What are the symptoms of whooping cough and why are cases rising across Europe?

A resurgence of whooping cough, or pertussis, is affecting several European countries.

The highly contagious respiratory infection, sometimes called the “100-day cough” because the coughing associated with it can last weeks, is caused by a bacterium.

It is particularly dangerous for infants before vaccination. Here’s what you need to know about it.

Where is there a resurgence in Europe?

Increases in whooping cough have been reported since mid-2023 in Belgium, Croatia, Denmark, Spain, Sweden, and Norway, with particular increases this year in the Czech Republic and the Netherlands.

In the Czech Republic, pertussis cases are at the highest level reported since the 1960s, with more than 6,300 cases of the illness between January and the first week of April.

Spain had reported more than 8,200 cases by March, according to a report from health authorities, a large increase compared to the 1,200 cases reported in all of 2023.

The Netherlands reported more than 3,600 cases of whooping cough between January and March 2024, of which 228 were in infants.

Greek health authorities have also reported higher cases than the previous year, with 82 cases of whooping cough since the beginning of 2024. This is compared to just nine cases last year.

Why is there a resurgence of whooping cough cases in Europe?

Typically, whooping cough cases will peak every three to five years.

“The last peak in most European countries was either in 2012 or in 2018, and so it’s quite logical to see now a resurgence of pertussis,” Sylvain Brisse, Director of the Institut Pasteur’s Biodiversity and Epidemiology of Bacterial Pathogens Unit, told Euronews Health.

“The unusual thing is that due to the COVID pandemic and the infection control barriers [restrictions]… there was a delay in the resurgence,” he added.

During the pandemic in 2020 and 2021, there were almost no cases of whooping cough, so both the pandemic delay and the pathogen’s cyclical nature could contribute to the latest resurgence, he added.

A spokesperson for the World Health Organization (WHO)’s regional office in Europe specified that across the region, which encompasses Europe and parts of Central Asia, pertussis vaccination coverage has decreased since the pandemic.

“Before 2019, almost 70 per cent of countries in the Region reported 90 per cent or higher coverage with a first booster dose of the vaccine. Coverage decreased during the pandemic and has not recovered since, now only about 50 per cent of countries have reported 90 per cent coverage,” WHO Europe said.

They added, however, that increases can come from more reporting and awareness about the condition as well.

What are the symptoms of whooping cough?

While symptoms start like a common cold, whooping cough can cause weeks of sudden, violent coughing fits. People can even vomit after the intense coughing fits.

Health authorities say that infants, babies, and young children may have pauses in breathing or turn blue.

The Netherlands’ public health institute said that more than half of babies with whooping cough are admitted to hospital and can occasionally die from pertussis.

People who are vaccinated, however, will generally have fewer symptoms and may not cough for as long.

“Really the severe disease and the deaths are seen only in [newborns up to] six months more or less. They are very fragile, especially before three months when they have not been vaccinated yet or just after the first vaccination,” said Brisse.

Unvaccinated adults, meanwhile, “can cough for weeks, which is annoying. You don’t sleep anymore. In many cases, you have a paroxysmal cough during the night. So that’s that’s a bit tiring and depressing,” he said.

Pertussis is also highly contagious, with one person infecting on average 15 others.

What should countries do to prevent pertussis?

Vaccines are available to prevent whooping cough, but according to Brisse, many countries only require them for children.

“The vaccines protect well, but they protect for about 5 to 7 years, and then after that, people become susceptible again. That’s why we would ideally need to re-vaccinate perhaps every ten years. But that’s not the case, it’s only for children in some countries,” he said.

Vaccination is also recommended now in most European countries for pregnant women, which is an effective measure for protecting newborn babies from death.

“In France, we [have] now recommend vaccination of pregnant women…but the uptake of this measure is not very high,” said Brisse.

In the UK, maternal vaccine uptake fell from nearly 75 per cent in December 2017 to 60 per cent in December 2023, health authorities said.

The Czech Republic imported110,000 vaccines from the UK, Canada, and France last week to vaccinate children and pregnant women as they respond to rising cases of whooping cough. Vaccines for adults will arrive this week, the health ministry said.

In addition to routine infant vaccination and vaccinating pregnant women in the second or third trimester, WHO Europe recommends that people who contract whooping cough are treated quickly with antibiotics and do not come into contact with infants, young children, or pregnant women.

“When you are coughing from pertussis, it’s recommended to not go to work, at least for two or three days when you take antibiotics and during the [whole] period of contagiousness, so three weeks, if you don’t take antibiotics,” said Brisse.

“It’s especially important to protect the young children or the neonates, so for example, if there was a birth and one of the parents coughs, you should avoid approaching the neonate,” he added.

According to Public Health France, more than half of children infected with pertussis get it from one of their parents.