Whooping Cough (Pertussis)
A highly contagious bacterial respiratory infection that causes prolonged coughing fits and can be life-threatening for young infants.
What causes Whooping Cough (Pertussis)?
Whooping cough is caused by Bordetella pertussis bacteria. It spreads through respiratory droplets and close contact when an infected person coughs or sneezes.
Symptoms and what to notice
Early cold-like symptoms can progress to violent coughing fits, vomiting after coughing, exhaustion, and a high-pitched whoop. Infants may have apnea or breathing difficulty with little or no cough.
How long can it last?
Symptoms usually begin 5 to 10 days after exposure, sometimes as late as 21 days. Coughing commonly lasts for weeks and may recur for months while the airways recover.
How serious is Whooping Cough (Pertussis)?
Pertussis is most dangerous for babies. About one in three U.S. infants younger than one year with pertussis need hospital care, and severe complications can include apnea, pneumonia, seizures, brain injury, and death.
Treatment and management
Antibiotics such as azithromycin, clarithromycin, or erythromycin can treat infection and reduce spread; trimethoprim-sulfamethoxazole is an alternative for some patients. Early treatment is most helpful, while severe infant illness may require hospital respiratory support.
Vaccine: who and when?
Products: DTaP vaccines for children younger than 7 include Daptacel and Infanrix, plus combination vaccines Kinrix, Pentacel, Quadracel, and Vaxelis. Tdap products for older children and adults are Adacel and Boostrix. CDC recommends a five-dose DTaP series, one routine adolescent Tdap dose, Tdap for adults who never received it, and one Tdap dose during every pregnancy, preferably early in weeks 27 through 36.
Cost note: Patient cost varies by product, provider, insurance, and eligibility. U.S. routine vaccines are commonly covered without cost sharing when given by an in-network provider, and eligible children can receive vaccines through the Vaccines for Children program.
Trusted source
Patient cost varies by insurance, provider, location, and eligibility. Coverage and public-health access differ, so listed prices are examples rather than guaranteed patient prices. This page is for general education and does not replace individualized medical advice, diagnosis, vaccination assessment, or treatment.
Whooping Cough (Pertussis): History, Symptoms, Transmission, Treatment, Prevention, and Vaccine Information
Whooping cough, medically known as pertussis, is a highly contagious bacterial infection of the respiratory system. It is caused primarily by the bacterium Bordetella pertussis.
The disease is best known for repeated, violent coughing attacks that can become so intense that the infected person struggles to breathe. After a coughing episode, a person may take a rapid, deep breath that produces the characteristic high-pitched “whoop” from which the disease gets its common name.
However, not everyone with pertussis develops the classic whooping sound. Infants may have little or no cough and instead develop pauses in breathing called apnea. Vaccinated adolescents and adults often develop a persistent cough without the classic whoop.
Pertussis can affect people of any age, but it is especially dangerous for young infants. Approximately one-third of babies younger than 1 year who develop pertussis require hospitalization, according to CDC data.
Vaccines have dramatically reduced the burden of pertussis compared with the period before widespread vaccination. However, neither vaccination nor previous infection provides lifelong protection. As immunity declines over time, adolescents and adults can become infected again and may unknowingly transmit the bacteria to vulnerable infants.
Pertussis therefore remains endemic in the United States and continues to cause periodic outbreaks.
Important: This article provides general educational information and is not a substitute for diagnosis, vaccination advice, or treatment from a qualified healthcare professional.
What Is Whooping Cough?
Whooping cough is an acute respiratory infection caused by Bordetella pertussis, a small gram-negative bacterium that infects humans.
Humans are the only known reservoir for B. pertussis. There is no known animal reservoir or insect vector responsible for maintaining ordinary pertussis transmission.
The bacteria attach to microscopic hair-like structures called cilia that line portions of the respiratory tract.
Once attached, the bacteria release several biologically active substances and toxins that interfere with normal airway function.
These include:
- Pertussis toxin
- Adenylate cyclase toxin
- Tracheal cytotoxin
- Filamentous hemagglutinin
- Pertactin
- Fimbrial proteins
Damage to the ciliated lining of the respiratory tract contributes to inflammation and the prolonged, severe cough characteristic of the disease.
Whooping Cough Quick Facts
| Feature | Information |
|---|---|
| Medical name | Pertussis |
| Common name | Whooping cough |
| Cause | Bordetella pertussis |
| Type of organism | Gram-negative bacterium |
| Main transmission | Respiratory droplets and close contact |
| Human reservoir | Yes |
| Animal reservoir | None known |
| Typical incubation period | 5 to 10 days |
| Possible incubation range | Up to 21 days |
| Characteristic symptom | Repeated paroxysmal coughing |
| Classic sound | Inspiratory “whoop” |
| Highest-risk group | Young infants |
| Specific treatment | Antibiotics |
| Vaccine available | Yes |
| Childhood vaccine | DTaP |
| Adolescent/adult vaccine | Tdap |
| Pregnancy vaccination | Tdap during every pregnancy |
| U.S. status | Endemic and nationally notifiable |
CDC recommends pertussis vaccination across the lifespan, with different vaccine formulations depending on age and pregnancy status.
The History of Whooping Cough
Whooping cough has been recognized for centuries and was once one of the most feared childhood diseases.
Before vaccination became widespread, pertussis infected enormous numbers of children and caused substantial infant and childhood mortality.
The discovery of its bacterial cause, followed by the development of vaccines, transformed pertussis from a major childhood killer into a largely preventable disease.
However, pertussis never disappeared completely.
Possible Early Descriptions
Historical researchers have proposed that illnesses resembling pertussis may have been described before the sixteenth century.
Some medical writings from medieval Asia and Europe contain descriptions of epidemic coughing illnesses that could have represented pertussis.
