Whooping cough (pertussis)
Pertussis, whooping cough, is a highly contagious infectious disease of the respiratory tract. It is notifiable in Austria and is caused by the bacterium Bordetella pertussis. It is possible to contract the disease several times despite having been infected and immunised, as the protective effect of the antibodies formed does not last long. Infants and young children are particularly affected by severe cases. Most deaths occur in the first year of life (approx. 1 % of those affected).
There are three stages in the initial infection of unvaccinated people:
- the catarrhal stage is characterised by cold-like symptoms such as a runny nose and cough, rarely also a slight fever (lasting between 1-2 weeks)
- the convulsive stage, which can last 4-6 weeks, is characterised by coughing attacks. During these barking, paroxysmal and spasmodic coughing attacks, the patient may choke up thick mucus and subsequently vomit
- During the decrementi stage, the coughing fits subside (lasting 6-10 weeks)
In vaccinated persons, pertussis can often manifest itself as a long-lasting cough, but without the classic accompanying symptoms mentioned above. In unvaccinated infants under 6 months of age, pneumonia and even respiratory arrest can occur.
The best prevention against whooping cough is immunisation. It is included in the free childhood vaccination programme and must be boostered at school age. After this basic immunisation, the vaccination must also be regularly boostered in adulthood. The pertussis vaccination is recommended for everyone.
In order to protect infants in the first months of life, pregnant women in the third trimester in particular are recommended to be vaccinated (Ministry of Health: "Faktencheck: Keuchhusten. Impffen schützt!").
Situation in Austria
Pertussis cases rose steadily in Austria before the COVID-19 pandemic. There was an increase in complications in adults and long-term courses. While 579 cases were reported nationwide in 2015, there were already 2,233 cases in 2019. The low figures in previous years are due to the effects of the pandemic and the measures taken.
Typical whooping cough symptoms are often present in infants and young children, whereas they are often absent in adults, older children and adolescents. In any case, laboratory diagnostics should be carried out to confirm the diagnosis. Within the first few weeks after the onset of coughing, detection of the bacterium in a nasopharyngeal swab using a PCR test and, if necessary, cultural cultivation is recommended. Serodiagnostics can be carried out later in the course of the disease.
Pertussis can lead to complications such as pneumonia, middle ear infections, loss of appetite, dehydration, seizures, neurological disorders, hernias, rib fractures, rectal prolapse and respiratory arrest. Severe cases can lead to death. Deaths occur most frequently in infants who die from pneumonia or lack of oxygen to the brain.
Pertussis can occur at any age. The number of adults and adolescents diagnosed with whooping cough is increasing. The age groups with the most pertussis diagnoses are currently infants under one year of age and adolescents between 10 and 20 years of age. All persons who have not been immunised or fully immunised against Bordetella pertussis are at risk, regardless of their age. A clinical picture similar to whooping cough can also be caused by the related pathogens Bordetella parapertussis and B. holmesii.
Choice of therapy
In addition to symptomatic therapy, macrolide antibiotics such as erythromycin, azithromycin and clarithromycin are primarily used to treat pertussis.
- Detection of Bordetella pertussis using PCR: the ECDC has specific recommendations for carrying out PCR diagnostics for pertussis (Guidance and protocol Pertussis). A deep nasopharyngeal swab should preferably be taken.
- Detection of Bordetella pertussis by culture: it is recommended to culture the pathogen in addition to PCR diagnostics, as this is the only way to carry out molecular biological characterisation and antibiotic resistance testing. A deep nasopharyngeal swab should preferably be taken.
- Serodiagnostics: this is useful between the 2nd and 8th week after the onset of coughing attacks. The recommended method for serological diagnostics is to perform an enzyme-linked immunosorbent assay (ELISA) to detect IgG antibodies against pertussis toxin.
In Austria, the reference centre for pertussis is located at the Institute for Specific Prophylaxis and Tropical Medicine at the Medical University of Vienna.
Institute for Specific Prophylaxis and Tropical Medicine
Medical University of Vienna
Tel: +43 1 40160 / 38295
Fax: +43 1 40160 / 938280
Last updated: 09.01.2024