TB in children, England, 2022
Updated 15 February 2024
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Main messages
In 2022, the overall number and rate of TB notifications in children remained stable with 136 children (aged less than 15 years) notified with TB in England in 2022 compared with 127 in 2021. The rate remained the same at 1.3 per 100,000.
More children notified with TB were born in the UK compared with all individuals with TB (66.2% in children versus 20.9%).
The delay between symptom onset and treatment start was 44 days which has risen from a low of 30.5 days in 2015.
Directly observed treatment (DOT), a treatment adherence strategy where the patient takes treatment under direct in-person observation by a designated individual, was offered to 18% of children with TB and 79% of children who were offered DOT received it.
Treatment completion proportion for children with TB that was not severe or rifampicin resistant (RR) or multidrug resistant (MDR) was stable at around 90%.
Vaccine coverage for the 5 local authorities who conducted universal bacille Calmette-Guerin (BCG) vaccination programmes ranged from 49.8% to 89.0% in the financial year 2022 to 2023, compared with 43.3% to 66.7% in the previous financial year.
TB in children
Children are particularly vulnerable to TB, especially those aged under 5 years who are at greatest risk of developing severe TB disease. Older children aged 15 years or over have a similar TB risk and clinical presentation to adults (aged 18 years or over). For TB reporting, children are defined as those aged under 15 years. This is in line with data reported to the World Health Organization (WHO).
The epidemiology, care pathways and management of children with suspected and with actual TB infection and disease, are distinct from those for adults, so data for children is presented separately in this report.
Children are identified as a specific population group requiring actions in the joint UKHSA and NHS England (NHSE) collaborative action plan 2021 to 2026, but there are no high-level indicators to report relating to TB in children as the rate of TB in children remains at 1 per 100,000.
TB incidence and epidemiology in children
TB notification numbers, notification rates and geographical distribution
Figures 1 and 2 and Supplementary Table 1 of the accompanying data set show the numbers and rates of TB notifications in children from 2000 to 2022 for all children and by country of birth (UK and non-UK born).
In 2022, 136 children (aged less than 15 years) were notified with TB in England, a rate of 1.3 per 100,000 (95% confidence interval (CI) 1.1 to 1.6). This is an increase in the number, but the same rate compared with 2021 (127 children, rate was 1.3 per 100,000 (95% CI 1.1 to 1.5)).
Figure 1. The overall number TB notifications in children aged less than 15 years, England, 2000 to 2022
The data used in this graph can be found in Supplementary Table 1 of the accompanying data set.
Figure 2. The rates of TB notifications in children aged less than 15 years, England, 2000 to 2022
The data used in this graph can be found in Supplementary Table 1 of the accompanying data set.
Distribution of TB in children by UKHSA region
Numbers of children with TB varies by UKHSA region. This is presented in 3 years of aggregated data (due to low numbers), in Supplementary Table 2 of the accompanying data set, with numbers largely reflecting the regional patterns for all TB notifications.
As numbers of children with TB decrease, specialist care may need to be delivered through regional networks, especially in areas with the lowest incidence.
Demographic characteristics of children with TB in England
TB in children by country of birth and ethnicity
In 2022, 90 out of 136 (66.2%) children notified with TB with a known country of birth, were born in the UK. This proportion was higher in 2022 compared with 2021 when it was at 58.3% reversing a decline since a peak in 2016 (78.8%) (Supplementary Table 1 of the accompanying data set).
Appendix Figure A1 and Figure A2 show the numbers and rates of TB notification for UK and non-UK born children. In 2022, the TB notification rate in UK born children was 0.9 per 100,000 (95% CI 0.8 to 1.2), similar to 2021 and down from the peak of 3.4 per 100,000 in 2008 (Supplementary Table 1 of the accompanying data set). The rate of TB notification in non-UK born children was 6 times higher than in UK born children (6.2 per 100,000 in 2022, down from a peak of 32 per 100,000 in 2008).
