View source for Whooping cough

{{short description|Human disease caused by the bacteria Bordetella pertussis}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Use dmy dates|date=August 2020}}
{{Infobox medical condition (new)
| name = Whooping cough
| synonyms = Pertussis, 100-day cough
| image = Pertussis.jpg
| image_size = 250 px
| caption = A young boy coughing due to pertussis
| field = [[Infectious disease (medical specialty)|Infectious disease]]
| symptoms = Runny nose, fever, cough<ref name=CDC2014S/>
| complications = Vomiting, [[rib fracture|broken ribs]], [[fatigue (medicine)|exhaustion]]<ref name=CDC2014S/><ref name=CDC2013Com/>
| onset = 
| duration = ~ 3 months<ref name=CDC2015Facts/>
| causes = ''[[Bordetella pertussis]]'' ([[airborne disease|spread through the air]])<ref name=CDC2014C/>
| risks = 
| diagnosis = [[Nasopharyngeal swab]]<ref name=CDC2013Sam/>
| differential = 
| prevention = [[Pertussis vaccine]]<ref name=Update10/>
| treatment = [[Antibiotics]] (if started early)<ref name=CDC2013Tr/>
| medication = 
| frequency = 16.3&nbsp;million (2015)<!-- incidence table --><ref name=GBD2015Pre/>
| deaths = 58,700 (2015)<ref name=GBD2015De/>
}}
<!-- Definition and symptoms -->

'''Whooping cough''' ({{IPAc-en|'|h|uː|p|ɪ|ŋ}} or {{IPAc-en|'|ʍ|ʊ|p|ɪ|ŋ}}), also known as '''pertussis''' or the '''100-day cough''', is a highly contagious, [[Vaccine-preventable diseases|vaccine-preventable]] [[Pathogenic bacteria|bacterial disease]].<ref name=CDC2014S/><ref name=":2">{{Cite web |date=2022-09-07 |title=Preventing Whooping Cough (Pertussis) {{!}} CDC |url=https://www.cdc.gov/pertussis/about/prevention/index.html |access-date=2023-05-21 |website=Centers for Disease Control |language=en-us}}</ref> Initial symptoms are usually similar to those of the [[common cold]] with a [[rhinorrhea|runny nose]], fever, and mild cough, but these are followed by two or three months of severe coughing fits.<ref name=CDC2014S/> Following a fit of coughing, a high-pitched whoop sound or gasp may occur as the person breathes in.<ref name=CDC2014S/> The violent coughing may last for 10 or more weeks, hence the phrase "100-day cough".<ref name=CDC2015Facts>{{cite web|title=Pertussis (Whooping Cough) Fast Facts|url=https://www.cdc.gov/pertussis/fast-facts.html|website=cdc.gov|access-date=12 February 2015|date=13 February 2014|url-status=live|archive-url=https://web.archive.org/web/20150207090550/http://www.cdc.gov/pertussis/fast-facts.html|archive-date=7 February 2015}}</ref> The cough may be so hard that it causes [[fatigue]], vomiting, and [[rib fracture]]s.<ref name=CDC2014S/><ref name="CDC2013Com">{{cite web |date=4 August 2022 |title=Pertussis (Whooping Cough) Complications |url=https://www.cdc.gov/pertussis/about/complications.html |access-date=26 March 2024 |website=Centers for Disease Control}}</ref> Children less than one year old may have little or no cough and instead have [[apnea|periods when they cannot breathe]].<ref name="CDC2014S">{{cite web |date=August 4, 2022 |title=Pertussis (Whooping Cough) Signs & Symptoms |url=https://www.cdc.gov/pertussis/about/signs-symptoms.html |access-date=26 March 2023 |website=Centers for Disease Control}}</ref> The [[incubation period]] is usually seven to ten days.<ref name=CDC2012Pink/> Disease may occur in those who have been vaccinated, but symptoms are typically milder.<ref name=CDC2014S/>

