Managing whooping cough: what nurses need to know
Cases of whooping cough (pertussis), a contagious respiratory tract infection, are rising and can have serious complications, especially for unvaccinated babies
- Whooping cough (pertussis), also known as the 100-day cough, is a bacterial infection of the lungs and airways and is easily spread
- People of any age can get this highly contagious and debilitating illness, and those who have been vaccinated tend to have milder symptoms
- Data show there were 1,468 cases confirmed between January and February 2024, compared to 858 cases for the whole of 2023
Whooping cough (pertussis) cases are on the rise in England and young children can be particularly vulnerable to it.
Cases are likely to be seen by nurses in primary care and emergency departments, but other nurses in a range of settings, including health visitors and those working on respiratory wards, should be alert to the signs.
Also known as the 100-day cough, as it can last for weeks or months, the condition often causes a distinctive ‘whoop’ sound from a gasp for breath during coughing.
What is whooping cough?
Whooping cough is a bacterial infection of the lungs and airways, which is spread easily by coughing and sneezing.
It can cause serious complications, particularly for unvaccinated babies under six months old.
University College London professor of children’s health Helen Bedford, who has a background as a nurse and health visitor, says: ‘It is is a debilitating, nasty illness, with a cough that continues for a long time and is often worse at night.’
Why is there concern about whooping cough?
Cases are on the rise in England, according to data from the UK Health Security Agency (UKHSA). There were 1,468 cases confirmed between January and February 2024 in England, compared with 858 cases for the whole of 2023.
‘In young babies, who are not vaccinated or only partially vaccinated, whooping cough can be very serious. It can cause pneumonia, seizures and brain damage, with a death rate of about 1%’
Helen Bedford, professor of children’s health at University College London
This comes after a prolonged period of low case numbers due to COVID-19 restrictions that reduced social mixing. Cases of whooping cough do rise cyclically every three to five years, but vaccination rates have dropped, the UKHSA says.
Who does whooping cough affect?
People of any age can get whooping cough. Around half of the 1,468 cases in England were in babies and young people up to aged 14. The rest were over 15 years old. Those who have been vaccinated or have had the disease previously tend to experience shorter and milder symptoms, but do not have lifelong immunity, says the National Institute for Health and Care Excellence (NICE).
Nurses should be aware it is most dangerous in babies under six months of age, as it is associated with high rates of severe illness, hospitalisation and death.
‘In young babies, who are not vaccinated or only partially vaccinated, it can be very serious. It can cause pneumonia, seizures and brain damage, with a death rate of about 1%,’ says Professor Bedford.
What are the symptoms?
Whooping cough has three phases of symptoms, starting with one to two weeks of the catarrhal phase, with symptoms similar to a cold. Fever is relatively uncommon.
The paroxysmal phase lasts about a week, with bouts of rapid, violent and uncontrolled coughing followed by the characteristic ‘whoop’ sound, which is caused by sharp inhalation of breath. This can come with post-coughing vomiting.
The ‘whoop’ is less common in adults and in young babies. Babies may not cough, but often present with apnoea (pauses in breathing), says Professor Bedford.
The convalescent phase usually lasts two to three weeks, during which there is a gradual improvement in cough.
How can nurses care for patients with whooping cough?
Patients should be admitted to hospital if they have pneumonia, seizures or significant breathing difficulties – such as long periods of breathlessness or choking, shallow breathing or apnoea.
If they do not need hospital admission, they can receive antibiotics if their cough started in the last 21 days, according to NICE.
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As the initial symptoms appear to be like a cold, patients are often not seen in the window when antibiotic prescribing is useful, says Professor Bedford. Outside of this window patients will not normally need any specific treatment and antibiotics are unlikely to help.
Advise self-care measures such as rest, adequate fluid intake, and the use of paracetamol or ibuprofen for symptomatic relief, NICE advises.
If a case occurs in a household with a small, unvaccinated baby, all occupants should be offered prophylactic antibiotics.
How effective is the whooping cough vaccination?
The most effective way to avoid whooping cough is vaccination, but uptake has fallen recently. While vaccination does not offer lifelong protection, it does reduce the severity if an individual does contract it.
Children receive this vaccine at eight, 12 and 16 weeks, and as part of the pre-school booster.
Professor Bedford says declining vaccination rates are contributing to increases in cases. The number of children receiving all three doses of the vaccine containing whooping cough (known as the 6-in-1), has declined from 94.7% of children in England in 2012-13 to 91.8% in 2022-23 and some areas are much lower.
In 2012, vaccination was introduced for pregnant women, ideally between 16 and 32 weeks of pregnancy, to reduce rates of whooping cough in babies too young to be vaccinated.
University College London professor of children’s health Helen Bedford says: ‘Many babies catch whooping cough from their mother, so the vaccine for pregnant women works in two ways, by passing antibodies to their unborn child and by protecting themselves so that they won’t pass it on’.
The vaccination of pregnant women has been shown to be more than 90% effective in preventing whooping cough cases and hospital admissions in young babies as well as in preventing deaths.
Last December, 59.5% of eligible pregnant women in England received the vaccine, according to the UK Health Security Agency. But there were huge variations across the country, with only 24.5% of pregnant women in north central London receiving it late last year.
What other advice can nurses give to those with the condition and their family?
Nurses should inform people that, even with antibiotic treatment, whooping cough is likely to cause a protracted cough, and that it is normal for this to take several weeks to clear up.
Children should stay off school until they have completed 48 hours of antibiotic treatment, or for 21 days after the onset of symptoms, NICE says. Anyone with whooping cough should avoid contact with children under one who are unvaccinated or partially vaccinated until they have had 48 hours of treatment.
What should healthcare workers do to protect themselves and others?
Nurses who have suspected or confirmed whooping cough should stay off work until they have had 48 hours of treatment, or 21 days of symptoms, NICE states.
Healthcare staff who work with babies or pregnant women should take prophylactic antibiotics if they live with someone with confirmed or suspected whooping cough and have not had a vaccine in the past five years. Immunisation should also be considered.
The UKHSA says that healthcare workers who have whooping cough should inform their occupational health department and infection prevention control team as soon as possible.
If two or more cases of pertussis occur in a healthcare setting, an outbreak control team should be convened, according to Public Health England. If transmission is most likely to have occurred in the healthcare setting, consideration should be given to offering vaccination more widely.
What else can nurses do to protect the public from whooping cough?
Find opportunities to ask parents if their children are up to date on all their immunisations and, if not, encourage and support them to get any missing doses, Professor Bedford says.
‘Remind parents of the importance of vaccines and that their children complete the course,’ Professor Bedford says.
Erin Dean is a health journalist