7 Key Whooping Cough Symptoms You Should Know

Whooping cough, medically known as pertussis, is a highly contagious respiratory infection caused by the bacterium Bordetella pertussis. This disease earned its distinctive name from the characteristic “whooping” sound that patients make when gasping for air after intense coughing fits. While whooping cough can affect individuals of all ages, it poses the greatest danger to infants and young children whose immune systems are still developing.

The disease typically progresses through three distinct stages, with symptoms evolving over several weeks. Early recognition of whooping cough symptoms is crucial for prompt medical attention and preventing transmission to others. Understanding these warning signs can help protect vulnerable populations and enable timely intervention.

1. Severe Coughing Fits (Paroxysmal Coughing)

The hallmark symptom of whooping cough is intense, uncontrollable coughing fits that occur in rapid succession. These episodes, known as paroxysmal coughing, consist of numerous consecutive coughs without the opportunity to breathe in between.

During these fits, patients experience:

• Multiple rapid coughs: A series of 5-10 or more coughs occurring one after another without pause
• Red or purple face: The face may become flushed or change color due to the intensity of coughing
• Exhaustion: These episodes are physically draining and can occur multiple times per hour, especially at night
• Duration: Each coughing fit typically lasts 1-2 minutes but can feel much longer

The coughing fits are often triggered by various factors including eating, drinking, yawning, or even changes in temperature. These episodes are most prominent during the paroxysmal stage of the illness, which typically begins 1-2 weeks after initial symptoms appear and can last for several weeks.

2. The Characteristic “Whoop” Sound

The distinctive high-pitched “whoop” sound is the symptom that gives this disease its common name. This sound occurs when the patient desperately gasps for air after a prolonged coughing fit.

Key characteristics of the whooping sound include:

• Inspiration whoop: The sound is produced during the sharp, sudden inhalation following a coughing episode
• High-pitched tone: It resembles a whistling or crowing sound caused by air rushing through narrowed airways
• Not always present: Interestingly, many patients, especially infants and adults, may never develop the classic whoop
• Indication of severity: When present, it typically signals the paroxysmal stage of the disease

In infants under 6 months, the whoop is often absent. Instead, they may experience breathing pauses (apnea) or turn blue from lack of oxygen, making the disease particularly dangerous for this age group. Adults and adolescents may also not produce the whooping sound, which can lead to delayed diagnosis.

3. Vomiting After Coughing Episodes

Vomiting immediately following coughing fits is an extremely common and distressing symptom of whooping cough. This occurs due to the violent nature of the coughing episodes and their effect on the stomach and diaphragm.

This symptom manifests in several ways:

• Post-tussive emesis: Vomiting that occurs immediately after or during intense coughing fits
• Thick mucus expulsion: Patients may bring up large amounts of thick, sticky mucus along with stomach contents
• Weight loss risk: Frequent vomiting can lead to dehydration and weight loss, particularly concerning in young children
• Feeding difficulties: Infants may struggle to keep down feedings, complicating nutrition

The vomiting associated with whooping cough can be so consistent that it becomes an important diagnostic clue. Parents and caregivers should monitor fluid intake carefully, as the combination of vomiting and exhaustion from coughing can quickly lead to dehydration, especially in young children.

4. Initial Cold-Like Symptoms

The first stage of whooping cough, known as the catarrhal stage, closely resembles a common cold. This similarity often leads to misdiagnosis or delayed recognition of the disease.

During this initial phase lasting 1-2 weeks, patients experience:

• Runny nose: Clear nasal discharge similar to typical cold symptoms
• Mild fever: Low-grade temperature, usually not exceeding 100.4°F (38°C)
• Sneezing: Frequent sneezing episodes
• Mild, occasional cough: A gentle cough that gradually worsens
• Watery eyes: Tearing and eye irritation

These symptoms are most contagious during this early stage, yet they are easily mistaken for a routine respiratory infection. This makes whooping cough particularly insidious, as infected individuals may unknowingly spread the disease before the characteristic coughing fits develop. After this stage, the cough intensifies dramatically, signaling progression to the paroxysmal stage.

5. Breathing Difficulties and Apnea

Respiratory distress is a serious and potentially life-threatening symptom of whooping cough, particularly in infants and young children. The infection causes inflammation and mucus buildup in the airways, leading to various breathing complications.