<!-- Cause and diagnosis -->
The bacterium ''[[Bordetella pertussis]]'' causes pertussis, which is spread easily through the coughs and sneezes of an infected person.<ref name="CDC2014C">{{cite web|title=Pertussis (Whooping Cough) Causes & Transmission|url=https://www.cdc.gov/pertussis/about/causes-transmission.html|website=cdc.gov|access-date=12 February 2015|date=4 September 2014|url-status=live|archive-url=https://web.archive.org/web/20150214040511/http://www.cdc.gov/pertussis/about/causes-transmission.html|archive-date=14 February 2015}}</ref><ref name="auto">{{Cite web |title=Pertussis |url=https://www.who.int/health-topics/pertussis |access-date=2024-03-26 |website=World Health Organization |language=en}}</ref> People are infectious from the start of symptoms until about three weeks into the coughing fits.<ref name="CDC2013Tr">{{cite web |date=28 August 2013 |title=Pertussis (Whooping Cough) Treatment |url=https://www.cdc.gov/pertussis/clinical/treatment.html |url-status=live |archive-url=https://web.archive.org/web/20150211094551/http://www.cdc.gov/pertussis/clinical/treatment.html |archive-date=11 February 2015 |access-date=13 February 2015 |website=cdc.gov}}</ref> Diagnosis is by collecting a [[nasopharyngeal swab|sample from the back of the nose and throat]].<ref name=CDC2013Sam/> This sample can then be tested either by [[Cell culture|culture]] or by [[polymerase chain reaction]].<ref name=CDC2013Sam>{{cite web|title=Pertussis (Whooping Cough) Specimen Collection|url=https://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html|website=cdc.gov|access-date=13 February 2015|date=28 August 2013|url-status=live|archive-url=https://web.archive.org/web/20150208221312/http://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html|archive-date=8 February 2015}}</ref>

<!-- Prevention and treatment -->
Prevention is mainly by [[vaccination]] with the [[pertussis vaccine]].<ref name=Update10>{{cite journal | vauthors = Heininger U | title = Update on pertussis in children | journal = Expert Review of Anti-Infective Therapy | volume = 8 | issue = 2 | pages = 163–73 | date = February 2010 | pmid = 20109046 | doi = 10.1586/eri.09.124 | s2cid = 207217558 }}</ref> Initial immunization is recommended between six and eight weeks of age, with four doses to be given in the first two years of life.<ref>{{cite journal | title = Revised guidance on the choice of pertussis vaccines: July 2014 | journal = Relevé Épidémiologique Hebdomadaire | volume = 89 | issue = 30 | pages = 337–40 | date = July 2014 | pmid = 25072068 | url =https://www.who.int/wer/2013/wer8930.pdf?ua=1 | archive-url = https://web.archive.org/web/20150213144751/http://www.who.int/wer/2013/wer8930.pdf?ua=1 | url-status = live | archive-date = 13 February 2015 }}</ref> Protection from pertussis decreases over time, so additional doses of vaccine are often recommended for older children and adults.<ref>{{cite journal | title = Pertussis vaccines: WHO position paper | journal = Relevé Épidémiologique Hebdomadaire | volume = 85 | issue = 40 | pages = 385–400 | date = October 2010 | pmid = 20939150 }}</ref> Vaccination during pregnancy is highly effective at protecting the infant from pertussis during their vulnerable early months of life, and is recommended in many countries.<ref name="pmid32054444">{{cite journal | vauthors = Vygen-Bonnet S, Hellenbrand W, Garbe E, von Kries R, Bogdan C, Heininger U, Röbl-Mathieu M, Harder T | title = Safety and effectiveness of acellular pertussis vaccination during pregnancy: a systematic review | journal = BMC Infect Dis | volume = 20 | issue = 1 | article-number = 136 | date = February 2020 | pmid = 32054444 | pmc = 7020352 | doi = 10.1186/s12879-020-4824-3 | doi-access = free }}</ref> Antibiotics may be used to prevent the disease in those who have been exposed and are at risk of severe disease.<ref>{{cite web|title=Pertussis (Whooping Cough) Prevention|url=https://www.cdc.gov/pertussis/clinical/prevention.html|website=cdc.gov|access-date=13 February 2015|date=10 October 2014|url-status=live|archive-url=https://web.archive.org/web/20150208221327/http://www.cdc.gov/pertussis/clinical/prevention.html|archive-date=8 February 2015}}</ref> In those with the disease, antibiotics are useful if started within three weeks of the initial symptoms, but otherwise have little effect in most people.<ref name=CDC2013Tr/> In pregnant women and children less than one year old, antibiotics are recommended within six weeks of symptom onset.<ref name=CDC2013Tr/> Antibiotics used include [[erythromycin]], [[azithromycin]], [[clarithromycin]], or [[trimethoprim/sulfamethoxazole]].<ref name=CDC2013Tr/> Evidence to support interventions for the cough, other than antibiotics, is poor.<ref name=Wang2014>{{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 | article-number = CD003257 | date = September 2014 | pmid = 25243777 | doi = 10.1002/14651858.CD003257.pub5 | url = https://ora.ox.ac.uk/objects/uuid:66161792-3b06-4f30-bdbf-3f2000828ade/datastreams/ATTACHMENT01 | pmc = 7154224 }}</ref> About 50% of infected children less than a year old require hospitalization and nearly 0.5% (1 in 200) die.<ref name=CDC2014S/><ref name=CDC2013Com/>