Supplementary Table 3 of the accompanying data set shows the numbers and TB notification rates for children by place of birth (UK and non-UK born) by reported ethnicity. Among children born in the UK, the highest numbers of children were in the white and Pakistani ethnic groups (31 and 14 children respectively).
Among children born outside the UK, the highest numbers and rates of children notified with TB were reported as having Black African ethnicity (11 children, 13.9 per 100,000, 95% CI 6.9 to 24.8) and Indian ethnicity (9 children, 9.9 per 100,000, 95% CI 4.5 to 18.7).
Table 1 shows that (excluding the UK) India, Pakistan and Somalia were the most frequent countries of birth among children diagnosed with TB in 2022, with 6.7% born in India, 5.2% born in Pakistan and 4.4% born in Somalia.
Table 1. Most frequent countries of birth for children with TB, England, 2022
| Country of birth | Number of children | Proportion of children (%) |
|---|---|---|
| United Kingdom | 90 | 66.7 |
| India | 9 | 6.7 |
| Pakistan | 7 | 5.2 |
| Somalia | 6 | 4.4 |
Note: place of birth was unknown for one child.
Age and sex distribution differ between UK-born and non-UK-born children
In 2022, there were more notifications of TB in children in females (77 of 136, 56.6%) than males (59 of 136, 43.4%). There were more females in the UK born children where 57.8% (52 of 90) compared to 53.3% (24 of 45) in the non-UK born children. Appendix Figures A3 and A4 and Supplementary Table 4 in the accompanying data set show the differences in proportion by age and sex in UK and non-UK born children respectively.
Overall, numbers of TB notifications were highest in the 10 to 14 years age groups at 72 children (52.9% of total children) and lowest in children aged 5 to 9 years at 23 children (16.9%). Appendix Figure A5 shows the number of TB notifications by age (per year).
Age-specific numbers and rates for data aggregated for years 2000 (when enhanced surveillance began) to 2022 are shown in Appendix Figures A5 and A6. Rates for UK born are highest in those aged 0 to 3 years and 11 to 14 years (Supplementary Table 5 of the accompanying data set). In non-UK born children rates are highest in those aged 0 to 2 years and those aged 12 to 14 years.
Clinical characteristics
Site of disease
Over half (64.7%) of children had pulmonary disease. The proportion differed by age group, being highest in the 0 to 4 years group (70.7%) and lowest in the 10 to 14 years group (61.1%) (Table 2)
There were 9 children (6.6%) classified as having severe TB disease (TB meningitis, cryptic disseminated or miliary TB).
Table 2. Site and severity of disease in children with TB, England, 2022
| Clinical characteristic | 0 to 4 years | 5 to 9 years | 10 to 14 years | Total |
|---|---|---|---|---|
| All disease sites | 41 (30.2%) | 23 (16.9%) | 72 (52.9) | 136 (100%) |
| Pulmonary | 29 (70.7%) | 15 (62.2%) | 44 (61.1%) | 88 (64.7%) |
| Extra-pulmonary | 22 (53.7% | 12 (52.2%) | 37 (51.4%) | 71 (52.2%) |
| Severe TB | 2 (4.9%) | 2 (8.7%) | 5 (6.9%) | 9 (6.6%) |
| Lymph nodes only | 8 (19.5%) | 4 (17.4%) | 20 (27.8%) | 32 (23.6%) |
| Other | 1 (2.4%) | 1 (4.3%) | 6 (8.3%) | 8 (5.9%) |
Notes
1. Severe disease comprises TB meningitis, miliary TB or cryptic disseminated TB.
2. Children with pulmonary disease may have disease in other sites as well and therefore numbers may add up to more than the number of total children.
Rates of TB notification in children as a proxy for recent transmission
TB in children indicates likely recent transmission as children have a limited time during which they could have become infected and, if they develop active infection, this is usually within 12 months. Therefore, the rate of TB notification in children (aged under 15 years) born in the UK can be used as a proxy for recent transmission within England.
Figure 3 shows the rate for UK born children only over the period 2000 to 2022 (Supplementary Table 1 of the accompanying data set). The rates have decreased since a peak in 2008.
