Tuberculosis in children and adolescents: EU/EEA observes a rise in 2023

As young children have an increased risk of developing tuberculosis (TB) disease during the first year after infection, childhood TB serves as an indicator of ongoing transmission within a community. 

In 2023, 1,689 children and young adolescents below the age of 15 years were diagnosed with tuberculosis in the European Union/European Economic Area (EU/EEA) countries. This particular age group usually represents a relatively small proportion among the overall reported TB cases in the region, with a range from 3.4% in 2021 for example to 6.4% in 2016.

However, the data for children and young adolescents indicate a slight increase from 2022 to 2023 with a rise in the notification rate for paediatric TB from 2.0 per 100,000 population to 2.5 per 100,000 population.

In their rapid communication published in Eurosurveillance ahead of World Tuberculosis Day on 24 March 2025, Cristea et al. analysed the trends and characteristics among the reported paediatric TB cases in the  EU/EEA between 2015 and 2023 to identify reasons for the recent uptick since 2021. The authors characterised each age group by comparing the proportion of paediatric TB among all reported TB cases for two periods: the mean proportion of notifications 2015 to 2020 versus yearly data for 2021 to 2023.

Highest proportion of paediatric TB among children aged 1 to 4 years

Between 2015 and 2023, in total 16,414 paediatric TB cases were notified, with an average of 1,946 cases per year (range: 1,142 in 2021 to 3,126 in 2016). These paediatric cases are part of the overall 393,104 recorded TB cases across the EU/EEA during this time.

Looking at the data for children and adolescents, the authors observed a fluctuating trend over this period: while there was a substantial decrease of 37% between 2019 to 2021, notifications gradually went up again from 2021 to 2023.

The highest proportion of paediatric TB was observed in children aged 1 to 4 years old (n = 5,394; 33%) and pulmonary TB was the predominant clinical manifestation across all for analysed age groups.

While none of the countries that provided data on childhood TB for those years showed cases across all four age groups, 17 countries reported a ≥5% increase in proportion of paediatric TB notifications in at least one age group. Five countries (Estonia, Ireland, Italy, Malta and Slovenia) noted increases in one age group, seven saw a rise in two (Croatia, Cyprus, Denmark, Luxembourg, Portugal, Norway and Romania) and five countries reported increases in three age groups (Czechia, Germany, Hungary, Lithuania and Slovakia).
 

No specific explanation for recent increase in paediatric TB across the EU/EEA

Infants, i.e. children below one year of age, and young children diagnosed with TB in the 28 EU/EEA countries reporting data on childhood TB, were predominantly born in the country where they were diagnosed whereas young adolescents (10–14 years of age) with TB were often born outside the reporting country. The data show that drug-resistant paediatric TB was rare and no extensively drug-resistant tuberculosis was diagnosed in children.

Cristea et al. note that during the same time Europe observed an increase in TB notifications among those aged >15 years, this was also described in the United States, the United Kingdom and Canada. All three countries reported significant increases in TB notifications among children and adolescents in 2022 and 2023.

The authors theorise that e.g. improved diagnosis and reporting of paediatric TB, social risk factors among children born in the reporting country, and changes in population movements might have played a role in the EU/EEA rise, “but our analysis of TB surveillance data could not single out a specific explanation for the increase.”

Even though Cristea et al. acknowledge that the numbers of notified paediatric cases remain relatively low across the EU/EEA, they argue that “strengthened surveillance, prompt contact tracing and preventive measures are needed to limit the potential ongoing TB transmission.”

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References/notes to editors: 

[1] Cristea Veronica, Ködmön Csaba, Gomes Dias Joana, Rosales-Klintz Senia, the paediatric TB expert group. Increase in tuberculosis among children and young adolescents, European Union/European Economic Area, 2015 to 2023. Euro Surveill. 2025;30(11):pii=2500172.
Available from: https://doi.org/10.2807/1560-7917.ES.2025.30.11.2500172

[2] In the Eurosurveillance issue marking World TB Day 2025, you can find the following articles on tuberculosis:
Domaszewska Teresa, Koch Anders, Jackson Sarah, Häcker Brit, Jonsson Jerker, Langholz Kristensen Kristina, Soini Hanna, Arrazola de Oñate Wouter, Guthmann Jean-Paul, Hauer Barbara, O´Meara Mary, Nordstrand Karine, Sizaire Vinciane, de Vries Gerard. Tuberculosis rates in migrants in low-incidence European countries, according to country of origin, reporting country and recency of immigration, 2014 to 2020. Euro Surveill. 2025;30(11):pii=2400489.
Available from: https://www.https://doi.org/10.2807/1560-7917.ES.2025.30.11.2400489

Vasiliu Anca, Cristea Veronica, Stoycheva Krista, Rosales-Klintz Senia, Lange Christoph, Zenner Dominik, Ködmön Csaba. Shifting tuberculosis dynamics in the EU/EEA: geographical and drug resistance trends among people of foreign origin, 2019 to 2023. Euro Surveill. 2025;30(11):pii=2500173.
Available from: https://doi.org/10.2807/1560-7917.ES.2025.30.11.2500173

[3] World Tuberculosis Day is observed on 24 March each year around the world. Its overall goal is to raise awareness about the burden of TB worldwide and the status of TB prevention and control efforts. TB elimination is defined as less than one case of TB disease per 1 million population per year.