Overview
Whooping cough (pertussis) is a highly contagious bacterial respiratory infection caused by Bordetella pertussis. It causes severe prolonged coughing fits followed by a characteristic whooping sound when breathing in. It can be life-threatening in young infants. Vaccination is the primary prevention but immunity wanes, causing outbreaks even in vaccinated populations.
How common is it?
Whooping cough remains common globally despite vaccination. In the UK, cyclical outbreaks occur every 3 to 4 years. Cases declined dramatically with vaccination but periodic outbreaks still affect thousands each year.
Causes and risk factors
Bordetella pertussis attaches to the cilia of the respiratory tract, releasing toxins that cause inflammation and impair mucociliary clearance, leading to severe, prolonged coughing.
Common risk factors
- Exposure to infected persons (droplet and contact transmission)
- Waning immunity after vaccination or previous infection
- Unvaccinated or incompletely vaccinated status
- Young infants under 3 months (most vulnerable — not yet fully vaccinated)
Symptoms
- Stage 1 (catarrhal, 1 to 2 weeks): symptoms resembling a cold — runny nose, mild cough, low fever
- Stage 2 (paroxysmal, 2 to 6 weeks): severe coughing fits of up to 20 coughs per breath, often followed by a high-pitched whoop on inspiration, vomiting after coughing, and cyanosis in infants
- Stage 3 (convalescent, weeks to months): gradual decrease in coughing
- Infants may not whoop — they may simply stop breathing (apnoea)
- Adults and vaccinated individuals: prolonged cough without classic features (often missed)
When to see a doctor
Call emergency services for pauses in breathing, blue or grey skin, severe breathing difficulty or unresponsiveness. Seek urgent assessment if a baby under 6 months has possible whooping cough, or a cough is worsening. Contact a clinician after exposure if you are pregnant or will be around a young baby.
Diagnosis
Nasopharyngeal swab for Bordetella culture or PCR (most sensitive in the first 2 weeks). Serology (pertussis IgG) in later stages. Blood count: marked lymphocytosis is characteristic.
Treatments
Antibiotics
Antibiotics may reduce spread when prescribed at the appropriate stage. The medicine and course depend on age and clinical circumstances; coughing can persist despite treatment. A clinician or public-health team decides which household or other contacts need preventive antibiotics, taking account of timing and vulnerable people.
Supportive care
Hospitalisation for young infants, those with severe disease, or infants who stop breathing. Oxygen, feeding support, and monitoring. Avoid cough suppressants (ineffective). Rest and fluids.
Isolation
Isolate from others until 48 hours after starting antibiotics (or 21 days from onset of cough if untreated) to prevent spread.
Self-care and lifestyle
- Isolate coughing individuals promptly when whooping cough is suspected
- Ask the clinical or public-health team which contacts need assessment or preventive antibiotics; do not assume every close contact needs the same treatment.
- Young infants should be kept away from coughing contacts as much as possible
Prevention
Keep childhood vaccinations up to date using the current local schedule. In the UK, whooping-cough vaccination is offered in every pregnancy, usually around the 20-week scan and from 16 weeks. Ask your midwife if it has not been offered. Babies still need their own routine vaccines.
Sources for targeted updates
Updated: 24 October 2026. Urgent-care guidance and the specific treatment or self-care statements corrected in this update. This update covers the named sections; a full review of the remaining guide is pending.