Whooping cough (pertussis):
why adults get it too — and what helps

1. What is whooping cough?

Whooping cough (pertussis) is a bacterial infection of the airways. The pathogen Bordetella pertussis produces toxins that paralyse and damage the tiny hair-like cilia lining the bronchi. The result is a cough that comes in violent fits and can drag on for many weeks — which is why it is popularly known as the “100-day cough”.^¹

For a long time, whooping cough was regarded as a childhood illness. That is no longer true: according to the RKI, around 60 per cent of cases occur in adults. The reason: neither vaccination nor having had the illness protects for life. After the last vaccination, protection largely holds for a few years and then wanes — anyone can catch it several times in their life.^¹,² After quiet years during the pandemic, notifications rose steeply in 2023 and above all in 2024.

In Germany, whooping cough is a notifiable disease: even a suspected case, the illness itself and every laboratory confirmation are reported by name to the local public health office (Gesundheitsamt) — the practice or the laboratory takes care of this.^¹

2. Course: the three stages

After infection, it usually takes 9 to 10 days (range 6 to 20 days) for the first symptoms to appear. In unvaccinated people, the illness classically runs through three stages:^¹

Often atypical in adults

In teenagers, adults and vaccinated people, the classic picture is often missing. Frequently, all that remains is a protracted, dry cough that is worse at night and comes in fits. This is why whooping cough in adults is often recognised late or not at all.^¹,³

3. Symptoms and complications

• Coughing fits — several short, violent bursts of coughing in a row, until there is hardly any air left.
• A drawn-out intake of breath after the fit — in adults often only faint.
• Retching and vomiting — typical at the end of a fit.
• Disturbed nights — the fits cluster at night; in between, many people feel almost well.
• Hardly any fever — a high fever points more towards a complication or another infection.

Complications in adults

The cough is so violent that it can cause further damage. The RKI lists, among other things, middle ear and sinus infections, rib fractures, hernias of the abdominal wall such as an inguinal hernia, involuntary loss of urine and bleeding into the whites of the eyes.^¹ The most common serious complication is pneumonia, especially in infants and older people. Anyone who already had stress incontinence often notices it getting markedly worse.

4. Infection, risk groups and mix-ups

Whooping cough is spread by droplets when coughing, sneezing and speaking and is highly contagious. Infectiousness begins at the end of the incubation period, is greatest in the catarrhal stage and, without treatment, can last up to three weeks after the coughing fits begin. With an effective antibiotic, it usually ends after about five days.^¹

• Infants — especially in the first months of life, before their own vaccination takes effect.
• Pregnant women in the third trimester — less for their own sake than for the newborn.
• People with lung diseases such as asthma or COPD — the cough can throw the underlying condition off balance.
• Older people and people with a weakened immune system — a higher risk of pneumonia.

How the causes of a persistent cough differ in general is explained in the symptom article Cough.

5. Diagnosis: a swab rather than waiting

Whooping cough is an obvious suspect if a cough lasts more than two weeks and comes with fits, retching or a drawn-out intake of breath — and all the more so after contact with a confirmed case. The diagnosis is confirmed in the laboratory.^¹

• Medical history: How long have you been coughing, and how? Have you been in contact with people who are coughing, and when were you last vaccinated against whooping cough? Which medicines do you take?
• PCR from a nasopharyngeal swab: The method of choice in the first two to three weeks after the cough begins. The swab is taken from deep in the back of the nose, not from the throat.
• Blood test for antibodies: Only meaningful from about two weeks after the cough begins — and not if you were vaccinated in the last twelve months.
• Listening to the chest and, if needed, an X-ray: If fever, shortness of breath or chest pain suggest pneumonia.

Don't wait to see a doctor until the cough “goes away on its own”: the sooner the diagnosis is made, the sooner the chain of infection can be broken. Call ahead so that the practice doesn't seat you in a full waiting room.

6. Treatment: what the antibiotic can do

Honesty matters here: an antibiotic only shortens whooping cough if it is given early — in the catarrhal stage or in the first one to two weeks of the coughing fits. Later on, the bacterial toxin has already damaged the airways, and the cough carries on despite treatment.^¹

Even then, the antibiotic makes sense: it ends infectiousness within a few days and so protects babies, pregnant women and people with pre-existing conditions around you. The decision is made by the treating practice.

