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 2018

Since 2012, Scotland has experienced a long-term outbreak of pertussis, as has the rest of the UK.

Figure 1 shows the number of laboratory reports in Scotland from 2011 until the end of 2018. In 2012 and 2013 there were 1926 and 1188 laboratory confirmed cases, respectively. While this declined to a total of 684 laboratory confirmed cases in 2017 it still remains well above the levels historically seen in Scotland over the previous 10 year period, for example 119 in 2011. In 2018, there was a further decrease to 443 confirmed cases of pertussis.

Figure 1 is a bar chart showing the number of laboratory reports of Bordetella pertussis by month from 2011 until 2018 (week 39). The figure shows the outbreak of infection which occurred in 2012 into 2013 with 1926 and 1188 cases, respectively.  While this declined to a total of 684 laboratory-confirmed cases in  2017 still remains well above the levels historically seen in Scotland over the previous 10-year period, for example 119 in 2011. In 2018, there was a further decrease to 443 confirmed cases of pertussis.

Age breakdown of cases

Young infants are the group most likely to develop complications from 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. The aim is to protect young infants in the first few weeks of life before they are old enough to start the routine childhood programme at eight weeks.

Figure 2 presents the proportion of laboratory reports by age breakdown for pertussis by year from 2012 until the end of 2018. In 2018 the highest proportion of reports is in those aged 10 to 14 years and adults aged 30 to 69 years.

Figure 2 presents the proportion of laboratory reports by age breakdown for pertussis by year from 2012 until 2018. Thus far in 2018 the highest proportion of reports is in those aged 10-14 years and adults aged 30-69 years.

Figure 3 shows that in 2018 there were 21 cases of pertussis in infants under 1 year of age (4.7%) compared to 37 in 2017, with an incidence rate of 39.2 per 100,000, compared to 239.1 per 100,000 at the start of the outbreak in 2012. Incidence rates in those aged 10 to 14 years and 40 to 49 years were higher than other age groups apart from those aged under 1 year, with 12.1 and 13.0 per 100,000 respectively.

In 2018 there were 12 cases in infants aged two months and under compared to 26 cases in 2017 which remains low despite the continued high activity in older age groups. This is still well below that of 95 cases in 2012 demonstrating the positive impact of vaccination programme in reducing the incidence of pertussis in young infants.

Figure 3 presents the number of laboratory reports of pertussis by age group for 2018 as a bar chart and the incidence rate per 100,000 as a line graph.   Figure 3 shows that in 2018 there were 21 cases of pertussis in infants under 1 year of age (4.7%) compared to 37 in 2017) with an incidence rate of 39.2 per 100,000, compared to 239.1 per 100,000 at the start of the outbreak in 2012. Incidence rates in those aged 10 to 14 years and 40 to 49 years were higher than other age groups apart from those aged under 1 year, with 12.1 and 13.0 per 100,000 respectively.

Laboratory confirmed cases by NHS board

The number of laboratory reports and rates per 100,000 of the population by NHS board in 2018 are shown in Figure 4. There is variation between NHS boards with the highest rates in NHS Grampian followed by NHS Ayrshire & Arran and NHS Borders.

Figure 4 presents the number of laboratory reports of pertussis by NHS board in 2018 as a bar chart and the incidence rate per 100,000 as a line graph. The number of laboratory reports and rates per 100,000 of the population by NHS board in 2018 are shown in Figure 4. There is variation between NHS boards with the highest rates in NHS Grampian followed by NHS Ayrshire & Arran and NHS Borders.

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 2018

Figure 1 presents the vaccine uptake by month for Scotland from October 2012 until the end of December 2018. These data are available from approximately 97% of GP practices. The quarterly vaccine uptake for Scotland was 68.8% in the fourth quarter of 2018, which was an increase from the previous quarter (64.4%).

Figure 1 is a bar chart which shows vaccine uptake by month for Scotland from October 2012 until 2018 (Q4). The quarterly vaccine uptake for Scotland was 68.8% in the fourth quarter of 2018, which was an increase from the previous quarter (64.4%).

Figure 2 presents the cumulative percentage vaccine uptake by NHS board for the third quarter of 2018, which ranges from 52.0% to 80.0% across NHS boards.

Figure 2 is a bar chart which presents the cumulative percentage vaccine uptake by NHS board for 2018 (Q4), which ranges from 52.0% to 80.0% across NHS boards.

In order for the uptake figures to be accurately recorded, it is important that the date of vaccination and date of delivery are entered in the GP software system promptly, in order that data is included in the extract. This can be affected by different modes of delivery of the programme e.g. in rural areas, the community midwives may offer the vaccine and this can result in delay in data being entered into the system.