Because no microbiological testing was available, these early reports cannot always be confirmed.
The first well-established description of a pertussis epidemic generally recognized in medical history occurred in 1578.
1578: Guillaume de Baillou Describes an Epidemic
French physician Guillaume de Baillou documented an epidemic of severe coughing illness in Paris in 1578.
His description included violent coughing attacks and severe respiratory distress, particularly among children.
This episode is widely regarded as the first clearly documented pertussis epidemic in European medical literature.
Baillou’s account appeared in writings that were published after his death.
At the time, physicians had no understanding of bacteria or the mechanisms by which respiratory infections spread.
1679: The Term “Pertussis”
The word pertussis came into medical use during the seventeenth century.
English physician Thomas Sydenham used the term in 1679.
The word is derived from Latin roots and is commonly interpreted as referring to an intense or violent cough.
Different languages developed their own names for the disease, many of which referred to the characteristic sound or violence of the coughing attacks.
Why Is It Called Whooping Cough?
During a classic coughing attack, the patient produces a rapid series of forceful coughs.
These coughs may empty much of the air from the lungs.
The patient then makes a forceful inhalation through a narrowed upper airway.
This rapid intake of air can produce a high-pitched sound called the whoop.
The name “whooping cough” developed from this recognizable clinical feature.
However, the whoop is not present in every case.
Infants may develop apnea instead, while vaccinated older children and adults may experience prolonged coughing without a recognizable whoop.
1900 to 1906: The Bacterium Is Identified
Belgian scientists Jules Bordet and Octave Gengou played a central role in discovering the cause of pertussis.
They observed the organism associated with whooping cough around 1900.
In 1906, Bordet and Gengou successfully isolated the bacterium responsible for the disease.
The organism was eventually named Bordetella pertussis, honoring Bordet.
The ability to grow and study the bacterium in the laboratory opened the way for vaccine research.
The Bordet-Gengou Medium
Bordet and Gengou developed specialized culture conditions that allowed the difficult-to-grow pertussis bacterium to be isolated.
A specialized bacterial culture medium became known as Bordet-Gengou medium.
This work was particularly important because B. pertussis is a fastidious organism, meaning it requires relatively specific conditions for successful laboratory growth.
1910s: Early Pertussis Vaccines
Once scientists could grow B. pertussis, researchers began experimenting with vaccines made from killed bacterial cells.
Various experimental whole-cell vaccines appeared during the early twentieth century.
Whole-cell pertussis vaccines were first licensed in the United States in 1914, although vaccine manufacturing and effectiveness were not yet standardized to modern standards.
Early vaccines produced inconsistent results because different laboratories used different bacterial strains, manufacturing methods, concentrations, and testing standards.
A more reliable vaccine would emerge through later work.
Pearl Kendrick and Grace Eldering Transform Pertussis Prevention
Two public health scientists, Pearl Kendrick and Grace Eldering, made major contributions to development and testing of effective pertussis vaccines during the 1930s.
Working at the Michigan Department of Health, they studied children affected during pertussis outbreaks and improved whole-cell vaccine preparations.
Their work included carefully designed clinical studies comparing vaccinated and unvaccinated children.
Their research helped establish that standardized pertussis vaccination could substantially reduce disease.
Their work also contributed to combining pertussis vaccine with diphtheria and tetanus protection.
1940s: Widespread Vaccination Changes Pertussis
Before vaccination, pertussis was one of the most common childhood diseases in the United States.
More than 200,000 cases could be reported annually during the prevaccine era.
Whole-cell pertussis vaccination became widely used during the 1940s.
In 1948, pertussis vaccine was available in combination with diphtheria and tetanus toxoids as the DTP vaccine.
This combination protected against:
- Diphtheria
- Tetanus
- Pertussis
Following widespread vaccination, reported pertussis incidence declined dramatically.
CDC reports that annual case numbers fell by more than 90% compared with the prevaccine era.
Why Was the Whole-Cell Vaccine Replaced in the United States?
Whole-cell pertussis vaccines were effective, but they were relatively reactogenic.
Children frequently experienced reactions such as:
- Injection-site pain
- Redness
- Swelling
- Fever
- Irritability
Concerns about these reactions stimulated development of vaccines containing selected purified components of the bacterium instead of the entire killed bacterial cell.
These became known as acellular pertussis vaccines.
“Acellular” means the vaccine does not contain whole bacterial cells.
1980s and 1990s: Acellular Pertussis Vaccines Arrive
Acellular pertussis vaccines were developed and evaluated during the late twentieth century.
The first DTaP vaccine was licensed in the United States in 1991 for later doses of the childhood vaccination schedule.
By 1997, the Advisory Committee on Immunization Practices recommended DTaP instead of whole-cell DTP for the entire routine childhood series.
The United States no longer uses whole-cell DTP vaccines.
Modern U.S. childhood pertussis vaccines use purified acellular pertussis components.
2005: Tdap Expands Protection to Adolescents and Adults
Protection following childhood pertussis vaccination decreases over time.
As researchers increasingly recognized pertussis among teenagers and adults, vaccines containing reduced quantities of diphtheria and pertussis antigens were developed for older age groups.
In 2005, two Tdap vaccines were licensed in the United States:
- Adacel
- Boostrix
CDC subsequently recommended routine Tdap vaccination for adolescents and expanded recommendations for adults.
2012: Tdap During Every Pregnancy
Infants are at greatest risk of severe and fatal pertussis during their first months of life.
However, routine infant DTaP vaccination does not begin until 2 months of age.
To help protect babies during this vulnerable period, CDC began recommending Tdap vaccination during every pregnancy in 2012.
Maternal antibodies produced after vaccination cross the placenta and provide the newborn with temporary protection after birth.
