Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Pertussis infection: Epidemiology, microbiology, and pathogenesis

Paul Cornia, MD
Benjamin A Lipsky, MD, FACP, FIDSA, FRCP
Section Editors
Stephen B Calderwood, MD
Sheldon L Kaplan, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Pertussis, also known as "whooping cough," is a highly contagious acute respiratory illness caused by Bordetella pertussis. Sydenham is credited with naming the illness pertussis in 1679, from the Latin term meaning "intense cough." In addition, the Chinese term for pertussis translates to "the 100-day cough." These names describe the key clinical features of infection. However, the classic clinical manifestations of pertussis infection (cough with paroxysms, inspiratory whoop, and posttussive emesis) are frequently absent in adolescents and adults.

The microbiology, epidemiology, and pathogenesis of pertussis are reviewed here. The clinical manifestations, diagnosis, management, and prevention of pertussis are discussed separately. (See "Pertussis infection in adolescents and adults: Clinical manifestations and diagnosis" and "Pertussis infection in infants and children: Treatment and prevention" and "Pertussis infection in infants and children: Clinical features and diagnosis".)


Pertussis is caused by the gram-negative coccobacillus B. pertussis, a strict human pathogen with no known animal or environmental reservoir [1]. The organism is fastidious, surviving only a few hours in respiratory secretions and thus requiring special media for culture.

Eight additional Bordetella species have been described: B. parapertussishu, B. parapertussisov (ovine-adapted parapertussis), B. bronchiseptica, B. avium, B. hinzii, B. holmesii, B. trematum, and B. petrii [2]. Three of these species (B. parapertussis, B. bronchiseptica, and B. holmesii) can cause respiratory illness in humans. B. parapertussis may cause a spectrum of disease ranging from a nonspecific upper respiratory tract illness to classic pertussis (ie, clinically indistinguishable from that of B. pertussis) [3,4]. B. bronchiseptica causes respiratory infections in a variety of mammals; infection in humans can occur in immunocompromised hosts with animal exposure [5]. B. holmesii infection has been described in the setting of septicemia and respiratory infection clinically similar to classic pertussis [6-9].


