Whooping cough

File:Whooping cough boy.ogv

The classic symptoms of pertussis are a paroxysmal cough, inspiratory whoop, and fainting, or vomiting after coughing.{{cite journal | vauthors = Cornia PB, Hersh AL, Lipsky BA, Newman TB, Gonzales R | title = Does this coughing adolescent or adult patient have pertussis? | journal = JAMA | volume = 304 | issue = 8 | pages = 890–6 | date = August 2010 | pmid = 20736473 | doi = 10.1001/jama.2010.1181 | s2cid = 14430946 }} The cough from pertussis has been documented to cause subconjunctival hemorrhages, rib fractures, urinary incontinence, hernias, and vertebral artery dissection. Violent coughing can cause the pleura to rupture, leading to a pneumothorax. Vomiting after a coughing spell or an inspiratory whooping sound on coughing almost doubles the likelihood that the illness is pertussis. The absence of a paroxysmal cough or posttussive emesis makes it almost half as likely.

The illness usually starts with mild respiratory symptoms including mild coughing, sneezing, or a runny nose (known as the catarrhal stage). After one or two weeks, the coughing classically develops into uncontrollable fits, sometimes followed by a high-pitched "whoop" sound, as the person tries to inhale. About 50% of children and adults "whoop" at some point in diagnosed pertussis cases during the paroxysmal stage. This stage usually lasts up to 3 months, or sometimes longer. A gradual transition then occurs to the convalescent stage, which usually lasts one to four weeks. A decrease in paroxysms of coughing marks this stage, although paroxysms may occur with subsequent respiratory infection for many months after the onset of pertussis.{{Cite web | url=https://www.cdc.gov/vaccines/pubs/pinkbook/pert.html |title = Pink book | Pertussis | Epidemiology of Vaccine-Preventable Diseases | CDC|date = 2 March 2019}}

Symptoms of pertussis can be variable, especially between immunized and non-immunized people. Immunized people can present with a milder infection; they may only have the paroxysmal cough for a couple of weeks and may lack the "whooping" characteristic.{{Cite journal|last1=Nguyen|first1=Van Tuong Ngoc|last2=Simon|first2=Lauren|date=1 September 2018|title=Pertussis: The Whooping Cough|journal=Primary Care: Clinics in Office Practice|series=Infectious Disease|volume=45|issue=3|pages=423–431|doi=10.1016/j.pop.2018.05.003|pmid=30115332|s2cid=240275364 |issn=0095-4543}} Although immunized people have a milder form of the infection, they can still spread the disease to others who are not immune.

The time between exposure and the development of symptoms is on average 7–14 days (ranging 6–20 days),Heymann, David L. (ed): Pertussis; in Control of Communicable Diseases Manual. p. 457. American Public Health Association, Washington DC, 2008, {{ISBN|978-0-87553-189-2}} and rarely as long as 42 days.{{cite web |title=Pertussis (whooping cough) |url=http://www.health.ny.gov/diseases/communicable/pertussis/fact_sheet.htm |publisher=New York State Department of Health |access-date=8 June 2013 |url-status=live |archive-url=https://web.archive.org/web/20130722133222/http://www.health.ny.gov/diseases/communicable/pertussis/fact_sheet.htm |archive-date=22 July 2013 }}

Pertussis is caused by the bacterium Bordetella pertussis. It is an airborne disease (through droplets) that spreads easily through the coughs and sneezes of an infected person.

