Summary
A Global Burden of Disease analysis estimates that pertussis incidence and age-standardized mortality declined between 1990 and 2023. Its modeled estimates show that the highest population-adjusted mortality risk remained among infants aged 1–5 months.
A Global Burden of Disease (GBD) analysis published in Nature Medicine estimates that pertussis caused about 18.96 million cases and 115,242 deaths worldwide in 2023. Across 204 countries and territories, its modeled age-standardized mortality rate fell 61.2% and its age-standardized incidence rate fell 41.6% between 1990 and 2023. Age-standardized rates adjust for differences in population age structure, helping compare burden across places and over time.
The study analyses GBD estimates, not a direct count of every infection or death. Its results show long-term progress alongside substantial differences in who faces the greatest risk.
The post-pandemic rise was near pre-pandemic levels by 2023
Compared with the unusually low pandemic-period estimates, modeled pertussis incidence and mortality rebounded between 2020 and 2023. The paper reports increases of 102.6% for incidence and 66.1% for mortality over that period. But comparison with 2019 gives a different perspective: the global age-standardized incidence rate was 293.7 per 100,000 in 2023, close to 286.4 in 2019. The mortality rate was 1.79 per 100,000 in 2023, slightly below 1.88 in 2019. The authors therefore describe the 2023 estimates as a return toward pre-pandemic levels, rather than an unprecedented global surge.
The analysis combines surveillance and mortality data with statistical modeling. For locations with less complete cause-of-death data, the mortality model estimates deaths by combining estimated incidence with a modeled case-fatality ratio. These are burden estimates, not counts based solely on confirmed diagnoses and registered deaths.
Infants faced the highest modeled mortality risk
In 2023, the estimated pertussis mortality rate among infants aged 1–5 months was 45.7 per 100,000—more than twice the rate for children aged 12–23 months and nearly three times that for children aged 2–4 years. The rate for this infant group was estimated at 108.1 per 100,000 in 1990. The study identifies the first months of life as the period of greatest population-adjusted risk, before infants have completed their primary vaccination series.
The modeled burden was also geographically uneven. Sub-Saharan Africa accounted for an estimated 63–65% of global pertussis deaths in 2023. The paper says the region’s larger share chiefly reflects slower declines than in other regions, rather than an increase in its absolute mortality. This regional estimate needs particular care: all 46 sub-Saharan African locations in the analysis used the model pathway that estimates deaths from incidence and case-fatality assumptions. The authors caution that this modeled concentration is conditional on those assumptions and is not a directly observed distribution of deaths.
For India, the study estimates an 85.1% decline in the age-standardized pertussis mortality rate from 1990 to 2023 (95% uncertainty interval, 33.2–98.2%). The authors point to timely routine infant vaccination, maternal immunization where recommended and feasible, and stronger surveillance as priorities. Because the analysis estimates disease burden rather than comparing prevention programmes, it identifies groups and regions for attention but does not measure the effect of a particular vaccination strategy.