OBJECTIVES: Pertussis (whooping cough) is an upper respiratory infection, causing uncontrollable and severe coughing. Pertussis outbreaks are associated to a substantial increase in resource use that may vary depending on the setting. This study aims at better understanding the economic burden of pertussis outbreaks, by setting. METHODS: A systematic review of literature on pertussis outbreaks was conducted, including references published between 2011 and 2014, using Medline, Embase, the Cochrane library and relevant websites as potential sources. All population-based studies reporting information about epidemiology, burden or costs of pertussis outbreaks were included, without geographical restriction. RESULTS: Thirty eight observational studies from 14 countries were included. Classification of outbreaks by setting was straightforward: 29 outbreaks occurred over a territory (country, region, city, etc.), 4 outbreaks in a school, 2 outbreaks at hospital, 2 in an isolated community and 1 at university. Costs included in this study were costs incurred in controlling the outbreak. Treatments with antibiotics or prophylaxis were reported in 10 references covering all settings. GP or specialist visits were reported in 3 articles (2 outbreaks over a territory and 1 outbreak in a school). Finally 22 references reported information on hospitalisations: hospitalisation rates ranged from 0% to 8.8% for cases of pertussis (in 2 references, no hospitalisation occurred in the population exposed to the outbreak). Length of stay was reported in 2 references: 8.9 days in hospital and 13 days in paediatric intensive care unit considering an outbreak at hospital, and 4 days (1 to 48 days) over a territory. CONCLUSIONS: The extent and the management of outbreaks differed by setting, and the economic burden of pertussis outbreaks was not always comparable. Nevertheless this review shows that the burden may be substantial.