Humans are the only host species of B. pertussis.{{Cite web |date=2018-06-29 |title=15.3E: Whooping Cough |url=https://bio.libretexts.org/Bookshelves/Microbiology/Microbiology_(Boundless)/15%3A_Diseases/15.03%3A_Bacterial_Diseases_of_the_Respiratory_System/15.3E%3A_Whooping_Cough |access-date=2024-03-29 |website=Biology LibreTexts |language=en}} Outbreaks of whooping cough have been observed among chimpanzees in a zoo and wild gorillas; in both cases, it is considered likely that the infection was acquired as a result of close contact with humans.{{cite journal | vauthors = Gustavsson OE, Röken BO, Serrander R | title = An epizootic of whooping cough among chimpanzees in a zoo | journal = Folia Primatologica; International Journal of Primatology | volume = 55 | issue = 1 | pages = 45–50 | year = 1990 | pmid = 2394416 | doi = 10.1159/000156498 }}{{Cite journal |last1=Palacios |first1=Gustavo |last2=Lowenstine |first2=Linda J. |last3=Cranfield |first3=Michael R. |last4=Gilardi |first4=Kirsten V. K. |last5=Spelman |first5=Lucy |last6=Lukasik-Braum |first6=Magda |last7=Kinani |first7=Jean-Felix |last8=Mudakikwa |first8=Antoine |last9=Nyirakaragire |first9=Elisabeth |last10=Bussetti |first10=Ana Valeria |last11=Savji |first11=Nazir |last12=Hutchison |first12=Stephen |last13=Egholm |first13=Michael |last14=Lipkin |first14=W. Ian |date=April 2011 |title=Human Metapneumovirus Infection in Wild Mountain Gorillas, Rwanda |url=https://wwwnc.cdc.gov/eid/article/17/4/10-0883_article |journal=Emerging Infectious Diseases |language=en-us |volume=17 |issue=4 |pages=711–713 |doi=10.3201/eid1704.100883 |pmc=3377396 |pmid=21470468}} Several zoos have a long-standing custom of vaccinating their primates against whooping cough.{{cite book | vauthors = Loomis MR |chapter=Immunoprofylaxis in infant great apes | veditors = Graham CE, Bowen JA |series=Monographs in Primatology |volume=5 |title=Clinical Management of Infant Great Apes |pages=107–112 |publisher=Liss |location=New York |year=1985}}

After the bacteria are inhaled, they initially adhere to the ciliated epithelium in the nasopharynx. Surface proteins of B. pertussis, including filamentous hemagglutinin and pertactin, mediate attachment to the epithelium. The bacteria then multiply.{{cite book|last1=Top|first1=Karina A.|last2=Halperin|first2=Scott A.|editor1-last=Kasper|editor1-first=Dennis L.|editor2-last=Fauci|editor2-first=Anthony S. |title=Harrison's Infectious Diseases|date=2017|publisher=McGraw-Hill Education|location=New York|isbn=978-1-259-83597-1|pages=502–506|edition=3|chapter=Pertussis and other Bordetella infections}}{{cite journal | vauthors = Kilgore PE, Salim AM, Zervos MJ, Schmitt HJ | title = Pertussis: Microbiology, Disease, Treatment, and Prevention | journal = Clinical Microbiology Reviews | volume = 29 | issue = 3 | pages = 449–86 | date = July 2016 | pmid = 27029594 | pmc = 4861987 | doi = 10.1128/CMR.00083-15 }} In infants, who experience more severe disease, the bacteria spread down to the lungs.

The bacteria secrete several toxins. Tracheal cytotoxin (TCT), a fragment of peptidoglycan, kills ciliated epithelial cells in the airway and thereby inhibits the mechanism which clears the airways of mucus and debris.{{cite journal | vauthors = Hewlett EL, Burns DL, Cotter PA, Harvill ET, Merkel TJ, Quinn CP, Stibitz ES | title = Pertussis pathogenesis—what we know and what we don't know | journal = The Journal of Infectious Diseases | volume = 209 | issue = 7 | pages = 982–5 | date = April 2014 | pmid = 24626533 | pmc = 3952676 | doi = 10.1093/infdis/jit639 }} TCT may contribute to the cough characteristic of pertussis.{{cite journal | vauthors = Melvin JA, Scheller EV, Miller JF, Cotter PA | title = Bordetella pertussis pathogenesis: current and future challenges | journal = Nature Reviews. Microbiology | volume = 12 | issue = 4 | pages = 274–88 | date = April 2014 | pmid = 24608338 | pmc = 4205565 | doi = 10.1038/nrmicro3235 }} Pertussis toxin causes lymphocytosis by an unknown mechanism. The elevated number of white blood cells leads to pulmonary hypertension, a major cause of death by pertussis. In infants who develop encephalopathy, cerebral hemorrhage and cortical atrophy occur, likely due to hypoxia.