Figure 3. The overall rate of TB notification in children (less than 15 years) born in the UK, England, 2000 to 2022
The data used in this graph can be found in Supplementary Table 1 of the accompanying data set.
Preventing TB in children
BCG vaccination
The BCG vaccination programme has undergone several changes in response to changing trends in TB epidemiology. The programme is a risk-based programme recommended for individuals at higher risk of exposure to TB. This includes all infants (0 to 12 months) with a parent or grandparent who was born in a country where the annual incidence of TB is over 40 cases per 100,000 population per year. In addition to this, all infants living in an area of the UK with an incidence above 40 per 100,000 population should be offered the BCG vaccine.
Detailed information on the BCG programme can be found in the Green Book. Evaluation studies have identified that BCG is most effective against the most severe forms of the disease, such as TB meningitis in children and less effective in preventing respiratory disease, which is the more common form in adults.
The timing of the neonatal BCG immunisation was changed to a 28-day immunisation programme in September 2021. This change was prompted by the addition of screening for severe combined immunodeficiency (SCID) to the routine new-born screening test at 5 days of age. The attenuated BCG vaccine is contraindicated in babies with positive SCID screen, so sufficient time is needed to allow the outcome of the SCID screening to be available before proceeding with BCG vaccination. This made BCG immunisation at 28 days necessary to avoid potential risk to severely immunocompromised babies.
As part of the Cover of Vaccination Evaluated Rapidly (COVER) programme, BCG has been included in the quarterly childhood vaccine coverage data extraction from local child health information systems (CHIS) and has included denominators of eligible children and therefore coverage for all local authorities since April 2022 of children at 3 months and, since January 2023, at 3 and 12 months of age. Annual data of BCG coverage for all local authorities at 3 months is reported by NHS England.
In Table 3a, BCG vaccine coverage data is presented for England and by region from April 2022 to March 2023. For England BCG coverage at 3 months of age for eligible children was 68.8%, varying from 54.8% in the North East to 74.9% in the East of England.
In the 5 local authorities in London that offered universal vaccination, and coverage of the selective programme for Leicester local authority. Of the 5 authorities who have offered universal vaccination only Newham still has a TB incidence greater than the 40 per 100,000 population per year.
Table 3a. Annual BCG vaccine coverage of children up to 3 months old in England and in regions: April 2022 to March 2023
| Area | Eligible population | Number of children vaccinated | Coverage (%) |
|---|---|---|---|
| England | 158,373 | 109,029 | 68.8 |
| North East | 2,731 | 1,496 | 54.8 |
| North West | 16,338 | 11,389 | 69.7 |
| Yorkshire and The Humber | 11,674 | 8,628 | 73.9 |
| East Midlands | 9,879 | 6,141 | 62.2 |
| West Midlands | 21,194 | 14,793 | 69.8 |
| East of England | 15,654 | 11,727 | 74.9 |
| London | 54,195 | 38,004 | 70.1 |
| South East | 20,665 | 13,399 | 64.8 |
| South West | 6,043 | 3,452 | 57.1 |
Table 3b. Annual BCG vaccine coverage of children up to 3 months old in English local authorities with universal BCG programmes and Leicester local authority: April 2022 to March 2023
| Upper tier local authority | Three-year average (2020 to 2022) annual TB rate per 100,000 | Number of eligible children | Number of children vaccinated | BCG coverage |
|---|---|---|---|---|
| Newham | 41.3 (37.5 to 45.3) | 5,442 | 4,285 | 78.7 |
| Brent | 37.4 (33.7 to 41.4) | 2,904 | 2,006 | 69.1 |
| Hounslow | 29.6 (26.1 to 33.5) | 2,156 | 1,918 | 89.0 |
| Ealing | 30.5 (27.3 to 34.0) | 2,818 | 2,330 | 82.7 |
| Redbridge | 26.7 (23.5 to 30.2) | 3,181 | 1,585 | 49.8 |
| Leicester | 38.9 (35.3 to 42.8) | 2,600 | 1,768 | 68.0 |
Notes
1. BCG vaccine coverage for financial year 2022 to 2023 for children at 3 months of age is extracted from Table 11a of the Childhood Vaccination Coverage statistics, England, 2022 to 2023 This table reports coverage of children up to 3 months this year compared with at one year in previous publication years.
