Whooping cough

Background

Whooping cough or pertussis is an acute bacterial disease of the respiratory tract, resulting from infection with Bordetella pertussis. It can affect people of all ages but while adolescents and adults tend to suffer with a prolonged cough, unimmunised infants are at risk of severe complications and death.

Complications of whooping cough include:

  • pneumonia
  • seizures
  • encephalitis
  • long-term brain damage as a result of cerebral hypoxia

Vaccination is the most effective way to prevent pertussis transmission, although protection through vaccination or from past infection isn't for life.

For further information on the transmission, symptoms and treatment of whooping cough please visit the NHS Inform website.

Guidance

Guidance is available from Public Health England (PHE) for the public health management of pertussis.

The guidance has been approved for use in Scotland by the Scottish Health Protection Network Guidance Group (SHPN-GG) and should be used in conjunction with the SHPN addendum.

Read the addendum and access the guidelines on our website

PHE also offer further guidance, data and analysis on pertussis.

Immunisation

For more information on whooping cough immunisation, including updates, please refer to the Public Health England (PHE) Green book, chapter 24.

Training

Visit NHS Education for Scotland (NES) for training and education materials for healthcare professionals.

For all infection prevention and control guidance visit the A-Z ​pathogens section of the National Infection and Prevention Control Manual.

Data and surveillance

Surveillance update for April to June 2020

Figure 1 shows the number of positive laboratory reports of Bordetella pertussis in Scotland from 2012 through 2020. Following an outbreak in 2012 and 2013, during which there were 1,896 and 1,188 laboratory reports of pertussis, respectively, the number of reports has declined but remains elevated when compared with pre-outbreak levels. There were 23 laboratory reports in the second quarter of 2020, bringing the total number of reports to the end of the second quarter of 2020 to 189. This is lower than the number of laboratory reports for the corresponding period in 2019 (276 reports), 2017 (378 reports) and 2016 (533 reports), but higher than in 2018 (172 reports).    

Figure 1: Number of laboratory reports of Bordetella pertussis in Scotland by month, 2012 to 2020 (week 26)

Figure 1 is a bar chart showing the number of laboratory reports of Bordetella pertussis by month from 2012 through the second quarter of 2020. The figure shows the outbreak that occurred in 2012 into 2013 with 1,896 and 1,188 reports, respectively, as well as an increase in activity that occurred in 2016 (1,075 reports). The number of laboratory reports has declined since 2016 but remains elevated when compared with pre-outbreak levels.

Age breakdown of cases

Young infants are the group most likely to develop complications from pertussis infection which can require hospital treatment and, in severe cases, can be fatal. In response to the outbreak, a pertussis vaccination programme for pregnant women was introduced in October 2012 with the aim of protecting young infants in the first few weeks of life before they are old enough to start the routine childhood vaccination programme at eight weeks.

Figure 2 presents the percentage of laboratory reports for pertussis by age group and year from 2012 through the second quarter of 2020. The data for 2020 indicate that adults aged 50 to 59 years accounted for a comparatively higher percentage of laboratory reports than did individuals in other age groups.

Figure 2: Percentage of Bordetella pertussis laboratory reports in Scotland by age group and year, 2012 to 2020 (to week 26)

Figure 2 is a stacked bar chart that shows the percentage of laboratory reports of pertussis by age group and year from 2012 through the second quarter of 2020. The data for 2020 indicate that adults aged 50 to 59 years accounted for a comparatively higher percentage of laboratory reports than did individuals in other age groups.

Figure 3 presents the number of laboratory reports for pertussis by age group for the first two quarters of 2020. The graph shows that the 50-59 age group accounted for the highest number of cases, however incidence was highest among children under one year of age at 9.8 per 100,000 population as shown in Figure 4. This was followed by children aged 1 to 4 years, with an incidence of 7.2 per 100,000 population.

Figure 3: Number of laboratory reports of Bordetella pertussis in Scotland by age group, 2020 (to week 26)

Figure 3 is a bar chart showing the number of laboratory reports for Bordetella pertussis by age group during the first and second quarter of 2020. The graph shows that the 50-59 age group accounted for the highest number of cases.

Figure 4: Incidence of Bordetella pertussis per 100,000 population in Scotland by age group, 2020 (to week 26)

Figure 4 is a bar chart showing the incidence of Bordetella pertussis per 100,000 population by age group during the first and second quarter of 2020. During this period, incidence was highest among children under one year of age at 9.8 per 100,000 population.

Laboratory reports by NHS board

Figure 5 shows the number of pertussis laboratory reports by NHS board during the first and second quarter of 2020, while Figure 6 presents incidence per 100,000 population. There is variation between NHS boards, with NHS Highland having the highest incidence (7.5 reports per 100,000 population), whereas NHS Orkney, NHS Shetland, and NHS Western Isles had no positive laboratory reports during this period.

Figure 5: Number of laboratory reports of Bordetella pertussis in Scotland by NHS board, 2020 (to week 26)

Figure 5 is a bar chart showing the number of laboratory reports of Bordetella pertussis by NHS Board during the first and second quarter of 2020. NHS Greater Glasgow and Clyde had the highest number of cases during this period (47 reports), while NHS Orkney, NHS Shetland, and NHS Western Isles had no positive laboratory reports during this period

Figure 6: Incidence of Bordetella pertussis per 100,000 population in Scotland by NHS board, 2020 (to week 26)

Figure 6 is a bar chart showing the incidence of Bordetella pertussis per 100,000 population by NHS Board during the first and second quarter of 2020. There is variation between NHS Boards, with NHS Highland having the highest incidence (7.5 reports per 100,000 population).

Vaccination

In response to the increase in cases and to protect young infants in the first few weeks of life until starting the routine childhood immunisation programme at eight weeks, a programme was introduced in October 2012 to offer pertussis vaccination to all pregnant women.

The vaccine is offered between gestational weeks 16 and 32 to maximise protection of the baby from birth. Women may still be immunised after week 32 of pregnancy but this may not offer as high a level of passive immunological protection to the baby. Vaccination late in pregnancy may, however, directly protect the mother against disease and thereby reduce the risk of exposure to her infant.

As pertussis continues to circulate in Scotland above historical levels, immunisation of pregnant women is vital. The immunity young infants will receive from the mother, although very important in the first few weeks of life, is only short term protection. Therefore it's important that infants are vaccinated as part of the routine childhood schedule on time in order to provide longer term protection.


Vaccine uptake in Scotland