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Pertussis infection in infants and children: Clinical features and diagnosis

Sylvia Yeh, MD
ChrisAnna M Mink, MD
Section Editor
Morven S Edwards, MD
Deputy Editor
Mary M Torchia, MD


The clinical presentation, including complications, and the diagnosis of pertussis (whooping cough) infection in infants and children will be discussed here. The treatment and prevention of pertussis in infants and children; the microbiology, epidemiology, and pathogenesis of pertussis infection; and the clinical features, treatment, and prevention of pertussis in adolescents and adults are discussed separately:

(See "Pertussis infection in infants and children: Treatment and prevention".)

(See "Pertussis infection: Epidemiology, microbiology, and pathogenesis".)

(See "Pertussis infection in adolescents and adults: Clinical manifestations and diagnosis".)

(See "Pertussis infection in adolescents and adults: Treatment and prevention".)


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Literature review current through: Sep 2016. | This topic last updated: Sep 15, 2016.
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  1. Crowcroft NS, Booy R, Harrison T, et al. Severe and unrecognised: pertussis in UK infants. Arch Dis Child 2003; 88:802.
  2. Abu Raya B, Bamberger E, Kassis I, et al. Bordetella pertussis infection attenuates clinical course of acute bronchiolitis. Pediatr Infect Dis J 2013; 32:619.
  3. Zouari A, Touati A, Smaoui H, et al. Dual infection with Bordetella pertussis and Mycoplasma pneumoniae in three infants: case reports. Infection 2012; 40:213.
  4. Nuolivirta K, Koponen P, He Q, et al. Bordetella pertussis infection is common in nonvaccinated infants admitted for bronchiolitis. Pediatr Infect Dis J 2010; 29:1013.
  5. Versteegh FG, Mooi-Kokenberg EA, Schellekens JF, Roord JJ. Bordetella pertussis and mixed infections. Minerva Pediatr 2006; 58:131.
  6. Edwards KM, Halasa N. Are pertussis fatalities in infants on the rise? What can be done to prevent them? J Pediatr 2003; 143:552.
  7. 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.
  8. Centers for Disease Control and Prevention. Pertussis (whooping cough). Surveillance & Reporting. http://www.cdc.gov/pertussis/surv-reporting.html (Accessed on September 29, 2016).
  9. 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.
  10. Warfel JM, Beren J, Merkel TJ. Airborne transmission of Bordetella pertussis. J Infect Dis 2012; 206:902.
  11. Cherry JD, Brunell PA, Golden GS, Karzon DT. Report of the Task Force on Pertussis and Pertussis Immunization - 1988. Pediatrics 1988; 81:933.
  12. Cherry JD. Epidemiological, clinical, and laboratory aspects of pertussis in adults. Clin Infect Dis 1999; 28 Suppl 2:S112.
  13. GORDON JE, HOOD RI. Whooping cough and its epidemiological anomalies. Am J Med Sci 1951; 222:333.
  14. Cherry JD, Heininger U. Pertussis and other Bordetella infections. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th, Cherry JD, Harrison GJ, Kaplan SL, et al. (Eds), Elsevier Saunders, Philadelphia 2014. p.1616.
  15. Cherry JD, Tan T, Wirsing von König CH, et al. Clinical definitions of pertussis: Summary of a Global Pertussis Initiative roundtable meeting, February 2011. Clin Infect Dis 2012; 54:1756.
  16. Cherry JD. Pertussis in the preantibiotic and prevaccine era, with emphasis on adult pertussis. Clin Infect Dis 1999; 28 Suppl 2:S107.
  17. Centers for Disease Control and Prevention (CDC). Pertussis outbreak in an Amish community--Kent County, Delaware, September 2004-February 2005. MMWR Morb Mortal Wkly Rep 2006; 55:817.
