There’s a cough going around that paediatricians tell me is making babies really unwell. What’s deeply worrying is that some very young babies have died from it. The cough is whooping cough — or pertussis.
This is an illness that can be prevented, or its impact reduced, by vaccination.
But there’s been a surge in cases recently: you may well have heard people complaining about the 100-day cough. I’ve had it (and ended up in A&E when I couldn’t breathe) and wrote about it for Mail Online.
Since January, there have already been 8,015 doctor notifications (whooping cough is a notifiable disease) and 2,041 laboratory-confirmed cases, compared with just 207 (so a rise of about 3,800 per cent) and 30 respectively last year for the same period.
There were 52 cases of babies under three months with whooping cough in January and February alone this year; by contrast, there were only 48 cases for the whole of last year.
Riley Hughes (pictured with his mum Catherine) was otherwise healthy when he died from whooping cough aged just 32 days in 2015
And these figures may be a significant underestimate, as people with mild disease may not see a doctor.
‘We are seeing massive numbers of cases of pertussis at the moment,’ Dr Liz Whittaker, a paediatric consultant and honorary clinical senior lecturer in the department of infectious disease at Imperial College London, tells me.
Paediatric intensive care units are on ‘surge capacity’ for pertussis and measles, meaning there are many cases.
Dr Ronny Cheung, a consultant paediatrician from the Royal College of Paediatrics and Child Health, adds: ‘There’s no doubt we’ve been seeing quite a lot more of it on the wards and A&E in recent times. My suspicion is we’re probably still underestimating the true prevalence at the moment.’
While adults describe it as the worst cough they’ve ever had — causing difficulty breathing, incontinence and even fractured ribs — it can be fatal in babies. ‘The mortality is one death in every 100 in the under three months category,’ says Dr Whittaker. ‘We don’t see this in other age groups.
‘As well as coughing, which is quite severe, they can stop breathing.’
Their white blood cells also increase, sometimes reaching very high levels, ‘causing the blood vessels to clog up, and causing cardiac failure’, adds Dr Whittaker.
The rise in cases has already claimed the lives of babies too young to receive the vaccine.
The UK Health Security Agency (UKHSA) reported the death of one baby in the last quarter of 2023. But colleagues have told me of further deaths that aren’t yet showing in official figures.
Whooping cough is a highly infectious bacterial infection, but those under three months are most at risk because they’re too young to be vaccinated.
The first dose of the pertussis vaccine is normally given at two months, which is why pregnant women are offered the jab between 16 and 32 weeks as the antibodies pass across the placenta and protect the baby in the first few months of life.
Dozens of babies in the UK used to die every year before this vaccination programme was introduced.
‘Most of our admissions are still in the pre-immunisation under-three-month group,’ says Dr Cheung. ‘I’ve seen these babies in my practice where they come with coughing bouts, apnoea [pauses in breathing] or looking very dusky [i.e. blue] or desaturating [with low oxygen levels], and that’s very worrying.’
The number of two-year-olds who have had the full round of vaccinations has dropped over the past decade and cases of whooping cough are shooting up
Danielle Knox knows just how terrifying this can be. Her then seven-week old son Tom was admitted to hospital for a week in December with a severe cough and episodes of apnoea. He was treated with antibiotics and needed regular suctioning.
As Danielle, 33, a health sciences lecturer from Glasgow, told me last week, because Tom didn’t have a ‘whoop’ sound, he wasn’t tested for pertussis; but very young babies do not have the typical ‘whoop’.
Other children need multiple readmissions for it. ‘I had a patient who was admitted for the third time in six weeks — they’re still having blue spells at night,’ explains Dr Cheung.
Airfinity, a disease-forecasting company, says ‘the risk of infections is expected to remain elevated in the coming weeks’.
One of the problems is low rates of vaccination. 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; in 2014 it was 96.3 per cent.
And lack of awareness means the disease continues to spread.