File:Bordetella pertussis.jpg

A physician's overall impression is most effective in initially making the diagnosis. Single factors are much less useful.{{cite journal | vauthors = Ebell MH, Marchello C, Callahan M | title = Clinical Diagnosis of Bordetella Pertussis Infection: A Systematic Review | journal = Journal of the American Board of Family Medicine | volume = 30 | issue = 3 | pages = 308–319 |year = 2017 | pmid = 28484063 | doi = 10.3122/jabfm.2017.03.160330 | doi-access = free }} In adults with a cough of less than 8 weeks, vomiting after coughing or a "whoop" is supportive.{{cite journal | vauthors = Moore A, Harnden A, Grant CC, Patel S, Irwin RS | title = Clinically Diagnosing Pertussis-associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report | journal = Chest | volume = 155 | issue = 1 | pages = 147–154 | date = January 2019 | pmid = 30321509 | pmc = 6859243 | doi = 10.1016/j.chest.2018.09.027 }} If there are no bouts of coughing or there is a fever the diagnosis is unlikely. In children who have a cough of less than 4 weeks vomiting after coughing is somewhat supportive but not definitive.

Methods used in laboratory diagnosis include culturing of nasopharyngeal swabs on a nutrient medium (Bordet–Gengou medium), polymerase chain reaction (PCR), direct fluorescent antibody (DFA), and serological methods (e.g. complement fixation test).{{cite book|first=Agustín|last=Pedro-Pons|title=Patología y Clínica Médicas|year=1968|edition=3rd|page=615|volume=6|publisher=Salvat|isbn=84-345-1106-1|language=es|location=Barcelona}} The bacteria can be recovered from the person only during the first three weeks of illness, rendering culturing and DFA useless after this period. However, PCR may have some limited usefulness for an additional three weeks.

Serology may be used for adults and adolescents who have already been infected for several weeks to determine whether antibodies against pertussis toxin or another virulence factor of B. pertussis are present at high levels in the person's blood.{{Cite web| url = http://www.eurodiagnostica.com/index.php?headId=4&pageId=4&langId=1&diseaseId=8#nr1-tab| title = Pertussis| website = Euro Diagnostica| publisher = Euro Diagnostica AB| access-date = 29 February 2016| url-status = live| archive-url = https://web.archive.org/web/20160304231237/http://www.eurodiagnostica.com/index.php?headId=4&pageId=4&langId=1&diseaseId=8#nr1-tab| archive-date = 4 March 2016}}

A similar, milder disease is caused by B. parapertussis.{{cite book | vauthors = Finger H, von Koenig CH | title = Bordetella–Clinical Manifestations. In: Barron's Medical Microbiology | editor = Baron S | display-editors = etal | edition = 4th | publisher = Univ of Texas Medical Branch | year = 1996 | chapter-url = https://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1694 | isbn = 0-9631172-1-1 | url-status = live | archive-url = https://web.archive.org/web/20071014175713/http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1694 | archive-date = 14 October 2007 | chapter = Bordetella | pmid = 21413270 }}

The primary method of prevention for pertussis is vaccination.{{cite web|title=Pertussis {{!}} Whooping Cough {{!}} Vaccination {{!}} CDC|url=https://www.cdc.gov/pertussis/vaccines.html|website=www.cdc.gov|access-date=27 May 2017|url-status=live|archive-url=https://web.archive.org/web/20170526025248/https://www.cdc.gov/pertussis/vaccines.html|archive-date=26 May 2017}} Evidence is insufficient to determine the effectiveness of antibiotics in those who have been exposed, but are without symptoms.{{cite journal | vauthors = Altunaiji S, Kukuruzovic R, Curtis N, Massie J | title = Antibiotics for whooping cough (pertussis) | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD004404 | date = July 2007 | volume = 2013 | pmid = 17636756 | doi = 10.1002/14651858.CD004404.pub3 | pmc = 11322855 }} Preventive antibiotics, however, are still used frequently in those who have been exposed and are at high risk of severe disease (such as infants).

Pertussis vaccines are effective at preventing illness and are recommended for routine use by the World Health Organization{{cite web|title=Annex 6 whole cell pertussis|url=https://www.who.int/biologicals/publications/trs/areas/vaccines/whole_cell_pertussis/Annex%206%20whole%20cell%20pertussis.pdf|work=World Health Organization|access-date=5 June 2011|url-status=live|archive-url=https://web.archive.org/web/20120324184124/http://www.who.int/biologicals/publications/trs/areas/vaccines/whole_cell_pertussis/Annex%206%20whole%20cell%20pertussis.pdf|archive-date=24 March 2012}} and the United States Centers for Disease Control and Prevention.{{cite web|title=Pertussis: Summary of Vaccine Recommendations|url=https://www.cdc.gov/vaccines/vpd-vac/pertussis/recs-summary.htm|work=Centers for Disease Control and Prevention|access-date=5 June 2011|url-status=live|archive-url=https://web.archive.org/web/20110629042921/http://www.cdc.gov/vaccines/vpd-vac/pertussis/recs-summary.htm|archive-date=29 June 2011}} The vaccine saved an estimated half a million lives in 2002.