2. BCG coverage by quarter at 3 and 12 months of age from April 2022 to March 2023 has previously been reported.
3. Three-year average TB incidence rate per 100,000 for upper tier local authority.
Detecting TB in children
Delays in the care pathway in children
The prompt diagnosis and treatment of active TB can improve treatment outcomes and reduce the period of infectiousness and potential onwards transmission.
Breakdown of the period of treatment delay into the periods between symptom onset, seeking healthcare, diagnosis and then start of treatment can identify where further research into the causes of delay and of appropriate interventions should be targeted. There are likely to be different factors associated with delays between presentation at a healthcare service, receiving a diagnosis and then starting treatment.
Time from symptom onset to TB diagnosis in children (diagnostic delay)
The median diagnostic delay was 43 days in 2022, compared with 37 days in 2021 (Supplementary Table 6 of the accompanying data set).
Delays in notification
Notification of TB is required within 3 days of a suspected or confirmed TB diagnosis. The median time to notification for children with pulmonary TB in England was 2 days in 2022 (Supplementary Table 6 of the accompanying data set).
In 2022, 57.8% of children were notified within 3 days of diagnosis, the highest proportion since 2012 (Supplementary Table 7 of the accompanying data set).
Culture confirmation
Overall, in 2022, 39.0% (53 out of 136 individuals) of children had TB disease confirmed by culture. The proportion was the same in pulmonary and non-pulmonary disease (Supplementary Table 8 of the accompanying data set).
It is harder to obtain samples from children to confirm the diagnosis of TB by culture of the bacteria. This is reflected by much lower culture confirmation rates in children (39% in 2022, compared with 62.6% in all age groups). It can be harder to obtain sputum samples from young children as they do not always have a productive cough. Obtaining clinical samples from children can require invasive procedures which may not be considered necessary to confirm the diagnosis of TB. As such, fewer children will have samples for culture confirmation and will be treated empirically (in line with British Association for Paediatric Tuberculosis clinical guidance).
Culture confirmation proportions for children differed by UKHSA region (Supplementary Table 9 of the accompanying data set). As numbers are small in most regions, there can be significant fluctuation in culture confirmation proportions from year to year.
Drug resistance
Susceptibility of the TB bacteria to anti-tuberculous agents is reported for all culture-confirmed individuals with TB. In 2022 of the 53 children with culture confirmed TB:
- 2 were isoniazid resistant, without MDR TB, at diagnosis
- 1 (1.9%) was MDR or rifampicin resistant (RR) TB at diagnosis.
- there were no children with pre-extensively drug resistant (pre-XDR) at diagnosis
A total of 4 children were treated for MDR TB or pre-XDR (2.9% of the children with TB in 2022). This number includes children that have not had a culture-confirmed diagnosis but were treated as MDR TB or pre-XDR TB due to clinical circumstances.
Controlling TB in children
Time from symptom onset to TB treatment start (treatment delay)
Only the delays for children with pulmonary disease are described in the following section. Data was available for 61.4% (54 out of 88).
Table 4 shows the number and proportion of children notified with pulmonary TB with a treatment delay between 2 to 4 months and more than 4 months from 2016 to 2022. A similar proportion of cases were missing information on treatment delays in 2021 and 2022 (39.1% and 38.6% respectively), which was mainly due to missing information for date of symptom onset.
