Visit the NSW Health whooping cough (pertussis) fact sheet for information and advice on symptoms, treatment and ways to protect your family.
Pertussis (whooping cough), is an acute infectious disease caused by the bacterium Bordetella pertussis. Pertussis is transmitted via respiratory droplets.
Pertussis is a bacterial respiratory infection that causes a prolonged coughing illness. Clinical manifestations of pertussis vary by age.
Unvaccinated children can have a characteristic paroxysmal cough with a ‘whoop’ when breathing in. This is less common in people who have been vaccinated. In very young infants, the cough may be minimal or absent, and the only symptoms may be apnoea or cyanosis.
Pertussis symptoms usually present within 5 to 10 days after exposure, but sometimes take up to 21 days to present.
Please refer to the NSW Health pertussis control guideline for more information on clinical presentation.
Pertussis infection is diagnosed with a polymerase chain reaction (PCR) test. The optimal diagnostic sample is a nasopharyngeal swab.
Bordetella pertussis is included in some respiratory multiplex PCR panels. Check with your pathology provider.
To best care for a patient with suspected pertussis, and to reduce transmission within the community:
Patients should stay home:
Infectious patients should not attend childcare, aged care, school or work:
Notify your local public health unit by calling 1300 066 055 once the diagnosis of pertussis is suspected in patients who attend childcare or school settings.
See the NSW Health pertussis control guidelines for high priority case cohorts.
Babies and young infants are at greatest risk of complications and sudden death from pertussis. Pertussis related deaths are almost always in babies under two months of age.
If you suspect pertussis in neonates urgently refer for specialist assessment.
Infants under six months of age should be monitored frequently and referred to hospital early if they have any concerning symptoms. They may require hospitalisation to monitor the severity of respiratory compromise, and to prevent or treat complications.
See the NSW Health pertussis control guideline for further information on the management of cases and their contacts or call your public health unit.
Treatment is the responsibility of the attending doctor. For recommended treatment see the latest edition of Therapeutic Guidelines .
Note: Antibiotic therapy is not indicated 21 days or more after cough onset. After this time patients are no longer infectious and antibiotics don’t change the clinical course of the disease. For further detail, see Section 9: case treatment in the NSW Health pertussis control guideline.
Macrolides are compatible with breastfeeding. However, infants treated with macrolides may have loose bowel motions. Trimethoprim and sulfamethoxazole should be avoided in breastfeeding if neonate is preterm, unwell or has hyperbilirubinaemia.
Azithromycin is the preferred agent in infants younger than one month of age. Macrolides may be associated with infantile hypertrophic pyloric stenosis in this age group. It is recommended that administration of antibiotics to neonates is done in consultation with specialist infectious diseases, neonatal or paediatric services and may require a risk-benefit assessment.
See your HealthPathways or refer to the Therapeutic Guidelines (eTG) for the latest advice.
When treating a case of pertussis it's important to consider other people who may be at risk of developing the infection.
These people may need information about pertussis and a subset may need antibiotic prophylaxis.
For people identified as contacts of a pertussis case:
Regimens for antibiotic prophylaxis are the same as for treatment of cases.
Asymptomatic contacts do not need testing unless they develop symptoms.
Pregnant contacts who are in their last trimester may need referral to their general practitioner or obstetrician if not recently vaccinated for pertussis.
Public health unit staff can help to identify high risk contacts and provide advice on how they should be managed. Contact your local public health unit by calling 1300 066 055.
Please see the NSW Health pertussis control guideline for further information on contact management, including the definition of high-risk contacts.
Vaccination is the best intervention to prevent pertussis.
Pertussis vaccines that contain 3 or more pertussis antigens have a vaccine efficacy:
However, immunity wanes over time. This means that even fully immunised people can develop pertussis (although they often have less severe illness).
Pertussis antigens are included in combination vaccines that also protect against diphtheria, tetanus, hepatitis B, polio and Haemophilus influenzae type b.
Pregnant women - Offer all pregnant women diphtheria-tetanus-pertussis vaccine between 20 and 32 weeks gestation in each pregnancy to provide the infant with passive immunity at birth.
Pertussis-containing vaccines can be co-administered to pregnant women with the RSV vaccine Abrysvo.
Babies and children - Vaccinate infants on time at 6-8 weeks, 4 months, 6 months and 18 months of age. Provide children age 4 years with a vaccine.
Adolescents - Provide adolescents a pertussis booster between the ages of 11 to 13 through the NSW School Vaccination Program.
A booster is recommended for:
For further information on pertussis vaccination see:
Bordetella parapertussis and Bordetella holmesii can cause symptoms similar to pertussis but usually milder.
There is limited data on the effectiveness of antibiotic treatment for B.parapertussis and B.holmesii. Treatment should be based on clinical judgement, with consideration of treatment for people at higher risk of severe disease, including infants aged less than 6 months, the elderly and severely immunocompromised people.
The pertussis vaccine does not protect against B.parapertussis or B.holmesii. There is no evidence to support the use of antibiotic prophylaxis for contacts of people with B.parapertussis and B.holmesii. However, antibiotic prophylaxis may be considered for close contacts at higher risk of severe disease.
Children with B.parapertussis and B.holmesii should be kept at home from childcare or school until their symptoms have resolved.
Notification of people with B.parapertussis and B.holmesii to public health units is not required.
