Research and analysis

Tuberculosis in children aged 0 to 17 years, England, 2023

Published 5 December 2024

Applies to England

Main messages

Previously this chapter reported on children under 15 years old; this year children and young people up to and including 17 years of age are included to better reflect service provision in England.

In 2023:

• the number of tuberculosis (TB) notifications in children aged 0 to 17 years of age increased by 12.1%, 259 children compared with 231 in 2022, similar to the rise observed for all TB notifications (11.0%); the overall notification rate increased from 1.9 per 100,000 in 2022 to 2.2 per 100,000 in 2023
• the proportion of children notified with TB who were born in the UK was 39.4% in 2023, decreased from 54.5% in 2022 but still higher than the proportion in adults (20.1%)
• history of homelessness was reported in 9.6% of children notified with TB (23 out of 239 with information recorded), higher than the proportion in all individuals notified with TB aged over 15 years (6.6%)
• adolescents were the most affected with 20 out of 104 (19.2%) aged 15 to 17 years
• most children with a history of homelessness were also asylum seekers (15 out of 23 children)
• being an asylum seeker was reported in 20.5% of all children notified with TB (49 out of 239 with information recorded) - this is compared with 6.4% asylum seeker status in all TB notifications aged over the age of 15
• for non-UK born children the proportion reported with asylum seekers status was 34% (49 out of 143 with information recorded), most of whom were aged 15 to 17 years (43 out of 49); this is compared with 8.0% of reported asylum seeker status in all non-UK born individuals notified with TB over the age of 15
• the delay between symptom onset and treatment start was 45 days, stable compared with recent years (49 days in 2022)
• observed treatment, which includes both directly observed therapy (DOT) and video observed therapy (VOT), is a key contributor for supporting treatment completion in individuals with more complex needs; in 2023, DOT or VOT was offered to 29.7% of children, an increase from 24.7% in 2022. In 2023; 77.9% of children offered DOT or VOT received it
• treatment completion at 12 months for children diagnosed in 2022 who were expected to complete treatment by the end of 2023 was consistent with previous years, with 88.9% recorded as completing treatment
• vaccine coverage for the neonatal Bacille Calmette-Guerin (BCG) vaccination programme, including for the 5 local authorities who conducted universal neonatal programmes, can be found in the Tuberculosis prevention, England, 2023 chapter

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 such as TB meningitis. Older children aged 15 years or over tend to have a similar clinical presentation to adults (aged 18 years or over).

The epidemiology, care pathways and management of children with suspected and confirmed TB infection and disease, are distinct from those for adults, as such, data for children are presented separately in this report.

In previous years’ TB reports children have been defined as those aged under 15 years, in line with World Health Organization (WHO) reporting. This year’s annual report includes data on children up to and including aged 17 years as UK paediatric services include individuals up to 16 years and may cover those up to 18 years as per the clinical guidance from the British Association for Paediatric Tuberculosis.

Children are identified as a specific population group requiring actions in the joint UKHSA and NHS England (NHSE) collaborative action plan 2021 to 2026 so data on this group are reported separately in this chapter.

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 dataset show the numbers and rates of TB notifications in children from 2011 to 2023 for all children and by country of birth (UK and non-UK born).

In 2023, 259 children (aged under 18 years) were notified with TB in England, an increase of 12.1% in the number compared with 2022, similar to the all notifications (11.0% increase). The rate in children under 18 years old was 2.2 per 100,000 (95% confidence interval (CI) 1.9 to 2.5), higher than 2022 (231 children, rate 1.9 per 100,000 (95% CI: 1.7 to 2.2)). In 2023, 140 children aged under 15 years were notified compared with 136 in 2022.

Figure 1. Overall number of TB notifications in children aged under 18 years, England, 2011 to 2023

The data used in Figure 1 can be found in Supplementary Table 1 of the accompanying dataset.

Figure 2. Rates of TB notifications in children aged less than 18 years, England, 2011 to 2023

The data used in Figure 2 can be found in Supplementary Table 1 of the accompanying data set.

Distribution of TB in children by UK Health Security (UKHSA) region

The number of children with TB varies by UKHSA region with London having the highest number of notifications (88 children). This is presented in Supplementary Table 2 of the accompanying dataset and largely reflects the regional patterns for all TB notifications.

Demographic characteristics of children with TB in England

TB in children by country of birth and ethnicity

In 2023, 102 out of 259 (39.4%) children notified with TB with a known country of birth, were born in the UK. This is lower than in 2022 (126 notifications, 54.5%).

Appendix Figure A1 and Figure A2 show the numbers and rates of TB notification for UK and non-UK born children.

