2023 TB Surge: Rising Tuberculosis Cases Among Children and Adolescents in EU/EEA

Since young children face a higher risk of developing tuberculosis (TB) within a year of infection, childhood TB serves as a key indicator of ongoing transmission in a community (1^✔ ✔Trusted Source
Increase in tuberculosis among children and young adolescents, European Union/European Economic Area, 2015 to 2023

Go to source). 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 pediatric TB from 2.0 per 100,000 population to 2.5 per 100,000 population.

Analyzing Paediatric TB Trends

In their rapid communication published in Eurosurveillance ahead of World Tuberculosis Day on 24 March 2025, Cristea et al. analyzed 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.

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.

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).

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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.

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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.”

Reference:

1. Increase in tuberculosis among children and young adolescents, European Union/European Economic Area, 2015 to 2023 - (https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2025.30.11.2500172)

Source-Eurekalert