Pertussis: The Whooping Cough Still Killing Thousands of Babies
Why This Vaccine-Preventable Disease Continues Threatening Infants
Three-month-old Amara gasped desperately for air, her tiny face turning blue as violent coughing consumed her fragile body. Her mother, 24-year-old Grace from rural Uganda, held her daughter helplessly, watching in terror as Amara struggled to breathe between coughing fits so severe they caused vomiting. “She’s been coughing like this for a week,” Grace explained to Dr. Peter Okello at the health clinic. “The cough sounds like a high-pitched ‘whoop’ when she finally catches her breath. She can’t eat because she vomits everything. She’s getting weaker every day.”
Dr. Okello immediately recognized the distinctive “whooping” sound—pertussis, commonly called whooping cough, a highly contagious bacterial infection that can be deadly for infants. “Amara has severe pertussis,” he explained urgently. “Babies under six months are most vulnerable because they’re too young to be fully vaccinated. The disease causes such violent coughing that babies can’t breathe, eat, or sleep. Some stop breathing entirely during coughing fits. Others develop pneumonia or brain damage from lack of oxygen. Without immediate treatment, many babies die.”
Amara needed hospitalization for oxygen therapy, antibiotics, and intensive monitoring, but the nearest hospital with pediatric intensive care was 150 kilometers away over terrible roads. Grace hadn’t been vaccinated against pertussis during pregnancy, which would have protected Amara during her most vulnerable first months. Grace’s older children weren’t fully vaccinated either, and one likely transmitted the infection to baby Amara. This preventable tragedy unfolds thousands of times annually worldwide, killing approximately 160,700 children under five each year—mostly infants too young to be vaccinated.
According to the World Health Organization, pertussis is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. Despite effective vaccines being available since the 1940s, pertussis remains a significant global health problem. The disease spreads easily through respiratory droplets when infected people cough or sneeze, and infected individuals can spread pertussis before knowing they’re sick. While pertussis affects all ages, it’s most dangerous for young infants who haven’t completed their vaccination series. Pertussis vaccination has prevented millions of deaths, yet gaps in vaccination coverage, waning immunity in adults, and delays in vaccine administration continue allowing this preventable disease to kill thousands of babies annually.
Understanding Pertussis
Pertussis, also known as whooping cough, is caused by Bordetella pertussis bacteria that attach to the tiny hair-like projections (cilia) lining the respiratory tract. The bacteria release toxins that damage cilia, causing airways to swell and produce thick mucus. The disease progresses through three distinct stages over weeks to months.
The catarrhal stage (first 1-2 weeks) resembles a common cold with runny nose, mild cough, occasional sneezing, and sometimes low-grade fever. During this highly contagious stage, people often don’t realize they have pertussis, continuing normal activities while unknowingly spreading bacteria to others, including vulnerable infants.
The paroxysmal stage (2-6 weeks or longer) brings the characteristic severe coughing fits. Rapid, violent coughs occur in succession without breathing between coughs. A desperate gasping “whoop” sound occurs when the patient finally inhales after a coughing fit—hence the name “whooping cough.” Coughing fits can cause vomiting, exhaustion, and turning blue from oxygen deprivation. In infants, the “whoop” may not occur; instead, they may stop breathing entirely (apnea) during or after coughing fits. This stage is exhausting and dangerous, particularly for babies.
The convalescent stage (weeks to months) involves gradual recovery with less frequent and less severe coughing fits, though coughing can persist for months, sometimes recurring with subsequent respiratory infections. Chinese medicine traditionally called pertussis “the 100-day cough” because symptoms persist so long.
Transmission occurs easily through respiratory droplets when infected people cough, sneeze, or talk. Close contact facilitates spread, making households, schools, and healthcare settings common transmission sites. People are most contagious during the catarrhal stage and first two weeks of coughing, before diagnosis often occurs. Like measles and other vaccine-preventable diseases, pertussis spreads rapidly in unvaccinated populations.
Who Is Most at Risk?
