Pertussis Guide
Pertussis is highly contagious, severe, and preventable – get the latest evidence-based updates every healthcare professional needs.
Key Summary
- What it is: Pertussis (whooping cough) is a highly contagious respiratory infection that can cause severe illness and death, especially in infants.
- Symptoms: Starts like a cold (runny nose, mild fever, cough), progressing to violent coughing fits that may last weeks. Infants may not “whoop” but can become critically ill.
- High-risk groups: Infants <6 months, pregnant women (and newborns), household contacts of infants, adolescents/adults with waning immunity, and healthcare workers.
- Transmission: Spread via coughing/sneezing; up to 90% of unprotected household contacts may be infected. Infectious for ~3 weeks after symptoms begin.
- Vaccines:
- Children: 5-dose NIP schedule (2, 4, 6, 18 months, 4 years), plus adolescent booster (11–13y).
- Adults: dTpa every 10 years; recommended for ≥50y, ≥65y, travellers, and healthcare workers.
- Pregnancy: Free on NIP at 20–32 weeks to protect newborns.
- Effectiveness: 3-dose series provides ~84% protection; immunity wanes but adolescent/adult boosters restore ~92% protection.
- Prevention: Maternal vaccination, infant immunisation, boosters, and cocooning household contacts.
- Treatment: Early antibiotics reduce spread but are ineffective if cough >3 weeks.
- Safety: Acellular vaccines are safe, with mostly mild side effects; safe in pregnancy with no increased risk of complications.
About Pertussis
Pertussis (also known as whooping cough) is a highly contagious bacterial infection affecting the respiratory system, and can cause severe illness and death. Children under 6 months of age who get whooping cough, usually require hospitalisation and are at greatest risk of severe disease and death.
A pertussis sufferer is infectious for up to 3 weeks. They infect an estimated 90% of unprotected and unvaccinated household contacts.[1]
As a healthcare professional you play a critical role in the patient’s decision making. 73% of people would take your advice and have the pertussis vaccine. From a survey conducted in Western Australia, it was suggested that pertussis vaccination rates of 94% were achievable if providers were to recommend them during pregnancy.[2]
Between 2008 and 2012, all Australian States experienced their largest pertussis epidemic on record. The highest rates of disease were in infants <6 months old, and children aged 5–9 years.[3]
In 2024, there were 57,223 cases of pertussis reported nationally. Children under 15 years of age accounted for 66% of these notifications. In 2023, 2,454 cases were reported nationally.[4]
There was a dramatic drop in reported pertussis cases between 2020 and 2022. This was likely due to the COVID-19 pandemic (e.g. increased physical distancing, travel restrictions, emphasis on hygiene, changes in testing priorities and diversion of resources).[5]
Cause And Transmission
Pertussis is an acute respiratory illness caused by the Bordetella pertussis bacterium.
Pertussis is highly contagious and only found in humans. It spreads by airborne droplets when an infected person sneezes or coughs. The droplets can be breathed in by others or passed on to others by touching a contaminated surface.
People with pertussis are most infectious in the first 3 weeks after the onset of symptoms.
Symptoms
Symptoms will start to appear 1–3 weeks after exposure to the bacteria. The disease begins like a cold, with a runny nose, mild fever and a cough.
The cough gets worse and can last 1–2 months or longer.
The illness is characteristically known for repeated violent bouts of coughing followed by a whooping inspiration.
The whoop may be absent in very young infants, older children, and adults.
Some children cough so much they vomit afterwards.
Pertussis Complications
Severe complications, which occur almost exclusively in unvaccinated people, include pneumonia, hypoxic encephalopathy and death.
Some of the complications of whooping cough in young babies include:
- Haemorrhage
- Apnoea
- Pneumonia
- Inflammation of the brain
- Convulsions
- Permanent brain damage
- Death
How Is Pertussis Treated?
Pertussis is treated with an antibiotic usually azithromycin for 5 days or clarithromycin for 7 days or trimethoprim-sulfamethoxazole for 7 days. These antibiotics will prevent the spread of pertussis to other people.[6]
If patients have been coughing for more than 3 weeks, they are rarely infectious. In these cases, antibiotics are usually not needed.
Who Should Be Vaccinated?
Infants and children
Infants and children are recommended to receive pertussis-containing vaccine in a 5-dose schedule
Infants and children can receive a free pertussis vaccine under the National Immunisation Program (NIP). The NIP schedule is updated when there are changes to the schedule which is announced publicly to HCPs by the Australian Government.
Adolescents
Adults
Pregnancy/Breastfeeding
A single dose of pertussis-containing vaccine is recommended in each pregnancy
Healthcare workers
Healthcare workers are recommended to receive pertussis-containing vaccine every 10 years
Early childhood educators and carers
Travellers
Travellers who need protection against polio are recommended to receive dTpa-IPV
Adult household contacts and carers of infants
People with a history of pertussis infection
Vaccine Effectiveness
A 3-dose primary series of immunisation with DTPa vaccine at 2 months, 4 and 6 months of age results in 84% protective efficiency against severe disease.[8]
Immunity to pertussis wanes over time. Effectiveness of 3 doses of DTPa vaccine declined progressively from 2 years of age to less than 50% by 4 years of age.[9]
A large trial in adolescents and adults demonstrated overall vaccine efficiency against confirmed pertussis of 92% within 2.5 years of vaccination.[10]
Vaccination Side Effects
Compared to whole-cell pertussis vaccines (dTpw), acellular pertussis vaccines are associated with a much lower incidence of:
- Fever (20% vs 45%)
- Local reactions (10% vs 40%)3
Extensive limb swelling can occur with booster doses of dTpa. Such reactions commence within 48 hours of vaccination, last 1–7 days and resolve completely.[11]
Vaccination Co-Administration
Do not mix dTpa or dTpa-containing vaccines with any other vaccine in the same syringe, unless specifically registered for use in this way.