The multi-component acellular pertussis vaccine is 71–85% effective, with greater effectiveness against more severe strains.{{cite journal | vauthors = Zhang L, Prietsch SO, Axelsson I, Halperin SA | title = Acellular vaccines for preventing whooping cough in children | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 9 | pages = CD001478 | date = September 2014 | pmid = 25228233 | doi = 10.1002/14651858.CD001478.pub6 | pmc = 9722541 }} Despite widespread vaccination, pertussis has persisted in vaccinated populations. It remains "one of the most common vaccine-preventable diseases in Western countries". The 21st-century resurgence in pertussis infections is attributed to a combination of waning immunity and bacterial mutations that elude vaccines.{{cite journal | vauthors = Mooi FR, Van Der Maas NA, De Melker HE | title = Pertussis resurgence: waning immunity and pathogen adaptation – two sides of the same coin | journal = Epidemiology and Infection | volume = 142 | issue = 4 | pages = 685–94 | date = April 2014 | pmid = 23406868 | doi = 10.1017/S0950268813000071 | publisher = Oxford University Press | pmc = 9151166 | s2cid = 206283573 }}{{cite journal | vauthors = van der Ark AA, Hozbor DF, Boog CJ, Metz B, van den Dobbelsteen GP, van Els CA | title = Resurgence of pertussis calls for re-evaluation of pertussis animal models | journal = Expert Review of Vaccines | volume = 11 | issue = 9 | pages = 1121–37 | date = September 2012 | pmid = 23151168 | doi = 10.1586/erv.12.83 | s2cid = 10457474 }}

Immunization does not confer lifelong immunity; a 2011 CDC study indicated that protection may last only three to six years. This covers childhood, which is the time of greatest exposure and greatest risk of death from pertussis.{{cite journal |vauthors=Versteegh FG, Schellekens JF, Fleer A, Roord JJ | title = Pertussis: a concise historical review including diagnosis, incidence, clinical manifestations and the role of treatment and vaccination in management | journal = Rev Med Microbiol | year = 2005 | volume = 16 | issue = 3 | pages = 79–89 | url= http://www.revmedmicrobiol.com/pt/re/revmedmicrob/abstract.00013542-200508000-00001.htm | doi=10.1097/01.revmedmi.0000175933.85861.4e| s2cid = 71775827 | url-access = subscription }}

An effect of widespread immunization on society has been the shift of reported infections from children aged 1–9 years to infants, adolescents, and adults, with adolescents and adults acting as reservoirs for B. pertussis and infecting infants who have had fewer than three doses of vaccine.{{cite journal | vauthors = Mattoo S, Cherry JD | title = Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to Bordetella pertussis and other Bordetella subspecies | journal = Clinical Microbiology Reviews | volume = 18 | issue = 2 | pages = 326–82 | date = April 2005 | pmid = 15831828 | pmc = 1082800 | doi = 10.1128/CMR.18.2.326-382.2005 }}

Infection induces incomplete natural immunity that wanes over time.{{cite book|title=Disease Control Priorities in Developing Countries|edition=2nd|date=2006|veditors=Jamison DT, Breman JG, Measham AR|display-editors=etal|url=https://www.ncbi.nlm.nih.gov/books/NBK11728/|chapter=Vaccine-Preventable Diseases|vauthors=Brenzel L, Wolfson LJ, Fox-Rushby J|display-authors=etal|at=[https://www.ncbi.nlm.nih.gov/books/NBK11768/table/A2667/ Table 20.1 Selected Vaccine-preventable Diseases and Vaccines]|chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK11768/|publisher=International Bank for Reconstruction and Development, World Bank|location=Washington DC|pmid=21250343|isbn=978-0-8213-6179-5}} A 2005 study said estimates of the duration of infection-acquired immunity range from 7 to 20 years and the different results could be the result of differences in levels of circulating B. pertussis, surveillance systems, and case definitions used. The study said protective immunity after vaccination wanes after 4–12 years.{{cite journal | vauthors = Wendelboe AM, Van Rie A, Salmaso S, Englund JA | title = Duration of immunity against pertussis after natural infection or vaccination | journal = The Pediatric Infectious Disease Journal | volume = 24 | issue = 5 Suppl | pages = S58-61 | date = May 2005 | pmid = 15876927 | doi = 10.1097/01.inf.0000160914.59160.41 | s2cid = 45434262 | doi-access = free }} One study suggested that the availability of vaccine exemptions increases the number of pertussis cases.{{cite journal | vauthors = Yang YT, Debold V | title = A longitudinal analysis of the effect of nonmedical exemption law and vaccine uptake on vaccine-targeted disease rates | journal = American Journal of Public Health | volume = 104 | issue = 2 | pages = 371–7 | date = February 2014 | pmid = 24328666 | pmc = 3935668 | doi = 10.2105/AJPH.2013.301538 }}