In 2023, the TB notification rate in UK-born children was 1.0 per 100,000 (95% CI: 0.8 to 1.2), similar to 2022 (see Supplementary Table 1 of the accompanying data set). The TB notification rate in non-UK born children was 14 times higher than in UK born children (14.2 per 100,000 in 2023 (n=157), compared with 10.9 per 100,000 in 2022 (n=104)).

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 Black-African and White ethnic groups (26 and 25 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 (55 children, 23.7 per 100,000, 95% CI: 18.2 to 30.9) and Pakistani ethnicity (24 children, 44.2 per 100,000, 95% CI: 29.6 to 65.9).

Table 1 shows that after the UK: Afghanistan, Pakistan and India were the most frequent countries of birth among children diagnosed with TB in 2023, with 15.4% born in Afghanistan, 7.7% born in Pakistan and 4.2% born in India.

Table 1. The top five countries of birth for children with TB, England, 2023

Country of birth	Number of Children	Proportion of Children (%)
United Kingdom	102	39.4
Afghanistan	40	15.4
Pakistan	20	7.7
India	11	4.2
Nigeria	11	4.2

Note: there was no missing country of birth.

Age and sex distribution differ between UK-born and non-UK-born children

In 2023, More children notified with TB were male (157 of 259, 60.6%) than female (102 of 259, 39.4%). 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.

The most common age group in children notified with TB was 15 to 17 years (119 children, 45.9%) and least common in 5 to 9 years (14 children, 9.3%).

This reflects the global pattern of higher incidence in children under 5, decreasing through the middle childhood years and then increasing again in adolescence.

Appendix Figure A5 shows the number of TB notifications by age (per year).

Age-specific numbers and rates for data aggregated for years 2011 (when TB in the UK was previously at its highest) to 2023 are shown in Appendix Figures A5 and A6. Rates for UK born individuals were highest in those aged 0 to 2 years and 15 to 17 years (see Supplementary Table 5 of the accompanying data set). In non-UK born children rates were highest in those aged 15 to 17 years.

Clinical characteristics

Site of disease

Over half (60.6%) of children had pulmonary disease. The proportion differed by age group, being highest in children aged 0 to 4 years (72.5%) and lowest in children aged 10 to 14 years (49.2%) (see Table 2).

There were 21 children (8.1%) 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, 2023

Site of disease	0 to 4 years	5 to 9 years	10 to 14 years	15 to 17 years
Total number of children	51	24	65	119
Pulmonary TB	37 (72.5%)	12 (50.0%)	32 (49.2%)	76 (63.9%)
Extra pulmonary TB	27 (52.9%)	18 (75.0%)	42 (64.6%)	65 (54.6%)
Severe TB	7 (13.7%)	1 (4.2%)	5 (7.7%)	8 (6.7%)
Lymph node only	13 (25.5%)	11 (45.8%)	26 (40.0%)	35 (29.4%)
Other	3 (5.9%)	3 (12.5%)	4 (6.2%)	7 (5.9%)

Notes:

• severe disease comprises TB meningitis, miliary TB or cryptic disseminated TB
• 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 is often associated with recent transmission as children have a limited time during which they could have become infected and, if they develop active disease, 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 2011 to 2023 (see Supplementary Table 1 of the accompanying data set). After a fairly steady decline from 2012, the TB notification rate in this group increased in 2019, then declined again, until a small increase in 2022, and then remained static in 2023 at less than 1 notification per 100,000 population.

Figure 3. The overall rate of TB notification in children (under 15 years) born in the UK, England, 2011 to 2023

The data used in Figure 3 can be found in Supplementary Table 1 of the accompanying data set.

Clinical comorbidities

In 2023 very few children had diabetes (n=2) and smoked (n=9).

Social risk factors in children with TB

In 2023 very few children drank alcohol (n=2) or misused drugs (n=2). All children recorded with these risk factors were in the 15 to 17 years age group (see Supplementary table 5 in the accompanying dataset). The only years when a child was reported with one of these social risk factors (SRFs) in another age group (10 to 14 years) were 2022 and 2021.

Homelessness and asylum seeker status in children notified with TB

History of homelessness or being an asylum seeker in children notified with TB has not previously been described in annual reports. In 2023, 9.6% of children under 18 years old were reported to have a history of homelessness (23 out of 239) and 19.2% of children aged 15 to 17 years (20 out of 104) (see Figure 4), compared with all people notified with TB (6.4%) (see chapter TB incidence and Epidemiology, England, 2023) but was less common in younger children.

