A recent analysis has revealed that despite long-standing immunisations and decades of progress, 18.9m people worldwide developed pertussis (whooping cough), and 115 000 died from the disease in 2023, with infants and people in sub-Saharan Africa bearing a disproportionate burden, reports CIDRAP News.
“This burden remains profoundly inequitable and inversely correlated with the socio-demographic index,” write the researchers – led by a team at the Institute for Health Metrics and Evaluation, University of Washington – in Nature Medicine. “Sub-Saharan Africa now accounts for roughly 65% of global deaths, with the highest population-adjusted risk concentrated among infants under six months.”
Cases, deaths rose sharply after pandemic
To estimate pertussis incidence, mortality and disability-adjusted life years across 204 countries and territories, the team analysed data from the Global Burden of Disease 2023 study.
They found that from 1990 to 2023, age-standardised pertussis incidence declined by 41.6%, and the age-standardised death rate fell 61.2%.
But cases and deaths rose sharply after the Covid-19 pandemic. Compared with 2020 estimates, pertussis incidence rose by 102.6%, and pertussis-related mortality increased 66.1% by 2023 (though the 95% uncertainty intervals [UIs] were wide – 77.0% to 128.2% and 2.4% to 174.5%, respectively – indicating considerable imprecision in the numbers).
Those increases largely represented a return to pre-pandemic levels, however, rather than an unprecedented global surge, with the estimated age-standardised incidence rate in 2023 being broadly comparable to the 2019 rate.
Deaths concentrated in sub-Saharan Africa
Sub-Saharan Africa accounted for roughly 65% of estimated pertussis deaths in 2023, up from about 30% in 1990. “This growing proportional share primarily reflects slower rates of decline compared with other regions, rather than an absolute increase in regional mortality,” noted the researchers.
Infants younger than six months had the highest risk of death globally, at 45.7 per 100 000 (although the UI was wide) – more than double that of the 12- to 23-month-old group (19.6) and nearly triple that of the two- to four-year-old group (6.6).
“This intense risk concentration in early infancy represents a marked improvement from 1990, when mortality rates in the one-to-five-month group were 108.1 per 100 000,” they added.
Improvement in infant mortality was slowest in sub-Saharan Africa: while the mortality rate among infants had declined by 58.1% since 1990, it remained remarkably high, at 92.1 per 100 000, but again with wide UIs, in 2023.
The authors call for stronger routine immunisation and access to care in regions where pertussis deaths are highest, along with continued surveillance to detect and prevent transmission. They also emphasise timely infant and maternal immunisation to protect babies before they complete their primary vaccine series.
Study details
Global, regional and national burden of pertussis in 1990–2023: a Global Burden of Disease study
GBD 2023 Pertussis Collaborators, Jonathan F. Mosser & Jue Liu
Published in Nature Medicine on 21 October 2026
Abstract
Despite long-standing immunisation programmes, 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-standardised mortality decreased by 61.2% and age-standardised 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 socio-demographic 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 modelled geographic concentration of pertussis mortality and support strengthening timely infant vaccination, maternal immunisation where recommended and feasible and robust surveillance in highly susceptible regions.
CIDRAP article – Global pertussis burden remains high despite decades of progress (Open access)
See more from MedicalBrief archives:
Whooping cough makes a comeback in the US
Whooping cough cases still rising
Pertussis resurgence: Incomplete coverage and vaccination ‘hesitancy’
Booster vaccine during pregnancy cuts pertussis incidence in infants