That really awful hacking cough that’s going around? It’s called pertussis – ‘whooping cough’ or the ‘100-day cough’, as it’s known to most people – and cases are surging in the UK.
While it’s a very nasty infection if you contract it as a child or adult, for very small babies, it can be lethal.
Earlier this week I wrote about how paediatric colleagues had told me babies were dying as a result of the infection, although the UK Health Security Agency (UKHSA) had reported just one death in this cycle – at the end of 2023.
But today it has released data saying that five babies have died from whooping cough between the beginning of January and the end of March this year.
This brings the total to six baby deaths in this current cycle of whooping cough (which started last summer).
‘There are still no indications that cases have peaked in England and Wales, therefore the risk of infections is expected to remain elevated in the coming weeks,’ Airfinity, a disease forecasting company, tells me.
Catherine Hughes, from Perth, Australia, described how her otherwise healthy baby son Riley contracted whooping cough
The month-old died in hospital in 2015 after catching whooping cough
Catherine Hughes said of her baby son: ‘You never “get over” losing your child in this way and you never forget the terrifying sound of the cough that took your child’s life’
There is inevitably a lag between deaths and official reported figures, so already, by mid-May, the number of deaths is thought to be higher. And with paediatric intensive care units now on ‘surge capacity’ because of pertussis and measles – which means, essentially, that there are many cases – that number may well, tragically, rise.
Earlier this week I reported the harrowing words of Catherine Hughes, describing the death of her month-old son Riley in 2015 after the otherwise healthy baby had contracted whooping cough.
‘You never “get over” losing your child in this way and you never forget the terrifying sound of the cough that took your child’s life,’ the mother of two, from Perth, Australia, said to me.
Babies should not be dying of this disease: there is a vaccine, offered to women who are between 16 and 32 weeks’ pregnant, since the antibodies pass across the placenta and protect the baby in the first few months of life. This maternal vaccine is 92 per cent effective in protecting newborn babies up until two months old, according to the UKHSA. After this age, the child is old enough to get the first dose of the diphtheria, tetanus and pertussis vaccine (DTP) as part of their vaccination programme.
Yet the uptake among pregnant women in the UK has fallen dramatically, from 74.7 per cent in 2017 to just 59.5 per cent in 2023. In parts of London it’s as low as 36 per cent.
And shockingly we’re heading towards recording the same number of annual deaths we used to see before the maternal jab was introduced.
‘We are seeing case numbers at levels similar to what we saw in 2012, and this as at a time before we had a vaccination programme for pregnant women in place,’ warns Dr Gayatri Amirthalingam, a consultant epidemiologist at the UKHSA.
To put this into perspective, in the 12 years prior to the introduction in 2012 of the maternal pertussis vaccination, every year there were around 63 deaths in babies aged under one year with confirmed pertussis.
Then, for the whole 11-year period from 2013 to the end of March 2024, there were 26 of these tragic deaths in babies too young to be fully protected by infant vaccination. But six of them – nearly a fifth – have occurred in this current surge, up until March this year.
‘We now have a life-saving intervention – the maternal vaccine, and it’s important that mothers take this and at the right time,’ says Dr Amirthalingam.
Whooping cough is considered so serious that, since 1940, it’s been classed as a ‘notifiable’ disease – one of 34 diseases, mainly highly infectious ones, that need to be notified to official bodies such as the UKHSA (others include anthrax, leprosy and rabies).
According to the latest available figures – until April 28 – there are 2,041 laboratory-confirmed pertussis cases since the start of the year in England and Wales compared to 30 last year in the same period, with more than 8,000 notifications from doctors in England and Wales (that figure was just 207 in the same period for 2023).
These numbers will not be the whole picture because lots of people will not realise they or their children have it and will continue to socialise at work or school, spreading it further. On top of this, not all those affected, including babies, make the characteristic ‘whoop’ sound between coughs, making it harder to detect.
‘Vaccination remains the best defence against whooping cough and it is vital that pregnant women and young infants receive their vaccines at the right time,’ Dr Amirthalingam says.
All babies are given three doses of the 6-in-1 jab at eight, 12 and 16 weeks of age to protect against whooping cough and other serious diseases such as diphtheria and polio, with a pre-school booster offered at three years four months.
Jill Cunningham, 53, from Sunderland, became incontinent with the disease and the cough was so severe that it would make her vomit
But the vaccine rate in children is also dropping. In September 2023, the number of two-year-olds who’d completed the schedule of routine six-in-one vaccinations (given at eight weeks, three months and four months), which includes protection against pertussis, was 92.9 per cent, compared with 96.3 per cent in March 2014.
Why is vaccination declining? There are many reasons: vaccine hesitancy that started with MMR and increased during the pandemic as the voices of anti-vaccine campaigners cut through.
