History and exam
Key diagnostic factors
common
cough
Seen in almost all patients, beginning at 1-2 weeks after infection; may persist for weeks to months.[10] CDC: pertussis (whooping cough) Opens in new window
Some infants have atypical disease and initially have apnoeic spells with only minimal cough or other respiratory symptoms.
inspiratory whooping
Patients may report paroxysmal coughing ending in a high-pitched inspiratory whoop, typically beginning in the second week of illness and persisting for 1-6 weeks. Frequently absent in adolescents and adults.[10] CDC: pertussis (whooping cough) Opens in new window
coryza
Rhinorrhoea, sneezing, a non-specific mild cough, and low-grade fever may be present in the early (catarrhal) stage of disease (1-2 weeks after infection).[10]
post-tussive vomiting
Paroxysms of coughing may end with gagging or emesis. Most common in children.
Other diagnostic factors
Risk factors
strong
unvaccinated or under-vaccinated status
Unvaccinated or under-vaccinated people have an increased risk of contracting pertussis and of severe disease.[11] Natural infection and immunisation, however, do not provide long-term immunity. One model suggests that, in children and adolescents, the initial protective efficacy of 85% to 90% for Tdap vaccine falls by approximately 10% per year.[13] In another study, overall vaccine efficacy in adolescents who received acellular pertussis vaccines fell from 64% to 34% 2-4 years after vaccination.[14] Waning immunity is primarily responsible for the persistence of pertussis in school-aged children and older individuals.[10]
close contact with an infected person, especially in the household
Humans are the only host of Bordetella pertussis.[2][10] Transmission occurs primarily via large respiratory droplets generated by coughing or sneezing, mostly in the catarrhal stage of the illness, and can also occur through airborne particles.[1] Up to 80% of close contacts of infected individuals may develop pertussis. Studies suggest that immediate household contacts are primarily responsible for the transmission of infection to infants.[15][16]
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