  18. Cherry JD, Beer T, Chartrand SA, et al. Comparison of values of antibody to Bordetella pertussis antigens in young German and American men. Clin Infect Dis 1995; 20:1271.
  19. Heininger U, Klich K, Stehr K, Cherry JD. Clinical findings in Bordetella pertussis infections: results of a prospective multicenter surveillance study. Pediatrics 1997; 100:E10.
  20. Chan MH, Ma L, Sidelinger D, et al. The California pertussis epidemic 2010: A review of 986 pediatric case reports from San Diego county. J Pediatric Infect Dis Soc 2012; 1:47.
  21. Halperin SA, Wang EE, Law B, et al. Epidemiological features of pertussis in hospitalized patients in Canada, 1991-1997: report of the Immunization Monitoring Program--Active (IMPACT). Clin Infect Dis 1999; 28:1238.
  22. Horiba K, Nishimura N, Gotoh K, et al. Clinical manifestations of children with microbiologically confirmed pertussis infection and antimicrobial susceptibility of isolated strains in a regional hospital in Japan, 2008-2012. Jpn J Infect Dis 2014; 67:345.
  23. Harnden A, Grant C, Harrison T, et al. Whooping cough in school age children with persistent cough: prospective cohort study in primary care. BMJ 2006; 333:174.
  24. Hoppe JE. Neonatal pertussis. Pediatr Infect Dis J 2000; 19:244.
  25. Heininger U, Cherry JD, Eckhardt T, et al. Clinical and laboratory diagnosis of pertussis in the regions of a large vaccine efficacy trial in Germany. Pediatr Infect Dis J 1993; 12:504.
  26. Schläpfer G, Cherry JD, Heininger U, et al. Polymerase chain reaction identification of Bordetella pertussis infections in vaccinees and family members in a pertussis vaccine efficacy trial in Germany. Pediatr Infect Dis J 1995; 14:209.
  27. Nieves DJ, Singh J, Ashouri N, et al. Clinical and laboratory features of pertussis in infants at the onset of a California epidemic. J Pediatr 2011; 159:1044.
  28. Mikelova LK, Halperin SA, Scheifele D, et al. Predictors of death in infants hospitalized with pertussis: a case-control study of 16 pertussis deaths in Canada. J Pediatr 2003; 143:576.
  29. Izurieta HS, Kenyon TA, Strebel PM, et al. Risk factors for pertussis in young infants during an outbreak in Chicago in 1993. Clin Infect Dis 1996; 22:503.
  30. Winter K, Harriman K, Zipprich J, et al. California pertussis epidemic, 2010. J Pediatr 2012; 161:1091.
  31. Murray EL, Nieves D, Bradley JS, et al. Characteristics of severe Bordetella pertussis infection among infants </= 90 days of age admitted to pediatric intensive care units – Southern California, September 2009 - June 2011. J Pediatric Infect Dis Soc 2013; 2:1.
  32. Bisgard KM, Pascual FB, Ehresmann KR, et al. Infant pertussis: who was the source? Pediatr Infect Dis J 2004; 23:985.
  33. Tubiana S, Belchior E, Guillot S, et al. Monitoring the Impact of Vaccination on Pertussis in Infants Using an Active Hospital-based Pediatric Surveillance Network: Results from 17 Years' Experience, 1996-2012, France. Pediatr Infect Dis J 2015; 34:814.
  34. Skoff TH, Kenyon C, Cocoros N, et al. Sources of Infant Pertussis Infection in the United States. Pediatrics 2015; 136:635.
  35. Centers for Disease Control and Prevention (CDC). Pertussis--United States, 1997-2000. MMWR Morb Mortal Wkly Rep 2002; 51:73.
  36. Marshall H, Clarke M, Rasiah K, et al. Predictors of disease severity in children hospitalized for pertussis during an epidemic. Pediatr Infect Dis J 2015; 34:339.
  37. Straney L, Schibler A, Ganeshalingham A, et al. Burden and Outcomes of Severe Pertussis Infection in Critically Ill Infants. Pediatr Crit Care Med 2016; 17:735.
  38. Centers for Disease Control and Prevention (CDC). Pertussis--United States, 2001-2003. MMWR Morb Mortal Wkly Rep 2005; 54:1283.