But it is also down to convenience – when it comes to maternity vaccines, pregnant mothers often have other children needing their attention and might struggle to get to an appointment. There may also be a lack of knowledge about why it is so important.
Whooping cough is a cyclical disease that peaks every three to five years. The last cyclical increase occurred in 2016.
‘A peak year is therefore overdue. The impact of the pandemic also means there is reduced immunity in the population,’ states the UKHSA.
Which makes both maternal and childhood vaccine more important than ever, says Dr Liz Whittaker, an honorary clinical senior lecturer in the department of infectious disease at Imperial College London. ‘The maternal vaccine is a very safe vaccine that we have tested extensively over the last 12 to 14 years and are very confident of.’ She herself had the booster in both her pregnancies.
Should the rest of us, who may not be pregnant, consider getting a booster? It is a highly infectious disease and certainly anyone who’s had the infection will testify to how awful it is even for grown adults.
Jill Cunningham, 53, from Sunderland, started coughing on January 16. She remembers that date because she was in a dermatology appointment for her psoriasis and her nurse was worried she had picked something up. She is on methotrexate, a drug that suppresses her immune system to tackle autoimmune conditions such as psoriasis, which as a result makes her vulnerable to infections.
Her daughter, Isla, 11, was also coughing. But the GP had told her mother children can get up to eight coughs a year from different viruses. Jill just thought this was one of those.
While Isla’s cough was worse than her usual coughs, Jill’s was more aggressive still. She was up all night with it and had to take time off work – she is a self-employed cleaner; she even became incontinent with it and the cough was so severe that it would make her vomit.
In February Jill went to the GP and saw someone who wasn’t her normal doctor and told them she had heard there was whooping cough going around her daughter’s school.
‘The GP laughed and said this wasn’t whooping cough, and that it was a chest infection and gave me antibiotics for it – I now know they weren’t the ones needed to treat whooping cough,’ Jill told me. ‘By that point I’d had to go back to work and so I carried on working.’
The cough got worse and so in March, she went to see her own GP who this time diagnosed whooping cough – but this was way beyond the first 21 days when it is most infectious. The GP didn’t do a swab but did notify the UKHSA. Because she was outside the 21 days, she wasn’t given an antibiotic.
‘When I tell people about it they don’t believe me or take it seriously because there’s no news about it – there’s no information,’ Jill tells me. ‘I found out because I started to look it up and then I put it on Facebook, and then other parents from Isla’s school got in touch because their children were coughing and then turned out to have it. We’ve had to find out for ourselves.
‘People were saying “it’s just the 100 day cough, it’s not serious and doesn’t matter” – not realising how serious it is if babies catch it.’
Jill cannot understand the lack of awareness about this, when it is so deadly to babies. ‘Why isn’t more being done to make people know? I would have kept my daughter off school if I had known it was whooping cough.’
Dr Saleyha Ahsan thought she was safe from the disease because she’d had the vaccine – but was proved wrong
Those of you who were vaccinated as a child might think you have nothing to fear. That’s what I thought. And when I went to A&E with whooping cough, because I was having laryngospasms – that’s when my airway was blocking and I couldn’t breathe in – the emergency consultant, who was excellent, assumed as I did that it couldn’t be the disease because I’d had the vaccine.
But I’ve been learning a lot about this and the fact is that, even after the vaccine, you can still contract whooping cough. Even children get it after the vaccine, but it can make the condition less severe. The protection typically wanes over ten years.
A longer lasting vaccine, developed in the 1950s, provided 80 per cent protection but that version caused some babies to become unwell within hours of receiving it.
Dr Doug Jenkinson a retired GP from Nottinghamshire, with a special interest in whooping cough (he runs an awareness website, whoopingcough.net) has written a book called Outbreak In The Village, after his own daughter became unwell when she was given it as a baby in 1969.
Nicola was feverish and screaming a few hours after the jab, and because Dr Jenkinson was working as a junior doctor at the time, he managed to get her seen by a paediatric consultant. She recovered after days in hospital.
This vaccine had been made from killed bacteria, which produces an immune reaction that lasts much longer, but this type of pertussis vaccine is no longer used – and the price has been shorter immunity.
So who can get the booster?
Pregnant women should ensure they are vaccinated. ‘Whilst the optimal time for receiving the vaccine is between 20-32 weeks, if you are further along in your pregnancy and not yet had your vaccine, it’s not too late,’ says Dr Amirthalingam. ‘Please speak to your midwife or GP practice today.’
Because evidence shows that a significant amount of transmission can occur between hospital staff and patients, boosters are offered to healthcare workers, particularly if they are working with high-risk groups such as babies, children and expectant mothers.
You can pay privately for the jab – it is offered in travel clinics but only on a consultation and only if travelling to certain countries such as Australia – at a cost of around £100. The issue is that there is no single booster for pertussis. It comes as a combined vaccine for diphtheria, tetanus and polio.
