Global, regional and national burden of pertussis in 1990–2023: a Global Burden of Disease study
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.
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Authors: GBD 2023 Pertussis Collaborators, Qiao Liu, Sijia Wang, Noga Shalev, Ashley A. Harris, Stephanie A. Price, Tuhina Srivastava, Ishu Poudyal, Benn K. D. Sartorius, Hasan Aalruz, Sherief Mohamed Abd-Elsalam, Habtamu Abebe, Armita Abedi, Olifan Zewdie Abil, Richard Gyan Aboagye, Amr Selim Abu Lila, Aishah Fadila Adamu, Muhammad Sohail Afzal, Saira Afzal, Sajjad Ahmad, Suleiman Idris Ahmad, Tauseef Ahmad, Ayman Ahmed, Jahanzaib Mian Ahmed, Kenni Wojujutari Ajele, Oluwasefunmi Akeju, Akil Akhtar, Karolina Akinosoglou, Damilare Michael Akintunde, Hammad Akram, Tariq Al Zoubi, Yazan A. Al‐Ajlouni, Muath A. Alammar, Mohammad T AlBataineh, Ali Mamoon Alfalki, Mohammad Daud Ali, Shahid Ali, Montaha Al‐Iede, Hamid Alinejad Rokny, Morteza Alipour, Hazim Alkousheh, Sabah Al-Marwani, Joseph Uy Almazan, Ahmad Rajeh Al-Qudimat, Najim Zafer Alshahrani, Ali Salman Al-Shami, Awais Altaf, Jaffar A. Al‐Tawfiq, Nelson Alvis‐Guzmán, Hany Aly, Raed M. Al‐Zoubi, Isha Amatya, Saeed Amini, Bibin Gnanadhason Anand, Abhishek Anil, Aisha Ansari, Saeid Anvari, Razique Anwer, Jalal Arabloo, Mosab Arafat, Demelash Areda, Muhammad Shahzad Aslam, Seyyed Shamsadin Athari, Lemessa Assefa A Ayana, Habtamu Molla Ayele, Damilola Jeremiah Ayowole, Maciej Banach, Hiba Jawdat Barqawi, Mohammad‐Mahdi Bastan, Narasimha Murthy Beeraka, Payam Behzadi, Desalegn Weldebrhan Bekru, Alemu Gedefie Belete, Pankaj Bhardwaj, Priyadarshini Bhattacharjee, Trupti N. Bodhare, Colin Stewart Brown, Jefferson Antonio Buendía, Yasser Khalil Bustanji, Zahid A Butt, Felix Carvalho, Rama Mohan Chandika, Vijay Kumar Chattu, Anis Ahmad Chaudhary, Akhilanand Chaurasia, Haiyan Chen, Patrick R Ching, Devasahayam J Christopher, Dinh‐Toi Chu, Haley Marie Cionfolo, Omid Dadras, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Samuel Demissie Darcho, Nihar Ranjan Dash, Fernando Pio de la Hoz, Rodrigo DeAntonio, Sindhura Deekonda, Anteneh Assefa Desalegn
Institutions: University of Washington, The University of Queensland, University of South Carolina, Columbia University, University of Jeddah, Peking University, Universidade do Porto, Imperial College London, Hashemite University, Al Ain University, Tulane University, Montefiore Medical Center, University of Oxford, Emory University, UNSW Sydney, Zhejiang University, Iran University of Medical Sciences, Universidad Nacional de Colombia, Christian Medical College, Vellore, Indian Council of Medical Research, Wollo University, Haramaya University, Virginia Commonwealth University, Jimma University, Indiana University School of Medicine, Tehran University of Medical Sciences, Public Health Foundation of India, UK Health Security Agency, Tanta University, Chulalongkorn University, University of Waterloo, University of Balochistan, Universität Hamburg, University of Ha'il, Sana'a University, Qatar University, University of Oslo, Nazarbayev University, University of Sharjah, Imam Abdulrahman Bin Faisal University, Ottawa University, Medical University of Lodz, Newcastle University, University of Lahore, University of Gondar, Africa Centres for Disease Control and Prevention, Shaqra University, All India Institute of Medical Sciences, University of Patras, Lebanese American University, University of Health and Allied Sciences, Kuwait University, Universidad de Antioquia, Guilan University of Medical Sciences, University of Jordan, Sechenov University, University of Khartoum, Imam Mohammad ibn Saud Islamic University, Cleveland Clinic, University of the Coast, MRC Unit the Gambia, All India Institute of Medical Sciences Bhubaneswar, Ahmadu Bello University, North-West University, Hamad Medical Corporation, Jazan University, University of Warwick, American University of Ras Al Khaimah, Al-Zaytoonah University of Jordan, Ambo University, Federal Medical Centre, Vietnam National University, Hanoi, Universidad de Cartagena, King Edward Medical University, Saudi Aramco Medical Services Organization, Mekelle University, Zanjan University of Medical Sciences, Institute for Health Metrics and Evaluation, Yarmouk University, Universiti Malaysia Sarawak, King George's Medical University, General University Hospital of Patras, Polish Mother’s Memorial Hospital Research Institute, University of Management and Technology, Abasyn University, Brookdale University Hospital and Medical Center, Datta Meghe Institute of Higher Education and Research, Non-Communicable Diseases Research Center, Baylor Scott & White Health, Tennessee State University, Wollega University, Xiamen University Malaysia, National Institute for Implementation Research on Non-Communicable Diseases, Federal Ministry of Health, Nepal Health Research Council, VNU International School, Sohail University, Médecins Sans Frontières, Médecins Sans Frontières, Equator University of Science and Technology, Islamic Azad University, Shahr-e-Qods Branch, Al-Shifa Trust Eye Hospital, Booz Allen Hamilton (United States)