Summary 

Whooping cough can be very serious for babies and children – especially those under 1 year old. If babies catch whooping cough, they:

• may not be able to feed or breathe properly.
• may become so ill they need to go to the hospital.
• could end up with serious complications such as pneumonia and brain damage.

To protect your baby, get your free immunisation during pregnancy and take your baby for their free immunisations when they’re 6 weeks, 3 months and 5 months old. 

When it’s infectious

People with whooping cough are infectious from 6 days after exposure to the bacteria, when symptoms are like a normal cold, to 3 weeks after the ‘whooping’ cough begins – unless they are treated with antibiotics

Many babies catch whooping cough from their older siblings or parents – often before they’re old enough to be vaccinated.

How common is whooping cough?

Most cases of whooping cough occur in adults whose immunity has faded. In these cases, symptoms tend to be less serious, although the persistent cough can be unpleasant and frustrating

Outbreaks of the disease occur every 3–5 years.

Symptoms 

The symptoms of whooping cough usually appear around a week after infection. This delay is known as the incubation period.

Whooping cough tends to develop in 3 stages.

Initial stage (catarrhal stage)

During this stage, symptoms include:

• a runny nose
• sneezing
• slight fever
• a mild irritating cough
• feeling generally unwell

This stage is when you’re most infectious. It lasts for 1 or 2 weeks.

The second stage (paroxysmal stage)

Coughing fits (paroxysms) are the main symptom in this stage. A paroxysm is a spasm of coughing followed by a big breath in or high-pitched ‘whoop’ in children. Babies and adults generally don’t have the high-pitched ‘whoop’.

The paroxysmal symptoms of whooping cough may include:

• intense bouts of coughing, which bring up thick phlegm
• a ‘whoop’ sound with each sharp intake of breath after coughing
• vomiting after coughing, especially in infants and young children
• tiredness and redness in the face from the effort of coughing

Babies and young children often appear very ill and may turn blue and vomit from coughing so much.

This stage usually lasts 2 to 3 weeks but can persist for up to 10 weeks.

Third stage (recovery stage)

During this stage, the cough gradually gets better. After several weeks the cough disappears. However, for months you may still get coughing fits whenever you get a respiratory infection like a cold.

When to see your doctor

See your doctor if you think you or a family member may have whooping cough, particularly if they:

• have prolonged coughing spasms
• turn blue while coughing
• cough with a whooping sound
• are un-vaccinated

When to seek immediate medical advice

You should seek immediate medical advice if:

• you have a baby of 6 months or younger who appears to be very ill
• you (or your child) appear to be experiencing significant breathing difficulties such as extended periods of breathlessness
• you (or your child) develop serious complications, such as seizures (fits) or pneumonia, an infection that causes inflammation of the tissues in your lungs

In babies, whooping cough is very serious and may require hospitalization.

Treatment 

Whooping cough is normally treated with antibiotics at home. The antibiotics will stop you from being infectious after 5 days of taking them (this can be shortened to 2 days if azithromycin is used). Try to keep away from other people during this time – keep your child home from school or preschool.

However, without antibiotics, you may still be infectious until 3 weeks after your intense bouts of coughing start

Young babies (less than 1-year-old) with whooping cough may need hospital treatment to avoid developing complications.

If your child is admitted to the hospital to be treated for whooping cough, they are normally put into an isolation room. This is to stop the infection from spreading to other patients.

See your doctor

If you think you or a family member may have whooping cough, see your doctor as soon as possible.

Your doctor can test to see whether it is whooping cough.

• If it is whooping cough, you may be given antibiotics. It is important that you complete the course of antibiotics
• Your doctor will also tell you how to care for yourself or your child at home while you’re recovering.

If whooping cough is diagnosed in the later stages, it is unlikely that you will be prescribed antibiotics as you will no longer be infectious and they will not improve your symptoms.

Self-care

If you or a family member has whooping cough, try these ideas.

• Warm drinks may be soothing and help break the coughing spasm.
• A humidifier in the bedroom may help (it must be cleaned every 2 or 3 days).
• Use saline nose drops to help remove thick mucus.
• Drink lots of clear fluids.
• Keep away from things that trigger coughing, like cigarette smoke, perfumes or pollutants.

Prevention

Help stop the spread of whooping cough

• Make sure all your children are up to date with their immunizations.
• Keep your baby away from anyone with a cough.
• If you have a cough yourself, stay away from babies.
• If you’ve got a cough that won’t go away, see your doctor.

Immunization

The vaccines used are INFANRIX- Hexa, INFANRIX-IPV, and Boostrix.

It’s important to protect babies from whooping cough by getting immunized while you are pregnant, and immunizing babies on time – at 6 weeks, 3 months and 5 months old. 

Booster doses are given to children when they’re 4 and 11 years old.

What if my child is behind with their vaccinations?

If your baby or child hasn’t been immunized, talk to your GP or practice nurse. They can arrange a time for your child to be immunized. It’s never too late to catch up. Whooping cough vaccine is free for all children under 18.

