Paeds · infectious-diseases
Pertussis
Also known as Whooping cough · Bordetella pertussis infection · 100-day cough · Pertussis (infant apnoea presentation) · Cough illness due to Bordetella pertussis
Fellowship topic on pertussis (whooping cough) in children: the Bordetella pertussis organism and its toxin-mediated, ciliary-paralysing pathophysiology; the classic catarrhal-paroxysmal-convalescent course in older children and the atypical, life-threatening infant presentation dominated by apnoea; the differential of prolonged cough and of infant apnoea; PCR and serology interpreted by age and duration; stepwise management from PICU support of the young infant through macrolide treatment, isolation, exclusion, notification and contact chemoprophylaxis; the complications (pneumonia, seizures, encephalopathy, apnoea); the DTaP/Tdap, maternal-Tdap and cocoon prevention strategy; waning acellular-vaccine immunity and the resurgence problem; special populations (infants, pregnant women, unvaccinated communities, immunocompromised, Indigenous, rural and refugee children); and ANZ/UK/US/Canada guidance.
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Target exams
Red flags
- An infant under six months with apnoea, cyanosis, choking or an acute life-threatening event — the whoop may be absent and this presentation can kill; admit and monitor
- Pneumonia complicating pertussis — the commonest severe complication and a leading cause of death, especially in young infants
- Seizures, encephalopathy or marked lethargy after paroxysms — suggests hypoxic brain injury and mandates urgent assessment
- Exhaustion, dehydration or weight loss from post-tussive vomiting and poor feeding — the infant is tiring and needs supportive admission
- A partially or unvaccinated infant with a household cough contact — very high risk; do not wait for the classic course
Life stages
Care settings
Clinical exam formats
Board mappings
- General Paediatrics and Infectious Diseases: pertussis — clinical course, infant presentation, diagnosis and treatment
- Immunisation: the DTaP/Tdap schedule and the maternal-vaccination programme
- Renewed curriculum — Infectious diseases: pertussis recognition, public-health management, chemoprophylaxis and notification
- Community and population child health: vaccine strategy, resurgence drivers and outbreak response
- General Paediatrics: pertussis — diagnosis and management of the coughing child and the apnoeic infant
- Public health: notification, isolation, exclusion and contact prophylaxis
- Long Case / Structured discussion: the apnoeic or coughing infant — diagnosis, management, complications and prevention
- Communication station: explaining pertussis, isolation, prophylaxis and the immunisation strategy to a family
- Level 2 / 3 — Infection: pertussis as a vaccine-preventable respiratory infection; diagnosis, treatment and public-health responsibilities
- Public health and immunisation: the DTaP/Tdap and maternal-vaccination programme; notification and outbreak response
- Foundation of Practice (FOP): pertussis clinical course, complications and infant presentation
- Applied Knowledge in Practice (AKP): diagnosis, macrolide treatment, prophylaxis and immunisation strategy
- History-taking and management: the child with prolonged cough or the infant with apnoea
- Communication: explaining pertussis, isolation, prophylaxis and vaccination to a family
- General Pediatrics Content Outline — pertussis: diagnosis, treatment, complications and prevention
- Infectious Diseases: Bordetella pertussis, PCR/serology, macrolide treatment and chemoprophylaxis
- Bright Futures / immunisation: DTaP/Tdap schedule and maternal Tdap
- Patient Care: diagnosis and stepwise management of pertussis across age groups
- Systems-Based Practice and Population Health: notification, isolation, contact prophylaxis and the immunisation programme
- Medical Knowledge: pertussis pathophysiology, complications and vaccine strategy
- Medical Expert: pertussis diagnosis, treatment and complications
- Health Advocate and Collaborator: immunisation, maternal Tdap, notification and public-health coordination
- Communicator: explaining pertussis, isolation and prevention to families
Two faces of the same organism
Older child / adult
Young infant (<6 months)
Catarrahal (1–2 weeks, looks viral, most contagious) → Paroxysmal (2–8 weeks, the whoop and post-tussive vomiting) → Convalescent (weeks to months, the fading "hundred-day cough"). The trap: a young infant may skip straight to apnoea with no whoop at all, so a household cough contact plus apnoea is pertussis until proven otherwise. [1] [3]
Overview & Definition
Picture a four-month-old brought to the emergency department after a coughing turn at home in which the mother thought the baby had stopped breathing. The baby is now pink and feeding, but the mother has had a chronic cough for three weeks. There is no whoop here, no classic paroxysm to anchor the diagnosis — yet this is exactly how infant pertussis presents, and it is exactly the presentation that kills. Recognising it early turns a preventable death into a survivable illness. [8] [1]
Pertussis, or whooping cough, is an acute infection of the respiratory tract caused by the Gram-negative coccobacillus Bordetella pertussis, spread by respiratory droplets. In an older immunised child it produces the familiar paroxysmal cough with an inspiratory whoop; in a young infant it may produce nothing more than apnoea. The disease is vaccine-preventable, yet it remains endemic worldwide because immunity — whether from vaccination or from natural infection — wanes over time. [1] [3]
The clinician's job has two halves. The acute half is to recognise the sick infant, support breathing, start a macrolide, and prevent spread through isolation, notification and contact prophylaxis. The preventive half is to deliver the immunisation programme — maternal Tdap in every pregnancy, the childhood DTaP series, the adolescent booster, and cocooning of household contacts — because the infant who never reaches the hospital is infant programme has protected. [8] [1]
References10ShowHide
- [1]WHO Pertussis vaccines: WHO position paper, August 2015--Recommendations. Vaccine, 2016.PMID 26562318
- [2]Ward JI; Cherry JD; Chang SJ; Partridge S; et al Efficacy of an acellular pertussis vaccine among adolescents and adults. N Engl J Med, 2005.PMID 16221778
- [3]Tan T; Halperin S; Cherry JD; Edwards K; et al Pertussis immunization in the global pertussis initiative North American region: recommended strategies and implementation considerations. Pediatr Infect Dis J, 2005.PMID 15876933
- [4]Altunaiji S; Kukuruzovic R; Curtis N; Massie J Antibiotics for whooping cough (pertussis). Cochrane Database Syst Rev, 2007.PMID 17636756
- [5]Glanz JM; McClure DL; Magid DJ; Daley MF; et al Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children. Pediatrics, 2009.PMID 19482753
- [6]Warfel JM; Zimmerman LI; Merkel TJ Comparison of Three Whole-Cell Pertussis Vaccines in the Baboon Model of Pertussis. Clin Vaccine Immunol, 2016.PMID 26561389
- [7]Zimmerman LI; Papin JF; Warfel J; Wolf RF; et al Histopathology of Bordetella pertussis in the Baboon Model. Infect Immun, 2018.PMID 30126900
- [8]Skoff TH; Deng L; Bozio CH; Hariri S US Infant Pertussis Incidence Trends Before and After Implementation of the Maternal Tetanus, Diphtheria, and Pertussis Vaccine. JAMA Pediatr, 2023.PMID 36745442
- [9]Havers FP; Skoff TH; Rench MA; Epperson M; et al Maternal Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccination During Pregnancy: Impact on Infant Anti-Pertussis Antibody Concentrations by Maternal Pertussis Priming Series. Clin Infect Dis, 2023.PMID 35642525
- [10]Alvarez J; Godoy P; Plans-Rubio P; Camps N; et al Azithromycin to Prevent Pertussis in Household Contacts, Catalonia and Navarre, Spain, 2012-2013. Emerg Infect Dis, 2020.PMID 33079034