Rising Childhood Tuberculosis in Europe and Central Asia: Pandemic Disruptions Reveal Critical Gaps
Health authorities across Europe and Central Asia are reporting a concerning rebound in childhood tuberculosis (TB) after years of gradual decline. The recent uptick in pediatric TB cases-driven largely by interruptions to routine health services during the COVID-19 pandemic-has exposed weaknesses in detection, treatment delivery, and prevention for children and adolescents. Experts caution that without rapid, targeted interventions the rebound could erode hard‑won public health gains and increase pressure on overstretched health systems.
How COVID-19 Set Back Pediatric TB Control
The pandemic’s ripple effects hit TB programs hard. Lockdowns, clinic closures and the reallocation of staff and laboratory capacity to the COVID response resulted in fewer screenings, delayed investigations of symptomatic children, and interruptions to long-term treatment courses. Many families avoided health facilities for fear of infection, and contact tracing programs were curtailed-creating conditions for undetected household transmission.
- Reduced clinic access and fear of exposure led to later presentation and diagnosis.
- Contact tracing and household screening were deprioritized in several settings.
- Stock shortages and supply-chain problems limited access to some pediatric drug formulations.
Diagnostic and Treatment Weaknesses Specific to Children
Pediatric TB differs from adult disease: children often have subtle, non-specific symptoms and are less likely to produce sputum for bacteriological testing. Many health systems in the region still lack child-adapted diagnostic pathways-such as stool-based molecular tests, enhanced radiology capacity for young patients, or routine use of WHO-recommended Xpert MTB/RIF assays for pediatric samples. Similarly, shortages of age‑appropriate, palatable TB medicines and inconsistent dosing guidance have hampered adherence and treatment outcomes among children.
Common challenges include:
- Late recognition: Non-specific signs (failure to thrive, prolonged cough, fever) are often attributed to other childhood illnesses.
- Limited pediatric formulations: Crushing adult pills or off-label dosing reduces acceptability and increases risk of incorrect dosing.
- Underreporting: Surveillance systems frequently miss pediatric cases, masking the true burden and impeding targeted responses.
Regional Snapshot: Emerging Patterns and Estimates
While national reporting varies, regional analyses and WHO summaries show children account for an estimated one in nine TB cases globally-about 11%-and the share can be higher where adult case-finding has also declined. Several countries in Eastern Europe and Central Asia have reported year-on-year rises in pediatric notifications since 2019, with smaller but notable increases in parts of Western Europe linked to pockets of social vulnerability and migration-related barriers to care.
| Region | Recent Annual Pediatric TB Notifications (approx.) | Reported Treatment Success (estimated) |
|---|---|---|
| Eastern Europe | ~4,000-5,000 | ~65-70% |
| Central Asia | ~3,000-3,500 | ~60-65% |
| Western Europe | ~1,000-1,800 | ~74-78% |
Note: Figures represent recent regional estimates compiled from national reports and international summaries; local variation is substantial. Treatment success rates for children remain uneven and, in some settings, fall short of adult program outcomes.
Practical Steps to Reverse the Trend
Public health experts recommend a combination of programmatic and community-based actions to control childhood tuberculosis in the near term and strengthen systems for the future.
1. Rebuild and modernize surveillance
Invest in digital, real‑time reporting platforms and integrate pediatric-specific indicators. Improved data linkage between primary care, paediatric clinics and national TB programs helps identify clusters and prioritize responses.
2. Expand child-friendly diagnostics and treatment
Scale up use of molecular diagnostics suitable for children (including stool and gastric aspirate testing where available) and procure WHO‑recommended pediatric formulations. Training clinicians to use age‑appropriate diagnostic algorithms will speed detection.
3. Community outreach and decentralized care
Mobile clinics, community health workers and school-based screening in high-risk areas can find children who do not reach conventional services. In Kyrgyzstan and remote provinces of several countries, community-led initiatives have improved contact tracing and adherence-examples that can be broadened.
4. Preventive therapy and vaccination efforts
Ensure high coverage of BCG vaccination where indicated and expand eligibility and uptake of TB preventive therapy (TPT) for child contacts of infectious cases. Shorter TPT regimens (e.g., weekly rifapentine-based courses where approved) can improve adherence.
5. Strengthen the pediatric workforce
Targeted training for primary care providers, paediatricians and nurses on early signs of TB, appropriate sample collection in children and family-centered adherence support is essential.
Policy Priorities and Program Actions
| Priority | Key Actions |
|---|---|
| Surveillance upgrade | Adopt digital case management; disaggregate data by age groups |
| Diagnostic accessibility | Deploy child-adapted molecular tests and strengthen referral networks |
| Medication supply | Procure pediatric fixed-dose combinations and buffer stock to avoid shortages |
| Community delivery | Use mobile teams and community health workers to reach marginalized households |
Looking Forward: Research, Funding and Collaboration
Beyond immediate program fixes, sustained investments in vaccine research, novel pediatric diagnostics and operational research are needed. Cross‑border collaboration-sharing protocols, laboratory capacity and best practices-will help regions with limited resources respond faster. Increased domestic and donor funding to rebuild TB services lost during the pandemic will be critical to prevent a prolonged resurgence.
Conclusion
The rise in childhood tuberculosis across Europe and Central Asia is a stark reminder that the pandemic’s indirect effects can reverse progress on other major health threats. Strengthening surveillance, expanding access to pediatric diagnostics and treatments, and delivering services closer to communities are urgent priorities. Coordinated action now can prevent further spread, protect children’s health, and preserve decades of progress against TB.