Pregnancy and child

Sharp rise in whooping cough cases

England and Wales have seen a steep rise in cases of whooping cough, BBC News reported today. Cases more than doubled from 2010 to 2011, and three babies have died from whooping cough complications in England and Wales so far in 2012.

Several newspapers also covered the news, which is based on a new report from the Health Protection Agency (HPA). The report shows that 665 confirmed cases of whooping cough were reported between January and March 2012, compared to 1,040 cases throughout the whole of 2011. The increase has been reported across all regions in England with some areas reporting clusters of cases in schools, universities and health clinics.

While the disease is generally unpleasant in older people, it can lead to fatal complications in babies. The HPA points out that since the beginning of 2012, the cases have included very young children, who have the highest risk of complications. In the UK, there is a vaccination programme to immunise children against whooping cough, and the HPA is urging parents to ensure their children are up to date with vaccinations. Babies are given courses of whooping cough vaccination up until the age of four months. This will protect them for years to come, although they may be given a booster jab shortly before starting school. The disease is highly contagious, especially in the early stages, and anyone suspected of having it should stay away from other people until it has completely cleared up.

Dr Mary Ramsay, head of immunisation at the HPA, said: “Whooping cough can be a very unpleasant infection. Anyone showing signs and symptoms – which include severe coughing fits accompanied by the characteristic “whoop” sound in young children but as a prolonged cough in older children and adults – should visit their GP.”

What is whooping cough?

Whooping cough, also known as pertussis, is a bacterial infection of the lining of the airways. It usually affects babies and young children, although teenagers and adults can develop the condition.

It is known as whooping cough because the main symptom is a hacking cough, which is often followed by a sharp intake of breath that sounds like a “whoop”. Other symptoms include a runny nose, raised temperature, severe coughing fits and vomiting after coughing. See your GP if you notice any of the symptoms of whooping cough.

Whooping cough is highly infectious. The condition is caused by a bacterium called Bordetella pertussis in the windpipe (trachea) and the two airways that branch off it to the lungs (the bronchi). The bacteria can be passed from person to person through droplets in the air from coughing and sneezing, leading to infection. Read more about what causes whooping cough.

While whooping cough is unpleasant in older people, babies and young children are at risk of serious complications such as such as pneumonia, dehydration, breathing difficulties, excessive vomiting, seizures and brain damage, low blood pressure and kidney failure. Severe complications, such as pneumonia and brain damage, can be fatal, although this is extremely rare and mostly occurs in babies under six months.

Older children and adults are occasionally affected by complications of whooping cough but they are usually far less serious. They include nosebleeds, and bruised ribs and burst blood vessels in the whites of the eyes caused by intense bouts of coughing.

Why are cases going up?

The annual number of cases of whooping cough in the UK is usually very low, thanks to the UK’s vaccination programme. However, the HPA reported a surge in cases in 2011, with 1,040 laboratory-confirmed cases. This is more than double the 421 cases reported in 2010. Most of this increase was in teenagers and adults between the ages of 15 and 40.

The latest figures for the first three months of 2012 suggest the increase is continuing, possibly even more sharply. Since the beginning of 2012, cases have included very young children, who have the highest risk of complications. The BBC reported that of the 665 confirmed cases between January and March 2012, 65 were in babies under three months old. These cases occurred before the babies had completed all their shots against whooping cough, so they were not fully vaccinated.

The HPA says that peaks in whooping cough cases are usually seen every three to four years. However, the total number of cases in 2011 was slightly above what might be expected in a typical peak year. The reasons for this are unclear. It is possible that as more teenagers and adults have been infected, there is a greater risk of them passing on the disease to very young children who are not yet fully protected by vaccination.

The HPA also said that changes in laboratory techniques to diagnose the disease and heightened awareness of the disease may mean that more cases are being reported and confirmed.

Is whooping cough preventable?