Current CDC guidance recommends Tdap during 27 through 36 weeks of each pregnancy, preferably during the earlier part of that period.
What Causes Whooping Cough?
Pertussis is caused by Bordetella pertussis.
The bacterium does not usually invade deeply into the tissues in the way that some bacteria do.
Instead, much of the disease results from the bacteria attaching to respiratory cells and releasing biologically active toxins.
How Does Bordetella Pertussis Infect the Airways?
The respiratory tract contains ciliated epithelial cells.
Cilia are microscopic hair-like structures that help move:
- Mucus
- Dust
- Microorganisms
- Cellular debris
out of the respiratory system.
B. pertussis uses specialized proteins to attach to these cells.
Important attachment factors include:
- Filamentous hemagglutinin
- Pertactin
- Fimbriae
Once established, the organism produces toxins that interfere with normal airway defenses.
What Is Pertussis Toxin?
Pertussis toxin is one of the most important virulence factors produced by B. pertussis.
It alters signaling inside human cells and contributes to many biological effects associated with infection.
Pertussis toxin is also one of the major antigens included in modern acellular pertussis vaccines.
Other bacterial products, including adenylate cyclase toxin and tracheal cytotoxin, contribute to respiratory injury and inflammation.
How Does Whooping Cough Spread?
Pertussis spreads primarily from person to person through respiratory secretions.
Transmission can occur when an infected person:
- Coughs
- Sneezes
- Talks at close range
- Spends prolonged time near another person
Respiratory droplets containing B. pertussis can enter another person’s nose or respiratory tract.
Close household contact creates particularly favorable conditions for transmission.
Among susceptible household contacts, secondary attack rates can be extremely high. CDC’s Pink Book describes rates of approximately 80% among susceptible household contacts.
Does Whooping Cough Spread Through Animals?
No known animal reservoir maintains human pertussis.
CDC describes pertussis as a human disease.
There is no known insect vector comparable to the mosquitoes that spread diseases such as Zika or yellow fever.
What Is the Incubation Period?
Symptoms usually begin approximately 5 to 10 days after exposure.
However, the incubation period can occasionally extend to approximately 21 days.
During this period, the infected person may initially feel completely normal.
When Is Pertussis Most Contagious?
Pertussis is particularly contagious during the early catarrhal stage, when symptoms may resemble an ordinary cold.
This creates a major public health problem.
A person may spread the bacteria before anyone realizes that the illness is pertussis.
Without effective antibiotic treatment, a person may remain infectious from the beginning of the catarrhal stage into approximately the third week after the onset of paroxysmal coughing.
People treated with an appropriate antibiotic are generally considered substantially less infectious after completing about 5 days of effective treatment.
What Are the Three Stages of Whooping Cough?
Classical pertussis is traditionally divided into three stages:
- Catarrhal stage
- Paroxysmal stage
- Convalescent stage
These stages can overlap, and disease severity varies considerably depending on age and vaccination status.
Stage 1: The Catarrhal Stage
The first stage often resembles a common cold.
Symptoms may include:
- Runny nose
- Nasal congestion
- Sneezing
- Mild cough
- Low-grade fever
- Watery eyes
- General discomfort
In infants, apnea may occur even during the early stage.
The cough gradually becomes more frequent and severe.
This stage commonly lasts approximately 1 to 2 weeks.
It is also the stage during which antibiotics are most likely to reduce disease severity because the bacteria are still actively present in the respiratory tract.
Why Is Early Pertussis Difficult to Recognize?
The initial symptoms are nonspecific.
A child or adult may appear to have:
- A cold
- Mild viral respiratory infection
- Allergies
- Early influenza-like illness
By the time the characteristic severe cough develops, substantial airway injury may already have occurred.
This explains why early diagnosis is valuable but sometimes difficult.
Stage 2: The Paroxysmal Stage
The second phase is characterized by paroxysms, meaning sudden attacks of repeated coughing.
During a typical episode, a person may cough many times rapidly without taking a normal breath between coughs.
The episode may be followed by:
- A high-pitched inspiratory whoop
- Gasping
- Vomiting
- Exhaustion
- Facial redness
- Bluish discoloration from temporary oxygen shortage
CDC describes an average of approximately 15 coughing attacks per 24 hours during the paroxysmal stage, although severity varies widely.
Attacks often occur more frequently at night.
Why Does the “Whoop” Occur?
Repeated coughing expels air from the lungs.
After the coughing sequence, the person rapidly inhales.
Air passing through a narrowed upper airway can generate the characteristic high-pitched whooping sound.
The whoop is particularly associated with children.
It may be absent in:
- Young infants
- Vaccinated people
- Adolescents
- Adults
Therefore, the absence of a whoop does not rule out pertussis.
Can Pertussis Cause Vomiting?
Yes.
Severe coughing can trigger vomiting, known as post-tussive vomiting.
Patients may vomit after repeated coughing attacks.
Frequent vomiting can contribute to:
- Dehydration
- Weight loss
- Poor nutrition
Infants can be especially vulnerable.
Stage 3: The Convalescent Stage
The final phase is recovery.
Coughing attacks gradually become:
- Less frequent
- Less intense
- Shorter
Recovery may still take several weeks.
Coughing episodes can return temporarily when the person develops another respiratory infection.
CDC notes that recurrent coughing paroxysms may occur for months after the original pertussis illness begins.
This extremely prolonged cough is one reason pertussis has historically been called the 100-day cough in some parts of the world.
Why Can the Cough Continue After the Bacteria Are Gone?
Antibiotics kill or suppress the bacteria, but they cannot immediately reverse respiratory damage that has already occurred.
By the time severe coughing has developed, toxins and inflammation have damaged airway tissues.
