Abstract
Despite long-standing immunization programs, pertussis remains a major cause of vaccine-preventable mortality, particularly among infants. Here we present a primary assessment of global pertussis incidence, mortality and disability-adjusted life years across 204 countries and territories from 1990 to 2023. We show that despite short-term pandemic-period fluctuations, the dominant global pattern from 1990 to 2023 was long-term decline: age-standardized mortality decreased by 61.2% and age-standardized incidence by 41.6%. Relative to the anomalously low pandemic-period estimates, incidence and mortality rebounded by 102.6% (95% uncertainty interval, 77.0–128.2%) and 66.1% (95% uncertainty interval, 2.4–174.5%), respectively, between 2020 and 2023. In 2023 alone, we estimated 18.9 million cases and 115,000 deaths attributable to pertussis. This burden remains profoundly inequitable and inversely correlated with the sociodemographic index; sub-Saharan Africa now accounts for roughly 65% of global deaths, with the highest population-adjusted risk concentrated among infants younger than 6 months. Our findings highlight a modeled geographic concentration of pertussis mortality and support strengthening timely infant vaccination, maternal immunization where recommended and feasible and robust surveillance in highly susceptible regions. Updates to the Global Burden of Disease study showed that while global trends in pertussis (whooping cough) declined from 1990 to 2023, the rebound in incidence and mortality since 2020, particularly in high-income regions, reflects stalled vaccination progress worldwide.