Young infants, particularly those under six months, face the greatest danger from pertussis. They’re too young to have completed the primary vaccination series (usually given at 2, 4, and 6 months), leaving them vulnerable. Babies account for most pertussis hospitalizations and nearly all deaths. Complications in infants include apnea (stopping breathing), pneumonia (occurring in about 20% of infant cases), seizures from oxygen deprivation or brain swelling, encephalopathy (brain damage), and death (approximately 1% of hospitalized infants die despite treatment).
Pregnant women who contract pertussis can experience severe complications and may transmit infection to newborns. Adults and adolescents typically experience milder disease than infants but can suffer weeks of debilitating cough, miss work or school, and unknowingly transmit infection to vulnerable infants. People with weakened immune systems face higher complication risks.
Unvaccinated individuals of any age remain vulnerable. Even vaccinated people can contract pertussis as immunity wanes over time, though disease is usually milder than in unvaccinated people. Healthcare workers face occupational exposure risks and can transmit infection to vulnerable patients. Like newborn health challenges broadly, protecting the most vulnerable requires protecting entire communities through vaccination.
The Global Burden
Before widespread vaccination, pertussis caused millions of cases and hundreds of thousands of deaths annually worldwide. Vaccination dramatically reduced this burden, yet pertussis remains a significant problem. Globally, WHO estimates approximately 24.1 million pertussis cases and 160,700 deaths occur annually in children under five, with the vast majority of deaths in infants under one year.
Reported cases likely represent only a fraction of true burden because many cases go undiagnosed—mild cases in vaccinated individuals or adults are often mistaken for common colds, diagnostic testing isn’t available in many low-resource settings, and healthcare access limitations prevent many from seeking care. Even in countries with strong surveillance, pertussis is likely under-reported.
Geographic patterns show highest burden in regions with low vaccination coverage, particularly parts of Africa and Asia. However, even countries with high overall vaccination coverage experience outbreaks when coverage drops in certain communities, immunity wanes in adolescents and adults, or vaccine timing leaves young infants vulnerable before completing primary series. Like maternal mortality concentrating in areas with weakest health systems, pertussis deaths occur predominantly where vaccination and healthcare are least accessible.
Vaccination: The Primary Prevention
Pertussis vaccines are highly effective at preventing disease. Two main vaccine types exist: whole-cell pertussis (wP) vaccines containing killed whole Bordetella pertussis bacteria, effective but associated with more frequent local reactions like swelling and fever, and acellular pertussis (aP) vaccines containing purified bacterial components, causing fewer side effects but possibly providing shorter-lasting immunity.
Both vaccines are typically combined with diphtheria and tetanus vaccines as DTP (diphtheria-tetanus-pertussis). WHO recommends three primary doses in infancy (typically at 2, 4, and 6 months or 6, 10, and 14 weeks depending on national schedules), booster doses in early childhood and adolescence to maintain immunity, and vaccination during pregnancy (ideally 27-36 weeks gestation) to protect newborns during their most vulnerable first months through transferred maternal antibodies.
Maternal vaccination during pregnancy represents a critical strategy. Pregnant women vaccinated during pregnancy produce antibodies that cross the placenta to the fetus, providing protection during the newborn’s first months before infant vaccination series is complete. Studies show maternal vaccination reduces infant pertussis by approximately 90% during the first two months of life when babies are most vulnerable.
Vaccine effectiveness is substantial—primary series prevents approximately 80-85% of cases, though protection wanes over time, requiring boosters. Even when vaccinated individuals contract pertussis, disease is usually milder with fewer complications. Like nutrition interventions preventing malnutrition, pertussis vaccination prevents the vast majority of serious disease and death.
Challenges in Pertussis Control
Despite effective vaccines, several challenges hinder pertussis elimination. Waning immunity means protection from childhood vaccination decreases over time, leaving adolescents and adults susceptible. While they usually experience milder disease, they can transmit infection to vulnerable infants. This has led to increased pertussis in adolescents and adults in recent decades.
Delayed primary vaccination leaves infants vulnerable during early months. Gaps in maternal vaccination coverage mean many babies aren’t protected by maternal antibodies. Vaccine hesitancy in some communities creates clusters of unvaccinated individuals where pertussis spreads rapidly. Incomplete vaccination series (missing doses) reduces protection.