Vaccination is the most effective protection against whooping cough infection. The whooping cough vaccine is given as part of the 5-in-1 vaccine, which also protects against diphtheria, tetanus, polio and Hib (haemophilus influenzae type b). In the UK, babies are given their courses of the 5-in-1 vaccine when they are two, three and four months old. A pre-school booster vaccine is also given before children start school (when they are about three years and four months old).

The vaccine is a harmless, “inactive” version of the whooping cough infection. This means the body can recognise the pertussis bacterium in future and produce antibodies to fight off any further whooping cough infections. The vaccine is given in three separate jabs and a booster so a child's body has time to build up an effective level of protection.

As babies and young children are mostly severely affected by diseases such as whooping cough, the 5-in-1 vaccine is given at a young age. The vaccine is very safe.

The HPA says that the pre-school booster is also important. It not only boosts protection in the child, but also reduces the risk of them passing the infection on to vulnerable babies as those under four months are not fully protected by the vaccine.

What should I do if someone in the family has whooping cough?

Whooping cough is much less serious in older children and adults than it is in babies and young children. Your GP will usually advise you to manage the infection at home and follow some simple advice:

  • Get plenty of rest.
  • Drink lots of fluids to prevent dehydration. 
  • Clear any excess mucus or vomit from airways during bouts of coughing so it cannot be inhaled and cause choking. 
  • Use paracetamol or ibuprofen medicines to relieve symptoms if you or your child feel distressed or unwell. Do not give aspirin to children under 16 years old, and make sure that any medications or doses you give are appropriate for children by checking the packaging.
  • Stay away from other people for five days after you have completed any prescribed course of antibiotics or (if you are not prescribed antibiotics) until you have not had intense bouts of coughing for three weeks. Even though you or your child may still have bouts of coughing after three weeks, it is unlikely that you will still be infectious.

How can it be treated?

Whooping cough can be treated successfully with antibiotics if caught early (within three weeks of the cough starting) and most people make a full recovery. The course of antibiotics prevents the infection spreading further and will stop you being infectious after five days of taking them. However, without antibiotics, someone may still be infectious until three weeks after the intense bouts of coughing start.

If whooping cough is not diagnosed until the later stages of the infection, antibiotics are not useful. This is because the bacterium that causes whooping cough has already gone by this time, so you are no longer infectious. Antibiotics will make no difference to your symptoms at this stage. Your doctor can prescribe antibiotics to vulnerable close contacts of people with proven whooping cough, if it’s caught within the three-week infectious period.

Because babies are affected more severely by whooping cough, those under one year old will often need treatment in hospital. They may be given antibiotics into a vein through a drip (intravenously), as well as other treatments.

What action is the HPA taking?

Dr Ramsay of the HPA said: “Whooping cough can spread easily to close contacts such as household members. Vaccination is the most effective way to protect people from this infection and uptake of the vaccine is very good.  Parents should ensure their children are up to date with their vaccinations so that they are protected at the earliest opportunity.”

She added: “The pre-school booster is also important, not only to boost protection in that child but also to reduce the risk of them passing the infection on to vulnerable babies, as those under four months cannot be fully protected by the vaccine.”

Are other infectious conditions increasing?

Since the beginning of 2012, there have been various similar warnings over rises in the rates of measles, and the HPA is also reminding parents to ensure their children are protected against measles. There has been a slight increase in cases since the beginning of 2012, with 253 laboratory-confirmed measles cases between January and March, compared to 200 cases reported for the same period in 2011. The majority of cases have been in unvaccinated individuals.

Dr Ramsay continued: “As we approach the time of year when many children are travelling on school trips and family holidays, we are again urging parents to protect their children against measles by ensuring they have been immunised with two doses of MMR. This is particularly important given the increase in cases in children and young adults over the last few months.

"Measles is a highly infectious disease which spreads very easily particularly in schools and universities. It's never too late to get your child immunised with two doses of the MMR vaccine. We cannot stress enough that measles is serious and in some cases it can be fatal. Delaying immunisation puts children at risk."

NHS Attribution