Abstract
Background Communicable disease control has long been a focus of global health policy. There have been substantial
reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know
less about this burden in older children and adolescents, and it is unclear whether current programmes and policies
remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in
the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to
systematically characterise the burden of communicable diseases across childhood and adolescence.
Methods In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their
manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or
presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific
mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disabilityadjusted
life-years [DALYs]) for children and adolescents aged 0–24 years. Data were reported across the Sociodemographic
Index (SDI) and across time (1990–2019), and for 204 countries and territories. For HIV, we reported the
mortality-to-incidence ratio (MIR) as a measure of health system performance.
Findings In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured
by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents
globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in
communicable disease burden from young children to older children and adolescents (largely driven by the
considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger
than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were
predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of
communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lowerrespiratory-
tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children
and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the
only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years,
and especially in females. Excess MIRs for HIV were observed for males aged 15–19 years in low-SDI settings.
Interpretation Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract
infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However,
efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and
adolescents. Older children and adolescents also experience a large burden of communicable disease, further
highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial
morbidity caused by communicable diseases affecting child and adolescent health across the world.