Bryony Thomson’s ten-year-old daughter had whooping cough, leaving her unable to breathe. The family moved a mattress into the bathroom so she could sleep there with the hot water running during the night — the steam gave relief.
Bryony, 38, who is a vet in Whitburn, County Durham, asked the headteacher to alert other parents, because so many other children were coughing, too. But the UKHSA advised against it because there was only one reported case. It requires two unrelated cases to send out a formal alert.
By the first week in January, Bryony’s daughter was coughing four times a minute and was taken to A&E in the middle of the night. ‘She was gasping for air and started to turn blue. I was really frightened.’
One doctor told Bryony that her daughter would be fine and that ‘nobody dies of whooping cough these days’.
Adults, though not as vulnerable as babies with the disease, can end up breaking a rib such is the force of the coughing
Fortunately, Bryony’s daughter recovered.
But Riley Hughes was an otherwise healthy baby when he died from whooping cough aged just 32 days in 2015.
At three weeks old, he’d developed a mild cold and occasional cough. A doctor reassured his parents, Catherine and Greg, he was fine. But Riley was sleepy and not waking for feeds, so they took him to hospital.
He was admitted and diagnosed with pertussis. His condition quickly deteriorated and he was put on life support.
‘I wish I could remember the last time I saw Riley conscious,’ Catherine tells me. ‘I just have no memory of looking into his eyes for the last time.’
She’d gone home to rest (she’d been in hospital for four days with virtually no sleep and was exhausted), not realising time was so short. But Greg was there for their son’s last conscious hours.
‘Riley was screaming and screaming. He would have been in a lot of pain from the needles and cannulas they were administering. That’s how my baby will last remember the world,’ she says.
At 3am she got an urgent call from Greg telling her: ‘The doctors say you’ve got to come in, quickly.’
‘Riley was placed in my arms — I was shocked at how burning hot and swollen his tiny body was,’ says Catherine, from Perth, Australia. ‘The tubes were removed, and we cuddled, cried, kissed him, and sang to him a lullaby as the life slowly drained out of him.
‘At 2pm, our beautiful baby left us, left this world, and left us devastated and heartbroken.
READ MORE: My terrifying 100-day cough: A&E doctor tells how she was left unable to breathe for 30 seconds by whooping cough - as cases soar around the country. So should you be worried?
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‘If I had been offered a whooping cough booster during pregnancy, there is a good chance Riley would still be with us today.’
But when Catherine was pregnant, it was before Australia offered the maternal pertussis vaccine. Days after Riley’s death the vaccine programme began, resulting in a significant reduction in babies hospitalised with pertussis.
‘It’s bittersweet — I’m overjoyed that we have these fantastic pregnancy vaccination programmes, but really sad they weren’t implemented in time for Riley,’ says Catherine, who now campaigns to encourage women to be vaccinated.
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. Dr Whittaker says that in parts of London it’s as low as 36 per cent.
The decline in the pre-school booster’s dose also deeply worries experts. ‘In Harringay it’s down to 56 per cent and 65 per cent in Hammersmith and Fulham in London,’ explains Dr Whittaker. ‘This means we have primary school-age children who don’t have adequate protection. They all hang out together and pass it on.’
‘In addition, their parents have waning immunity and pick it up, then they pass it on. You’ve got this little perfect storm of pertussis-passing going on.’
‘The risk is that it’s passed on to somebody who is immunocompromised or to a baby.’
Professor Kamila Hawthorne, chair of the Royal College of GPs, said: ‘We would urge all parents to check that their children’s vaccinations — and their own — are up to date.’
This is what drives Catherine. ‘In every case I’ve heard of, where parents lost their babies to this insidious disease, they did not have, or weren’t offered, a vaccine during pregnancy.
‘Their stories are harrowing. 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 UKHSA’s advice is that if infected, avoid close contact with those at higher risk of serious illness (babies, elderly people and anyone who is immunocompromised). If you have to go out, wear a mask.