Pertussis (Whooping Cough) Frequently Asked Questions
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Pertussis (whooping cough) is highly contagious and one of the
most commonly occurring vaccine-preventable diseases in the United States.
People with pertussis usually spread the disease by coughing or
sneezing while in close contact with others, who then breathe
in the pertussis bacteria.
Many infants who get pertussis are infected by older siblings, parents
or other caregivers who might not even know they have the disease.
The best way to protect yourself from pertussis is by getting the pertussis vaccine.
Pertussis vaccines are safe and effective. Check with your doctor about
pertussis vaccines for yourself and your family. As an alternative,
whooping cough shots are available for free or low cost at some local
The series for children starts at 2 months of age, and continues at
4, 6, 15-18 and 4-6 years of age. (DTaP)
The booster shot (Tdap) is recommended by 11 years of age because
immunity from the childhood vaccines wears off over time.
Teens and adults who haven't yet received a pertussis booster shot should
also receive a dose as soon a possible.
Newborn infants are at highest risk of dying from pertussis in part because
they are too young to be protected from vaccines. Therefore, all of those who
are in close contact with young babies should be immunized against pertussis.
Some hospitals are currently offering Tdap for mothers who have just delivered
or other close contacts.
If you are planning on becoming pregnant or are currently pregnant, talk to your
doctor about getting the Tdap vaccine. Don't risk spreading this disease to your
baby. Make sure all people around your baby are vaccinated with Tdap including
siblings, grandparents, aunts, uncles, nannies, caregivers, childcare staff, etc.
If pertussis is circulating in the community, there is still a chance that a fully
vaccinated person (of any age) can catch this very contagious disease. This is
because no vaccine is 100% effective. However, when a vaccinated person gets
pertussis, the infection is usually less severe.
Keep young infants away from people with cough illness. Likewise, people with
cough illness should always stay away from young infants.
Health care workers all need Tdap to protect themselves and their patients
Pertussis symptoms can be different depending on how old you are or if you've been vaccinated.
Pertussis usually starts with cold-like symptoms, and maybe mild cough, but not every runny
nose is pertussis. Pertussis is often not suspected or diagnosed until a persistent cough
with spasms sets in after 1–2 weeks.
In infants, the cough may be mild or absent. However, infants may have a symptom known
as "apnea." Apnea is a brief pause in the child's breathing pattern.
Infants and children with pertussis can cough violently and rapidly, over and over,
until the air is gone from their lungs and they're forced to inhale with a loud
"whooping" sound. This extreme coughing can result in vomiting and exhaustion.
Illness is generally less severe in adolescents and adults.
The coughing fits usually last from 1 to 6 weeks, but can go on for up to 10 weeks or more.
Although children are often exhausted after a coughing fit, they usually appear relatively healthy in-between coughing episodes.
The illness can be milder (less severe) and the typical "whoop" absent in children,
adolescents, and adults who have been vaccinated.
Seeking treatment when pertussis symptoms first start is important.
If you or your child is having trouble breathing, seek medical attention immediately.
Tell the doctor if you or your child has been around others with cough/cold symptoms
or if you've heard that pertussis is in your community.
Antibiotic treatment may make the pertussis infection less severe if it is
started early, before coughing fits begin.
Antibiotic treatment can help prevent spreading the disease to close contacts (people
who have spent a lot of time around the infected person) and is necessary for
stopping the spread of pertussis.
Everyone should make sure they are up to date with recommended pertussis vaccines
for infants/children and Tdap
for adolescents/adults). If not sure, call your
doctor to see what's best for you and your family.
No serious reactions have been associated with DTaP or Tdap and getting these
vaccines is much safer than getting the dangerous kinds of diseases they prevent.
Infants and children are recommended to receive the childhood pertussis vaccine,
or DTaP, at 2, 4, and 6 months of age. A fourth shot is given between 15 and 18
months of age, and a fifth shot is given when a child enters school, at 4–6 years of age.
To maximize protection, all 5 doses of DTaP are needed on time according to the
recommended immunization schedule.
Since 2005, there has been an adolescent/adult pertussis booster vaccine (Tdap)
that can be used for prevention and control of pertussis.
The protection received from DTaP, the childhood vaccine, fades over time. Adolescents
and adults need Tdap, even if they were completely vaccinated with DTaP as children.
Pre-teens going to the doctor for their regular check-up at age 11 or 12 years
should get a dose of Tdap.
Adults 19-64 years old who didn't get Tdap as a pre-teen or teen should get
one dose of Tdap instead of their next Td booster.
The dose of Tdap can be given earlier than the 10-year mark since the last Td
booster, so it's a good idea for adults to talk to a healthcare provider
about what's best for their specific situation.
Getting vaccinated with Tdap is especially important for family members with
and caregivers of new infants.
We are not aware of any shortage of the vaccine. If a particular vaccine distributor
lacks pertussis vaccine, then a provider seeking vaccine should contact another distributor.