After contact: a preventive antibiotic

Close contacts, for example in the same household, may be given an antibiotic as a precaution (chemoprophylaxis) — according to the RKI, everyone who has not been vaccinated in line with STIKO recommendations or whose last whooping cough vaccination was more than ten years ago, and also fully vaccinated people if vulnerable people such as infants live around them. It makes sense up to three weeks after the first contact.^¹

7. Macrolides and cough medicines in practice

The standard drug is usually azithromycin. Macrolides are generally well tolerated; typical side effects are nausea, abdominal pain and diarrhoea. More important for people on long-term medication are the interactions.^⁵

• Heart rhythm: All macrolides can prolong the QT interval on the ECG. Take care with other drugs that have this effect, such as some antidepressants like citalopram, certain antipsychotics or heart rhythm medicines, and with low potassium or magnesium levels.
• Cholesterol-lowering drugs: Clarithromycin and erythromycin inhibit the breakdown of simvastatin and atorvastatin — the risk of muscle damage rises. Usually the statin is paused for the duration of treatment, or azithromycin is chosen.
• Anticoagulants: Macrolides can increase the effect of phenprocoumon; the INR should be checked.
• Other critical combinations: Colchicine, some immunosuppressants and some blood pressure medicines can reach dangerously high levels with clarithromycin.
• Antacids: Take antacids containing aluminium or magnesium at a different time from azithromycin.

You get the quickest overview when your complete medication list is to hand — see Drug interactions.

And cough medicines?

Many people reach for cough suppressants from the pharmacy. For whooping cough, there is no proven benefit; the fits are caused by damage to the airways and can hardly be suppressed this way. On top of that come risks: codeine is not suitable for children under 12 or during breastfeeding, and dextromethorphan can trigger serotonin syndrome together with certain antidepressants. Ask at the pharmacy before taking any over-the-counter cough medicine.

8. Protecting babies: pregnancy and cocooning

Infants are most at risk in the first months of life, and their own vaccinations only start at two months. STIKO therefore relies on two layers of protection:^²

• Vaccination in every pregnancy — at the start of the third trimester, or in the second trimester if there is an increased risk of premature birth. The mother's antibodies pass to the baby and protect it in the first weeks (passive “nest protection”). This applies even if the last vaccination was only a short time ago.
• Cocoon strategy — close contacts such as partners, siblings, grandparents and carers should ideally be vaccinated at least four weeks before the birth if their last whooping cough vaccination was ten or more years ago.
• Baby vaccinations on time — at 2, 4 and 11 months as a combination vaccine, with an additional dose for premature babies.

According to current knowledge, vaccination during pregnancy is considered safe for mother and baby. General information about medicines during this time is in the guide Medications during pregnancy.

9. Vaccination for adults

For adults, STIKO recommends combining the next due tetanus-diphtheria booster once with a whooping cough component (Tdap, with polio as well if needed). There is no single vaccine against whooping cough alone in Germany. Anyone who works with infants, children or patients should have a booster every ten years.^²

An honest assessment: today's vaccines protect well against severe illness, but not permanently against every infection. Vaccinated people can also fall ill a few years later — usually more mildly. Vaccination nevertheless remains the most important protection, above all for infants around you. Side effects are usually harmless: redness, swelling and pain at the injection site, occasionally fatigue. If you take immunosuppressants or cortisone, clarify the best timing with your practice — see Vaccines and medications.

10. Everyday life with whooping cough

• Keep away from babies and pregnant women — until you are no longer infectious, which is usually five days after starting the antibiotic.
• Community settings — according to the RKI, anyone who is looked after or works in a day-care centre (Kita), school or care home may return at the earliest five days after starting effective antibiotic treatment; without treatment, only three weeks after the cough began.
• Sit upright during a fit — lean slightly forward, spit out mucus rather than swallowing it, then breathe calmly through your nose.
• Avoid triggers — smoke, cold air and heavy exertion still provoke fits for weeks.
• Patience rather than one antibiotic after another — the cough can last for weeks to months. A second or third antibiotic usually achieves nothing at that point; new symptoms such as fever or shortness of breath should, however, be seen by a doctor.

Whooping cough wears people down above all through how long it lasts and the disturbed nights. It helps to jot down the course briefly — how many fits per night, with or without vomiting. That way you notice the slow improvement that easily gets lost in everyday life, and the practice can see if something isn't right.

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