<!-- Epidemiology and history -->
An estimated 16.3&nbsp;million people worldwide were infected in 2015.<ref name=GBD2015Pre>{{cite journal | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 | last1 = Vos | first1 = Theo | last2 = Allen | first2 = Christine | last3 = Arora | first3 = Megha | last4 = Barber | first4 = Ryan M. | last5 = Bhutta | first5 = Zulfiqar A. | last6 = Brown | first6 = Alexandria | last7 = Carter | first7 = Austin | last8 = Casey | first8 = Daniel C. | last9 = Charlson | first9 = Fiona J. | last10 = Chen | first10 = Alan Z. | last11 = Coggeshall | first11 = Megan | last12 = Cornaby | first12 = Leslie | last13 = Dandona | first13 = Lalit | last14 = Dicker | first14 = Daniel J. | last15 = Dilegge | first15 = Tina | last16 = Erskine | first16 = Holly E. | last17 = Ferrari | first17 = Alize J. | last18 = Fitzmaurice | first18 = Christina | last19 = Fleming | first19 = Tom | last20 = Forouzanfar | first20 = Mohammad H. | last21 = Fullman | first21 = Nancy | last22 = Gething | first22 = Peter W. | last23 = Goldberg | first23 = Ellen M. | last24 = Graetz | first24 = Nicholas | last25 = Haagsma | first25 = Juanita A. | last26 = Hay | first26 = Simon I. | last27 = Johnson | first27 = Catherine O. | last28 = Kassebaum | first28 = Nicholas J. | last29 = Kawashima | first29 = Toana | last30 = Kemmer | first30 = Laura }}</ref> Most cases occur in the [[developing world]], and people of all ages may be affected.<ref name=Update10/><ref name=Wang2014/> In 2015, pertussis resulted in 58,700 deaths – down from 138,000 deaths in 1990.<ref name=GBD2015De>{{cite journal | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/s0140-6736(16)31012-1 | last1 = Wang | first1 = Haidong | last2 = Naghavi | first2 = Mohsen | last3 = Allen | first3 = Christine | last4 = Barber | first4 = Ryan M. | last5 = Bhutta | first5 = Zulfiqar A. | last6 = Carter | first6 = Austin | last7 = Casey | first7 = Daniel C. | last8 = Charlson | first8 = Fiona J. | last9 = Chen | first9 = Alan Zian | last10 = Coates | first10 = Matthew M. | last11 = Coggeshall | first11 = Megan | last12 = Dandona | first12 = Lalit | last13 = Dicker | first13 = Daniel J. | last14 = Erskine | first14 = Holly E. | last15 = Ferrari | first15 = Alize J. | last16 = Fitzmaurice | first16 = Christina | last17 = Foreman | first17 = Kyle | last18 = Forouzanfar | first18 = Mohammad H. | last19 = Fraser | first19 = Maya S. | last20 = Fullman | first20 = Nancy | last21 = Gething | first21 = Peter W. | last22 = Goldberg | first22 = Ellen M. | last23 = Graetz | first23 = Nicholas | last24 = Haagsma | first24 = Juanita A. | last25 = Hay | first25 = Simon I. | last26 = Huynh | first26 = Chantal | last27 = Johnson | first27 = Catherine O. | last28 = Kassebaum | first28 = Nicholas J. | last29 = Kinfu | first29 = Yohannes | last30 = Kulikoff | first30 = Xie Rachel }}</ref><ref name=GBD204>{{cite journal | title = Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 385 | issue = 9963 | pages = 117–71 | date = January 2015 | pmid = 25530442 | pmc = 4340604 | doi = 10.1016/S0140-6736(14)61682-2 | vauthors = ((GBD 2013 Mortality Causes of Death Collaborators)) }}</ref> Outbreaks of the disease were first described in the 16th century.<ref name=CDC2012Pink/> The bacterium that causes the infection was discovered in 1906.<ref name=CDC2012Pink/> The pertussis vaccine became available in the 1940s.<ref name=CDC2012Pink>{{cite book|last1=Atkinson|first1=William |title=Pertussis Epidemiology and Prevention of Vaccine-Preventable Diseases|date=May 2012|publisher=Public Health Foundation|isbn=978-0-9832631-3-5|pages=215–230|edition=12th|url=https://www.cdc.gov/vaccines/pubs/pinkbook/pert.html|url-status=live|archive-url=https://web.archive.org/web/20170729141728/https://www.cdc.gov/vaccines/pubs/pinkbook/pert.html|archive-date=29 July 2017}}</ref>

