Whooping Cough (Pertussis) in Adults: Symptoms, Risks, and Prevention

Understand whooping cough (pertussis) in adults including symptoms, complications, treatment, and prevention to safeguard your health.

By Medha deb

Created on Oct 3, 2025

Whooping Cough (Pertussis) in Adults

Whooping cough, or pertussis, is a highly contagious respiratory infection that affects people of all ages, including adults. It is caused by the bacterium Bordetella pertussis and is best known for its severe, rapid coughing fits followed by a high-pitched “whoop” sound. While commonly associated with infants and young children, pertussis poses serious health risks to adults, especially those with waning immunity or underlying medical conditions.

What Is Pertussis (Whooping Cough)?

Pertussis is a bacterial infection of the respiratory tract that can cause long bouts of coughing, leading to significant discomfort and even complications, such as pneumonia or rib fractures from severe coughing. Before the introduction of widespread vaccination, pertussis was primarily a disease of childhood, but in recent decades, cases among adults have risen due to fading immunity over time.

Caused by: Bordetella pertussis bacterium
Highly contagious, spreading easily from person to person
Affects all ages, but particularly concerning for unvaccinated infants, older adults, and immunocompromised individuals

Why Are Adults at Risk?

Although childhood vaccination against pertussis is effective, immunity decreases over time. Adults who were vaccinated or previously infected as children can become susceptible to infection again as their protection wanes. Factors increasing the risk for adults include:

Waning immunity from childhood vaccination or earlier infection
Increased exposure to children or infants, such as in caregiving or teaching roles
Living in or working around large groups of people
Chronic respiratory illnesses (e.g., asthma, COPD)

Causes and Transmission

The Bordetella pertussis bacterium is spread through droplets released when an infected person coughs or sneezes. The bacteria attach to the lining of the airways and produce toxins that cause inflammation and disrupt the normal cleansing mechanisms of the respiratory tract.

Mode of transmission: Airborne droplets from coughing or sneezing
Incubation period: 5 to 10 days (can be up to 3 weeks)

Symptoms of Whooping Cough in Adults

The symptoms of pertussis in adults often develop in stages, which can make it difficult to recognize in the early phase. Symptoms typically appear 5–10 days after exposure but may emerge as late as three weeks.

Early (Catarrhal) Stage

Mild fever
Runny or stuffy nose
Red, watery eyes
Sore throat
Mild, occasional cough
Fatigue

These symptoms can easily be mistaken for a common cold or mild flu.

Progressive (Paroxysmal) Stage

After one to two weeks, the disease enters its most recognizable phase:

Severe, uncontrollable bouts of coughing (paroxysms)
Coughing fits that may last for several minutes and often worsen at night
Possible high-pitched “whoop” sound upon inhalation after coughing (less common in adults than in children)
Vomiting or gagging following coughing spells
Exhaustion or fatigue after coughing
Facial redness or even blue-tinged lips after coughing
Headaches or light-headedness after episodes

Unlike children, adults may not always exhibit the classic “whoop.” For many, a persistent dry cough is the only symptom, which can complicate diagnosis.

Recovery (Convalescent) Stage

The cough gradually lessens over weeks to months, but some adults may continue to cough for 2–3 months or longer. Repeated respiratory infections can trigger a return of symptoms temporarily.

Complications of Whooping Cough in Adults

Pertussis can be serious for adults, leading to multiple complications, especially in those with existing health concerns. Common complications include:

Broken or bruised ribs from intense coughing
Hernias
Fainting (syncope)
Pneumonia
Worsening of pre-existing respiratory conditions like asthma or COPD

Although rare, severe complications such as seizures or encephalopathy (brain inflammation) can occur, mainly in those with compromised immune systems.

When to See a Doctor

Early medical evaluation is critical if you experience a persistent cough lasting longer than two weeks, especially if accompanied by:

Repeated coughing fits
Difficulty breathing
Vomiting after coughing
Bluish or dusky color to the lips or face
Signs of pneumonia (chest pain, severe shortness of breath)

Timely diagnosis and treatment help reduce the risk of complications and prevent spread to vulnerable populations.

Diagnosis of Whooping Cough in Adults

Diagnosing pertussis in adults can be challenging since initial symptoms mimic those of many common respiratory infections. Healthcare providers rely on a combination of medical history, physical exam, and key diagnostic tests.