Figure 4. Proportion of individuals with a history of homelessness by age group in children aged under 18, England, 2018 to 2023

Notes:

• proportions are calculated for those with reported values
• history of homelessness was missing in:
  • 1.1% in 2018
  • 3.3% in 2019
  • 1.6% in 2020
  • 5.0% in 2021
  • 6.5% in 2022
  • 7.7% in 2023

The data used in this graph can be found in Supplementary Table 6 of the accompanying data set.

In 2023, 20.5% of all children notified with TB were reported to be asylum seekers (49 out of 239 with information recorded), and 34% (49 out of 143) of all children who were born outside of the UK, of whom most were aged 15 to 17 years (43 adolescents).

The number of children reported as asylum seekers has increased since 2021 with 9 children in 2019 and 2020 and 21 children in 2021, 38 in 2022 and 49 in 2023. In all years, the majority of these children were in the 15 to 17 year age group (see Figure 5 and Supplementary Table 6 in the accompanying dataset).

Figure 5. Proportion and number of asylum seekers in all TB notifications in non-UK born children by age group in children aged less than 18 years, England, 2021 to 2023

Notes:

• numbers of children are shown above the bars
• proportions are calculated for those with reported values
• asylum seeker status was collected more systematically from 2021 onwards, with very high proportions of missing data before this time (asylum seeker status was missing in 57.7% in 2021, 3.8% in 2022 and 8.9% in 2023)

The data used in this graph can be found in Supplementary Table 6 of the accompanying data set.

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.

Breaking down the period of treatment delay into the periods between symptom onset, seeking of healthcare, diagnosis and then start of treatment can identify where further investigation 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, receipt of diagnosis and then treatment commencement.

Time from symptom onset to TB diagnosis in children (diagnostic delay)

The median diagnostic delay was slightly shorter at 43 days in 2023, compared with 46 days in 2022 (see Supplementary Table 7 of the accompanying data set).

Delays in notification

In 2023, 58.7% of children were notified within 3 days of diagnosis, the highest proportion since 2019 (see Supplementary Table 8 of the accompanying data set) and similar to the notification rate within 3 days in adults (59.8%).

Culture confirmation

Overall, in 2023, 46.3% (120 out of 259 individuals) of children had TB disease confirmed by culture. The proportion was higher in pulmonary (54.1%) than non-pulmonary (34.3%) disease (see Supplementary Table 9 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 (46.3% in 2023, compared with 61.2% in all age groups). As young children may not produce sputum from coughing, 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).

Drug resistance

Susceptibility of the TB bacteria to anti-tuberculous agents is reported for all culture confirmed individuals with TB. In 2023 of the 120 children with culture confirmed TB:

• 7 (5.8%) had isoniazid mono-resistance
• 3 (2.5 %) had multidrug resistant (MDR) or rifampicin resistant (RR) TB at diagnosis
• there were no children with pre-extensively drug resistant (pre-XDR) at diagnosis

In 2023, 6 children were treated for MDR TB or pre-XDR (2.3%). This number includes children that have not had a culture-confirmed diagnosis but were treated with an MDR TB regimen, due to high clinical suspicion of MDR or RR TB or other reasons such as intolerance to rifampicin.

Controlling TB in children

Time from symptom onset to TB treatment start (treatment delay)

Treatment delay is any time after 2 months of symptom onset. Only delays for children with pulmonary, and therefore potentially infectious, disease are described in the following section.

Table 3 shows the number and proportion of children notified with pulmonary TB with a treatment delay between 0 to 2 months, 2 to 4 months and more than 4 months from 2019 to 2023. A similar proportion of children were missing information on treatment delays in 2022 and 2023 (29.9% and 33.1% respectively), which was mainly due to missing information for date of symptom onset.

Table 3. The number and proportion of children notified with pulmonary TB with a treatment delay between 0 to 2 months, 2 to 4 months and more than 4 months from 2019 to 2023, England

Year	Total (n)	0 to 2 months delay	2 to 4 months delay	over 4 months delay	Missing (percentage)	Pulmonary (n)
2019	155	99 (63.9%)	33 (21.3%)	23 (14.8%)	21.3	197
2020	140	86 (61.4%)	34 (24.3%)	20 (14.3%)	11.9	159
2021	87	50 (57.5%)	20 (23.0%)	17 (19.5%)	28.1	121
2022	103	60 (58.3%)	23 (22.3%)	20 (19.4%)	29.9	147
2023	105	68 (64.8%)	17 (16.2%)	20 (19.0%)	33.1	157

Notes:

• ‘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 onwards
• children diagnosed with TB post-mortem are excluded from these analyses
• the total includes the number of children with pulmonary TB with known duration of treatment delay
• the total pulmonary reflects the number of children with pulmonary TB, including those with no known duration of treatment delay

In 2023, two-thirds (68 of 105 children, 64.8%) of children with pulmonary disease started treatment within 2 months from TB symptom onset, higher than when compared with all notifications with pulmonary disease (39.9%) (see chapter TB treatment and outcomes, England, 2023), whilst 20 children (19.0%) experienced a treatment delay of more than 4 months.