==Signs and symptoms==
[[File:Whooping cough boy.ogv|thumb|upright=1.3|A boy with pertussis]]
The classic symptoms of pertussis are a [[paroxysmal]] cough, inspiratory whoop, and [[fainting]], or vomiting after coughing.<ref name=JAMA2010>{{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 }}</ref> The cough from pertussis has been documented to cause [[subconjunctival hemorrhage]]s, [[rib fracture]]s, [[urinary incontinence]], [[hernias]], and [[vertebral artery dissection]].<ref name=JAMA2010/> 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.<ref name="JAMA2010"/>

The illness usually starts with mild respiratory symptoms including mild coughing, sneezing, or a [[Rhinorrhea|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 attack|paroxysmal]] stage. This stage usually lasts up to 3 months, or sometimes longer.<ref name="CDC2014S" /> A gradual transition then occurs to the [[Convalescence|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.<ref name=":1">{{Cite web | url=https://www.cdc.gov/vaccines/pubs/pinkbook/pert.html |title = Pink book &#124; Pertussis &#124; Epidemiology of Vaccine-Preventable Diseases &#124; CDC|date = 2 March 2019}}</ref>

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.<ref name=":3">{{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}}</ref> Although immunized people have a milder form of the infection, they can still spread the disease to others who are not immune.<ref name=":3" />

===Incubation period===
The [[incubation period|time between exposure and the development of symptoms]] is on average 7–14 days (ranging 6–20 days),<ref>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}}</ref> and rarely as long as 42 days.<ref>{{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 }}</ref>

==Cause==
Pertussis is caused by the bacterium ''[[Bordetella pertussis]]''.<!--<ref name=CDC2014C/> --> It is an [[airborne disease]] (through droplets) that spreads easily through the coughs and sneezes of an infected person.<ref name=CDC2014C/>

===Host species===
Humans are the only host species of ''B. pertussis.''<ref>{{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}}</ref> 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.<ref>{{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 }}</ref><ref>{{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}}</ref> Several [[zoo]]s have a long-standing custom of vaccinating their primates against whooping cough.<ref>{{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}}</ref>

==Mechanism==
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.<ref name="Top2017">{{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}}</ref><ref name=Kilgore2016>{{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 }}</ref> In infants, who experience more severe disease, the bacteria spread down to the lungs.<ref name=Kilgore2016/>

The bacteria secrete several toxins. [[Tracheal cytotoxin]] (TCT), a fragment of [[peptidoglycan]], kills ciliated [[Epithelium|epithelial cells]] in the airway and thereby inhibits the [[Mucociliary clearance|mechanism]] which clears the airways of mucus and debris.<ref name=Hewlett2014>{{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 }}</ref> TCT may contribute to the cough characteristic of pertussis.<ref name=Melvin2014>{{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 }}</ref>  [[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.<ref name=Hewlett2014/><ref name=Kilgore2016/> In infants who develop [[encephalopathy]], [[cerebral hemorrhage]] and cortical atrophy occur, likely due to [[hypoxia (medical)|hypoxia]].<ref name=Kilgore2016/>

==Diagnosis==
[[File:Bordetella pertussis.jpg|thumb|Gram stain of ''Bordetella pertussis'']]

===Based on symptoms===
A physician's overall impression is most effective in initially making the diagnosis.<ref name=Eb2017/> Single factors are much less useful.<ref name=Eb2017>{{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 }}</ref> In adults with a cough of less than 8 weeks, vomiting after coughing or a "whoop" is supportive.<ref name=Mo2019>{{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 }}</ref> If there are no bouts of coughing or there is a fever the diagnosis is unlikely.<ref name=Mo2019/> In children who have a cough of less than 4 weeks vomiting after coughing is somewhat supportive but not definitive.<ref name=Mo2019/>