Some studies have suggested that while acellular pertussis vaccines effectively prevent disease, they have a limited impact on infection and transmission, meaning that vaccinated people could spread pertussis even though they may have only mild symptoms or none at all.{{cite journal | vauthors = Srugo I, Benilevi D, Madeb R, Shapiro S, Shohat T, Somekh E, Rimmar Y, Gershtein V, Gershtein R, Marva E, Lahat N | title = Pertussis infection in fully vaccinated children in day-care centers, Israel | journal = Emerging Infectious Diseases | volume = 6 | issue = 5 | pages = 526–9 | date = October 2000 | pmid = 10998384 | doi = 10.3201/eid0605.000512 | df = dmy-all | pmc = 2627963 }}{{cite web |url=https://www.who.int/wer/2015/wer9035.pdf |title=Pertussis Vaccines:WHO Position Paper |date=August 2015 |quote=It is plausible that in humans, as in nonhuman primates, asymptomatic or mildly symptomatic infections in DTaP-immunized persons may result in transmission of B. pertussis to others and may drive pertussis outbreaks. |url-status=live |archive-url=https://web.archive.org/web/20160304110610/http://www.who.int/wer/2015/wer9035.pdf |archive-date=4 March 2016 }} Pertussis infection in these persons may be asymptomatic, or present as illness ranging from a mild cough to classic pertussis with persistent cough (i.e., lasting more than seven days). Even though the disease may be milder in older persons, those who are infected may transmit the disease to other susceptible persons, including unimmunized or incompletely immunized infants. Older persons are often found to have the first case in a household with multiple pertussis cases and are often the source of infection for children.

The antibiotics erythromycin, clarithromycin, or azithromycin are typically the recommended treatment. Newer macrolides are frequently recommended due to lower rates of side effects. Trimethoprim-sulfamethoxazole (TMP/SMX) may be used in those with allergies to first-line agents or in infants who have a risk of pyloric stenosis from macrolides.

A reasonable guideline is to treat people aged more than a year within three weeks of cough onset, infants aged less than one year, and pregnant women within six weeks of cough onset. If the person is diagnosed late, antibiotics will not alter the course of the illness, and even without antibiotics, they should no longer be spreading pertussis. When used early, antibiotics decrease the duration of infectiousness, and thus prevent spread. Short-term antibiotics (azithromycin for 3–5 days) are as effective as long-term treatment (erythromycin 10–14 days) in eliminating B. pertussis with fewer and less severe side effects.

People with pertussis are most infectious during the first two weeks following the onset of symptoms.{{Cite web|url=https://www.cdc.gov/pertussis/about/causes-transmission.html|title=Pertussis {{!}} Whooping Cough {{!}} Causes and Transmission {{!}} CDC|date=1 February 2019|website=www.cdc.gov|language=en-us|access-date=24 April 2020}}

Effective treatments of the cough associated with this condition have not been developed.{{cite journal | vauthors = Wang K, Bettiol S, Thompson MJ, Roberts NW, Perera R, Heneghan CJ, Harnden A | title = Symptomatic treatment of the cough in whooping cough | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 9 | pages = CD003257 | date = September 2014 | pmid = 25243777 | doi = 10.1002/14651858.CD003257.pub5 | pmc = 7154224 }} The use of over-the-counter cough medications is discouraged and has not been found helpful.