Table 4. Number and proportion of children with treatment delay notified with pulmonary TB, England, 2016 to 2022
| Year | 2 to 4 months delay | Over 4 months delay | Total (n) | Missing (%) | Total pulmonary (n) |
|---|---|---|---|---|---|
| 2016 | 21 (18.4%) | 11 (9.6%) | 114 | 24 (17.4%) | 138 |
| 2017 | 15 (15.2%) | 19 (19.2%) | 99 | 10 (9.2%) | 109 |
| 2018 | 23 (25.3%) | 13 (14.3%) | 91 | 17 (15.7%) | 108 |
| 2019 | 14 (17.3%) | 10 (12.3%) | 81 | 29 (26.4%) | 110 |
| 2020 | 15 (18.8%) | 7 (8.8%) | 80 | 15 (15.8%) | 95 |
| 2021 | 8 (19.0%) | 7 (16.7%) | 42 | 27 (39.1%) | 69 |
| 2022 | 8 (14.8%) | 12 (22.2%) | 54 | 34 (38.6%) | 88 |
Notes
1. ‘2 to 4 months’ covers 61 to 121 days and ‘Over 4 months’ includes delays from 122 to 730 days. Delays over 730 days are excluded.
2. Children diagnosed with TB post-mortem are excluded from these analyses.
3. The total includes the number of children with pulmonary TB with known duration of treatment delay.
4. The total pulmonary reflects the number of children with pulmonary TB, including those with no known duration of treatment delay.
In 2022, just over two-thirds (34 of 54 cases, 63.0%) of children with pulmonary disease were treated within 2 months from TB symptom onset. 12 (22.2%) children experienced a delay of more than 4 months from symptom onset to treatment start.
In 2022 the median treatment delay for children notified with pulmonary TB was 44 days (IQR: 21 to 100 days) compared with 42 days in 2021. The median treatment delay of 44 days is the highest recorded between 2012 and 2022 (supplementary Table 6 of the accompanying data set).
Treatment delay attributable to pre-healthcare or in-healthcare factors in children notified with pulmonary TB
The proportion of treatment delay due to the time between symptom onset and presentation at a health facility has varied over the last 5 years (Figure 4).
Figure 4. Breakdown of median treatment delay among children with pulmonary TB, by time from symptom onset to presentation at any healthcare service and time from presentation at healthcare service to start of treatment, England, 2018 to 2022
Notes
1. This figure is limited to children with a known duration of treatment delay and a valid date for first presentation at healthcare service, on or before the start of treatment.
2. The date of presentation to any healthcare service refers to the earliest date the child was seen by healthcare professionals, whether this was at a health facility or at a TB service.
Numbers are too low to provide an overview of TB treatment delays among children by geographical sub-regions other than at the national level.
Treatment delay by age group, sex and place of birth
Due to small numbers, the data is presented as aggregated numbers across the last 5 years. Appendix Table A1 shows the proportion of children notified with pulmonary TB between 2018 to 2022 who experienced treatment delay by age group, and Appendix Table A2 shows the same by sex, and Appendix Table A3 by place of birth.
Treatment delay is any time after 2 months of diagnosis. This is further split into ‘2 to 4 months’ post-diagnosis and ‘greater than 4 months’ post-diagnosis. In the last 5 years, 66.4% of children started treatment within 2 months of symptom onset compared with 38% of pulmonary TB cases for all people notified with TB. A treatment delay was more common in children in older age groups. Treatment delay was more common in children born outside of the UK (38.9%) compared with UK born children (31.8%).
Enhanced support for children undergoing TB treatment
Enhanced care management (ECM) is a package of tailored supportive care All children notified with TB should be offered at least level one of ECM. The ECM levels recorded in the National TB Surveillance System (NTBS) comprise:
- level 0 for standard care management
- level 1 for people with clinical or social issues or both which have an impact on treatment, which may include children with TB, or those with human immunodeficiency virus (HIV) and taking antiretrovirals
- level 2 for people with complex clinical or social issues or both affecting treatment and necessitating, for example, weekly visits and may include persons with complex side effects or single drug resistance
- level 3 for people with very complex clinical or social issues or both affecting treatment and necessitating DOT or video enhanced therapy (VOT) and may include people experiencing homelessness, multidrug-resistant or rifampicin-resistant TB, or those with complex contact tracing or cases in which the involvement of social services is required (see the Royal College of Nursing’s Case Management Tool for TB Prevention, Care and Control in the UK)
Table 5 shows levels of ECM by year. In 2022, almost all children notified with TB (89.0%) were assessed as requiring some level of enhanced case management. This is the highest proportion in any year, mainly due to an increased number of children being assessed as needing ECM level 1.