===Lab tests===
Methods used in laboratory diagnosis include [[microbiological culture|culturing]] of [[nasopharyngeal swab]]s on a nutrient medium ([[Bordet–Gengou agar|Bordet–Gengou medium]]), [[polymerase chain reaction]] (PCR), [[direct fluorescent antibody]] (DFA), and [[serology|serological]] methods (e.g. [[complement fixation test]]).<ref>{{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}}</ref> 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.<ref>{{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}}</ref>

===Differential diagnosis===
A similar, milder disease is caused by ''[[Bordetella parapertussis|B. parapertussis]]''.<ref>{{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/NBK7813/ | 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 }}</ref>

==Prevention==
The primary method of prevention for pertussis is [[vaccination]].<ref>{{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}}</ref> Evidence is insufficient to determine the effectiveness of antibiotics in those who have been exposed, but are without symptoms.<ref name=Cochrane07>{{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 | article-number = CD004404 | date = July 2007 | volume = 2013 | pmid = 17636756 | doi = 10.1002/14651858.CD004404.pub3 | pmc = 11322855 }}</ref> Preventive antibiotics, however, are still used frequently in those who have been exposed and are at high risk of severe disease (such as infants).<ref name=Update10/>

=== Vaccine ===
[[Pertussis vaccine]]s are effective at preventing illness<ref name=Cochrane2014/> and are recommended for routine use by the [[World Health Organization]]<ref name=WHO2007Vac>{{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}}</ref> and the United States [[Centers for Disease Control and Prevention]].<ref>{{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}}</ref> The vaccine saved an estimated half a million lives in 2002.<ref name=WHO2007Vac/>

The multi-component [[acellular]] pertussis vaccine is 71–85% effective, with greater effectiveness against more severe strains.<ref name=Cochrane2014>{{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 | article-number = CD001478 | date = September 2014 | pmid = 25228233 | doi = 10.1002/14651858.CD001478.pub6 | pmc = 9722541 }}</ref> Despite widespread vaccination, pertussis has persisted in vaccinated populations. It remains "one of the most common vaccine-preventable diseases in Western countries".<ref name=":0" /> The 21st-century resurgence in pertussis infections is attributed to a combination of waning immunity and bacterial mutations that elude vaccines.<ref name=":0">{{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 }}</ref><ref>{{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 }}</ref>

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.<ref name=JAMA2010/><ref>{{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 }}</ref>

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.<ref>{{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 }}</ref>

Infection induces incomplete [[natural immunity]] that wanes over time.<ref>{{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}}</ref> 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.<ref name="pmid15876927">{{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 }}</ref> One study suggested that the availability of vaccine exemptions increases the number of pertussis cases.<ref name="pmid24328666">{{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 }}</ref>

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.<ref>{{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 | pmc = 2627963 }}</ref><ref>{{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  }}</ref> 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.<ref name=":1" />

== Treatment ==
<!-- Antibiotics -->
The antibiotics [[erythromycin]], [[clarithromycin]], or [[azithromycin]] are typically the recommended treatment.<ref name=Cochrane07/> Newer [[macrolides]] are frequently recommended due to lower rates of side effects.<ref name=Update10/> [[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.<ref name=Update10/>

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.<ref name=Update10/> When used early, antibiotics decrease the duration of infectiousness, and thus prevent spread.<ref name=Update10/> 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.<ref name="Cochrane07"/>

People with pertussis are most infectious during the first two weeks following the onset of symptoms.<ref>{{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}}</ref>

<!-- Cough -->
Effective treatments of the cough associated with this condition have not been developed.<ref>{{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 | article-number = CD003257 | date = September 2014 | pmid = 25243777 | doi = 10.1002/14651858.CD003257.pub5 | pmc = 7154224 }}</ref> The use of over-the-counter cough medications is discouraged and has not been found helpful.<ref name=":3" />

== Prognosis ==
[[File:Pertussis world map - DALY - WHO2004.svg|thumb|upright=1.3|[[Disability-adjusted life year]] for pertussis per 100,000&nbsp;inhabitants as of 2004.{{Div col|small=yes|colwidth=10em}}
{{legend|#b3b3b3|No data}}
{{legend|#ffff65|Less than 50}}
{{legend|#fff200|50–100}}
{{legend|#ffdc00|100–150}}
{{legend|#ffc600|150–200}}
{{legend|#ffb000|200–250}}
{{legend|#ff9a00|250–300}}
{{legend|#ff8400|300–350}}
{{legend|#ff6e00|350–400}}
{{legend|#ff5800|400–450}}
{{legend|#ff4200|450–500}}
{{legend|#ff2c00|500–550}}
{{legend|#cb0000|More than 550}}
{{div col end}}]]