Pertussis is a highly contagious respiratory illness. In adolescents and adults, infection may result in a protracted cough and is occasionally associated with substantial morbidity. In children and particularly infants, morbidity is more often substantial and the disease may be fatal.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Oct 29, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Cotter PA, Miller JF. Bordetella. In: Principles of bacterial pathogenesis, Groisman EA. (Ed), Academic Press, Ltd, London 2001. p.619.
  2. Mattoo S, Cherry JD. Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to Bordetella pertussis and other Bordetella subspecies. Clin Microbiol Rev 2005; 18:326.
  3. Cherry JD, Seaton BL. Patterns of Bordetella parapertussis respiratory illnesses: 2008-2010. Clin Infect Dis 2012; 54:534.
  4. Koepke R, Bartholomew ML, Eickhoff JC, et al. Widespread Bordetella parapertussis Infections-Wisconsin, 2011-2012: Clinical and Epidemiologic Features and Antibiotic Use for Treatment and Prevention. Clin Infect Dis 2015; 61:1421.
  5. Woolfrey BF, Moody JA. Human infections associated with Bordetella bronchiseptica. Clin Microbiol Rev 1991; 4:243.
  6. Weyant RS, Hollis DG, Weaver RE, et al. Bordetella holmesii sp. nov., a new gram-negative species associated with septicemia. J Clin Microbiol 1995; 33:1.
  7. Yih WK, Silva EA, Ida J, et al. Bordetella holmesii-like organisms isolated from Massachusetts patients with pertussis-like symptoms. Emerg Infect Dis 1999; 5:441.
  8. Rodgers L, Martin SW, Cohn A, et al. Epidemiologic and laboratory features of a large outbreak of pertussis-like illnesses associated with cocirculating Bordetella holmesii and Bordetella pertussis--Ohio, 2010-2011. Clin Infect Dis 2013; 56:322.
  9. Tartof SY, Gounder P, Weiss D, et al. Bordetella holmesii bacteremia cases in the United States, April 2010-January 2011. Clin Infect Dis 2014; 58:e39.
  10. Warfel JM, Beren J, Merkel TJ. Airborne transmission of Bordetella pertussis. J Infect Dis 2012; 206:902.
  11. Deen JL, Mink CA, Cherry JD, et al. Household contact study of Bordetella pertussis infections. Clin Infect Dis 1995; 21:1211.
  12. Althouse BM, Scarpino SV. Asymptomatic transmission and the resurgence of Bordetella pertussis. BMC Med 2015; 13:146.
  13. Tiwari T, Murphy TV, Moran J, National Immunization Program, CDC. Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC Guidelines. MMWR Recomm Rep 2005; 54:1.
  14. Bergquist SO, Bernander S, Dahnsjö H, Sundelöf B. Erythromycin in the treatment of pertussis: a study of bacteriologic and clinical effects. Pediatr Infect Dis J 1987; 6:458.
  15. Bass JW, Klenk EL, Kotheimer JB, et al. Antimicrobial treatment of pertussis. J Pediatr 1969; 75:768.
  16. Centers for Disease Control and Prevention (CDC). Pertussis--United States, 1997-2000. MMWR Morb Mortal Wkly Rep 2002; 51:73.
  17. Mink CM, Cherry JD, Christenson P, et al. A search for Bordetella pertussis infection in university students. Clin Infect Dis 1992; 14:464.
  18. Centers for Disease Control and Prevention. MMMWR. Notifiable Diseases and Mortality Tables. April 20, 2012. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6115md.htm?s_cid=mm6115md_w (Accessed on April 30, 2012).
  19. Winter K, Harriman K, Schechter R, et al. Notes from the field: Pertussis--California, January-June 2010. MMWR Morb Mortal Wkly Rep 2010; 59:817.
  20. Centers for Disease Control and Prevention. Pertussis (Whooping Cough). Outbreaks. http://www.cdc.gov/pertussis/outbreaks.html.
  21. http://www.cdc.gov/pertussis/surv-reporting.html, (Accessed on October 17, 2013).
  22. Winter K, Glaser C, Watt J, et al. Pertussis epidemic--California, 2014. MMWR Morb Mortal Wkly Rep 2014; 63:1129.
  23. Centers for Disease Control and Prevention (CDC). Pertussis epidemic--Washington, 2012. MMWR Morb Mortal Wkly Rep 2012; 61:517.
  24. Cherry JD. The epidemiology of pertussis: a comparison of the epidemiology of the disease pertussis with the epidemiology of Bordetella pertussis infection. Pediatrics 2005; 115:1422.
  25. Cherry JD. The present and future control of pertussis. Clin Infect Dis 2010; 51:663.
  26. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1997; 46:1.
  28. Jenkinson D. Duration of effectiveness of pertussis vaccine: evidence from a 10 year community study. Br Med J (Clin Res Ed) 1988; 296:612.
  29. Cody CL, Baraff LJ, Cherry JD, et al. Nature and rates of adverse reactions associated with DTP and DT immunizations in infants and children. Pediatrics 1981; 68:650.