In 2023, the median treatment delay for children notified with pulmonary TB was 45 days (IQR: 22 to 92 days) compared with 49 days in 2022 (see Supplementary Table 7 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 (see Figure 6 and Supplementary Table 7 of the accompanying dataset). The median time from presentation at a healthcare setting to start of treatment rose slightly in 2023, from 20 days in 2022 to 23 days in 2023.

Figure 6. 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 2023

Notes:

• 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
• 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 (2019 to 2023). Appendix Table A1 shows the proportion of children notified with pulmonary TB between 2019 to 2023 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 was more common in older age groups. Treatment delay was similar between children born outside of the UK (51.4%) and UK born children (48.9%).

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 those where 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 4 Enhanced case management (ECM) in children notified with TB by year, England, 2019 to 2023

Year	Total	Any ECM	ECM Level 1	ECM Level 2	ECM Level 3	ECM Unknown level
2019	307	138 (45.0%)	11 (3.6%)	4 (1.3%)	76 (24.8%)	47 (15.3%)
2020	244	144 (59.0%)	30 (12.3%)	7 (2.9%)	68 (27.9%)	39 (16%)
2021	221	137 (62.0%)	56 (25.3%)	18 (8.1%)	43 (19.5%)	20 (9%)
2022	231	194 (84.0%)	123 (53.2%)	25 (10.8%)	46 (19.9%)	NA
2023	259	218 (84.2%)	113 (43.6%)	35 (13.5%)	70 (27%)	NA

In 2023 and 2022, most children notified with TB (84.2% and 84.0%, respectively) were assessed as requiring some level of enhanced case management. Including 70 (27%) requiring ECM level 3 in 2023, an increase from 46 (19.9%) in 2022.

Supplementary Table 11 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 2023. Some level of ECM was applied relatively evenly across groups.

Directly observed treatment or video observed treatment

According to National Institute for Health and Care Excellence (NICE) guidelines, DOT, which includes video observed therapy (VOT), 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 or VOT was offered and received by children with TB from 2011 to 2023 is shown in Supplementary Table 12 of the accompanying data set.

In 2023, missing data in relation to the offer of DOT or VOT was similar to 2022 with both years being much lower than previous years.

In 2023, DOT or VOT was offered to 29.7% of children (77 out of 259), compared with 24.7% in 2022. Of the 77 offered DOT or VOT in 2023, 77.9% 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 2022 as that is the latest year of notifications for which treatment completion is expected within the 2023 data. For children treated for MDR or RR TB, outcomes are reported for those notified up to and including 2021 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 5 below. For 208 children with non-MDR or non-RR TB notified in 2022 with non-severe disease, 185 (88.9%) had completed treatment by 12 months. At the time of data extraction, 195 (93.8%) of children had completed treatment at their last recorded outcome.

Table 5. 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: number of notifications	Treatment outcome at 12 months (percentage)	Last recorded outcome: number of notifications	Last recorded outcome (percentage)
Treatment completed	185	88.9	195	93.8
Died	0	0.0	0	0.0
Lost to follow up	3	1.4	4	1.9
Still on treatment	5	2.4	1	0.5
Treatment stopped	3	1.4	3	1.4
Not Evaluated	12	5.8	5	2.4
Total	208	99.9	208	100.0

Notes:

• excludes children with MDR or RR TB and those with miliary or cryptic disseminated TB or TB meningitis
• ‘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 7 below shows this target has been largely met over the last 10 years, with slightly lower completion rates for children notified in 2022 (see Supplementary Tables 13 and 14 of the accompanying data set). Treatment completion at 12 months is greater in children compared with all people with TB, 88.9% versus 82.8% (see chapterTB treatment and outcomes, England, 2023).

Figure 7. 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 Supplementary Table 13 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, who had not completed treatment by 12 months. The proportion of those not evaluated for the 2022 cohort is expected to decrease as more missing values are entered.

Figure 8 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 2022. From 2011 to 2022, 2 deaths were reported.

