The name whooping cough might conjure up images of Victorian England, but the disease has become increasingly common over the past decade and the latest data from the UK Health Security Agency (UKHSA) has revealed that it appears to be on the rise this winter.
Between July and the end of November 2023, there were 1,141 suspected cases of whooping cough in England and Wales, as reported by clinicians, nearly 700 more than the equivalent timeframes in 2021 and 2022.
So what is going on? A UKHSA spokesperson told the Telegraph that spikes in rates of the illness, which is caused by either Bordetella pertussis or Bordetella parapertussis bacteria, typically happen every three or four years.
But rather than 2023 being a particularly virulent whooping cough season, experts such as Paul Hunter, a professor of medicine at the University of East Anglia, believe that the current rates being observed this winter are similar to those being observed in 2019. He says that cases dipped between 2020 and 2022 as a direct consequence of lockdown measures and social restrictions.
“Far from being an epidemic of whooping cough, what we are seeing is a return to pre pandemic levels,” he says.
Instead, experts are more concerned about the fact that whooping cough seems to be far more common now, than it was during the 2000s when annual rates were typically in the hundreds rather than thousands.
What is whooping cough?
The name is given to a bacterial chest infection which can last for up to 100 days. “It’s highly contagious and it’s spread via respiratory droplets,” says Dr Safia Debar, executive health GP at Mayo Clinic Healthcare in London.
The illness progresses through three stages, the first being largely similar to a common cold with symptoms such as a runny nose, sore eyes and sneezing. After two weeks, infected individuals begin to develop bouts of intense coughing which can last for several minutes, sometimes followed by an audible whoop or gasp for breath between coughs. Young children may turn blue or grey due to difficulty breathing while adults might become red in the face.
Sufferers can then be left with a chronic cough which remains for several weeks.
Debar recommends that anyone with a persistent cough which has lasted for more than two weeks, should see a doctor.
“Particularly if you also have symptoms like lethargy and fever, or you’ve been in contact with somebody with whooping cough, then definitely seek medical attention,” she says. “Without treatment, people are infectious for three weeks, but with antibiotics, you’re not infectious after five days.”
How serious is whooping cough?
The illness is most dangerous to newborn babies and infants. Most children under six months require hospitalisation after contracting whooping cough due to the risks of brain swelling and convulsions, and 1-3% of those under three months die from the illness.
“Babies are vulnerable because their immune systems haven’t fully developed,” explains Dr Dipender Gill, a medical doctor and researcher at Imperial College London. “It’s quite prevalent in school-aged children as well, so those who are 11 to 18 years old.”
In teenagers and adults, serious cases of whooping cough can lead to pneumonia, fainting and even rib fractures due to the intensity of the coughing fits. However, Gill says it tends to be the elderly and those with compromised immune systems who are most vulnerable.
“The whole population is susceptible to getting the infection,” says Gill. “But I think it can lead to particularly severe symptoms in elderly people, because as you age, your immune system becomes more impaired or if your immune system was impaired for other reasons such as cancer treatment or transplantation and immunosuppressive therapy.”
How can you protect yourself and others?
Because whooping cough is so infectious, Debar recommends self-isolating if your doctor suspects that you have the illness, at least for the five-day period while antibiotic treatment kicks in.
However, the most effective preventable measure is to get vaccinated. Babies at eight, 12 and 16 weeks old are eligible for an immunisation to whooping cough on the NHS along with other vaccines. An additional booster shot can be given when the child is three.
Experts are particularly keen to raise awareness that the whooping cough vaccine is now recommended for pregnant women. “Newborns and babies in the first few months of life are more likely to get severe disease, [and] this is almost entirely preventable if the mother is vaccinated in pregnancy and her protective antibodies can then reach the baby through the placenta, and protect [it] until the baby gets its own vaccines,” says Beate Kampmann, professor of paediatric infection & immunity at the London School of Hygiene and Tropical Medicine.
Kampmann recommends checking your own vaccine records in case you missed receiving this jab. It is also possible for concerned older individuals to receive a booster vaccine for whooping cough.
How is it treated?
Debar says that doctors will typically do a throat swab to see whether someone is infected with the Bordetella pertussis bacterium and if so, prescribe antibiotics.
“Antibiotics are given on a case by case basis,” she says. “After the first three weeks, the infection tends to wane and sometimes if you’re just left with the chronic cough, it could be that you do not need antibiotics.”
She says that once any fever has passed, it’s not necessary to remain in bed the whole time, and instead there are certain remedies which can be taken to try and alleviate the coughing.
“You want to strengthen your immune system,” says Debar. “Some people will use cough remedies, we find that they don’t really work. But things like saline sprays can sometimes provide symptomatic relief. I love natural remedies, so ginger, turmeric, all things to strengthen immunity. The coughing can be worse at night so you want the environment around you to be as moist as possible. So, use a humidifier, make sure the temperature is appropriate, and make sure you’re well hydrated. Maybe try an extra pillow if that helps.”
Why is whooping cough more common now?
Experts say that effective vaccinations have driven down annual rates of whooping cough from an illness, which impacted tens of thousands of individuals in the 1980s, to relatively low numbers now.
However, rates have still steadily increased since 2010, and some believe this may reflect increasing vaccine hesitancy.
“It could reflect a relative decline in vaccination specifically for whooping cough,” says Gill. “There’s been similar patterns with other previously well-controlled diseases for which vaccines are available, entirely related to the decline in vaccination rates.”
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