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Whooping Cough

Checked: 28-05-2024 by Rob Adams Next Review: 28-05-2026

Overview

Please see Pertussis: guidance, data and analysis - GOV.UK for information about symptoms, diagnosis and management of pertussis.

There is also information on diagnosis and management on the CKS website.

Suspect pertussis in patients with a cough illness lasting 14 days or more without an apparent cause plus one of the following:

paroxysms of coughing
inspiratory ‘whoop’
post-tussive vomiting.

Diagnosis and Treatment

Diagnosis

Advice on testing should be obtained from your local Health Protection Team.

Recommended tests for pertussis testing vary according to the length of time since cough onset. See the 'Testing for Pertussis in Primary Care' document on the Pertussis: guidelines for public health management - GOV.UK page.

**Update November 2024 - 'From 2nd December 2024 the Bacteriology Laboratory (Severn Pathology) will no longer offer a culture service for the detection of Bordetella pertussis. PCR is more sensitive than culture as it does not require the organisms to be viable. If screening for B. pertussis is required, a pernasal swab can be taken and sent to the laboratory for testing via a molecular (PCR) method. This offers increased sensitivity and an improved turnaround time for the result.' See Bordetella Service Update Letter November 2024**

For children aged 2-16 years, the UKHSA will send out oral fluid testing kits -these are for surveillance purposes only as the result takes longer than a PCR test performed in primary care. They can only send oral fluid testing kits to cases notified by a GP.

Treatment

Once whooping cough is suspected clinically, it is important to commence antibiotics if the persons symptoms started less than 21 days ago. This is to reduce severity of disease as well as prevention of transmission to others. People are not infectious 48hrs after commencing antibiotics. It is not recommended to await test results before commencing antibiotics if whooping cough is suspected.

Preferred antibiotic is clarithromycin (or erythromycin if pregnant) as outlined in the BNSSG Antimicrobial Guidelines (page 5). These guidelines also advise that

In infants and toddlers with a dry cough consider bronchiolitis (no antibiotics needed).
In infants and toddlers with a barking cough consider croup (no antibiotics needed).

Further antibiotic options are listed in the document Guidelines for the public health management of pertussis (publishing.service.gov.uk) on page 28, Table 2 sets out antibiotic therapy for persons whose onset is less than 3 weeks.

Reporting and Referral

Pertussis is a notifiable disease and if suspected then the local Health Protection Team should be informed.

For all cases that are notified, the health protection team will send patients up to date information and if onset of symptoms is within 21 days, undertake a risk assessment for vulnerable contacts i.e. pregnant women of 32 weeks pregnancy or more, OR infants less than one year old who may be partially or unimmunised OR health care or educational staff whose work involves close contact with these groups.

Vaccination

The Green book (chapter 24) gives information on vaccination programme for pertussis.

Pertussis vaccination in Pregnancy

See the Vaccination in Pregnancy page.

Patient Information

Information for individuals diagnosed with whooping cough

Whooping cough - NHS (www.nhs.uk)

Vaccinations in Pregnancy | Campaigns | Campaign Resource Centre (dhsc.gov.uk)

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