  39. Bortolussi R, Miller B, Ledwith M, Halperin S. Clinical course of pertussis in immunized children. Pediatr Infect Dis J 1995; 14:870.
  40. Tozzi AE, Ravà L, Ciofi degli Atti ML, et al. Clinical presentation of pertussis in unvaccinated and vaccinated children in the first six years of life. Pediatrics 2003; 112:1069.
  41. Barlow RS, Reynolds LE, Cieslak PR, Sullivan AD. Vaccinated children and adolescents with pertussis infections experience reduced illness severity and duration, Oregon, 2010-2012. Clin Infect Dis 2014; 58:1523.
  42. Taylor ZW, Ackerson B, Bronstein DE, et al. Wheezing in children with pertussis associated with delayed pertussis diagnosis. Pediatr Infect Dis J 2014; 33:351.
  43. McIntyre PB, Sintchenko V. The "how" of polymerase chain reaction testing for Bordetella pertussis depends on the "why". Clin Infect Dis 2013; 56:332.
  44. Heininger U, Schmidt-Schläpfer G, Cherry JD, Stehr K. Clinical validation of a polymerase chain reaction assay for the diagnosis of pertussis by comparison with serology, culture, and symptoms during a large pertussis vaccine efficacy trial. Pediatrics 2000; 105:E31.
  45. Ward JI, Cherry JD, Chang SJ, et al. Bordetella Pertussis infections in vaccinated and unvaccinated adolescents and adults, as assessed in a national prospective randomized Acellular Pertussis Vaccine Trial (APERT). Clin Infect Dis 2006; 43:151.
  46. Levene I, Wacogne I. Question 3. Is measurement of the lymphocyte count useful in the investigation of suspected pertussis in infants? Arch Dis Child 2011; 96:1203.
  47. Paddock CD, Sanden GN, Cherry JD, et al. Pathology and pathogenesis of fatal Bordetella pertussis infection in infants. Clin Infect Dis 2008; 47:328.
  48. Donoso A, León J, Ramírez M, et al. Pertussis and fatal pulmonary hypertension: a discouraged entity. Scand J Infect Dis 2005; 37:145.
  49. Halasa NB, Barr FE, Johnson JE, Edwards KM. Fatal pulmonary hypertension associated with pertussis in infants: does extracorporeal membrane oxygenation have a role? Pediatrics 2003; 112:1274.
  50. Pierce C, Klein N, Peters M. Is leukocytosis a predictor of mortality in severe pertussis infection? Intensive Care Med 2000; 26:1512.
  51. 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.
  52. Mark A, Granström M. Impact of pertussis on the afflicted child and family. Pediatr Infect Dis J 1992; 11:554.
  53. Watts CC, Acosta C. Pertussis and bilateral subdural hematomas. Am J Dis Child 1969; 118:518.
  54. Greenberg DP, von König CH, Heininger U. Health burden of pertussis in infants and children. Pediatr Infect Dis J 2005; 24:S39.
  55. Wallace SS, Cruz AT, Quinonez RA, Caviness AC. Risk factors for complications in hospitalized young infants presenting with uncomplicated pertussis. Hosp Pediatr 2011; 1:16.
  56. Vincent JM, Wack RP, Person DA, Bass JW. Pertussis as the cause of recurrent bradycardia in a young infant. Pediatr Infect Dis J 1991; 10:340.
  57. Surridge J, Segedin ER, Grant CC. Pertussis requiring intensive care. Arch Dis Child 2007; 92:970.
  58. Sawal M, Cohen M, Irazuzta JE, et al. Fulminant pertussis: a multi-center study with new insights into the clinico-pathological mechanisms. Pediatr Pulmonol 2009; 44:970.
  59. Olsen M, Thygesen SK, Østergaard JR, et al. Hospital-Diagnosed Pertussis Infection in Children and Long-term Risk of Epilepsy. JAMA 2015; 314:1844.
  60. Haberling DL, Holman RC, Paddock CD, Murphy TV. Infant and maternal risk factors for pertussis-related infant mortality in the United States, 1999 to 2004. Pediatr Infect Dis J 2009; 28:194.