Breathing difficulties present as:

• Apnea episodes: Pauses in breathing lasting 10 seconds or longer, most common in infants under 6 months
• Cyanosis: Bluish discoloration of the skin, lips, or nail beds indicating insufficient oxygen
• Rapid breathing: Increased respiratory rate as the body struggles to get adequate oxygen
• Chest retractions: Visible pulling in of the chest wall between ribs or above the collarbone during breathing
• Wheezing: High-pitched whistling sounds during breathing, though less common than in other respiratory conditions

For infants, apnea can be the primary symptom rather than coughing, making whooping cough especially dangerous for this age group. Any breathing difficulties in a young child should be treated as a medical emergency requiring immediate attention. These respiratory complications are why hospitalization is often necessary for infants with whooping cough.

6. Extreme Fatigue and Exhaustion

The relentless nature of whooping cough coughing fits takes a severe toll on the body, resulting in profound exhaustion that affects daily functioning and quality of life.

This exhaustion is characterized by:

• Sleep deprivation: Coughing fits frequently occur at night, disrupting sleep for both patients and caregivers
• Physical weakness: The energy expended during coughing episodes leaves patients feeling drained and weak
• Difficulty with daily activities: Normal tasks become challenging due to constant interruptions from coughing
• Extended recovery period: Even after acute symptoms improve, fatigue can persist for weeks
• Loss of appetite: Exhaustion combined with fear of triggering coughing fits while eating leads to reduced food intake

Children may become irritable and listless, while adults often report being too tired to work or perform routine activities. The cumulative effect of repeated coughing fits, vomiting, and sleep disturbance creates a cycle of exhaustion that significantly impacts recovery. Rest is crucial, though difficult to achieve when coughing fits are frequent.

7. Prolonged Cough That Persists for Weeks

One of the most distinctive features of whooping cough is the extraordinary duration of the cough, which has earned pertussis the nickname “the 100-day cough” in some cultures.

The prolonged cough follows a characteristic pattern:

• Catarrhal stage (1-2 weeks): Mild cough that gradually worsens
• Paroxysmal stage (2-8 weeks): Severe coughing fits at their worst, occurring multiple times daily
• Convalescent stage (weeks to months): Gradual decrease in frequency and severity, though coughing may return with subsequent respiratory infections
• Total duration: The entire illness typically lasts 6-10 weeks but can persist for several months
• Residual cough: A lingering cough may remain long after the infection has cleared

Unlike most respiratory infections that resolve within a week or two, whooping cough symptoms can persist for three months or longer. This extended timeline is due to the damage caused by the Bordetella pertussis toxins to the airways’ cilia (tiny hair-like structures that help clear mucus). Recovery is gradual, and patients may experience a recurrence of coughing fits when they catch other respiratory infections, even after whooping cough has resolved.

Main Causes of Whooping Cough

Whooping cough is caused by specific bacterial infection and spreads through particular transmission routes. Understanding these causes is essential for prevention and control.

Bacterial Infection: Bordetella pertussis

The sole cause of whooping cough is infection with the bacterium Bordetella pertussis. This highly specialized pathogen targets the respiratory system, attaching to the cilia lining the airways. The bacteria produce toxins that damage the respiratory tract, paralyze the cilia, and trigger inflammation, leading to the characteristic symptoms of the disease. In rare cases, a related bacterium called Bordetella parapertussis can cause a similar but typically milder illness.

Airborne Transmission

Whooping cough spreads extremely easily through respiratory droplets when an infected person coughs, sneezes, or talks. These droplets can be inhaled by anyone in close proximity, typically within 6 feet. The disease is most contagious during the catarrhal stage and the first two weeks after coughing begins, often before people realize they have whooping cough rather than a common cold.

Close Contact with Infected Individuals

Prolonged exposure to someone with whooping cough significantly increases infection risk. Family members, caregivers, and household contacts are at particularly high risk. Studies show that up to 80% of susceptible household contacts will become infected after exposure. This is why isolating infected individuals and identifying contacts for preventive treatment is crucial for outbreak control.

Waning Immunity

Immunity from both vaccination and natural infection decreases over time. Protection from childhood vaccines typically wanes after 5-10 years, which explains why adolescents and adults can contract and spread whooping cough, often serving as sources of infection for vulnerable infants. Previously infected individuals can also get whooping cough again, though subsequent infections are generally milder.