  30. Zhang L, Prietsch SO, Axelsson I, Halperin SA. Acellular vaccines for preventing whooping cough in children. Cochrane Database Syst Rev 2014; :CD001478.
  31. Clark TA, Messonnier NE, Hadler SC. Pertussis control: time for something new? Trends Microbiol 2012; 20:211.
  32. Witt MA, Katz PH, Witt DJ. Unexpectedly limited durability of immunity following acellular pertussis vaccination in preadolescents in a North American outbreak. Clin Infect Dis 2012; 54:1730.
  33. Klein NP, Bartlett J, Rowhani-Rahbar A, et al. Waning protection after fifth dose of acellular pertussis vaccine in children. N Engl J Med 2012; 367:1012.
  34. Misegades LK, Winter K, Harriman K, et al. Association of childhood pertussis with receipt of 5 doses of pertussis vaccine by time since last vaccine dose, California, 2010. JAMA 2012; 308:2126.
  35. Tartof SY, Lewis M, Kenyon C, et al. Waning immunity to pertussis following 5 doses of DTaP. Pediatrics 2013; 131:e1047.
  36. Wessels MR, Brigham KS, DeMaria A Jr. Case records of the Massachusetts General Hospital. Case 6-2015. A 16-year-old boy with coughing spells. N Engl J Med 2015; 372:765.
  37. Klein NP, Bartlett J, Fireman B, et al. Comparative effectiveness of acellular versus whole-cell pertussis vaccines in teenagers. Pediatrics 2013; 131:e1716.
  38. Witt MA, Arias L, Katz PH, et al. Reduced risk of pertussis among persons ever vaccinated with whole cell pertussis vaccine compared to recipients of acellular pertussis vaccines in a large US cohort. Clin Infect Dis 2013; 56:1248.
  39. Centers for Disease Control and Prevention. Pertussis (Whooping Cough). Pertussis in Other Countries. http://www.cdc.gov/pertussis/countries.html.
  40. Centers for Disease Control and Prevention (CDC). Pertussis--United States, 2001-2003. MMWR Morb Mortal Wkly Rep 2005; 54:1283.
  41. Güriş D, Strebel PM, Bardenheier B, et al. Changing epidemiology of pertussis in the United States: increasing reported incidence among adolescents and adults, 1990-1996. Clin Infect Dis 1999; 28:1230.
  42. Dworkin MS. Adults are whooping, but are internists listening? Ann Intern Med 2005; 142:832.
  43. Hewlett EL, Edwards KM. Clinical practice. Pertussis--not just for kids. N Engl J Med 2005; 352:1215.
  44. Tanaka M, Vitek CR, Pascual FB, et al. Trends in pertussis among infants in the United States, 1980-1999. JAMA 2003; 290:2968.
  45. Vitek CR, Pascual FB, Baughman AL, Murphy TV. Increase in deaths from pertussis among young infants in the United States in the 1990s. Pediatr Infect Dis J 2003; 22:628.
  46. Cornia PB, Hersh AL, Lipsky BA, et al. Does this coughing adolescent or adult patient have pertussis? JAMA 2010; 304:890.
  47. von König CH, Halperin S, Riffelmann M, Guiso N. Pertussis of adults and infants. Lancet Infect Dis 2002; 2:744.
  48. Nelson JD. The changing epidemiology of pertussis in young infants. The role of adults as reservoirs of infection. Am J Dis Child 1978; 132:371.
  49. Bisgard KM, Pascual FB, Ehresmann KR, et al. Infant pertussis: who was the source? Pediatr Infect Dis J 2004; 23:985.
  50. Wendelboe AM, Njamkepo E, Bourillon A, et al. Transmission of Bordetella pertussis to young infants. Pediatr Infect Dis J 2007; 26:293.
  51. Kowalzik F, Barbosa AP, Fernandes VR, et al. Prospective multinational study of pertussis infection in hospitalized infants and their household contacts. Pediatr Infect Dis J 2007; 26:238.
  52. Edwards KM. Overview of pertussis: focus on epidemiology, sources of infection, and long term protection after infant vaccination. Pediatr Infect Dis J 2005; 24:S104.
  53. Skoff TH, Kenyon C, Cocoros N, et al. Sources of Infant Pertussis Infection in the United States. Pediatrics 2015; 136:635.
  54. Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci U S A 2014; 111:787.
  55. Liu BC, McIntyre P, Kaldor JM, et al. Pertussis in older adults: prospective study of risk factors and morbidity. Clin Infect Dis 2012; 55:1450.
  56. Paddock CD, Sanden GN, Cherry JD, et al. Pathology and pathogenesis of fatal Bordetella pertussis infection in infants. Clin Infect Dis 2008; 47:328.
  57. Christie CD, Baltimore RS. Pertussis in neonates. Am J Dis Child 1989; 143:1199.
  58. Smith C, Vyas H. Early infantile pertussis; increasingly prevalent and potentially fatal. Eur J Pediatr 2000; 159:898.
  59. Pawloski LC, Queenan AM, Cassiday PK, et al. Prevalence and molecular characterization of pertactin-deficient Bordetella pertussis in the United States. Clin Vaccine Immunol 2014; 21:119.
  60. Martin SW, Pawloski L, Williams M, et al. Pertactin-negative Bordetella pertussis strains: evidence for a possible selective advantage. Clin Infect Dis 2015; 60:223.