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Ear Infections Whooping cough

whooping cough

Whooping cough is an infection of the nose and throat and lungs which causes long bursts of coughing. In young children the coughing spell often ends in a whooping noise when the child can finally take a breath in. Children can have several coughing spells each hour, including while they are sleeping. They can also go on having coughing spells for many weeks (up to about three months for some). Older children and adults can have whooping cough without the whooping sound. Immunisation against whooping cough can be very effective in protecting children.

What is whooping cough?


Whooping cough is an infection caused by a
bacterium, Bordetella pertussis. Outbreaks of whooping cough were first described in the 16th Century.

The coughing spells seem to be caused by


thick mucous in the lungs, which is difficult to cough up.

Pertussis kills about 250,000 children


worldwide each year. Nine Australian babies died from whooping cough between 1996 and 1997.

In Australia, there are epidemics of whooping


cough about every three to five years.

How does it spread?


The infection spreads by droplets that are
coughed or sneezed out. These droplets can be breathed in or they can be carried to the nose by hands which come in contact with the droplets (e.g. through handling used tissues or by touching surfaces which have the droplets on them).

Whooping cough is very easy to catch. 70% to


100% of people living in the same house as someone with whooping cough will get the infection unless they have been immunised or have had the infection.

Who is most at risk?


Any one who is not protected (by recent
immunisation or by having had the infection before) can get whooping cough, including older children and adults.

More than 60% of people who get the


infection in Australia are over ten years of age. Adults and children over ten can get the infection even when they have been immunised as a baby.

Babies are at most risk of having severe


health problems from whooping cough. About one in 200 babies who get whooping cough before they are six months old will die from the infection.

How long does it take to develop?


A child or adult who catches whooping cough will usually start to be unwell about seven to ten days after being exposed to the infection.

How long is it infectious?


A person with whooping cough is highly
infectious in the first few days (when they seem to only have a cold).

Without treatment with an effective


antibiotic, a person will go on being infectious for about three weeks.

If the illness is treated with an effective


antibiotic (often erythromycin), a person will usually stop being infectious within five days.

It can take a while for adults with


whooping cough to be diagnosed correctly, because they usually do not whoop. If their cough is treated with some common antibiotics the bacteria may not be killed, and they can go on being infectious for about three weeks.

Signs and symptoms of whooping cough


The illness usually starts like a cold with
runny nose and a cough which is not like the spells of coughing later in the illness.

After several days the long spells of


coughing start, causing difficulty breathing during the spells. The child will have many quick coughs in one spell. There can be several spells of coughing each hour (with an average of 25 coughing spells per day).

Young children often have a whoop after


the coughing spell (when they can finally breathe in). They might vomit any food or drink that they have recently swallowed, during the cough or soon afterwards.

Very young babies may not cough, but they


may just stop breathing for a minute or longer many times per day. If they cough there might not be the whoop.

Adults and older children may not whoop,


but they will have coughing spells and they may feel tired (the coughing can interfere with sleeping), and generally unwell. It can be many weeks before it is recognised that the older child or adult has whooping cough.

Finally, after several weeks or more, the


coughing spells start happening less often and they stop happening about two to three weeks later. If the person gets a cold soon after having whooping cough, the coughing can start again for a while (much shorter than the original illness).

Diagnosis of whooping cough


During an outbreak of whooping cough it
is usually possible to diagnose whooping cough from the symptoms.

Blood tests and tests on mucous from the nose


or throat can be done to confirm that the illness is whooping cough. X-rays may be done to check how well the lungs are working.

Treatment
If your child has been exposed to whooping
cough, see your doctor, as your child might need an antibiotic to protect him from becoming infected.

When it is recognised that a child or adult


has whooping cough an antibiotic, (often erythromycin), is prescribed. It will kill the bacteria but it does not stop the coughing which may go on for many weeks, unless the antibiotic is given very early in the illness.

Young babies with whooping cough are


often so ill that they need hospital treatment. Feeding can be a problem because they often vomit after coughing. A baby may need tube feeding.

Cough suppressing medicines may be helpful


for adults but probably should not be used for young children. Part of the reason for coughing is that there is sticky mucous in the airways which needs to be coughed up. Always check with your doctor before giving a child a cough suppressing medicine.

What can you do?


It is important to check often that the
child is eating and drinking enough.

It seems that feeding a young child


immediately after a coughing spell may mean the food and drink stays down. Feeding seems to trigger a coughing spell if the child has not coughed recently, but soon after a coughing spell, food and drink usually does not trigger another coughing spell.

