Global, regional and national burden of pertussis in 1990–2023: a Global Burden of Disease study

: 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.