Pertussis: background information on prevention and management

This content was originally produced by Public Health England (PHE). This content is now owned and managed by the UK Health Security Agency (UKHSA)

Whooping cough is a notifiable disease in England and Wales. A diagnosis may be made on clinical grounds without the need for laboratory confirmation. Notifications provide timely data relating to trends over time and by age.

Isolation of the B. pertussis organism through culture will confirm diagnoses. But culture lacks sensitivity and since 2001, the enhanced diagnostic methods based on PCR and serological testing, have been made available by PHE. These methods have increased case ascertainment, particularly the use of serology in adults. In 2013 Oral Fluid testing was made available for all children aged 5-16 years who had not had pertussis confirmed by other laboratory methods.

Classic (severe) pertussis, as defined by the World Health Organization (WHO), consists of at least 21 days of cough illness with paroxysms, associated whoops or post-tussis vomiting, and culture confirmation. In young infants, the typical ‘whoop’ may never develop and coughing spasms can be followed by difficulty in breathing (apnoea). Severe complications and deaths occur mostly in infants under 6 months of age. Serious illness is less common in older children and adults, however, they have the potential to transmit infection to vulnerable babies.

Respiratory and vaccine preventable bacteria reference unit (RVPBRU) provides national reference facilities for Bordetella pertussis and other bordetella.

Acellular pertussis vaccine is given in the primary course with diphtheria, tetanus, polio and Hib, as DTaP/IPV/Hib, given at aged 2, 3, and 4 months of age. For children born on or after 1 July 2024 there is a fourth dose DTaP/IPV/Hib given at 18 months. A further booster dose with acellular pertussis, given as dTaP-IPV, is given with the preschool boosters 3 years after the completion of the primary course and before school entry.