Who else is the vaccine recommended for?

Pregnant women should get a whooping cough booster vaccination from 16 weeks' gestation onwards. At this time, the mother can pass her immunity on to the baby, helping protect them until they are old enough to be vaccinated themselves.

Other adults can receive booster vaccinations for a cost. Immunization is recommended if:

• your work involves regular contact with infants
• you live with or care for infants under 12 months of age – even if the baby has been fully immunized.

Boosters should also be considered for other people who are vulnerable to whooping cough and at high risk of severe illness or complications (e.g., those with chronic respiratory conditions, congenital heart disease or immunodeficiency).

How effective is the vaccine?

Around 84% of babies are protected once they’ve completed 3 doses of vaccine (at 6 weeks, and 3 and 5 months of age).

Immunising against whooping cough during pregnancy protects about 90% of babies in their first few weeks of life.

Protection wanes over time. People can get whooping cough some years later, even if they’ve been immunized or have had it before. That’s why it’s important for 4 and 11-year-olds to have booster immunizations.

Making a decision about immunization

Risks associated with whooping cough

• The cough may last up to 3 months.
• It can lead to pneumonia.
• It can lead to brain damage, convulsions, and death. The risk of brain damage ranges from about one in 100 to one in 1000.

Risks associated with the vaccine

• In some overseas trials of acellular pertussis, between 0.7 and 2.6 recipients in 10,000 had fits or ‘shock-collapse’ – neither of which cause long-term problems. These reactions have not happened in overseas trials of the vaccine now being used in New Zealand.
• There is no association between the vaccine and sudden unexpected death in infancy (SUDI, formerly known as sudden infant death syndrome or SIDS).
• Anaphylaxis is very rare.

Summary 

Sore throats are usually caused by virus infections like colds or the flu.

When to see your doctor

You must see your doctor if you or a family member experiences any of the following:

• a sore throat that lasts more than a few days
• difficulty swallowing
• your tonsils are enlarged or coated
• a high temperature (above 39°C)
• swelling in your neck
• earache or joint pain.

Rheumatic fever

Sometimes a sore throat is caused by Streptococcus bacteria (strep throat). A strep throat can lead to rheumatic fever if it is not treated quickly with antibiotics. Rheumatic fever is a serious illness because it can cause heart damage.

Scarlet fever

Scarlet fever is the same illness like strep throat, but with a skin rash.

Scarlet fever can also lead to rheumatic fever – and to other illnesses, like pneumonia or infections.

The main symptom of scarlet fever is a red rash that feels rough. It usually begins on your chest, spreading to your neck, abdomen, and arms.

People with scarlet fever may have flushed cheeks and a red or white ‘strawberry tongue’.

If you or a family member has this type of rash and a sore throat, get to the doctor quickly so they can check it out.

Glandular fever

Having a sore throat is also one of the symptoms of glandular fever – along with fever and swollen glands in the neck.

Other symptoms of glandular fever include headache, feeling generally unwell, joint pains, tiredness, and loss of appetite.

Glandular fever generally isn’t serious but it can cause tiredness and loss of energy for a longer period – even up to a few months. 

If you think you or a family member may have glandular fever, you should see your doctor.

Treatment

Self-care

If you have a common sore throat, some of these things may help.

• Drink more fluids. (Drinking through a straw may hurt less.)
• Eat soft foods that are easy to swallow. Don’t eat spicy, salty or acidic foods.
• Try cold fluids, ice blocks, or honey and lemon juice in hot water.
• Gargle with warm salt water (1/2 tsp salt in 200ml water).
• Suck on hard sweets or throat lozenges.
• Take pain relief such as paracetamol or ibuprofen (as directed by your doctor or pharmacist).
• Breathe warm, humidified air.
• If you feel hoarse or lose your voice, rest your throat by talking less until it improves.

Treatment for strep throat

Strep throat is different from a common sore throat and must be treated with antibiotics. This can be given in three ways – capsules, liquid, or as an injection from a nurse or doctor.
 
If your child has the capsules or liquid, they are usually given for 10 days. It is important that your child takes all the antibiotics for the full 10 days, even if they feel better, to stop the strep throat from turning into rheumatic fever.

The one-off antibiotic injection to treat a strep throat might be a good alternative for your child if you think they may find it hard to take the full 10-day course of capsules or liquid.

Taking care of medicines

• Remember that some medicines aren’t safe for children, or for women during pregnancy.
• Always read the instructions and ask your doctor or pharmacist if you’re unsure.
• If you’re given penicillin or other antibiotics, you must take all the medicine you’re given – even after you’re feeling better. 

Prevention

To help stop infections spreading or coming back:

• Always cover your mouth and nose with a tissue when you sneeze or cough.
• Avoid close physical contact such as kissing, and don’t share eating or drinking utensils (eg, cups or knives and forks).
• Try to create space between your children when they sleep, to limit the chance of bugs such as those that cause strep throat is spread through coughs and sneezes. This is important all the time – not just when they are sick.