What is whooping cough and why are cases rising in England and Wales?

<span>Photograph: Murdo MacLeod/The Guardian</span>
Photograph: Murdo MacLeod/The Guardian

Whooping cough might sound like a disease of the Victorian era, but according to new data from public health bodies, it is on the rise in the UK.

Looking at 2023 until late November, data from the UK Health Security Agency (UKHSA) has revealed there were 1,141 suspected cases in England and Wales, compared with 450 for the same period of 2022 and 454 for that period in 2021 – about a 250% increase.

What is whooping cough?

Whooping cough, also known as pertussis, arises when bacteria called Bordetella pertussis cause an infection in the lungs and airways. It was once a common childhood infection and cause of death among babies, but a vaccine introduced in the 1950s changed that.

“Before the 1960s, when I guess we really got going with vaccination, there were epidemics every three years or so,” said Adam Finn, a professor of paediatrics at the University of Bristol.

Older children and adults can also get whooping cough – as neither vaccination nor infection provide lifelong immunity – and it is highly infectious. While less serious than in babies, according to Finn symptoms in these groups involve an ongoing cough – sometimes called a 100-day cough. The NHS notes hernia, sore ribs, middle ear infections and urinary incontinence can also arise.

Tell me more about these vaccines …

The early vaccine – which was made from whole, inactivated pertussis bacteria – worked well, but fears arose that it caused brain damage. This was subsequently found to be untrue, but the claims led to a drop in uptake, and a return of big epidemics of whooping cough in the 1980s. “Then gradually the rates of vaccination went back up again,” said Finn.

Modern whooping cough vaccines are based on more sophisticated technology in which proteins from the bacteria are purified, detoxified and administered.

Finn noted these jabs produced fewer side-effects such as fevers in babies, but the immunity they generated did not last as long. That led to a rise in whooping cough cases in teenagers and in adults around the start of the new millennium, followed by an increase in cases and deaths among babies.

As a result, from 2012 the whooping cough vaccine was offered to pregnant women in the UK, in the hope a mother’s antibodies would pass to her baby in the womb, giving protection from birth.

“This has resulted in a decline in the incidence of whooping cough in infants aged under three months,” the National Institute for Health and Care Excellence notes.

What is the current situation around cases?

According to data from UKHSA, from early July to the end of November this year there were 716 suspected cases of whooping cough in England and Wales, compared with 217 in the same period last year, and 213 in the same period of 2021.

What is unclear is the ages of those affected. “I think most of these 700-odd cases they’re describing will not be in young children. They’ll be in adults,” said Finn, adding it was likely the figures did represent a real rise rather than an increase in testing.

However, UKHSA noted lab-confirmed cases of whooping cough, while increasing, still remained lower than in the pre-pandemic years.

Why is whooping cough increasing?

Experts say it could be a hangover from restrictions during the Covid pandemic.

“Social distancing and lockdown measures imposed across the UK during the Covid-19 pandemic had a significant impact on the spread of infections, including whooping cough,” said Dr Gayatri Amirthalingam, a consultant epidemiologist at UKHSA.

Finn agreed, noting the restrictions meant fewer whooping cough infections and hence a smaller number of people with immunity. “And that means that when an infection comes, it gets more opportunities to spread,” he said.

What should people do?

Experts say it is vital pregnant women get vaccinated, and ensure their babies and young children receive the vaccine.

The whooping cough vaccine is given alongside five others to babies at eight, 12 and 16 weeks, and as part of a four-in-one booster to preschool children aged three years and four months.

The NHS notes that rest and fluids are important if infected, while paracetamol or ibuprofen can be taken. Severe cases may require hospital treatment.

The NHS adds that if whooping cough is diagnosed within three weeks of the infection, antibiotics can be given to help prevent others becoming infected.