What is whooping cough, what are the symptoms and how deadly is it?

The name whooping cough might conjure up images of Victorian England, but the disease is currently having a resurgence -  with five baby deaths.

More than 2,700 whooping cough cases have been reported across England so far in 2024 – more than three times the amount recorded in the whole of last year.

UK Health Security Agency (UKHSA) figures show there were 2,793 cases reported to the end of March. This is compared with the 858 cases for the whole of 2023.

Between July and the end of November 2023, there were 1,141 suspected cases of whooping cough in England and Wales, as reported by clinicians, nearly 700 more than the equivalent timeframes in 2021 and 2022.

The disease has spread across Europe. The European Centre for Disease Prevention and Control said that the bloc had seen more cases in the first three months of 2024 than an average year between 2012 and 2019.

It confirmed on Wednesday there had been 11 infant deaths and eight deaths among older adults on the continent.

So what is going on?

Whooping cough is a cyclical disease that peaks every 3-5 years. The last cyclical increase occurred in 2016, with a major outbreak last seen in 2012.

Health officials said that the current deadly outbreak is “overdue” following suppression of the spread of disease during the pandemic due to lockdown and other restrictions.

The UK Health Security Agency (UKHSA) said “the impact of the pandemic also means there is reduced immunity in the population”.

What is whooping cough?

The name is given to a bacterial chest infection which can last for up to 100 days. “It’s highly contagious and it’s spread via respiratory droplets,” says Dr Safia Debar, executive health GP at Mayo Clinic Healthcare in London.

The illness progresses through three stages, the first being largely similar to a common cold with symptoms such as a runny nose, sore eyes and sneezing. After two weeks, infected individuals begin to develop bouts of intense coughing which can last for several minutes, sometimes followed by an audible whoop or gasp for breath between coughs. Young children may turn blue or grey due to difficulty breathing while adults might become red in the face.

Sufferers can then be left with a chronic cough which remains for several weeks.

Debar recommends that anyone with a persistent cough which has lasted for more than two weeks, should see a doctor.

“Particularly if you also have symptoms like lethargy and fever, or you’ve been in contact with somebody with whooping cough, then definitely seek medical attention,” she says. “Without treatment, people are infectious for three weeks, but with antibiotics, you’re not infectious after five days.”

How serious is whooping cough?

The illness is most dangerous to newborn babies and infants. Most children under six months require hospitalisation after contracting whooping cough due to the risks of brain swelling and convulsions, and 1-3 per cent of those under three months die from the illness.

“Babies are vulnerable because their immune systems haven’t fully developed,” explains Dr Dipender Gill, a medical doctor and researcher at Imperial College London. “It’s quite prevalent in school-aged children as well, so those who are 11 to 18 years old.”

In teenagers and adults, serious cases of whooping cough can lead to pneumonia, fainting and even rib fractures due to the intensity of the coughing fits. However, Gill says it tends to be the elderly and those with compromised immune systems who are most vulnerable.

“The whole population is susceptible to getting the infection,” says Gill. “But I think it can lead to particularly severe symptoms in elderly people, because as you age, your immune system becomes more impaired or if your immune system was impaired for other reasons such as cancer treatment or transplantation and immunosuppressive therapy.”

How can you protect yourself and others?

Because whooping cough is so infectious, Debar recommends self-isolating if your doctor suspects that you have the illness, at least for five days while antibiotic treatment kicks in.

However, the most effective preventable measure is to get vaccinated. Babies at eight, 12 and 16 weeks old are eligible for an immunisation to whooping cough on the NHS along with other vaccines. An additional booster shot can be given when the child is three.

Experts are particularly keen to raise awareness that the whooping cough vaccine is now recommended for pregnant women.

“Newborns and babies in the first few months of life are more likely to get severe disease, [and] this is almost entirely preventable if the mother is vaccinated in pregnancy and her protective antibodies can then reach the baby through the placenta, and protect [it] until the baby gets its own vaccines,” says Beate Kampmann, professor of paediatric infection & immunity at the London School of Hygiene and Tropical Medicine.

Kampmann recommends checking your vaccine records in case you missed receiving this jab. It is also possible for concerned older individuals to receive a booster vaccine for whooping cough.

How is it treated?

Debar says that doctors will typically do a throat swab to see whether someone is infected with the Bordetella pertussis bacterium and if so, prescribe antibiotics.

“Antibiotics are given on a case-by-case basis,” she says. “After the first three weeks, the infection tends to wane and sometimes if you’re just left with the chronic cough, it could be that you do not need antibiotics.”

She says that once any fever has passed, it’s not necessary to remain in bed the whole time, and instead there are certain remedies which can be taken to try and alleviate the coughing.

“You want to strengthen your immune system,” says Debar. “Some people will use cough remedies, we find that they don’t really work. But things like saline sprays can sometimes provide symptomatic relief. I love natural remedies, so ginger, turmeric, all things to strengthen immunity.

“The coughing can be worse at night so you want the environment around you to be as moist as possible. So, use a humidifier, make sure the temperature is appropriate, and make sure you’re well hydrated. Maybe try an extra pillow if that helps.”

Why is whooping cough more common now?

The last major outbreak in England was in 2012 when 14 deaths were reported in one year.

Since then, vaccinations have been introduced, with all the deaths occurring in those too young for vaccination.

The whooping cough vaccine is routinely given as part of the: 6-in-1 vaccine – for babies at 8, 12 and 16 weeks.

In 2012, vaccination of pregnant women was introduced, to protect the youngest babies. However, vaccination rates have been falling in recent years.

Experts are concerned that the current outbreak is being fuelled by a combination of factors: vaccine hesitancy, suppression of disease linked to social distancing and reduced “population immunity” as a result.

Professor Paul Hunter, professor of medicine at the University of East Anglia (UEA), said the disease was much more common in the  last century until vaccines were introduced

“This current year looks like we may see more cases than we have seen in any of the last 40 years,” he said.

Prof Hunter said: “The infection can affect anyone who is not vaccinated and even some that are. However, the main risk of death or severe long-term complications is seen in young children, especially those under three months old.

“It is this age group that is most at risk of death and developing longer-term problems such as brain damage.

“The problem is that this age group is too young for the vaccine in most circumstances.

“That is why we offer vaccines to pregnant women. Not to protect them but to protect their babies during the riskiest first months of life.

“Vaccine uptake in pregnant women has been falling quite markedly in recent years.”