  61. Winter K, Zipprich J, Harriman K, et al. Risk Factors Associated With Infant Deaths From Pertussis: A Case-Control Study. Clin Infect Dis 2015; 61:1099.
  62. Lindgren C, Milerad J, Lagercrantz H. Sudden infant death and prevalence of whooping cough in the Swedish and Norwegian communities. Eur J Pediatr 1997; 156:405.
  63. Heininger U, Kleemann WJ, Cherry JD, Sudden Infant Death Syndrome Study Group. A controlled study of the relationship between Bordetella pertussis infections and sudden unexpected deaths among German infants. Pediatrics 2004; 114:e9.
  64. Cherry JD, Harrison R, Bradley JS, et al. Pertussis in young infants -- Guidance for clinicians. May 2010, updated June 2011. www.cdph.ca.gov/HealthInfo/discond/Pages/Pertussis.aspx (Accessed on July 10, 2015).
  65. World Health Organization. WHO-recommended surveillance standard of pertussis. http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/passive/pertussis_standards/en/ (Accessed on October 17, 2014).
  66. Ghanaie RM, Karimi A, Sadeghi H, et al. Sensitivity and specificity of the World Health Organization pertussis clinical case definition. Int J Infect Dis 2010; 14:e1072.
  67. Centers for Disease Control and Prevention. Pertussis (Whooping Cough). Diagnosis Confirmation. http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html.
  68. Faulkner, A, Skoff T, Martin S, et al. Pertussis. In: VPD Surveillance Manual, 5th Edition, 2011. http://www.cdc.gov/vaccines/pubs/surv-manual/index.html (Accessed on December 10, 2014).
  69. Tapiainen T, Aittoniemi J, Immonen J, et al. Finnish guidelines for the treatment of community-acquired pneumonia and pertussis in children. Acta Paediatr 2016; 105:39.
  70. Centers for Disease Control and Prevention (CDC). Outbreaks of respiratory illness mistakenly attributed to pertussis--New Hampshire, Massachusetts, and Tennessee, 2004-2006. MMWR Morb Mortal Wkly Rep 2007; 56:837.
  71. Mandal S, Tatti KM, Woods-Stout D, et al. Pertussis Pseudo-outbreak linked to specimens contaminated by Bordetella pertussis DNA From clinic surfaces. Pediatrics 2012; 129:e424.
  72. Centers for Disease Control and Prevention. Best practices for health care professionals on the use of polymerase chain reaction (PCR) for diagnosing pertussis. http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-pcr-bestpractices.html (Accessed on October 17, 2014).
  73. Wang K, Harnden A. Pertussis-induced cough. Pulm Pharmacol Ther 2011; 24:304.
  74. Centers for Disease control and Prevention. Guidelines for the Control of Pertussis Outbreaks. CDC: Atlanta, GA, 2000. http://www.cdc.gov/vaccines/pubs/pertussis-guide/guide.htm.
  75. Centers for Disease Control and Prevention. Pertussis (whooping cough). Specimen collection. www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html (Accessed on October 02, 2014).
  76. Waters V, Halperin S. Bordetella pertussis. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th, Mandell GL, Bennett JE, Dolin R (Eds), Elsevier, Churchill, Livingstone, Philadelphia 2009. p.2955.
  77. 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.
  78. Kamiya H, Otsuka N, Ando Y, et al. Transmission of Bordetella holmesii during pertussis outbreak, Japan. Emerg Infect Dis 2012; 18:1166.
  79. Spicer KB, Salamon D, Cummins C, et al. Occurrence of 3 Bordetella species during an outbreak of cough illness in Ohio: epidemiology, clinical features, laboratory findings and antimicrobial susceptibility. Pediatr Infect Dis J 2014; 33:e162.
  80. 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.
  81. Wirsing von König CH, Rott H, Bogaerts H, Schmitt HJ. A serologic study of organisms possibly associated with pertussis-like coughing. Pediatr Infect Dis J 1998; 17:645.