Global, regional, and national burden of pertussis in children aged 0–14 years from 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021

Abstract Background: Despite widespread vaccination efforts, pertussis remains a significant global public health concern, particularly among children. This study aimed to assess the burden and temporal trends of pertussis globally, regionally, and nationally by age, sex, and socio-demographic index (SDI) among children aged 0–14 years from 1990 to 2021. Methods: We analyzed data from the Global Burden of Disease Study (GBD) 2021 on pertussis incidence, disability-adjusted life years (DALYs), mortality, and years lived with disability. The estimated annual percentage changes (EAPCs) were calculated to quantify temporal trends. Joinpoint regression analysis was used to identify the points at which significant changes in the trend occurred. To update the temporal trend analyses beyond 2021, we also incorporated the most recent pertussis estimates for relevant countries and territories from the GBD 2023 dataset. Results: Globally, approximately 19.9 million new cases of pertussis were recorded among children aged 0–14 years (age-standardized incidence rate 1,022.1 per 100,000 population) and 11.9 million DALYs (age-standardized DALY rate 608.7 per 100,000 population) in 2019. The age-standardized incidence of pertussis decreased by an EAPC of 1.7 from 1990 to 2009 and by 1.3 from 2010 to 2019, and declined further by 2021, probably due to Coronavirus Disease 2019 control measures. However, this overall downward trend masked considerable regional variation. Between 2010 and 2019, 11 out of 21 GBD regions experienced rising incidence, particularly in Tropical Latin America, Central Europe, and Central Latin America. Among high-SDI countries, pertussis incidence increased substantially in Cyprus (EAPC 17.62) and Finland (EAPC 19.66) from 2011 to 2019. In 2019, infants under 1 year old exhibited the highest pertussis incidence, and girls consistently had higher rates than boys across all age groups. In 2023, the highest age-standardized incidence was observed in the United States Virgin Islands among high SDI countries (1,597.5 per 100,000 population) and in Bosnia and Herzegovina among high-middle SDI countries (1,074.3 per 100,000 population). Conclusions: Although the age-standardized incidence and DALYs of pertussis have declined among children aged 0–14 since 1990, the disease has resurged in about half of the regions worldwide. Pertussis-related incidence and DALYs were higher in infants under 1 year old and girls. Maternal vaccination, continuous surveillance, and tailored public health interventions should be targeted toward vulnerable populations to prevent pertussis resurgence.