Global seroepidemiology of pertussis: a systematic review and meta-analysis

Pertussis remains a global health concern despite widespread vaccination. Clinical reporting underestimates true disease burden due to underdiagnosis and asymptomatic cases. Consequently, serological surveillance is essential for accurately assessing infection rates and population immunity.

We conducted a systematic review and meta-analysis of studies published between January 2014 and October 2024 in PubMed, Web of Science, EMBASE, and the Cochrane Library. Observational studies reporting the seropositivity rate of PT-IgG or recent pertussis infection rate in general populations were included. Pooled estimates were calculated using random-effects models, with subgroup analyses by region, sex, age, and investigation year.

Analyzing 64 studies involving approximately 87,000 participants from 37 countries, the global pooled seropositivity rate was 23.3% (95% CI: 17.2-30.1%), and the recent infection rate was 3.6% (95% CI: 2.4-5.0%). Seropositivity exhibited a trimodal distribution: the first peak in infants aged 1-2 (25.8%), the highest peak in adolescents aged 10-19 (26.2%), a nadir in adults aged 20-39 (17.1%), followed by a tertiary rise in individuals ≥40 years (20.5%). Recent infection rates showed a similar pattern. Regional disparities were significant, with the Americas showing the highest seropositivity (51.2%), while the Eastern Mediterranean Region reported the highest recent infection rate (10.3%). Temporally, seropositivity increased from 18.0% (2011-2015) to 25.9% (2016-2022), whereas recent infection rates declined from 6.4 to 2.7%.

This study confirms the ongoing global circulation of Bordetella pertussis and insufficient population immunity. The revealed age- and regional disparities underscore the need to advance pertussis control from childhood immunization toward a precision public health model informed by seroepidemiological data.