Pertussis (whooping cough)BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l401 (Published 22 February 2019) Cite this as: BMJ 2019;364:l401
- Dipesh P Gopal, academic clinical fellow1,
- John Barber, National Medical Director’s clinical fellow2,
- Daniel Toeg, general practitioner3
- 1Centre for Primary Care and Public Health, Barts and The London School of Medicine & Dentistry, London E1 2AB, UK
- 2Research Department of Primary Care and Population Health, University College London Medical School (Royal Free Campus), London NW3 2PF, UK
- 3Caversham Group Practice, London NW5 2UP, UK
- Correspondence to: D P Gopal
What you need to know
Suspect pertussis in patients with 2 weeks of cough and coughing paroxysms, post-tussive vomiting, inspiratory whooping, no fever, or exposure to a person with confirmed pertussis
Immunisation is no guarantee of protection as vaccine efficacy decreases with time
Antibiotics within the first 21 days of illness can prevent transmission, but cough is likely to last up to three months and there are no recommended treatments for it
Consider admission if patient is clinically unwell or less than 6 months old, when mortality is higher
Report suspected and confirmed cases of pertussis to local public health agencies to initiate infection control measures
Offer pertussis vaccination to pregnant women in the second or third trimesters of pregnancy as it can provide passive immunity to neonates and young infants
Pertussis, also known as whooping cough, is caused by the Gram negative bacterium Bordetella pertussis.1 It is transmitted via airborne droplets and is highly infectious.2 Diagnosis is often delayed or missed,3 as pertussis mimics the presentation of a viral upper respiratory tract infection and can sometimes present atypically.2 In this article, we review the management of pertussis and present recent evidence and guidance on prevention through vaccination.
Sources and selection criteria
We performed a Medline search from January 2007 to December 2018 using the search terms ‘whooping cough’ and ‘pertussis.’ We included journal papers that we encountered from references of the papers from the initial search. We performed a similar search in the Cochrane database. We consulted the Public Health England website and the Centers for Disease Control and Prevention for guidelines on pertussis. We have referred to recent systematic reviews, meta-analyses and literature reviews in writing this manuscript but have cited individual clinical studies where there is no higher quality of evidence.
How common is it?
Pertussis affects nearly 24 million children under the age of …