Prevention of Whooping Cough

Preventing whooping cough requires a multi-faceted approach centered on vaccination and infection control practices. Given the serious complications that can occur, especially in infants, prevention is far preferable to treatment.

Vaccination

Vaccination remains the most effective tool for preventing whooping cough:

• DTaP vaccine for children: Children should receive five doses at 2, 4, 6, and 15-18 months, and 4-6 years
• Tdap booster for adolescents and adults: A single booster dose is recommended at age 11-12, with additional doses for adults who haven’t received one
• Pregnancy vaccination: Pregnant women should receive Tdap during the third trimester of each pregnancy to protect newborns through transferred antibodies
• Cocooning strategy: Family members and caregivers of newborns should ensure their vaccinations are up-to-date

Good Hygiene Practices

Basic infection control measures can reduce transmission risk:

• Frequent handwashing: Wash hands thoroughly with soap and water, especially after coughing or sneezing
• Respiratory etiquette: Cover mouth and nose with a tissue or elbow when coughing or sneezing
• Avoid sharing items: Don’t share utensils, cups, or towels with infected individuals
• Disinfect surfaces: Clean frequently-touched surfaces regularly, especially during outbreaks

Isolation of Infected Individuals

People diagnosed with whooping cough should stay home from work, school, or daycare until they have completed at least 5 days of appropriate antibiotic treatment or until 3 weeks after coughing began if untreated. This prevents spread to others during the most contagious period.

Prophylactic Treatment for Contacts

Close contacts of whooping cough patients, especially those at high risk for complications, may be offered preventive antibiotics by their healthcare provider. This is particularly important for households with infants, pregnant women, or immunocompromised individuals.

Limiting Infant Exposure

Since infants are most vulnerable to severe complications, limiting their exposure to crowds and sick individuals, especially before they complete their primary vaccination series, provides additional protection during their most vulnerable months.

Frequently Asked Questions (FAQ)

How long does whooping cough last?

Whooping cough typically lasts 6-10 weeks total, though it can persist for up to 3 months or longer. The illness progresses through three stages: the catarrhal stage (1-2 weeks), the paroxysmal stage with severe coughing fits (2-8 weeks), and the convalescent recovery stage (weeks to months).

Can adults get whooping cough?

Yes, adults can definitely get whooping cough, especially as immunity from childhood vaccination wanes over time. Adult cases are increasingly common and often go undiagnosed because symptoms may be milder and the characteristic “whoop” is frequently absent. However, adults can still spread the infection to vulnerable infants.

Is whooping cough contagious?

Whooping cough is highly contagious. It spreads through respiratory droplets when infected people cough or sneeze. The disease is most contagious during the early cold-like stage and the first two weeks after coughing begins. Up to 80% of susceptible household contacts may become infected after exposure.

When should I see a doctor for whooping cough?

Seek medical attention immediately if you or your child experiences severe coughing fits, difficulty breathing, the characteristic whooping sound, vomiting after coughing, or bluish skin color. For infants showing any signs of breathing difficulty or apnea (pauses in breathing), this is a medical emergency requiring immediate care.

Can you get whooping cough if you’ve been vaccinated?

Yes, it’s possible to get whooping cough even after vaccination because immunity wanes over time. However, vaccinated individuals who do contract whooping cough typically experience milder symptoms and fewer complications. This is why booster doses are recommended for adolescents, adults, and pregnant women.

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

A regular cough usually improves within 1-2 weeks and responds to typical treatments. Whooping cough causes severe, uncontrollable coughing fits that worsen over time, may produce a whooping sound, often lead to vomiting, and persist for weeks or months. The intensity and duration distinguish whooping cough from common respiratory infections.

How is whooping cough diagnosed?

Doctors diagnose whooping cough based on characteristic symptoms and confirm it through laboratory tests. These include nasal or throat swabs for culture or PCR testing (most accurate in the first 2-3 weeks of illness) and blood tests to check for antibodies. Early diagnosis is important for treatment and preventing spread to others.

Why is whooping cough dangerous for babies?

Infants under 6 months are at highest risk because they haven’t completed their vaccination series and their small airways become easily blocked. They may develop life-threatening complications including pneumonia, seizures, brain damage from lack of oxygen, and apnea. Approximately half of infants under 1 year who get whooping cough require hospitalization.

References:

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