Children who are coughing often will be


tired and uncomfortable (coughing can cause tummy pain from overused muscles). Some paracetamol or ibuprofen may help with aching muscles.

The topic Feeling sick has more ideas.

Immunisation
Immunisation of babies against whooping
cough protects most children completely, although a small number of immunised children may have a milder illness with whooping cough.

The immunisation is given at the same


time as immunising them against tetanus, diphtheria and polio (at two, four and six months and four years).

Immunisation of older children also


protects babies under two months (when whooping cough can be very severe) because there will be fewer children in

the community who can spread the infection to babies (babies are not protected by antibodies from their mother).

There is now a vaccine to protect children


over ten years and adults. This booster works if the person had a full set of immunisation as a baby. This immunisation is recommended to be given with tetanus and diphtheria at the age of 15 to 17 years (one injection with three vaccines).

Immunisation is also recommended for: adults before planning a pregnancy parents of newborn babies adults working with young children adults at age 50 years (when combined
tetanus, diphtheria and pertussis (whooping cough) vaccine can be used instead of diphtheria-tetanus).

However, the vaccine is not free at these


times.

Preventing the spread of whooping cough


Any person with whooping cough should
be excluded from child care, kindergarten and school until five days after starting treatment, or if not treated, for three weeks from the start of symptoms.

Children who are unwell should not


be at child care, kindergarten or school even if they are no longer infectious. The teachers are not able to provide the care that sick children need.

Any children under the age of seven


years who have not been immunised and have been in contact with someone with whooping cough should be excluded from child care, kindergarten or school for 14 days after the contact, or until they have been on antibiotic treatment for at least five days.

The National Health and Medical Research


Council in Australia recommends that anyone who has been exposed to whooping cough in the household or other close contacts (such as child care) should receive antibiotics for ten days even if they have been immunised (see your doctor).

Whooping cough is a notifiable disease in


Australia. The State Government health service will be notified of proven cases of whooping cough so that they can assist in stopping the spread of the infection.

Questions often asked about immunisation against pertussis


Question: Does pertussis immunisation cause permanent brain damage? Answer: No, it does not, and many studies have been done to show that there is no risk. A few babies become floppy for several hours after the injection. They always recover fully. However children who get ill with pertussis (especially babies) can have brain damage, and might die.

Question: Does the pertussis part of the vaccine (combined with tetanus, diphtheria, and in South Australia Hepatitis B vaccines) cause reactions such as fever and a sore spot where the injection was given? Answer: The type of pertussis vaccine has been changed recently. Since this new vaccine (a-cellular pertussis) has been used, there have been many fewer children who get a fever or sore injection sites, but they get the same amount of protection.

Question: Do children still need to be immunised against whooping cough? Answer: Yes, there have been regular outbreaks of whooping cough in Australia even in the last few years, and babies in Australia still die from whooping cough. In some countries where many children are not immunised against whooping cough, the numbers of children getting sick (and dying) with whooping cough is much higher than in Australia.

Question: How long does the protection from whooping cough last after immunisation? Answer: For some people, the protection against whooping cough starts to get lower around the age of 12 years. Having a booster around this age or later is not yet being recommended, but it is being considered.

Question: Is it better to wait until my child is a bit older before having the whooping cough immunisation? Answer: No. Waiting until your child is older is not recommended because it is when they are less than 12 months old that babies are most at risk.

Delivering a Healthy WA

For more information contact:


Local Community Child Health Nurse Local Family Doctor Ngala Family Resource Centre Helpline
8.00 a.m. 8.00 p.m. 7 days a week Telephone (08) 9368 9368 Outside metro area Freecall 1800 111 546 www.ngala.com.au

Parent Help Centre/Parenting line


Telephone (08) 9272 1466 (24 hour service) Outside metro area Freecall 1800 654 432

Children, Youth and Women's Health Service, reproduced with permission. The South Australian Government does not accept responsibility for the accuracy of this reproduction. The original version is published at http://www.cyh.com Warning This document is published as general information only. You should always consult a healthcare professional for diagnosis and treatment of any health condition or symptoms.

Disclaimer The advice and information contained herein is provided in good faith as a public service. However the accuracy of any statements made is not guaranteed and it is the responsibility of readers to make their own enquiries as to the accuracy, currency and appropriateness of any information or advice provided. Liability for any act or omission occurring in reliance on this document or for any loss, damage or injury occurring as a consequence of such act or omission is expressly disclaimed.

HP 8878 JULY06 21457

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