The respiratory tract needs time to recover.
This explains why starting antibiotics late in the illness may reduce transmission but may have little effect on the ongoing cough.
CDC notes that antibiotic treatment after approximately three weeks of illness is unlikely to substantially improve symptoms in most older patients because the bacteria may already be gone.
What Does Pertussis Look Like in Babies?
Pertussis can look very different in young infants.
A baby may not cough strongly enough to produce a whoop.
Instead, important symptoms can include:
- Apnea
- Gasping
- Difficulty breathing
- Cyanosis or bluish skin
- Poor feeding
- Vomiting
- Exhaustion
- Bradycardia in severe illness
- Seizures
- Pneumonia
CDC notes that apnea may sometimes be the only prominent symptom in an infant.
This makes pertussis particularly dangerous because parents may not recognize the classic disease.
Why Is Whooping Cough So Dangerous for Babies?
Young infants have:
- Smaller airways
- Less respiratory reserve
- Immature immune systems
- Limited ability to clear respiratory secretions
They may also be too young to have completed even the first doses of their DTaP vaccine series.
The first DTaP dose is routinely given at approximately 2 months of age.
Therefore, babies are highly dependent on protection transferred from their mother during pregnancy and reduced exposure to infected people.
How Often Are Babies Hospitalized?
CDC estimates that approximately 1 in 3 infants younger than 1 year with pertussis requires hospital care.
Among hospitalized infants younger than 1 year, CDC reports approximately:
| Complication | Approximate frequency |
|---|---|
| Apnea | 68% |
| Pneumonia | 22% |
| Convulsions | 2% |
| Encephalopathy | 0.6% |
| Death from complications | About 1% |
The youngest infants face the greatest risk.
What Complications Can Whooping Cough Cause?
Complications can result both from bacterial disease and from the mechanical stress of repeated violent coughing.
Possible complications include:
- Pneumonia
- Apnea
- Dehydration
- Weight loss
- Feeding difficulties
- Sleep disturbance
- Seizures
- Encephalopathy
- Pneumothorax
- Pulmonary hypertension in infants
- Rib fractures
- Hernias
- Nosebleeds
- Rectal prolapse
- Subdural bleeding
- Fainting
- Urinary incontinence
Can Severe Coughing Break a Rib?
Yes.
Repeated intense coughing can generate substantial mechanical pressure.
Rib fractures have been reported, particularly in adults and older people with severe prolonged coughing.
Violent coughing can also contribute to:
- Abdominal hernias
- Urinary incontinence
- Fainting
- Nosebleeds
Can Pertussis Affect the Brain?
Rarely, severe pertussis can be associated with encephalopathy, meaning abnormal brain function.
Possible mechanisms include:
- Severe oxygen deprivation during prolonged coughing or apnea
- Seizures
- Effects associated with severe systemic illness
Neurological complications are particularly concerning in infants.
What Is Pertussis in Teenagers and Adults Like?
Adolescents and adults frequently develop milder or less typical disease.
Possible symptoms include:
- Persistent cough
- Repeated coughing attacks
- Vomiting after coughing
- Difficulty sleeping
- Exhaustion
- Rib pain
- Urinary leakage during coughing
The classic whoop may be absent.
Because pertussis can resemble bronchitis or another prolonged respiratory infection, cases in adults may go undiagnosed.
Adults with mild disease can still transmit the bacteria to infants.
Can Vaccinated People Get Whooping Cough?
Yes.
Pertussis vaccination is highly important, but protection is not permanent.
People who have been vaccinated may eventually become susceptible as immunity decreases.
When vaccinated people do develop pertussis, their illness is generally less severe than illness in unvaccinated people.
Vaccination therefore remains valuable even though it does not guarantee lifelong protection.
Can Someone Get Whooping Cough More Than Once?
Yes.
Natural infection does not create permanent immunity.
CDC notes that observational studies suggest immunity following natural infection may persist approximately 4 to 20 years, but protection is not lifelong.
A person who previously had pertussis should still follow vaccination recommendations.
How Is Whooping Cough Diagnosed?
Diagnosis combines:
- Medical history
- Symptoms
- Exposure history
- Physical examination
- Laboratory testing
The best test depends partly on how long the patient has been coughing.
CDC recommends collecting a nasopharyngeal swab or aspirate from people with suspected pertussis when laboratory confirmation is appropriate.
What Is a Nasopharyngeal Swab?
A nasopharyngeal sample is collected from the back portion of the nasal cavity.
This is important because B. pertussis primarily colonizes respiratory surfaces in the nasopharynx.
A simple throat swab is generally not the preferred specimen for pertussis testing.
Culture for Pertussis
Bacterial culture is considered the traditional gold standard for confirming pertussis.
Advantages include:
- Very high specificity
- Ability to identify living B. pertussis
- Ability to obtain bacterial isolates for additional analysis
However, culture is relatively slow and can take several days.
It also becomes less sensitive as illness progresses.
Culture works best during approximately the first 2 weeks after cough onset.
PCR Testing
PCR detects genetic material from B. pertussis.
Advantages include:
- Rapid results
- High sensitivity
- Greater usefulness later in illness than culture
PCR generally performs best during the first 3 weeks of coughing and may remain useful through approximately week 4.
After the fourth week, the amount of bacterial DNA in the respiratory tract falls substantially, increasing the risk of false-negative results.
Serology
Blood antibody testing can sometimes help later in the illness.
CDC describes approximately 2 to 8 weeks after cough onset as the optimal period for serologic testing, although testing may sometimes be performed through 12 weeks.
Commercial serologic assays vary considerably in accuracy, so results require careful interpretation.