Pertussis-containing vaccines can be co-administered with most other vaccines. Pertussis-containing vaccines can be co-administered with influenza vaccine or RSV vaccine (Abrysvo) during pregnancy.[5]
Pertussis Vaccination During Pregnancy
Pertussis vaccine now funded during pregnancy under the NIP.
The optimal time to vaccinate is between 20 and 32 weeks gestation.[7]
Studies show no increased risk of adverse pregnancy outcomes (such as stillbirth, foetal distress or low birth weight) related to pertussis vaccination during pregnancy.[12]
Pertussis And Young Infants
Infants less than 6 months are at greatest risk of severe illness and death. 4 out of 5 babies with pertussis get it from someone at home.[13] Create a circle of protection for babies by vaccinating the people in contact with them.
While the following adults may not receive a free pertussis vaccination under the NIP, to best protect infants against pertussis they should follow these recommendations:
- Adult household contacts and carers (e.g. fathers and grandparents of infants) should ideally receive a dTpa vaccine at least 2 weeks before beginning close contact with the infant
- A booster vaccine is recommended for those who have not received one in the previous 10 years
- Adults working with infants and children under 4 should receive a dose of dTpa vaccine with a booster dose every 10 years
- All healthcare workers should receive a dose of dTpa with a booster dose every 10 years
Pertussis In Adults
25% of pertussis notifications in 2024 were adults 20 years and over.[4]
Patients and physicians may not be aware of the disease and diagnostic tests sometimes have limited sensitivity. Therefore, pertussis is likely to be under-diagnosed.
Pertussis can cause significant morbidity in adults, with a cough persisting for up to 3 months, and includes:
- Average of 10 work days lost
- Disruption to daily life
Adults (and adolescents) are a significant reservoir of infection.
Immunity acquired through vaccination or exposure to pertussis wanes and requires revaccination for protection.
dTpa is recommended for any adult who wishes to reduce the likelihood of becoming ill with pertussis.
Any adult who needs a tetanus-containing vaccine can have dTpa vaccine rather than dT, especially if they have not previously had a dTpa in adulthood.
References
- Decker MD, Edwards KM. Pertussis (Whooping Cough). J Infect Dis. 2021 Sep 30;224 (12 Suppl 2):S310-S320. doi: 10.1093/infdis/jiaa469. PMID: 34590129; PMCID: PMC8482022.
- Mak DB, Regan AK, Vo DT, Effler PV. Antenatal influenza and pertussis vaccination in Western Australia: a cross-sectional survey of vaccine uptake and influencing factors. BMC Pregnancy Childbirth. 2018 Oct 24;18(1):416. doi: 10.1186/s12884-018-2051-3. PMID: 30355329; PMCID: PMC6201540.
- NCIRS, Pertussis Factsheet https://ncirs.org.au/sites/default/files/2023-06/Pertussis%20factsheet%20June%202023.pdf, June 2023
- Department of Health, National Notifiable Diseases Surveillance System
- Australian Government Department of Health and Aged Care. Pertussis (whooping cough): Coadministration with other vaccines. In: The Australian Immunisation Handbook [Internet]. Canberra: Australian Government Department of Health and Aged Care; 2024 [cited 2025 Sep 19]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pertussis-whooping-cough#coadministration-with-other-vaccines
- Therapeutic Guidelines Ltd (eTG 2023 edition)
- Australian Immunisation Handbook. Pertussis (whooping cough). Canberra: Australian Government Department of Health; Available from https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pertussis-whooping-cough
- Zhang L, Prietsch SO, Axelsson I, Halperin SA. Acellular vaccines for preventing whooping cough in children. Cochrane Database of Systematic Reviews 2012;(3):CD001478
- Quinn HE, Snelling TL, Macarthney KK, McIntyre PB. Duration of protection after first dose of acellular pertussis vaccine in infants. Pediatrics 2014;133;e513-9
- Ward JI, Cherry JD, Chang SJ, et al. Efficacy of an acellular pertussis vaccine among adolescents and adults. New England Journal of Medicine 2005;353:1555-63
- Rennels MB. Extensive swelling reactions occurring after booster doses of diphtheria-tetanus-acellular pertussis vaccines. Seminares in Pediatric Infectious Diseases 2003;14:196-8
- Munoz FM, Bond NH, Maccato M, et al. Safety and immunogenicity of tetanus diphtheria and acellular pertussis immunisation during pregnancy in mothers and infants: a randomised clinical trial. JAMA 2014;311:1760-9
- Health Victoria. Pertussis (whooping cough). Melbourne: Department of Health, Victoria. Available from https://www.health.vic.gov.au/infectious-diseases/pertussis-whooping-cough
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