The pertussis vaccine is currently not licensed for adults ages 65 and older. However,
off-label use of any medication by any physician is permitted. There is no reason
to think vaccination of seniors would be harmful and there are ongoing studies to
determine the efficacy of the vaccine among this population. Seniors should talk with
their physician about getting a booster shot, especially is they are going to have
contact with a young infant.
Even with the success of pertussis vaccines, people continue to get pertussis in the US.
It will be difficult to eradicate pertussis since neither the vaccine or disease provides life-long immunity.
Since the 1980s, there's been an increase in the number of reported cases of
pertussis, especially among teens (10–19 years of age) and babies younger than 6 months of age.
Multiple factors have likely contributed to the increase, including waning immunity from
childhood pertussis vaccines, increased recognition, better diagnostic testing and increased reporting.
In 2008 there were more than 13,000 reported cases including 18 deaths from pertussis nationally.
Most deaths occur in babies who are too young to be fully vaccinated.
In 2005, the last peak year, there were more than 25,000 reported cases of pertussis.
But, many cases of pertussis are not recognized or reported so this is likely a
It is too early to know. In past years California has seen pertussis peak during
late summer or early fall. We're very concerned that this may also happen this year.
Pertussis occurs in a cyclical pattern, with the number of cases peaking every 3
to 5 years as people's immunity from the vaccine wears off and enough susceptible
people are in the population to sustain transmission of the bacteria.
The incidence of pertussis is cyclic with peaks occurring every two to five
years as the number of susceptible people in the population increases.
Factors leading to increase number of susceptibles include:
- New birth cohorts.
- Waning immunity to vaccine.
- Waning immunity to natural disease.
CDPH has implemented a number of interventions aimed at mitigating the effect of pertussis,
particularly in young infants, including:
Dissemination of educational materials to local public health departments, hospitals,
and healthcare providers, press releases to inform the public, and conducting
statewide round-table meetings with ethnic media.
- Dissemination of clinical guidance materials for healthcare providers;
- Promotion of the infant cocooning strategy;
Implementation of a free postpartum tetanus, diphtheria, and acellular
pertussis (Tdap) program for hospitals with Tdap immunization policies;
Initiation for a CDC investigation (Epi-Aid) into increased pertussis incidence in
the Central Valley region of California;
Offering free Tdap vaccine to local health jurisdictions to increase Tdap
immunization and community immunity levels;
Investigation of potential ways to reduce financial barriers to immunization
with Tdap; and
- Development of forthcoming recommendations about administration of Tdap vaccine to improve uptake.
Babies are susceptible until they have received 3 or more doses of pertussis
vaccine by age 6 months. Children aren't fully protected until they receive
5 shots between infancy and 5 years of age.
Newborn infants are at highest risk of dying from pertussis because they are
too young to be protected from vaccines. Therefore, all of those who are in
close contact with young babies should be immunized against pertussis.
Some hospitals are currently offering Tdap for mothers who have just
delivered or other close contacts: This includes parents, siblings,
caregivers, and health care professionals.
Pertussis is most severe for infants, who often catch the illness
from a family member or other caregiver.
- More than half of infants less than 1 year of age diagnosed with pertussis are hospitalized.
- About 1 in 20 infants with pertussis get pneumonia (lung infection).
- About 1 in 100 infants will have convulsions.
In rare cases, pertussis can be deadly, especially in infants less
than 3 months of age. This is the age group we're most concerned
about when it comes to pertussis.
Many infants who get pertussis are infected by older siblings, parents,
or other caregivers who might not even know they have the disease.
Make sure patients of all ages are up to date on pertussis-containing vaccines (see immunization
Administer one dose of Tdap vaccine to all pregnant adolescents and women during each pregnancy
(preferred during 27 through 36 weeks gestation) regardless of number of years from prior Td or Tdap vaccination.
Consider the diagnosis of pertussis in their patients and close contacts. The diagnosis of pertussis
is often delayed or missed. In the youngest infants, atypical presentation is common – the cough
may be minimal or absent and the primary symptom can be apnea.
Test for pertussis in their patients, using the correct tests (see
- Treat appropriately for pertussis. Because pertussis may progress rapidly in young infants, treat suspected and confirmed cases promptly.
- Quickly report cases of pertussis to their local public health department to assist with prevention of additional cases.
- Public health professionals can try to raise awareness among the community about pertussis vaccines, working with local immunization coalitions and other partners to maximize outreach.
- Public health professionals should continue with pertussis surveillance and reporting.
There is now a vaccine available for adults and adolescents that was not available prior
to May 2005. All pregnant adolescents and women should receive Tdap during each pregnancy
(preferred during 27 through 36 weeks gestation) regardless of number of years from prior
Td or Tdap vaccination. Parents, family members and caregivers of infants should be vaccinated to
provide a cocoon of protection around the infant. Neither vaccination nor illness
from whooping cough provides lifetime immunity. The vaccine wears off by the time
a child finishes middle school, so adolescents and adults need pertussis booster shots.