Pertussis Testing Timeline
| Time After Cough Begins | Test Most Useful |
|---|---|
| 0 to 2 weeks | Culture and PCR |
| 2 to 4 weeks | PCR, with culture becoming less sensitive |
| 2 to 8 weeks | Serology may become useful |
| 8 to 12 weeks | Selected serology may still be useful |
| After 12 weeks | Laboratory confirmation becomes more difficult |
Testing should always be interpreted alongside symptoms and epidemiological information.
How Is Whooping Cough Treated?
Pertussis is treated with antibiotics.
Unlike viral diseases such as Zika or yellow fever, pertussis is bacterial, so appropriate antibiotics can directly target the organism.
However, timing matters enormously.
Treatment during the first one or two weeks of illness, before severe coughing attacks become established, offers the greatest opportunity to reduce symptom severity.
Which Antibiotics Treat Pertussis?
CDC recommends several antibiotics for treatment or post-exposure prevention.
Preferred medicines generally include macrolide antibiotics such as:
- Azithromycin
- Clarithromycin
- Erythromycin
An alternative for eligible patients is:
- Trimethoprim-sulfamethoxazole
The correct medication depends on factors including:
- Age
- Pregnancy
- Drug allergies
- Other medications
- Cardiac conditions
- Local antibiotic resistance
- Ability to tolerate the medication
Antibiotics should be prescribed by a healthcare professional.
What Is the Preferred Antibiotic for Very Young Infants?
CDC identifies azithromycin as the preferred drug for treatment or prophylaxis in very young infants.
Macrolide exposure in very young infants has been associated with infantile hypertrophic pyloric stenosis, so monitoring is important.
However, CDC considers the risk of severe and potentially fatal pertussis to outweigh this potential medication risk when treatment is indicated.
Does Antibiotic Treatment Stop the Cough Immediately?
Usually not.
If treatment begins before severe coughing attacks develop, antibiotics may reduce disease severity.
If treatment begins later, antibiotics may no longer substantially shorten the cough.
The cough can persist because airway damage has already occurred.
This means someone may correctly complete antibiotic treatment yet continue coughing for weeks.
Who May Be Treated Even Before Test Results Are Available?
CDC advises clinicians to consider treatment before laboratory results return when:
- The clinical picture strongly suggests pertussis
- The patient is at high risk of severe disease
- The patient has close contact with someone at high risk
Infants and pregnant people near delivery are especially important because of the risk to newborns.
What Is Post-Exposure Prophylaxis?
Post-exposure prophylaxis, often abbreviated PEP, means giving antibiotics to certain people after they have been exposed to pertussis, even if symptoms have not yet developed.
CDC especially supports PEP for:
- Household contacts of a confirmed case
- People at high risk of severe pertussis
- People who will have contact with someone at high risk
The aim is particularly to prevent severe disease in infants and other vulnerable individuals.
How Is Severe Pertussis Treated in the Hospital?
Hospitalized patients may require supportive care such as:
- Continuous breathing monitoring
- Oxygen
- Airway suctioning
- Intravenous fluids
- Feeding support
- Monitoring for apnea
- Monitoring for pneumonia
- Intensive care in severe cases
CDC notes that keeping the airway clear, monitoring breathing, providing oxygen when needed, and preventing dehydration are major components of hospital care.
Young infants with severe disease may deteriorate quickly and require intensive monitoring.
Should Cough Medicines Be Used?
Ordinary over-the-counter cough medicines are generally not very effective against the cough of pertussis.
CDC advises patients to consult a healthcare provider before using cough medicine and notes that these medicines are usually not recommended for children younger than 4 years.
Home supportive care can include:
- Adequate fluids
- Small frequent meals
- Avoiding smoke
- Avoiding dust and chemical fumes
- Using a clean cool-mist humidifier when appropriate
Is There a Vaccine for Whooping Cough?
Yes.
Vaccination is the main preventive strategy against pertussis.
In the United States, pertussis protection is included in combination vaccines that also protect against:
- Diphtheria
- Tetanus
There are two principal pertussis vaccine categories:
- DTaP
- Tdap
What Is DTaP?
DTaP stands for:
Diphtheria, Tetanus, and acellular Pertussis
It contains:
- Diphtheria toxoid
- Tetanus toxoid
- Purified acellular pertussis components
DTaP is primarily used for babies and children younger than 7 years.
What Is the DTaP Schedule?
CDC recommends a 5-dose DTaP series.
The routine doses are given at:
- 2 months
- 4 months
- 6 months
- 15 through 18 months
- 4 through 6 years
The first three doses build initial protection.
The later doses strengthen and extend protection through early childhood.
What DTaP Vaccines Are Available in the United States?
Current U.S. products include standalone DTaP vaccines and combination vaccines containing DTaP.
Examples include:
- Daptacel
- Infanrix
- Kinrix
- Pediarix
- Pentacel
- Quadracel
- Vaxelis
Some combination products also protect against diseases such as:
- Polio
- Hepatitis B
- Haemophilus influenzae type b
The appropriate product depends on the child’s age and which dose is being administered.
What Is Tdap?
Tdap stands for:
Tetanus, reduced diphtheria, and acellular pertussis vaccine
It is formulated for older children, adolescents, and adults.
Tdap contains lower quantities of some antigens than pediatric DTaP.
Two Tdap vaccines are currently used in the United States:
- Boostrix
- Adacel
When Should Preteens Receive Tdap?
CDC recommends one routine dose of Tdap at approximately:
11 to 12 years of age
Adolescents who missed this dose should receive catch-up vaccination according to current recommendations.
Should Adults Receive Tdap?
Yes.
CDC recommends that adults who have never previously received Tdap receive a dose.
It can be administered regardless of when the person last received a tetanus or diphtheria-containing vaccine.
Afterward, adults require tetanus and diphtheria booster vaccination approximately every 10 years.
