What is whooping cough, and why is it serious in infants?
Whooping cough is a highly contagious bacterial respiratory infection caused by Bordetella pertussis, characterized by violent, uncontrollable coughing fits followed by a wheezing inhalation (“crow’s cry”). A notifiable disease in France, it is potentially fatal in infants under 6 months of age. Antibiotic treatment and vaccination are the only medically validated treatments—natural approaches are used only for symptomatic relief. Any infant experiencing coughing fits must be hospitalized immediately. Explore our respiratory health line, our dry cough products, and our children’s cough page for complementary natural support.
- Mechanism of whooping cough: Bordetella pertussis secretes toxins (pertussis toxin, adenylate cyclase, filamentous hemagglutinin) → destruction of bronchial cilia → mucus buildup → bronchial hyperreflexia → uncontrollable paroxysmal spasmodic coughing fits — the cough lasts an average of 6–10 weeks (“100-day cough”)
- Clinical phases: catarrhal phase (Days 1–14) — common nasopharyngeal symptoms (runny nose, mild fever, dry cough) — highly contagious — diagnosis often missed at this stage — paroxysmal phase (Days 14–42) — violent coughing fits (5–10 spasms with apnea + wheezing inspiratory resumption (“crowing”) + vomiting after coughing fits + exhaustion — convalescent phase (6–10 weeks) — residual cough gradually subsiding
- Severity in infants < 6 months: absence of the “crow’s crow” (replaced by cyanotic apneas) — bradycardia + cyanosis during coughing fits — risk of respiratory arrest — pneumonia + seizures + anoxic encephalopathy — mortality still not zero in France — routine hospitalization recommended at the first signs
- Contagiousness: extremely contagious (attack rate 80–90% among the unvaccinated) — transmission via respiratory droplets — contagious from the catarrhal phase up to 3 weeks after the onset of coughing fits (reduced to 5 days with effective antibiotics) — adults and adolescents are often the reservoir and transmit the infection to infants who have not yet been vaccinated
- Diagnosis: Nasopharyngeal PCR (gold standard—days 1–21 of cough) — culture on Bordet-Gengou medium (takes longer, less sensitive) — serology (delayed > Day 21) — Complete blood count (CBC): characteristic lymphocytosis, sometimes marked — should be considered in any adult with a cough lasting > 14 days
Antibiotic treatment and medical management
- Standard antibiotics: azithromycin — treatment of choice in infants and children (5 days) + in adults (3–5 days) — clarithromycin — 7 days — erythromycin — 14 days (alternative) — trimethoprim-sulfamethoxazole — alternative if macrolides are contraindicated — requires a doctor’s prescription — most effective if started during the catarrhal phase (before Day 14): reduces the duration of contagiousness but does not always shorten the duration of the cough if started during the paroxysmal phase
- Contact chemoprophylaxis: preventive treatment recommended for all close contacts of a confirmed case (same antibiotic regimen) — priority for unvaccinated infants, pregnant women, and immunocompromised individuals — to be started within 3 weeks of the last exposure
- Hospitalization for infants: continuous cardiorespiratory monitoring—oxygen therapy if desaturation occurs—suctioning of secretions—enteral feeding if there is repeated vomiting—assisted ventilation in cases of severe apneas—airborne isolation (surgical mask required)
- Additional non-pharmacological measures: rest—split meals (small, frequent meals triggered by gastric fullness)—humidifier to thin secretions—avoid irritants (tobacco, dust, dry air) — semi-sitting position — cough suppressants NOT recommended (contraindicated in children < 12 years of age, ineffective against the spasmodic cough associated with pertussis)
- Mandatory reporting: Whooping cough is a notifiable disease (MDO) in France — must be reported to the ARS upon laboratory confirmation — enables epidemiological surveillance and the implementation of preventive measures around cases
Natural respiratory support (as a complement to medical treatment)
- Thyme honey or black honey (for children over 1 year of age and adults): documented antitussive properties for irritative coughs — 1 teaspoon of thyme honey before bedtime — reduces the frequency of nighttime coughing fits — strictly contraindicated before age 1 (risk of infant botulism) — in infants, no natural remedy can replace hospitalization and antibiotics
- Thyme (Thymus vulgaris): expectorant + bronchial antispasmodic + antimicrobial properties — thymol + carvacrol — as an infusion (1 teaspoon of dried thyme per 200 mL of hot water, 5–10 min) with honey—as thyme syrup—may help thin secretions and reduce residual bronchial spasms during the convalescence phase
- Ginger: gingerols + shogaols — anti-inflammatory properties for the respiratory tract + mildly expectorant — as a decoction (grated fresh ginger + honey + lemon) — well tolerated in children ages 2 and up — relieves throat irritation after coughing fits
- Propolis: antimicrobial and anti-inflammatory properties for the respiratory mucous membranes — as an oral spray to reduce throat inflammation — as a diluted oral solution for adults and children over 3 years of age (check for allergies to bee products) — to support the immune system after the acute phase
- Aromatherapy (adults only; not for infants or children under 6 years of age): Eucalyptus radiata essential oil (expectorant and mild antibacterial—1 drop in 1 teaspoon of honey) — Ravintsara essential oil (antiviral + immunostimulant — diffusion + diluted application to the chest) — never diffuse in the presence of infants or children under 6 years of age — check out our products for colds and flu-like symptoms
Vaccination, “cocooning” strategy, and immune support
- Vaccination: the only effective prevention: combined acellular vaccine (DTaP-Polio-Hib — Infanrix Hexa) — French vaccination schedule: 2 months, 4 months, 11 months, booster at 6 years, 11–13 years, 25 years — protection gradually decreases (5–10 years after the booster), hence the importance of adult boosters
- “Cocooning” strategy: protect infants < 6 mois non vaccinés — vacciner tous les adultes en contact avec un nourrisson (parents, grands-parents, fratrie, assistantes maternelles) avant ou dès la naissance — rappel recommandé si >, and 10-year-olds without vaccination — vaccination of pregnant women in the third trimester (recommended in France since 2022 — transfer of maternal antibodies to the fetus)
- Post-pertussis immune support: Pertussis temporarily depletes the immune system— vitamin D3 + zinc + vitamin C during convalescence— echinacea as a short course of treatment after full recovery (not during the infectious phase)—visit our immune system page
- Possible recurrence: post-infectious immunity lasts 4–20 years (variable) — post-infection vaccination strengthens and prolongs protection — inform your primary care physician of any episode of prolonged cough lasting > 14 days to consider a diagnosis
- Warning signs requiring urgent medical attention: coughing fits accompanied by cyanosis or apnea (life-threatening emergency—call 15) — an infant with an “unusual cough” without a crowing sound + exhaustion — consistent vomiting after coughing fits with weight loss — persistent high fever (bacterial superinfection) — an adult with a cough lasting > 14 days with no improvement