File:Pertussis world map - DALY - WHO2004.svg for pertussis per 100,000 inhabitants as of 2004.{{Div col|small=yes|colwidth=10em}}

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While most healthy older children and adults fully recover, infection in newborns is particularly severe. Pertussis is fatal in an estimated 0.5% of US infants under one year of age.{{cite web |title=Pertussis: Complications |url=https://www.cdc.gov/pertussis/about/complications.html |publisher=Centers for Disease Control and Prevention |access-date=24 August 2012 |url-status=live |archive-url=https://web.archive.org/web/20120814112442/http://www.cdc.gov/pertussis/about/complications.html |archive-date=14 August 2012 }} First-year infants are also more likely to develop complications, such as apneas (31%), pneumonia (12%), seizures (0.6%) and encephalopathy (0.15%). This may be due to the ability of the bacterium to suppress the immune system.{{cite journal | vauthors = Carbonetti NH | title = Pertussis toxin and adenylate cyclase toxin: key virulence factors of Bordetella pertussis and cell biology tools | journal = Future Microbiology | volume = 5 | issue = 3 | pages = 455–69 | date = March 2010 | pmid = 20210554 | pmc = 2851156 | doi = 10.2217/fmb.09.133 }}

[[File:Whooping cough deaths per million by country 2019.svg|thumb|upright=1.3|Whooping cough deaths per million persons in 2019

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Pertussis is endemic worldwide. More than 151,000 cases were reported globally in 2018. However not all cases are reported or correctly diagnosed, especially in developing countries. Pertussis is one of the leading causes of vaccine-preventable deaths worldwide.{{cite web |title=Pertussis in Other Countries |url=https://www.cdc.gov/pertussis/php/global/?CDC_AAref_Val=https://www.cdc.gov/pertussis/countries.html |url-status=live |archive-url=https://web.archive.org/web/20130512041451/http://www.cdc.gov/pertussis/countries.html |archive-date=12 May 2013 |access-date=30 July 2024 |publisher=Centers for Disease Control and Prevention (CDC)}} A study in 2017 estimated the global burden of the disease to be 24 million cases per year with 160,000 deaths among young children, with about 90% of all cases occurring in developing countries.{{Cite journal |last1=Yeung |first1=Karene Hoi Ting |last2=Duclos |first2=Philippe |last3=Nelson |first3=E. Anthony S. |last4=Hutubessy |first4=Raymond Christiaan W. |date=September 2017 |title=An update of the global burden of pertussis in children younger than 5 years: a modelling study |url=https://pubmed.ncbi.nlm.nih.gov/28623146/ |journal=The Lancet. Infectious Diseases |volume=17 |issue=9 |pages=974–980 |doi=10.1016/S1473-3099(17)30390-0 |issn=1474-4457 |pmid=28623146}}

Epidemics of the disease occur cyclically, every three to 5 years, both in areas with vaccination programs and those without.{{Cite journal |last1=Bouchez |first1=Valérie |last2=Guiso |first2=Nicole |date=October 2015 |editor-last=Carbonetti |editor-first=Nicholas |title=Bordetella pertussis, B. parapertussis, vaccines and cycles of whooping cough |url=https://academic.oup.com/femspd/article/580714/Bordetella-pertussis-B-parapertussis-vaccines-and |journal=Pathogens and Disease |language=en |volume=73 |issue=7 |pages=ftv055 |doi=10.1093/femspd/ftv055 |pmid=26242280 |issn=2049-632X}} Over time, immunity declines in those who have either been vaccinated or have recovered from infection.{{Cite journal |last1=Burdin |first1=Nicolas |last2=Handy |first2=Lori Kestenbaum |last3=Plotkin |first3=Stanley A. |date=December 2017 |title=What Is Wrong with Pertussis Vaccine Immunity? The Problem of Waning Effectiveness of Pertussis Vaccines |url=http://cshperspectives.cshlp.org/content/9/12/a029454 |journal=Cold Spring Harbor Perspectives in Biology |language=en |volume=9 |issue=12 |pages=a029454 |doi=10.1101/cshperspect.a029454 |issn=1943-0264 |pmc=5710106 |pmid=28289064}} In addition, infants are born who are susceptible to infection. An epidemic can occur once herd immunity decreases below a certain level.{{Cite web |date=15 March 2017 |title=Facts and figures - Whooping cough |url=https://www.health.nsw.gov.au/Infectious/whoopingcough/Pages/facts-and-figures.aspx |access-date=2024-03-26 |website=NSW Health |language=en}} It is also possible that the bacterium is evolving to evade vaccine-induced immunity.{{Cite web |date=2022-06-14 |title=Pertussis (whooping cough) - Epidemic Control Toolkit |url=https://epidemics.ifrc.org/pdf/223 |access-date=26 March 2024 |website=The International Federation of Red Cross}}

