GPAtlas🧭 When to suspect
Suspect whooping cough (pertussis) in anyone with an acute cough lasting 14 days or more, without another apparent cause, plus one or more of: paroxysms (intense, uncontrollable coughing bouts), an inspiratory “whoop”, post-tussive vomiting, or undiagnosed apnoea in a young infant. Also suspect it in a person with compatible features who has been in contact with a confirmed case in the previous 21 days, or who attends a school or workplace in a known outbreak.
The presentation shifts with age and immunity. Young infants may never develop the classic whoop – coughing spasms can be followed by apnoea or cyanosis, and the first sign may be colour change or poor feeding rather than cough. In older children and adults, pertussis often presents as a persistent, episodic cough without the textbook features, so it belongs on the differential for any prolonged cough. Prior infection or vaccination produces only partial, waning immunity, so a milder illness does not exclude the diagnosis. Whooping cough is a notifiable disease.
This matters more than it did a few years ago. After historically low activity during the pandemic, cases rose from summer 2023 and sharply from December 2023, with the first quarter of 2024 exceeding 2012 levels and eleven infant deaths across 2024 – driven by falling vaccine coverage (both childhood and maternal) and waning population immunity, against a background of cyclical epidemics every 3–5 years.
| Stage | Features and duration |
|---|---|
| Catarrhal | Coryza, mild fever, sore throat, mild dry cough – indistinguishable from a common cold. Lasts 1–2 weeks and is the most infectious phase. |
| Paroxysmal | Bouts of intense coughing, often with an inspiratory whoop and post-tussive vomiting; worse at night; child typically well between bouts. Infants may show apnoea or cyanosis. Lasts 2–8 weeks. |
| Convalescent | Gradual decline over weeks to months – the “100-day cough”; paroxysms may briefly recur with later respiratory infections. |
Source: UKHSA · Green Book Chapter 24
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