Table 5. Enhanced case management (ECM) among children notified with TB by year, England, 2019 to 2022
| Year | Total | Any ECM | Level 1 | Level 2 | Level 3 | Unknown Level |
|---|---|---|---|---|---|---|
| 2019 | 168 | 86 (51.2%) | 10 (6.0%) | 4 (2.4%) | 43 (25.6%) | 29 (17.3%) |
| 2020 | 148 | 95 (64.2%) | 25 (16.9%) | 3 (2.0%) | 43 (29.1%) | 24 (16.2%) |
| 2021 | 127 | 85 (66.9) | 33 (26.0%) | 10 (7.9%) | 30 (23.6%) | 12 (9.4%) |
| 2022 | 136 | 121 (89.0%) | 91 (66.9%) | 15 (11.0%) | 15 (11.0%) | 0 (0%) |
Supplementary Table 10 of the accompanying data set shows the proportion of children by age, sex, place of birth and site of disease who were assessed as requiring different levels of ECM in 2022. Some level of ECM was applied relatively evenly across groups.
Directly observed treatment (DOT)
According to National Institute for Health and Care Excellence (NICE) guidelines, DOT should be offered as part of enhanced case management to children who themselves or whose parents:
- do not adhere to treatment (or have not in the past)
- have been treated previously for TB
- have a history of homelessness, drug or alcohol misuse
- are currently in prison, or have been in the past 5 years
- have a major psychiatric, memory or cognitive disorder
- are in denial of the TB diagnosis
- have multidrug resistant TB
- request DOT after discussion with the clinical team
- are too ill to administer the treatment themselves
Data reporting on whether DOT was offered and received by children with TB from 2012 to 2022 is shown in Supplementary Table 11 of the accompanying data set.
In 2022, missing data in relation to the offer of DOT was the lowest in the last 10 years at 7%.
In 2022, DOT was offered to 17.6% of children (24 out of 136). of whom (79.2% (19 out of 24) received it.
TB treatment outcomes in children with non-MDR or non-RR TB
Treatment outcomes at 12 months and last recorded treatment outcome
For children treated for non-MDR or non-RR TB, outcomes are reported for those notified up to and including 2021 as that is the latest year of notifications for which treatment completion is expected within the 2022 data. For children treated for MDR or RR TB, outcomes are reported for those notified up to and including 2020 as treatment can be up to 24 months (see Supplementary Table 22 of the accompanying data set. Further definitions of TB treatment cohorts can be found in the Methodology and definitions chapter.
Mutually exclusive treatment outcome categories are shown in Table 6 below. For 111 children with non-MDR or non-RR TB notified in 2021 with non-severe disease, 100 (90.1%) had completed treatment by 12 months. At the time of data extraction, 107 (96.4%) of children had completed treatment at their last recorded outcome.
Table 6. TB outcome at 12 months and the last recorded TB outcome for children notified up to 2021 with non-MDR or RR TB, with an expected treatment duration of less than 12 months, England, 2022
| Treatment outcome | Treatment outcome at 12 months (%) | Last recorded outcome (%) |
|---|---|---|
| Treatment completed | 100 (90.1%) | 107 (96.4%) |
| Died | No observations | No observations |
| Lost to follow up | No observations | No observations |
| Still on treatment | 1 (0.9%) | No observations |
| Stopped | 3 (2.7%) | 3 (2.7%) |
| Not evaluated | 7 (6.3%) | 1 (0.9%) |
| Total | 111 | 111 |
Notes
1. Excludes children with MDR or RR TB and those with miliary or cryptic disseminated TB or TB meningitis.
2. ‘Not evaluated’ includes unknown and transferred out.
The action plan target for all people notified with TB is to increase treatment completion within 12 months to 90% by 2026 for those with non-severe disease and an expected treatment duration of less than 12 months. Figure 5 below shows this target is met for children in all years except for 2020. Treatment completion for children has remained stable over the last 10 years (Supplementary Tables 12 and 13 of the accompanying data set). Treatment completion at 12 months is greater in children compared with all people with TB, 90.1% versus 84.2% (TB treatment and outcomes in England, 2022 report).