Before vaccines, an average of 178,171 cases was reported in the U.S., with peaks reported every two to five years; more than 93% of reported cases occurred in children under 10 years of age. With the widespread introduction of the DTP combined vaccine (diphtheria tetanus and pertussis) in the 1940s, pertussis incidence fell dramatically to approximately 1,000 by 1976, when they fluctuated between 1,000 and 30,000 annually.{{Citation |last1=Kuchar |first1=E. |title=Pertussis: History of the Disease and Current Prevention Failure |date=2016 |work=Pulmonary Dysfunction and Disease |volume=934 |pages=77–82 |editor-last=Pokorski |editor-first=Mieczyslaw |url=http://link.springer.com/10.1007/5584_2016_21 |access-date=2024-09-30 |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/5584_2016_21 |isbn=978-3-319-42009-7 |last2=Karlikowska-Skwarnik |first2=M. |last3=Han |first3=S. |last4=Nitsch-Osuch |first4=A.|pmid=27256351 |url-access=subscription }}{{cite web |date=23 July 2024 |title=Pertussis Cases by Year |url=https://www.cdc.gov/pertussis/php/surveillance/pertussis-cases-by-year.html |archive-url= |archive-date= |access-date=30 September 2024 |website=Centers for Disease Control and Prevention}}

Cases recorded outside of the U.S. were also recorded{{When|date=October 2024}} at high numbers comparable to their populations. Before the vaccine was discovered, Sweden averaged nearly 3,000 children deaths per year. With their population only being 1.8 million in the years 1749-64 this number was very high. The London population during the same period recorded over 3,000 deaths. The rates in London continued to grow into the 18th century. These numbers show how the disease affected not only the U.S. but also those around the world.{{Cite journal |last=Weston |first=Robert |date=October 2012 |title=Whooping Cough: A Brief History to the 19th Century |url=https://utpjournals.press/doi/10.3138/cbmh.29.2.329 |journal=Canadian Bulletin of Medical History |language=en |volume=29 |issue=2 |pages=329–349 |doi=10.3138/cbmh.29.2.329 |pmid=28155549 |issn=0823-2105|url-access=subscription }}

According to the {{As of|2024|bare=yes}} CDC, reports that cases of whooping cough have reached their highest levels since 2014.{{Cite web |last=America |first=Good Morning |title=Whooping cough cases surge: CDC |url=https://www.goodmorningamerica.com/wellness/video/whooping-cough-cases-surge-cdc-114757172 |access-date=2024-10-14 |website=Good Morning America |language=en}} This year, there have been over 16,000 cases, marking a fourfold increase compared to last year’s total of more than 3,700 cases.{{Cite web |last=CDC |date=2024-10-10 |title=Pertussis Surveillance and Trends |url=https://www.cdc.gov/pertussis/php/surveillance/index.html |access-date=2024-10-14 |website=Whooping Cough (Pertussis) |language=en-us}} The CDC has also confirmed two deaths related to the illness.{{Citation needed|date=October 2024}} The United States is seeing a return to pre-pandemic trends, where annual cases typically exceed 10,000.{{Cite web |last=Leake |first=Lindsey |title=Whooping cough cases up 342% since 2023 as U.S. outbreak continues. What to know about symptoms and spread |url=https://fortune.com/well/article/whooping-cough-pertussis-symptoms-spread-2024/ |access-date=2024-10-14 |website=Fortune Well |language=en}}File:Whooping Cough (8744519854).jpg