Diagnostic challenges include pertussis symptoms resembling common respiratory infections, making diagnosis difficult without laboratory testing, particularly in vaccinated individuals with milder disease. Limited laboratory capacity in many countries prevents confirmation of suspected cases. Antibiotic resistance hasn’t been a major problem yet, but surveillance continues.
Outbreak occurrence even in highly vaccinated populations due to waning immunity, timing of vaccination leaving young infants vulnerable, and the bacteria’s ability to spread before people know they’re infected all pose ongoing challenges.
Treatment and Management
Antibiotics, particularly azithromycin, erythromycin, or clarithromycin, can kill Bordetella pertussis bacteria. Treatment is most effective when started during the catarrhal stage (first 1-2 weeks) before severe coughing begins, reducing symptom severity and contagiousness. However, antibiotics started during the paroxysmal stage (established coughing) have little effect on symptoms’ severity or duration, though they reduce contagiousness, preventing transmission to others.
Supportive care for severe cases includes hospitalization for young infants and severe cases, oxygen therapy for babies experiencing breathing difficulties or turning blue, intravenous fluids if vomiting prevents adequate oral intake, monitoring for complications like apnea, pneumonia, or seizures, and gentle suctioning to clear thick mucus from airways.
Cough medications generally don’t help and aren’t recommended, particularly for infants. Rest, fluids, and small, frequent meals minimize vomiting from coughing fits. Prevention of transmission involves isolating infected individuals, particularly from infants and pregnant women, treating household contacts with antibiotics even if asymptomatic to prevent spread, and keeping infected children home from school/childcare for at least five days after starting antibiotics or three weeks if not treated.
Like palliative care focusing on symptom relief, pertussis management in the paroxysmal stage primarily supports patients through the illness since antibiotics won’t shorten the cough.
Amara’s Outcome and Lessons
Amara survived her pertussis infection after three weeks of hospitalization. “Those weeks were terrifying,” Grace recalled. “Watching your baby struggle to breathe, turn blue, and gasp for air is every mother’s nightmare. I didn’t know I should be vaccinated during pregnancy to protect her. I didn’t know my older children needed booster vaccines to prevent spreading diseases to their baby sister.”
Following Amara’s illness, Grace ensured all her children received catch-up vaccinations. She advocated in her community for maternal and childhood vaccination. “Amara was lucky—she survived,” Grace emphasized. “But I’ve met mothers whose babies died from whooping cough. These deaths are preventable through vaccination. Every pregnant woman should receive pertussis vaccine. Every infant should complete vaccination on schedule. Every child and adult should receive boosters. These vaccines save lives.”
Dr. Okello stresses systematic approaches: “Individual cases like Amara represent global failures to protect vulnerable infants through vaccination. We need strong immunization programs ensuring maternal vaccination during pregnancy, timely infant vaccination series, booster doses for children and adolescents, catch-up vaccination for under-vaccinated populations, and sufficient vaccine supply, cold chain, and trained health workers. We need education so families understand vaccination importance, healthcare worker training to recognize and treat pertussis early, surveillance systems detecting outbreaks rapidly, and outbreak response protocols containing spread. Pertussis is vaccine-preventable. Every death represents a failure to deliver vaccines effectively. By strengthening immunization programs, ensuring universal access to vaccines, educating communities, and prioritizing protection of vulnerable infants, we can eliminate pertussis as a major cause of infant death. Every baby deserves protection from preventable diseases. Achieving this demands sustained commitment, adequate resources, and recognition that vaccination is one of public health’s greatest achievements and most important ongoing priorities.”
Frequently Asked Questions (FAQs)
The characteristic “whoop” sound occurs during the paroxysmal stage when patients experience rapid, violent coughing fits without breathing between coughs. After prolonged coughing expelling air from lungs, patients desperately gasp to inhale. This forceful inhalation against inflamed, narrowed airways creates the high-pitched “whooping” sound. However, not everyone with pertussis makes this sound—young infants often don’t “whoop” at all. Instead, they may stop breathing entirely (apnea) during or after coughing fits, turn blue from oxygen deprivation, or have weak coughs. Adults and vaccinated individuals often have milder symptoms without the classic “whoop.” The presence or absence of whooping doesn’t determine disease severity—infants can have life-threatening pertussis without ever whooping.