Figure 5. Proportion of children treated for non-MDR or non-RR TB with expected treatment duration less than 12 months who completed treatment within 12 months
The data used in this graph can be found in Supplementaty Table 12 of the accompanying data set.
Appendix Figure A7 shows treatment outcomes at 12 months for children with non-severe and non-MDR or RR TB expected to complete treatment within 12 months over time. The proportion of those not evaluated for the 2021 cohort is expected to decrease as more missing values are entered. Figure 6 below shows that the proportion of children who died, were lost to follow-up, still on treatment or stopped treatment has remained very low and comparable from 2011 to 2021. From 2011 to 2021, 2 deaths were reported, of which 1 was incidental to TB.
Figure 6. Breakdown of children evaluated who did not complete treatment at 12 months for children with non-MDR or non-RR TB and expected treatment duration less than 12 months, England, 2011 to 2021
The data used in this graph can be found in Supplementary Table 12 of the accompanying data set.
12-month treatment outcomes by age and sex
Treatment outcomes at 12 months for the cohort of children treated for non-MDR or non-RR TB and without severe disease are reported in the following tables:
- by age group from 2011 to 2021 in Supplementary Table 14 of the accompanying data set
- by age and sex for notifications in 2021 in Supplementary Table 15 of the accompanying data set
In 2021, 90% of 0 to 4 year olds, 95% of 5 to 9 year olds, and 89% of 10 to 14 year olds completed treatment at 12 months. Treatment completion was similar between males and females at 89.3%% and 90.9%, respectively.
Numbers are too low to provide an overview of TB treatment outcomes among children by geographical regions.
Treatment duration
Of 127 children notified in 2021, 111 were expected to complete treatment within 12 months and 107 completed treatments. Of these, most completed treatment within the standard 6 to 8 months (66%, 70 out of 107). Just over 10% completed in less than 6 months, shorter than the full duration of the standard course, which may occur if a child started treatment abroad (Supplementary Table 16 of the accompanying data set).
TB treatment outcomes for the non-MDR or non RR TB cohort with severe disease
Supplementary Table 17 of the accompanying data set shows last recorded treatment outcome for children notified with severe TB (TB meningitis, miliary or cryptic disseminated TB) with non-MDR or non-RR TB by year from 2011 to 2021. From the 8 children notified in 2021 all completed treatment at the last recorded outcome.
Last recorded TB treatment outcomes for the entire non-MDR or non RR TB cohort
Last recorded treatment outcome for the entire non-MDR or non-RR TB cohort, including those with miliary or cryptic disseminated TB or TB meningitis are shown in the 2022 accompanying data set: by year (2011 to 2021) in Supplementary Table 18 and by site of disease (2021) in Supplementary Table 19.
Treatment completion as the last recorded outcome for the entire non-MDR or non-RR TB cohort was 96.7% in 2021. This has remained relatively static over time, with a peak of 98.9% in 2014 and a 11-year average of 97.3%.
Factors affecting treatment completion at last recorded outcome in the entire non-MDR or non RR-cohort
As shown in Supplementary Table 20 of the accompanying data set, when aggregated over the last 5 years there were only small differences in the proportion of children who completed TB treatment by the socio-demographic and disease characteristics of age, sex, place of birth, pulmonary disease and treatment delay. The 95% confidence intervals of the risk ratios all crossed 1, suggesting that observed differences in treatment completion occurred by chance.
TB treatment outcomes in the drug resistant (MDR or RR TB) cohort
Supplementary Table 21 of the accompanying data set shows TB treatment outcomes at 24 months for children notified with MDR or RR TB by year from 2010 to 2020 and totalling 26 children. The 2020 cohort comprised one child treated for MDR or RR TB, who completed treatment within 12 to 18 months.