B. pertussis was discovered in 1906 by Jules Bordet and Octave Gengou (the bacterium is subsequently named Bordetella pertussis in honour of Jules Bordet). They were able to successfully culture B. pertussis and went on to develop the first inactivated whole-cell vaccine in 1912, followed by other researchers in 1913 and 1914. These early vaccines had limited effectiveness. In the 1920s, Louis W. Sauer developed a vaccine for whooping cough at Evanston Hospital. In 1925 Danish physician Thorvald Madsen was the first to test a whole-cell vaccine on a wide scale. Madsen used the vaccine to control outbreaks in the Faroe Islands in the North Sea, however, two children died shortly after receiving the vaccine.{{cite journal | vauthors = Baker JP, Katz SL | title = Childhood vaccine development: an overview | journal = Pediatric Research | volume = 55 | issue = 2 | pages = 347–56 | date = February 2004 | pmid = 14630981 | doi = 10.1203/01.PDR.0000106317.36875.6A | doi-access = free }}{{Cite web |title=Pertussis |url=https://www.museumofhealthcare.ca/explore/exhibits/vaccinations/pertussis.html |access-date=2024-11-04 |website=Museum of Health Care}}{{Citation |last=Vaccines |first=Institute of Medicine (US) Committee to Review the Adverse Consequences of Pertussis and Rubella |title=Pertussis and Rubella Vaccines: A Brief Chronology |date=1991 |work=Adverse Effects of Pertussis and Rubella Vaccines: A Report of the Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines |url=https://www.ncbi.nlm.nih.gov/books/NBK234365/ |access-date=2024-11-04 |publisher=National Academies Press (US) |language=en |last2=Howson |first2=Christopher P. |last3=Howe |first3=Cynthia J. |last4=Fineberg |first4=Harvey V.}}

In 1932, an outbreak of whooping cough hit Atlanta, Georgia, prompting pediatrician Leila Denmark to begin her study of the disease. Over the next six years, her work was published in the Journal of the American Medical Association, and in partnership with Emory University and Eli Lilly & Company, she developed the first safe and effective pertussis vaccine.{{Cite web|title = Changing the Face of Medicine {{!}} Dr. Leila Alice Daughtry Denmark|url = https://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_78.html|website = www.nlm.nih.gov|access-date = 3 February 2016|url-status = live|archive-url = https://web.archive.org/web/20150321042123/http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_78.html|archive-date = 21 March 2015}} In 1942, American scientists Grace Eldering, Loney Gordon, and Pearl Kendrick combined the whole-cell pertussis vaccine with diphtheria and tetanus toxoids to generate the first DTP combination vaccine.{{cite web | last = Bannink | first = Jill | title = Finding aid for the Michigan women and the whooping cough vaccine collection[s] | url = http://grplpedia.grpl.org/wiki/images/6/65/328.pdf | url-status = live | archive-url = https://web.archive.org/web/20150205095413/http://grplpedia.grpl.org/wiki/images/6/65/328.pdf | archive-date = 5 February 2015 }} To minimize the frequent side effects caused by the pertussis component, Japanese scientist Yuji Sato developed an acellular vaccine consisting of purified haemagglutinins (HAs: filamentous strep throat and leukocytosis-promoting-factor HA), which are secreted by B. pertussis. Sato's acellular pertussis vaccine was used in Japan starting in 1981.{{cite journal | vauthors = Sato Y, Kimura M, Fukumi H | title = Development of a pertussis component vaccine in Japan | journal = Lancet | volume = 1 | issue = 8369 | pages = 122–6 | date = January 1984 | pmid = 6140441 | doi = 10.1016/S0140-6736(84)90061-8 | s2cid = 23621152 }} Later versions of the acellular vaccine in other countries consisted of additional defined components of B. pertussis and were often part of the DTaP combination vaccine.

{{Reflist}}

{{Medical condition classification and resources

| DiseasesDB = 1523

| ICD11 = {{ICD11|1C12}}

| ICD10 = {{ICD10|A|37||a|30}}

| ICD9 = {{ICD9|033}}

| ICDO =

| OMIM =

| MedlinePlus = 001561

| eMedicineSubj = emerg

| eMedicineTopic = 394

| eMedicine_mult = {{eMedicine2|ped|1778}}

| MeshID = D014917

|Orphanet=1489

}}

{{offline|med}}

{{Commons category}}

• [http://textbookofbacteriology.net/pertussis.html Pertussis at Todar's Online Textbook of Bacteriology]
• [https://www.pbs.org/wgbh/nova/body/vaccines-calling-shots.html PBS NOVA – Vaccines: Calling The Shots]
• {{cite web | url = https://medlineplus.gov/whoopingcough.html | work = MedlinePlus | publisher = U.S. National Library of Medicine | title = Whooping Cough }}

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