A global systematic literature review of Bordetella pertussis anti-PT IgG seroprevalence 2010 to 2023

OBJECTIVES: Pertussis has witnessed a resurgence in morbidity in recent years. In most countries, pertussis surveillance is inadequate for accurately estimating numbers of cases or deaths. The study aimed to identify the true burden of pertussis based on the published seroepidemiology studies of pertussis worldwide. METHODS: A systematic search of five databases was conducted to identify relevant population-based studies published between January 1, 2013, and December 31, 2024. The seroprevalence and sero-incidence of anti-pertussis (anti-PT) IgG antibodies were extracted and the estimated incidence of Bordetella pertussis (B. pertussis) infection was calculated based on the meaning of the cut-off value of anti-PT IgG with meta-analysis. The estimated case numbers and incidence of B. pertussis infection across WHO regions were calculated and compared with the data from ‌Global Burden of Disease (GBD) and Global Health Observatory (GHO). RESULTS: Totally 164 articles were eligible for inclusion in our systematic review and meta-analysis after screening. Overall, the global seroprevalence of pertussis anti-PT IgG antibodies was 23.39% (95% CI 12.63-39.20%) during 2010-2023 and the estimated incidence of B. pertussis infection was 5.11% (95% CI 2.97-8.63%). Compared with regions using whole-cell pertussis (wP) vaccines (24.63%), those predominantly employing acellular pertussis (aP) vaccines demonstrated a higher seroprevalence (26.39%) but lower estimated infection rates (aP: 4.23% vs. wP: 6.15%; P<0.001). Subgroup analysis showed that the seroprevalence of pertussis anti-PT IgG antibodies in different age groups ranged from 16.72% to 56.27%, while the estimated incidence of B. pertussis infection ranged from 3.84% to 13.75%. The World Health Organization African Region contributed the highest seroprevalence of pertussis anti-PT IgG antibodies at 46.28%, while the World Health Organization American Region had the highest incidence of B. pertussis infection at 13.46%. It is estimated that annual pertussis cases can reach 386 million and the incidence of pertussis is much higher than the reported data from GHO and the estimated data from GBD. CONCLUSIONS: The true burden of pertussis has likely been grossly underestimated, with its incidence potentially much higher than currently recognized.