Global, regional, and national burden of pathogen-attributable infectious diseases in children by age and sex, 1990–2021: a systematic analysis

Infectious diseases caused by bacterial and viral pathogens remain major contributors to the global disease burden in children, necessitating comprehensive assessments to inform public health strategies. This study sought to quantify pathogen-attributable burden and characterize its temporal trends in children aged 0–14 years from 1990 to 2021, with projections through 2050.

This study used data from the Global Burden of Disease (GBD) 2021 Study covering 204 countries and territories. Data analysis was conducted from October to December 2025, and projections through 2050 were generated using the Bayesian age–period–cohort (BAPC) model. The study assessed burden attributable to 34 major bacterial and viral pathogens among children from 1990 to 2021. Primary outcomes included pathogen-attributable deaths and disability-adjusted life-years (DALYs), stratified by sex, age, and Sociodemographic Index (SDI).

In 2021, 34 pathogens accounted for an estimated 1,266,053 deaths (95% UI: 856,833–1,812,077). Diarrheal diseases were the leading infectious syndrome (608,793 deaths; 95% uncertainty interval [UI]: 349,675–983,346), followed by lower respiratory infections (545,061 deaths; 95% UI: 424,541–681,064) and meningitis (112,199 deaths; 95% UI: 78,995–157,539). Streptococcus pneumoniae was the predominant pathogen, accounting for 173,041 deaths (95% UI: 136,353–210,258). It was the leading cause of deaths in 18 of 21 GBD regions, with the highest age-standardized deaths rates observed in Oceania. S. pneumoniae and rotavirus were the leading contributors to pathogen-attributable DALYs, and the burden generally declined with increasing age. A strong inverse correlation was observed between SDI and burden metrics, with low-SDI regions, particularly sub-Saharan Africa, bearing the highest burden. The neonatal period was associated with the highest burden, and boys experienced a greater burden than girls. Rotavirus was the leading cause of diarrheal mortality, whereas S. pneumoniae predominated in lower respiratory infection– and meningitis-related mortality. By 2050, although most pathogen-attributable burdens are projected to decline, lower respiratory infections caused by Mycoplasma pneumoniae, meningitis caused by Neisseria meningitidis, and diarrheal diseases attributable to non-typhoidal Salmonella and norovirus are expected to remain major public health challenges.

This study demonstrates a substantial pathogen-attributable infectious disease burden in children, particularly in boys and populations in low-SDI regions. These findings highlight the need for pathogen-specific, equity-oriented interventions and strengthened health systems to reduce persistent disparities in childhood infectious diseases.