Diagnostic Methods

Nose or throat swab (culture and PCR test): The gold standard for confirming pertussis; a mucus sample is collected from the nasopharynx and analyzed for the presence of Bordetella pertussis.
Blood tests: May be used to identify evidence of infection, though not specific for pertussis.
Chest X-ray: Used if pneumonia or other complications are suspected.
Clinical assessment: Detailed medical history and review of symptoms, especially cough duration and pattern.

Prompt and accurate diagnosis is particularly important for protecting infants, pregnant individuals, or others at high risk of severe illness.

Treatment of Whooping Cough in Adults

The primary treatment goals are to limit the severity and duration of symptoms, reduce the risk of serious complications, and prevent transmission to others. For adults, treatment is usually managed at home unless there are severe symptoms or underlying health problems.

Medical Treatments

Antibiotics: Early administration (within the first few weeks of illness) can shorten the illness and lower the risk of spreading infection. Common antibiotics include azithromycin, clarithromycin, or erythromycin.
Supportive care: Rest, adequate hydration, and small frequent meals can help maintain strength and reduce coughing triggers.
Isolation: Staying home from work or social activities for at least five days after beginning antibiotic therapy prevents further spread.

Over-the-counter cough medicines are generally not effective for whooping cough and are not recommended. Seek guidance from your healthcare provider before using any medication.

When Hospitalization May Be Needed

Serious symptoms such as severe respiratory distress, persistent vomiting, or evidence of dehydration
Presence of high-risk conditions (such as immunosuppression or underlying cardiac or lung disease)

Intravenous fluids and oxygen therapy may be used in severe cases.

Prevention of Whooping Cough (Pertussis) in Adults

The most effective prevention is vaccination. Adults can contract whooping cough even if they were vaccinated as children because immunity wanes with time. Booster shots help maintain protective immunity.

Pertussis Vaccination for Adults

Tdap vaccine: Recommended for all adults who have not received it previously, especially those who have close contact with infants, healthcare workers, and pregnant individuals.
Pregnant individuals: Should receive a Tdap vaccine during each pregnancy, preferably at 27–36 weeks gestation to provide passive immunity to the baby.
Routine boosters: Adults should consult their healthcare provider about the need for subsequent boosters, particularly if they work in health care or childcare settings.

Additional preventive measures:

Practice good hand hygiene and respiratory etiquette (i.e., covering mouth during coughs and sneezes)
Avoid close contact with individuals known to be infected
Stay home when experiencing symptoms compatible with pertussis until cleared by a healthcare provider
Ensure other household members are up to date on vaccines

Long-Term Outlook and Managing Pertussis in Adults

Most healthy adults recover from pertussis without long-term effects, though the classic cough may persist for months. Ongoing fatigue, chest discomfort, and sleep disruption are not uncommon during recovery. Older adults and individuals with underlying health conditions are at greater risk of extended symptoms and complications.

Important Considerations

Adhere to prescribed antibiotic regimen even if coughing improves
Notify close contacts, especially those at higher risk, if diagnosed
Promptly seek medical attention if new or worsening symptoms appear

Frequently Asked Questions (FAQs)

Q: How long is an adult with whooping cough contagious?

A: Adults with pertussis are most contagious in the early catarrhal stage and first two weeks of coughing. With proper antibiotic treatment, the risk of transmission drops significantly after five days.

Q: Can you get whooping cough more than once?

A: Yes, immunity after infection or vaccination wanes over time, so reinfection is possible. This is why booster vaccinations are recommended for adults.

Q: Why is whooping cough dangerous for infants and vulnerable adults?

A: Infants, pregnant people, and immunocompromised adults can develop severe or even fatal complications, including pneumonia and respiratory failure, due to immature or weakened immune systems.

Q: What if I was vaccinated as a child? Do I need a booster?

A: Yes, adults should get a Tdap booster if they have not received one, as protection from the childhood DTaP series decreases over time. This booster is critical for those around infants and in certain professions.

Q: Are antibiotics always needed for pertussis?

A: Antibiotics are most effective in early disease to reduce severity and transmission but may not shorten the course if given late. They still help prevent spread, so finishing the prescribed course is important.

Key Takeaways for Adults

Pertussis can affect adults even after childhood vaccination.
Classic symptoms may be subtle; persistent cough warrants evaluation.
Early diagnosis and treatment are essential to prevent complications and stop spread.
Booster vaccination helps protect both the individual and those around them.
Consult your healthcare provider if you develop a long-lasting cough or are in close contact with someone diagnosed with pertussis.

References

Author

medha deb

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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