Either Td or Tdap may be used for these routine boosters under current CDC guidance.
Why Is Tdap Recommended During Pregnancy?
Newborns are especially vulnerable to pertussis, but babies cannot begin their own DTaP series until approximately 2 months of age.
Vaccination during pregnancy allows the mother’s immune system to produce antibodies against pertussis.
These antibodies cross the placenta and enter the fetus.
The baby is therefore born with temporary passive protection during the first weeks of life.
CDC recommends one Tdap dose during every pregnancy, even if the mother received Tdap previously.
When Should Tdap Be Given During Pregnancy?
The recommended period is:
27 through 36 weeks of pregnancy
CDC prefers vaccination during the earlier portion of this window to maximize transfer of maternal antibodies to the fetus.
If Tdap is required earlier during pregnancy because of wound management or certain outbreak circumstances, it can be given earlier and should not routinely be repeated later during the same pregnancy.
How Effective Is Tdap During Pregnancy for Protecting Newborns?
CDC reports that Tdap vaccination during the third trimester reduces the risk of pertussis in babies younger than 2 months by approximately 78%.
Maternal vaccination is therefore one of the most important strategies for protecting infants during the period before they can develop protection from their own DTaP vaccinations.
Is Tdap Safe During Pregnancy?
Current CDC guidance considers Tdap vaccination during pregnancy safe.
CDC and FDA monitor vaccine safety through multiple systems, and CDC reports that no safety signals have been identified indicating an increased risk to pregnant people or their babies from recommended Tdap vaccination.
Both U.S. Tdap vaccines have been approved by FDA for use during pregnancy.
Why Is Vaccination Needed During Every Pregnancy?
Antibody levels decrease over time.
A Tdap dose received during an earlier pregnancy may therefore not provide sufficiently high antibody levels for a baby born during a later pregnancy.
Vaccination during each pregnancy helps maximize the amount of protective antibody transferred to each newborn.
Can Family Members Help Protect a New Baby?
Yes.
Parents, siblings, grandparents, caregivers, and others who will have close contact with a newborn should be up to date with recommended pertussis vaccination.
This approach has sometimes been called cocooning.
However, CDC notes that cocooning alone is difficult to implement and is not as effective as vaccinating the mother during pregnancy.
Maternal Tdap plus appropriate vaccination of close contacts provides stronger protection.
Why Doesn’t the Pertussis Vaccine Provide Lifelong Protection?
Immune protection against B. pertussis naturally decreases with time.
This happens after:
- Vaccination
- Natural infection
Protection from modern acellular pertussis vaccines tends to decline over several years.
This waning immunity is one reason adolescents and adults can become infected despite receiving appropriate childhood vaccination.
Why Has Pertussis Returned Despite Vaccination?
The increase in reported pertussis since the late twentieth century probably has several causes.
CDC identifies factors including:
- Waning immunity
- Improved diagnostic testing
- Increased awareness
- Better reporting
- Changes in circulating B. pertussis
- Periodic natural disease cycles
The transition from whole-cell to acellular pertussis vaccines is also relevant because protection from acellular vaccines appears to decline more quickly over time.
This does not mean vaccination is ineffective.
Vaccination substantially reduces the likelihood of severe disease and remains especially important for preventing infant illness and death.
Does Bordetella Pertussis Change Over Time?
Yes.
Like other organisms, B. pertussis can undergo genetic changes.
Researchers have documented changes in circulating bacterial strains, including strains with altered or absent production of some vaccine antigens such as pertactin.
Scientists continue investigating how bacterial evolution interacts with population immunity and vaccine effectiveness.
Waning immunity is nevertheless considered an important contributor to current pertussis epidemiology.
Is Antibiotic-Resistant Pertussis a Problem?
Antibiotic-resistant B. pertussis remains uncommon in the United States.
However, CDC reports increasing detection of macrolide-resistant pertussis in several other parts of the world, including areas of:
- Asia
- Australia
- Europe
- South America
CDC continues monitoring U.S. isolates for resistance.
Recent travel can therefore be relevant when physicians choose antibiotics.
How Can Whooping Cough Be Prevented?
The most important preventive measure is vaccination.
Additional precautions include:
- Covering coughs and sneezes
- Washing hands regularly
- Avoiding close contact with vulnerable infants while ill
- Seeking medical care for prolonged or severe cough
- Completing prescribed antibiotics
- Using post-exposure antibiotics when recommended
- Keeping household members appropriately vaccinated
How Long Should Someone With Pertussis Stay Away From Others?
The exact recommendation should be determined by healthcare or public health authorities.
In general, a person with pertussis who receives appropriate antibiotic therapy becomes substantially less infectious after approximately 5 days of effective treatment.
Without treatment, contagiousness can extend considerably longer, particularly through the first weeks of coughing.
This is especially important around:
- Infants
- Pregnant people
- Childcare settings
- Healthcare environments
Should Someone With Pertussis Avoid Babies?
Yes.
A person with suspected or confirmed pertussis should avoid close contact with newborns and young infants until a healthcare professional determines that transmission risk has been adequately addressed.
Young infants face the highest risk of hospitalization, complications, and death.
Is Whooping Cough a Reportable Disease?
Yes.
Pertussis is a nationally notifiable disease in the United States.
Healthcare providers and laboratories report cases according to state and local public health requirements.
Surveillance helps public health officials:
- Identify outbreaks
- Protect vulnerable contacts
- Track vaccine effectiveness
- Monitor circulating strains
- Monitor antibiotic resistance
How Common Is Whooping Cough Today?
Pertussis remains endemic in the United States, meaning cases continue to occur regularly rather than disappearing completely.
Disease activity naturally rises and falls over time.
