nasal flaring: The nostrils widening with each breath, a sign of breathing difficulty
• Wheezing or grunting sounds: Abnormal breathing sounds due to narrowed airways

Apnea is especially dangerous in young infants who may stop breathing for extended periods without the characteristic cough or whoop. This is why infants with whooping cough often require hospitalization for monitoring. Parents should watch for signs that their baby is struggling to breathe, including unusual chest movements, color changes, or pauses in breathing. Between coughing fits, some patients continue to experience shortness of breath and find it difficult to complete normal activities without becoming winded. Any significant breathing difficulty warrants immediate medical evaluation, as it can indicate complications such as pneumonia or respiratory failure.

What Causes Whooping Cough?

Whooping cough is caused by infection with the bacterium Bordetella pertussis. Understanding how this infection spreads and develops is essential for prevention and early recognition.

The Bacterium: Bordetella pertussis is a highly specialized bacterium that specifically targets the human respiratory system. Once inhaled, it attaches to the tiny hair-like projections (cilia) that line the respiratory tract. The bacteria then release toxins that damage these cilia, paralyze them, and cause inflammation. This damage prevents the respiratory system from clearing mucus normally, leading to the accumulation of thick secretions and the severe coughing that characterizes the disease.

Transmission Methods:

• Respiratory droplets: The primary mode of transmission is through airborne droplets when an infected person coughs, sneezes, or talks
• Close contact: Spending extended time near an infected person, especially in enclosed spaces, significantly increases risk
• Direct contact: Touching contaminated surfaces and then touching your face can transmit the bacteria, though this is less common
• Asymptomatic carriers: People with mild symptoms may unknowingly spread the disease

Risk Factors:

• Unvaccinated or under-vaccinated individuals: Those who haven’t completed the recommended vaccination series are at highest risk
• Infants under 12 months: Too young to have completed the full vaccination series and most vulnerable to severe complications
• Waning immunity: Immunity from both vaccination and natural infection decreases over time, typically after 5-10 years
• Pregnant women: Can pass the infection to newborns, who are at greatest risk of serious complications
• Healthcare workers and caregivers: Regular exposure to sick individuals increases infection risk
• People with compromised immune systems: Less able to fight off the infection effectively

The highly contagious nature of whooping cough means that up to 90% of non-immune household contacts of an infected person will contract the disease. The bacteria can survive on surfaces for short periods, though person-to-person respiratory transmission is far more common. Crowded environments like schools, daycare centers, and households with multiple children create ideal conditions for whooping cough to spread rapidly.

Prevention Strategies

Preventing whooping cough requires a multi-faceted approach centered on vaccination, but also including good hygiene practices and awareness of exposure risks.

Vaccination – The Primary Defense:

• DTaP vaccine for children: This vaccine protects against diphtheria, tetanus, and pertussis. Children should receive five doses at ages 2 months, 4 months, 6 months, 15-18 months, and 4-6 years
• Tdap booster for preteens and adults: A booster shot is recommended at age 11-12 and for adults who haven’t received one, especially those in close contact with infants
• Pregnancy vaccination: Pregnant women should receive the Tdap vaccine during each pregnancy, ideally between 27-36 weeks, to pass antibodies to the baby
• Cocooning strategy: Ensuring all family members and caregivers of newborns are vaccinated to create a protective barrier

Hygiene and Lifestyle Practices:

• Proper handwashing: Wash hands frequently with soap and water for at least 20 seconds, especially after coughing or sneezing
• Respiratory etiquette: Cover coughs and sneezes with a tissue or your elbow, not your hands
• Avoid close contact: Stay away from people who are coughing or showing symptoms of respiratory illness
• Clean surfaces: Regularly disinfect frequently-touched surfaces, especially during outbreaks
• Stay home when sick: If you develop symptoms, isolate yourself to prevent spreading the infection to others

Special Precautions for High-Risk Groups:

• Limit visitors for newborns, especially during whooping cough outbreaks
• Ensure anyone who will have close contact with infants is up-to-date on vaccinations
• Healthcare workers should maintain current Tdap vaccination status
• People with chronic respiratory conditions should be extra vigilant about prevention

Post-Exposure Preventive Measures:

If you’ve been exposed to someone with confirmed whooping cough, consult your healthcare provider promptly. They may recommend preventive antibiotics, especially for high-risk individuals such as infants, pregnant women, or those with compromised immune systems. Early antibiotic treatment can prevent the disease from developing or reduce its severity if taken within the first few weeks of infection.

It’s important to note that while vaccination significantly reduces the risk of whooping cough and lessens disease severity, no vaccine is 100% effective. However, vaccinated individuals who do contract pertussis typically experience milder symptoms and are less likely to spread the disease to others. Maintaining high vaccination rates in the community creates herd immunity, protecting those who cannot be vaccinated, such as newborns and individuals with certain medical conditions.

Frequently Asked Questions

How long does whooping cough last?

Whooping cough typically lasts 6-10 weeks in total, progressing through three stages: the catarrhal stage (1-2 weeks), the paroxysmal stage (1-6 weeks with severe coughing), and the convalescent stage (2-3 weeks of gradual recovery). Some people may have a lingering cough for several months.

Can adults get whooping cough?

Yes, adults can definitely get whooping cough. While often considered a childhood disease, adults account for a significant portion of cases, especially as vaccine immunity wanes over time. Adults may experience milder symptoms than children and might not have the characteristic “whoop,” but they can still spread the infection to vulnerable populations.

Is whooping cough contagious, and for how long?

Whooping cough is highly contagious. People are most contagious during the early cold-like stage and during the first two weeks of coughing. Without treatment, a person can remain contagious for up to three weeks after the coughing begins. Antibiotic treatment can reduce the contagious period to about five days after starting medication.

When should I see a doctor for whooping cough symptoms?

Seek medical attention immediately if you or your child experiences severe coughing fits followed by a whooping sound, vomiting after coughing, difficulty breathing, bluish skin color, or pauses in breathing (apnea). For infants under 6 months, any persistent cough warrants immediate medical evaluation as they are at highest risk for complications.

Can you get whooping cough even if you’re vaccinated?

Yes, it’s possible to get whooping cough even after vaccination, though vaccinated individuals typically experience milder symptoms and shorter illness duration. Vaccine immunity wanes over time, which is why booster shots are recommended. However, vaccination remains the most effective way to prevent severe disease and complications.

What’s the difference between whooping cough and regular cough?

A regular cough from a cold or flu typically improves within 1-2 weeks and rarely involves the severe, uncontrollable coughing fits seen in whooping cough. Whooping cough features distinctive rapid, consecutive coughs without breathing in between, often ending with a whooping sound or vomiting, and persists for many weeks despite other cold symptoms resolving.

Is whooping cough dangerous?

Whooping cough can be very dangerous, especially for infants under 1 year old. Complications can include pneumonia, seizures, brain damage, and in rare cases, death. Older children, teenagers, and adults typically have less severe cases but can still experience complications such as broken ribs, difficulty sleeping, and weight loss.

How is whooping cough diagnosed?

Doctors diagnose whooping cough through physical examination, medical history, and laboratory tests. These may include a nasal or throat swab to test for the presence of Bordetella pertussis bacteria, blood tests to check white blood cell counts, or chest X-rays to check for complications. Early testing is most accurate, as the bacteria become harder to detect later in the illness.

References:

• Centers for Disease Control and Prevention (CDC) – Pertussis Signs and Symptoms
• World Health Organization (WHO) – Pertussis Fact Sheet
• Mayo Clinic – Whooping Cough Symptoms and Causes
• NHS – Whooping Cough
• American Academy of Pediatrics – Whooping Cough Information