Figure 8. 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 13 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 2022 in Supplementary Table 15 of the accompanying data set
• by age and sex for notifications in 2022 in Supplementary Table 16 of the accompanying data set

In 2022, 87.2% of 0 to 4 year olds, 85% of 5 to 9 year olds, 86.2% of 10 to 14 year olds and 92.9% of 15 to 17 year olds completed treatment at 12 months. Treatment completion was similar between males and females at 89.3% and 88.5%, respectively.

Numbers are too low to provide an overview of TB treatment outcome in children by geographical region.

Treatment duration

Of 208 children notified without MDR or RR TB in 2022, expected to complete treatment within 12 months, 195 completed treatment at their last recorded outcome, of whom 189 had a treatment end date recorded. Of these 189, most completed treatment within the standard 6 to 8 months (67.7%, 128 out of 189). 181 completed treatment within 12 months. A small proportion,6.9%, completed in less than 6 months, shorter than the full duration of the standard course. Trial data was published in 2022 showing that a 4 month course was non-inferior to the usual 6 months course in non-severe TB disease (see Supplementary Table 17 of the accompanying data set).

TB treatment outcomes for the non-MDR or non-RR TB cohort with severe disease

Supplementary Table 18 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 2022. From the 17 children notified in 2022, 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 following supplementary tables:

• by notification year (2011 to 2022) in Supplementary Table 19 in the accompanying dataset
• by site of disease for notifications in 2022 in Supplementary Table 20 in the accompanying data set

Treatment completion as the last recorded outcome for the entire non-MDR or non-RR TB cohort was 94.2% in 2022. This has remained relatively static over time, with a peak of 98.8% in and an average of 97.0% for years 2011 to 2022.

Factors affecting treatment completion at last recorded outcome in the entire non-MDR or non RR-cohort

As shown in Supplementary Table 21 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. Where the 95% confidence intervals of the risk ratios all crossed 1, it suggests that observed differences in treatment completion occurred by chance.

TB treatment outcomes in the drug resistant (MDR or RR TB) cohort

Supplementary Table 22 of the accompanying data set shows TB treatment outcomes at 24 months for children notified with MDR or RR TB by year from 2011 to 2021 and totalling 51 children.

Supplementary Table 23 of the accompanying data set shows the last recorded treatment outcome for the same group, of whom 7 (100.0%) notified in 2021 had completed treatment as their last recorded outcome.

Appendix

Figure A1. Numbers of TB notifications in UK born and non-UK born children under 18 years, England, 2000 to 2023

The data used in Figure A1 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 18 years, England, 2000 to 2023

The data used in Figure A2 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, 2023

The data used in Figure A3 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, 2023

The data used in Figure A4 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, England, 2011 to 2023 (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, England, 2011 to 2023 (aggregated data)

The data used in this graph can be found in Supplementary Table 5 of the accompanying data set.

Table A1. Number and proportion of children with treatment delay notified with pulmonary TB by age group, England, 2019 to 2023

Time from symptom onset to treatment start	0 to 4 years	5 to 9 years	10 to 14 years	15 to 17 years	Total
0 to 2 months delay	82 (22.6%)	46 (12.7%)	85 (23.4%)	150 (41.3%)	363
2 to 4 months delay	11 (8.7%)	7 (5.5%)	31 (24.4%)	78 (61.4%)	127
over 4 months delay	12 (12.0%)	9 (9.0%)	25 (25.0%)	54 (54.0%)	100
Total	105	62	141	283	591

Table A2. Number and proportion of children with treatment delay (greater than 2 months) notified with pulmonary TB by age group and sex, England, 2019 to 2023

Age group	Female	Male	Total
0 to 4 years	16 (69.6%)	7 (30.4%)	23
5 to 9 years	6 (37.5%)	10 (62.5%)	16
10 to 14 years	41 (73.2%)	15 (26.8%)	56
15 to 17 years	50 (37.9%)	82 (62.1%)	132
All	113 (49.8%)	114 (50.2%)	227

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. Number and proportion of children with treatment delay notified with pulmonary TB by place of birth, England, 2019 to 2023

Time from symptom onset to treatment start	UK born	Non-UK born	Unknown	Total
0 to 2 months delay	185 (51.0%)	177 (48.8%)	1 (0.3%)	363
2 to 4 months delay	64 (50.4%)	62 (48.8%)	1 (0.8%)	127
over 4 months delay	55 (55.0%)	45 (45.0%)	0	100
Total	304	284	2	590

Notes:

• 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
• ‘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. Breakdown of treatment outcome at 12 months for children with non MDR or non RR TB with expected treatment duration less than 12 months who had not completed treatment, England, 2019 to 2022 (aggregate data)

The data used in this graph can be found in Supplementary Table 14 of the accompanying data set.