Historically, pertussis tends to produce periodic peaks even in highly vaccinated populations.
CDC reported a substantial increase in cases leading to a recent peak in November 2024.
Preliminary 2025 case numbers remained elevated compared with the years immediately before the COVID-19 pandemic, but declined from the 2024 peak.
As of CDC’s July 10, 2026 surveillance update, fewer U.S. cases had been reported in 2026 than during the same period of 2025.
These figures remain preliminary and can change as state reports are finalized.
Why Did Pertussis Cases Fall During the COVID-19 Pandemic?
Reported pertussis fell sharply during the COVID-19 pandemic.
Several factors probably contributed, including:
- Mask use
- Reduced social mixing
- School closures
- Reduced respiratory transmission
- Changes in healthcare-seeking behavior
- Changes in disease testing and reporting
As social interactions returned toward previous patterns, pertussis transmission also increased.
Longer-term trends are additionally influenced by waning immunity and natural epidemic cycles.
Is Whooping Cough the Same as Croup?
No.
Pertussis and croup are different illnesses.
| Feature | Whooping Cough | Croup |
|---|---|---|
| Main cause | Bordetella pertussis bacterium | Usually viral |
| Typical cough | Repeated coughing fits | Barking cough |
| Characteristic sound | Inspiratory whoop | Inspiratory stridor |
| Duration | Can last weeks or months | Usually much shorter |
| Vaccine | Pertussis vaccine available | No specific routine croup vaccine |
| Antibiotics | Used for pertussis | Usually not useful for viral croup |
Is Whooping Cough the Same as Bronchitis?
No.
Pertussis can resemble bronchitis, particularly in adults with a prolonged cough.
However, pertussis is a specific infection caused by B. pertussis.
Bronchitis is a broader description of inflammation involving the bronchial airways and can have many causes.
Persistent coughing should therefore not automatically be assumed to be ordinary bronchitis.
Is Whooping Cough Viral or Bacterial?
It is bacterial.
The primary cause is Bordetella pertussis.
This distinction is important because appropriate antibiotics can treat the bacterial infection and reduce transmission.
Can Antibiotics Completely Prevent Complications?
Not always.
Early treatment is most beneficial.
Once severe coughing and respiratory injury have developed, antibiotics cannot immediately reverse the damage already caused.
A patient may therefore continue experiencing coughing attacks despite successful elimination of the bacteria.
Can Pertussis Be Fatal?
Yes.
Deaths are uncommon compared with the prevaccine era, but severe and fatal pertussis still occurs.
The greatest risk is among young infants, especially babies who are unvaccinated or too young to have completed their primary vaccine series.
CDC estimates that approximately 1% of hospitalized infants younger than 1 year with pertussis die from complications.
Can Whooping Cough Cause Permanent Damage?
Most people recover completely.
However, severe complications such as prolonged oxygen deprivation, encephalopathy, severe pneumonia, or other critical illness can potentially cause lasting consequences.
Infants with severe disease require especially careful monitoring.
Can Breastfeeding Protect a Baby From Whooping Cough?
Breastfeeding provides many health benefits and can transfer some maternal antibodies.
However, breastfeeding alone does not provide adequate protection against pertussis.
CDC emphasizes Tdap vaccination during pregnancy because this transfers substantial protective antibody to the baby before birth.
The baby should then begin the routine DTaP vaccine series at the recommended age.
Can a Newborn Receive DTaP Immediately After Birth?
Routine DTaP vaccination begins at approximately 2 months of age.
Vaccinating the mother during pregnancy is therefore especially important because it helps bridge the period between birth and the baby’s first vaccine dose.
Can You Have Pertussis Without Knowing It?
Yes.
Vaccinated adolescents and adults may experience relatively mild illness that looks like an ordinary prolonged cough.
Because the classic whoop may be absent, the person may never realize that the infection is pertussis.
This creates a risk of unknowingly transmitting the bacteria to infants.
When Should Someone Contact a Healthcare Professional?
Medical evaluation is appropriate when someone has:
- A severe or persistent cough
- Repeated coughing attacks
- Vomiting after coughing
- A cough lasting several weeks
- Exposure to a confirmed pertussis case
- A characteristic whooping sound
- Difficulty breathing during coughing attacks
Evaluation is especially important when the patient:
- Is an infant
- Is pregnant
- Lives with an infant
- Works around infants
- Has a weakened respiratory system
When Is Whooping Cough an Emergency?
Seek urgent medical attention when an infant or other patient develops:
- Pauses in breathing
- Difficulty breathing
- Bluish or gray lips, face, or skin
- Severe choking or gasping
- Loss of consciousness
- Seizures
- Inability to maintain hydration
- Extreme exhaustion
- Signs of pneumonia
- Rapid worsening
Babies with suspected pertussis should receive particularly prompt medical assessment because they may deteriorate without displaying the classic whooping cough.
Frequently Asked Questions About Whooping Cough
What causes whooping cough?
Whooping cough is caused primarily by the bacterium Bordetella pertussis.
Is whooping cough contagious?
Yes.
Pertussis is highly contagious and spreads mainly through respiratory droplets and close contact.
How soon after exposure do symptoms appear?
Symptoms usually begin approximately 5 to 10 days after exposure, although the incubation period can extend to approximately 21 days.
Why is the disease called pertussis?
The term has roots associated with an intense or severe cough and has been used medically for centuries.
Does everyone make the whooping sound?
No.
The characteristic whoop may be absent in infants, vaccinated people, adolescents, and adults.
Can babies have pertussis without coughing?
Yes.
Some infants primarily develop apnea or breathing difficulties with little obvious coughing.
How long does whooping cough last?
The illness can last for many weeks.
Coughing attacks may occasionally recur for months, particularly when another respiratory infection irritates the healing airways.