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.<ref name="complications">{{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 }}</ref> First-year infants are also more likely to develop complications, such as [[apnea]]s (31%), pneumonia (12%), seizures (0.6%) and [[encephalopathy]] (0.15%).<ref name="complications"/> This may be due to the ability of the bacterium to suppress the [[immune system]].<ref>{{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 }}</ref>

==Epidemiology==
[[File:Whooping cough deaths per million by country 2019.svg|thumb|upright=1.3|Whooping cough deaths per million persons in 2019
{{Div col|small=yes|colwidth=10em}}
{{legend|#fef001|0.00–1.49}}
{{legend|#fcce02|1.50–2.99}}
{{legend|#faad03|3.00–5.99}}
{{legend|#f88b03|6.00–9.99}}
{{legend|#f44804|10.00–19.99}}
{{legend|#f22705|20.00–39.99}}
{{legend|#f00505|40.00–59.99}}
{{legend|#a80404|60.00–99.99}}
{{legend|#600202|100+}}
{{div col end}}]]

<!-- Global perspective -->
Pertussis is [[Endemic (epidemiology)|endemic]] worldwide. More than 151,000 cases were reported globally in 2018.<ref name="auto"/> However not all cases are reported or correctly diagnosed, especially in [[Developing country|developing countries]]. Pertussis is one of the leading causes of vaccine-preventable deaths worldwide.<ref name="cdcothercountries">{{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)}}</ref> 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.<ref>{{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 |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}}</ref><ref name=cdcothercountries/>

Epidemics of the disease occur cyclically, every three to 5 years, both in areas with vaccination programs and those without.<ref name=":12">{{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 |article-number=ftv055 |doi=10.1093/femspd/ftv055 |pmid=26242280 |issn=2049-632X}}</ref> Over time, immunity declines in those who have either been vaccinated or have recovered from infection.<ref>{{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 |article-number=a029454 |doi=10.1101/cshperspect.a029454 |issn=1943-0264 |pmc=5710106 |pmid=28289064}}</ref> In addition, infants are born who are susceptible to infection. An epidemic can occur once [[herd immunity]] decreases below a certain level.<ref name=":02">{{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}}</ref> It is also possible that the bacterium is evolving to evade vaccine-induced immunity.<ref>{{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}}</ref><ref name=":12" />

<!-- US specific perspective -->
In the U.S. prior to the introduction of the vaccine, pertussis incidence was between 100,000 and 200,000 cases per year. With the widespread introduction of the DTP combined vaccine (diphtheria tetanus and pertussis) in the 1940s, cases fell progressively through the 1950s and 1960s such that between 1965 and 2003  incidence was fewer than 10,000 cases per year.<ref>{{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 }}</ref><ref>{{cite web |date=23 July 2024 |title=Pertussis Cases by Year |url=https://www.cdc.gov/pertussis/php/surveillance/pertussis-cases-by-year.html |access-date=30 September 2024 |website=Centers for Disease Control and Prevention}}</ref>[[File:Whooping Cough (8744519854).jpg|thumb|An epidemiologist tests blood samples for pertussis during a 2010 outbreak.]]

==History==
=== Discovery ===
''Bordetella 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 [[NorthShore University HealthSystem#Evanston Hospital|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.<ref name="Baker_2004">{{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 }}</ref><ref>{{Cite web |title=Pertussis |url=https://www.museumofhealthcare.ca/explore/exhibits/vaccinations/pertussis.html |access-date=2024-11-04 |website=Museum of Health Care}}</ref><ref>{{Citation |last1=Vaccines |first1=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.}}</ref>

=== Vaccine ===

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 ''[[JAMA (journal)|Journal of the American Medical Association]]'', and in partnership with [[Emory University]] and [[Eli Lilly and Company|Eli Lilly & Company]], she developed the first safe and effective pertussis vaccine.<ref>{{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|archive-url = https://web.archive.org/web/20150321042123/http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_78.html|archive-date = 21 March 2015}}</ref> 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.<ref name="Bannink_2013">{{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 }}</ref> 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.<ref name="Sato_1984">{{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 }}</ref> 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.

== References ==
{{Reflist}}

== External links ==
{{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/video/vaccinescalling-the-shots/ 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 }}

{{Bacterial diseases}}

{{Authority control}}

[[Category:Whooping cough| ]]
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