Yes, vaccinated people can contract pertussis because: (1) Vaccine immunity wanes over time—protection decreases years after vaccination, particularly after childhood doses; (2) Vaccines don’t provide 100% protection—they prevent approximately 80-85% of cases; (3) Even when vaccinated people get pertussis, disease is usually much milder with fewer complications and lower death risk than unvaccinated individuals. This waning immunity is why booster doses are recommended for adolescents and why maternal vaccination during each pregnancy is crucial—it protects newborns during vulnerable first months. Despite breakthrough infections occurring, vaccination remains highly effective at preventing severe disease, hospitalization, and death. Vaccinated populations have dramatically lower pertussis burden than unvaccinated populations.
Young infants, particularly those under six months, face highest pertussis risks because: (1) Immature immune systems can’t fight infection effectively; (2) Small airways become blocked more easily by mucus and inflammation; (3) Weak respiratory muscles can’t clear secretions effectively; (4) Coughing fits cause apnea (stopping breathing) more frequently than in older children/adults; (5) Oxygen deprivation from apnea can cause brain damage or death; (6) Pneumonia develops more frequently; (7) They’re too young to be fully vaccinated—primary series isn’t complete until 6 months; (8) Small size means complications develop rapidly; (9) They can’t communicate distress verbally. Approximately half of infants under one year with pertussis require hospitalization, and about 1% of hospitalized infants die despite treatment. This vulnerability is why protecting infants through maternal vaccination and community immunity is critical.
Yes, absolutely. Pertussis vaccination during pregnancy (ideally between 27-36 weeks gestation) is strongly recommended because: (1) Pregnant women produce antibodies that cross placenta to fetus; (2) These maternal antibodies protect newborns during first 2-3 months before infant vaccination series provides protection; (3) Maternal vaccination reduces infant pertussis by approximately 90% during first two months of life when babies are most vulnerable; (4) The vaccine is safe during pregnancy with no increased risks of complications; (5) Protection requires vaccination during each pregnancy—immunity doesn’t carry over from previous pregnancies; (6) This strategy has proven highly effective where implemented. Maternal vaccination represents the most effective way to protect young infants during their most vulnerable period, preventing most severe disease and deaths.
Pertussis spreads through respiratory droplets when infected people cough, sneeze, talk, or breathe near others. Prevention strategies include: (1) Vaccination—primary prevention for individuals and community immunity protecting vulnerable infants; (2) Maternal vaccination protecting newborns; (3) Isolation—keeping infected people away from others, especially infants, for at least 5 days after starting antibiotics or 3 weeks if untreated; (4) Antibiotic prophylaxis—treating close contacts of pertussis patients with antibiotics even if asymptomatic to prevent infection and transmission; (5) Infection control—healthcare facilities using appropriate precautions for suspected pertussis patients; (6) Staying home—sick individuals avoiding school, work, childcare until non-contagious; (7) Hand hygiene—though less critical than for some diseases since pertussis primarily spreads through respiratory droplets; (8) Respiratory etiquette—covering coughs/sneezes. Vaccination remains the most effective prevention strategy.
References
- World Health Organization. (2024). Pertussis. Retrieved from https://www.who.int/health-topics/pertussis
- World Health Organization. (2024). Pertussis – Fact Sheet. Retrieved from https://www.who.int/news-room/fact-sheets/detail/pertussis
- World Health Organization. (2024). Immunization, Vaccines and Biologicals – Pertussis. Retrieved from https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/pertussis
- Observer Voice. Measles: The Highly Contagious Disease We Can Prevent. Retrieved from https://observervoice.com/measles-vaccine-prevention-symptoms/
- Observer Voice. Newborn Health: Protecting Babies in Their First 28 Days. Retrieved from https://observervoice.com/newborn-health-protecting-babies-first-28-days/
Disclaimer: This article is an adaptation of publicly available information from WHO’s Pertussis
health topic page (WHO, Geneva. Licence: CC BYNC-SA 3.0 IGO). WHO is not responsible for the
content or accuracy of this adaptation. This content is for informational and educational purposes
only and does not constitute medical advice. ObserverVoice.com is a news and information platform
— not a healthcare provider.
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