Editing Whooping cough (section)

==Signs and symptoms==
[[File:Whooping cough boy.ogv|thumb|upright=1.3|A boy with pertussis]]
The classic symptoms of pertussis are a [[paroxysmal]] cough, inspiratory whoop, and [[fainting]], or vomiting after coughing.<ref name=JAMA2010>{{cite journal | vauthors = Cornia PB, Hersh AL, Lipsky BA, Newman TB, Gonzales R | title = Does this coughing adolescent or adult patient have pertussis? | journal = JAMA | volume = 304 | issue = 8 | pages = 890–6 | date = August 2010 | pmid = 20736473 | doi = 10.1001/jama.2010.1181 | s2cid = 14430946 }}</ref> The cough from pertussis has been documented to cause [[subconjunctival hemorrhage]]s, [[rib fracture]]s, [[urinary incontinence]], [[hernias]], and [[vertebral artery dissection]].<ref name=JAMA2010/> Violent coughing can cause the [[pleura]] to rupture, leading to a [[pneumothorax]]. Vomiting after a coughing spell or an inspiratory whooping sound on coughing almost doubles the likelihood that the illness is pertussis. The absence of a paroxysmal cough or posttussive [[emesis]] makes it almost half as likely.<ref name="JAMA2010"/>

The illness usually starts with mild respiratory symptoms including mild coughing, sneezing, or a [[Rhinorrhea|runny nose]] (known as the [[catarrhal]] stage). After one or two weeks, the coughing classically develops into uncontrollable fits, sometimes followed by a high-pitched "whoop" sound, as the person tries to inhale. About 50% of children and adults "whoop" at some point in diagnosed pertussis cases during the [[Paroxysmal attack|paroxysmal]] stage. This stage usually lasts up to 3 months, or sometimes longer.<ref name="CDC2014S" /> A gradual transition then occurs to the [[Convalescence|convalescent]] stage, which usually lasts one to four weeks. A decrease in paroxysms of coughing marks this stage, although paroxysms may occur with subsequent respiratory infection for many months after the onset of pertussis.<ref name=":1">{{Cite web | url=https://www.cdc.gov/vaccines/pubs/pinkbook/pert.html |title = Pink book &#124; Pertussis &#124; Epidemiology of Vaccine-Preventable Diseases &#124; CDC|date = 2 March 2019}}</ref>

Symptoms of pertussis can be variable, especially between immunized and non-immunized people. Immunized people can present with a milder infection; they may only have the paroxysmal cough for a couple of weeks and may lack the "whooping" characteristic.<ref name=":3">{{Cite journal|last1=Nguyen|first1=Van Tuong Ngoc|last2=Simon|first2=Lauren|date=1 September 2018|title=Pertussis: The Whooping Cough|journal=Primary Care: Clinics in Office Practice|series=Infectious Disease|volume=45|issue=3|pages=423–431|doi=10.1016/j.pop.2018.05.003|pmid=30115332|s2cid=240275364 |issn=0095-4543}}</ref> Although immunized people have a milder form of the infection, they can still spread the disease to others who are not immune.<ref name=":3" />

===Incubation period===
The [[incubation period|time between exposure and the development of symptoms]] is on average 7–14 days (ranging 6–20 days),<ref>Heymann, David L. (ed): Pertussis; in Control of Communicable Diseases Manual. p. 457. American Public Health Association, Washington DC, 2008, {{ISBN|978-0-87553-189-2}}</ref> and rarely as long as 42 days.<ref>{{cite web |title=Pertussis (whooping cough) |url=http://www.health.ny.gov/diseases/communicable/pertussis/fact_sheet.htm |publisher=New York State Department of Health |access-date=8 June 2013 |url-status=live |archive-url=https://web.archive.org/web/20130722133222/http://www.health.ny.gov/diseases/communicable/pertussis/fact_sheet.htm |archive-date=22 July 2013 }}</ref>