Why is pertussis called the 100-day cough?
The nickname reflects the unusually long duration of coughing that can occur in some patients.
It should not be interpreted as meaning every patient coughs for exactly 100 days.
Can vaccinated people develop pertussis?
Yes.
Protection declines with time, but vaccinated people who develop pertussis generally experience less severe illness.
Can you get pertussis twice?
Yes.
Neither natural infection nor vaccination provides lifelong immunity.
Does having pertussis mean vaccination is no longer necessary?
No.
People who have recovered from pertussis should still follow age-appropriate vaccination recommendations because natural immunity decreases over time.
Is there a vaccine for whooping cough?
Yes.
DTaP is used primarily for young children, while Tdap is used for older children, adolescents, adults, and during pregnancy.
At what ages do babies receive DTaP?
Routine doses are recommended at:
- 2 months
- 4 months
- 6 months
- 15 through 18 months
- 4 through 6 years
What vaccine do teenagers receive?
CDC recommends one Tdap dose at approximately 11 to 12 years of age.
Do adults need a pertussis vaccine?
Adults who have never received Tdap should receive one dose.
Td or Tdap can subsequently be used for routine 10-year tetanus and diphtheria boosters.
Should Tdap be given during pregnancy?
Yes.
CDC recommends Tdap during every pregnancy, preferably during the early portion of weeks 27 through 36.
Why does someone need Tdap during every pregnancy?
Antibody levels decline.
A new dose during each pregnancy helps transfer high levels of protective antibodies to each baby before birth.
Does Tdap vaccination during pregnancy protect the newborn?
Yes.
CDC data indicate that third-trimester maternal Tdap vaccination prevents approximately 78% of pertussis cases among babies younger than 2 months.
Can antibiotics cure whooping cough?
Antibiotics eliminate susceptible B. pertussis bacteria, but the timing of treatment matters.
Early treatment can reduce illness severity.
Late treatment may have little effect on the persistent cough because airway injury has already occurred.
What antibiotics are commonly used?
CDC-recommended options include:
- Azithromycin
- Clarithromycin
- Erythromycin
Trimethoprim-sulfamethoxazole is an alternative in appropriate patients.
How is whooping cough tested?
Testing can include:
- Bacterial culture
- PCR
- Serology
The best test depends on how long the patient has been coughing.
Which test is most useful early?
Culture and PCR are particularly useful early in illness.
Culture is most sensitive during approximately the first 2 weeks, while PCR can generally be useful through approximately 3 to 4 weeks after cough begins.
Can pertussis cause pneumonia?
Yes.
Pneumonia is an important complication, particularly in infants.
Can pertussis cause seizures?
Yes.
Seizures can occur in severe disease, especially among infants.
Can whooping cough kill a baby?
Yes.
Although vaccination and modern medical care have greatly reduced deaths, pertussis remains potentially fatal in young infants.
Can adults spread pertussis to babies?
Yes.
Adults with mild or unrecognized pertussis can transmit the bacteria to infants.
Does pertussis occur only in winter?
No.
Pertussis can occur throughout the year.
Outbreak patterns fluctuate according to population immunity and disease transmission.
Has whooping cough been eradicated?
No.
Pertussis remains endemic in the United States and worldwide.
Is pertussis increasing in the United States?
Cases rose substantially during 2024 and remained elevated during 2025 compared with the years immediately before the pandemic.
CDC reported in July 2026 that preliminary 2026 cases were lower than during the same period of 2025.
These trends can continue to change.
Why Whooping Cough Remains an Important Disease
The history of pertussis demonstrates both the enormous success of vaccination and the difficulty of permanently controlling an infection when immunity naturally decreases.
In 1578, Guillaume de Baillou described a terrifying epidemic coughing illness without knowing its cause.
More than three centuries later, Jules Bordet and Octave Gengou successfully isolated Bordetella pertussis in 1906.
Scientists then began developing vaccines from killed bacterial cells.
During the 1930s, Pearl Kendrick and Grace Eldering helped demonstrate that properly manufactured pertussis vaccines could protect children.
By the late 1940s, widespread use of combined DTP vaccination transformed pertussis epidemiology.
The United States went from more than 200,000 reported cases during some prevaccine years to only a small fraction of that burden after routine childhood vaccination became established.
Later, acellular DTaP vaccines replaced whole-cell vaccines in the United States because they produced fewer common reactions.
Tdap expanded vaccination to adolescents and adults.
Maternal Tdap vaccination then created another important layer of protection by allowing antibodies to pass from a pregnant mother to her baby before birth.
Yet pertussis remains.
Neither infection nor vaccination produces lifelong immunity.
The bacterium continues circulating among children, adolescents, and adults, and periodic outbreaks continue even in highly vaccinated populations.
The greatest danger continues to fall on infants who are too young to have developed full vaccine protection.
That makes pertussis unusual among vaccine-preventable diseases.
Vaccination has prevented enormous numbers of severe illnesses and deaths, but controlling the disease requires protection across several generations at once.
Children need their DTaP series.
Adolescents need Tdap.
Adults who have never received Tdap need appropriate vaccination.
Pregnant people need Tdap during every pregnancy.
Families and healthcare systems need to recognize prolonged coughing illnesses before an infected person unknowingly exposes a newborn.
For most older children and adults, pertussis is exhausting and prolonged but ultimately resolves.
For a very young baby, the same bacterium can cause apnea, pneumonia, seizures, respiratory failure, or death.
That difference is the central reason vaccination, early diagnosis, timely antibiotic treatment, post-exposure prevention, and protection of newborns remain essential parts of modern pertussis control.
Medical and vaccine information reviewed against CDC, FDA, NIH/PubMed, and current U.S. public health guidance available through September 2026.