Supplementary Table 22 of the accompanying data set shows the last recorded treatment outcome for the same group, of whom 24 (92.3%) had completed treatment as their last recorded outcome. Two children, notified in 2010 and 2015, were reported as still on treatment as their last recorded outcome (7.7%).
Appendix
Figure A1. Numbers of TB notifications in UK born and non-UK born children under 15 years, England, 2000 to 2022
The data used in this graph can be found in Supplementary Table 1 of the accompanying data set.
Figure A2. TB notification rates in UK-born and non-UK born children under 15 years, England, 2000 to 2022
The data used in this graph can be found in Supplementary Table 1 of the accompanying data set.
Figure A3. Proportion of TB notifications in UK-born children by sex and age group, England, 2022
The data used in this graph can be found in Supplementary Table 4 of the accompanying data set.
Figure A4. Proportion of TB notifications in non-UK-born children by sex and age group, England, 2022
The data used in this graph can be found in Supplementary Table 4 of the accompanying data set.
Figure A5. Number of TB notifications by age for UK born and non-UK born children, 2000 to 2022 (aggregated data)
The data used in this graph can be found in Supplementary Table 5 of the accompanying data set.
Figure A6. Rates of TB by age for UK born and non-UK born children, 2000 to 2022 (aggregated data)
The data used in this graph can be found in Supplementary Table 5 of the accompanying data set.
Table A1 Average number and proportion of children with treatment delay notified with pulmonary TB by age group, England, 2018 to 2022
| Time from symptom onset to treatment start | 0 to 4 years | 5 to 9 years | 10 to 14 years | Total |
|---|---|---|---|---|
| 0 to 2 months | 105 (79.0%) | 45 (66.2%) | 81 (55.1%) | 231 (66.4%) |
| 2 to 4 months | 17 (12.8%) | 12 (17.7%) | 39 (26.5%) | 68 (19.5%) |
| Over 4 months | 11 (8.3%) | 11 (16.2%) | 27 (18.4%) | 49 (14.1%) |
| Total | 133 | 68 | 147 | 348 |
Notes
1. The row and column totals include the number of eligible children notified with pulmonary TB with a valid duration between symptom onset and treatment start.
2. ‘0 to 2 months’ covers 0 to 60 days, ‘2 to 4 months’ covers 61 to 121 days and ‘over 4 months’ includes delays from 122 to 730 days.
Table A2. Average number and proportion of children with treatment delay (greater than 2 months) notified with pulmonary TB by age group and sex, England, 2018 to 2022
| Age group (years) | Female | Male | Total (n) |
|---|---|---|---|
| 0 to 4 | 15 (23.4%) | 13 (18.4%) | 28 |
| 5 to 9 | 10 (31.3%) | 13 (36.1%) | 23 |
| 10 to 14 | 42 (42.4%) | 24 (50.0%) | 66 |
| Total | 67 (34.4%) | 50 (32.7%) | 117 |
Note: the row and column totals include the number of eligible children notified with pulmonary TB with a valid duration between symptom onset and treatment start between 60 and 730 days.
Table A3. Average number and proportion of children with treatment delay notified with pulmonary TB by place of birth, England, 2017 to 2022
| Time from symptom onset to treatment start | Non-UK born | UK born | Total |
|---|---|---|---|
| 0 to 2 months | 74 (61.2%) | 221 (68.2%) | 295 (66.3%) |
| 2 to 4 months | 23 (19.0%) | 60 (18.5%) | 83 (18.6%) |
| Over 4 months | 24 (19.8%) | 43 (13.3%) | 67 (15.1%) |
| Total | 121 | 324 | 445 |
Notes
1. The row and column totals include the number of eligible children notified with pulmonary TB with a valid duration between symptom onset and treatment start and a known place of birth.
2. ‘0 to 2 months’ covers 0 to 60 days, ‘2 to 4 months’ covers 61 to 121 days and ‘over 4 months’ includes delays from 122 to 730 days.
Figure A7. Treatment outcome at 12 months for children with non MDR or non RR TB with expected treatment duration less than 12 months, England, 2011 to 2021
The data used in this graph can be found in Supplementary Table 13 of the accompanying data set.