Research and analysis

5. Tuberculosis in children aged 0 to 17 years, England, 2024

Published 9 October 2025

Applies to England

Main points

In 2024:

• there were 292 notifications of tuberculosis (TB) in children aged 0 to 17 years old, a 12.7% increase compared to 2023 (n=259) and a similar increase to that observed for all TB notifications (13.6%)
• a notification rate of 2.4 per 100,000 population was observed in 2024, similar to the last 4 years
• the proportion of under-18s notified with TB who were born in the UK was 41.1% in 2024, similar to 2023 (39.8%) and higher than the proportion in adults (18.1%)
• nearly 1 in 3 TB notifications in children born outside the UK were in asylum seekers (30.6%) with almost all of these aged 15 to 17 years old (95.6%)
• over half of children with pulmonary TB were treated within 2 months of symptom onset (59.5%) and over 90% completed treatment within 12 months (non-multidrug resistant or non-rifampcin-resistant TB) (91.8%)
• the median time from presentation at a healthcare setting to start of treatment reduced from 23 days in 2023 to 19 days in 2024

Supplementary tables

Data relating to this chapter can be found in the 25 supplementary data tables in the accompanying spreadsheet, Tuberculosis in children aged 0 to 17 years, supplementary tables, which is available to download.

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 tend to have a similar TB risk and 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, so data for children is presented separately in this report.

This report includes data on children up to and including 17 years of age as UK paediatric services include individuals up to 16 years and may cover those up to 18 years following 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 is reported separately in this chapter.

TB incidence and epidemiology in children

TB notification numbers, notification rates and geographical distribution

In 2024, 292 children, aged under 18 years, were notified with TB in England as shown in Figure 1. This is an increase of 12.7% since 2023 and aligning with a 13.6% increase in notifications overall (see the TB incidence and epidemiology chapter). The TB notification rate per 100,000 population in children was 2.4 (confidence interval (CI): 2.1 to 2.7) in 2024 (see Supplementary table 1.5). As shown in Figure 2 TB rates in children showed an upward trend in 2023 and 2024 mirroring those observed for all people (see Supplementary Table 1.5 in the accompanying data set).

Figures 1 and 2 and Supplementary Table 1.5 of the accompanying data set show the numbers and rates of TB notifications in children from 2011 to 2024 for all children and by country of birth (UK and non-UK born).

Figure 1. The overall number TB notifications in children aged under 18 years, England, 2011 to 2024

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

Figure 2. The rates of TB notifications in children aged under 18 years, England, 2011 to 2024

The data used in Figure 2 can be found in Supplementary Table 1.5 of the accompanying data set.

Note: this is the first data release produced using the new Office for National Statistics (ONS) Annual Population Survey (APS) methodology, replacing the previous ONS Labour Force Survey (LFS) approach. A comparison of the 2 methods is provided in Supplementary tables 1, 1.5, 3, 3.5, 5 and 5.5. Further information about the changes can be found in the Methods and definitions chapter.

Distribution of TB in children by UKHSA region

The number of children with TB varies by UKHSA region with London reporting the highest proportion of cases (27.4%, 80 out of 292) followed by North West (17.8%, 52 out of 292), West Midlands (13.7%, 40 out of 292) and East Midlands (10.3%, 30 out of 292).This is presented in Supplementary Table 2 of the accompanying data set 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 2024, 41.1% (120 out of 292) of children notified with TB were born in the UK, which is similar to 2023 (39.8%), but lower than in 2022 (54.8%). The notification rate in those born in the UK was 1.1 per 100,000 population in 2024, broadly similar to the last 4 years.

Table 1 shows that after the UK, India, Afghanistan and Sudan were the most frequent countries of birth in children diagnosed with TB in 2024, with 9.6% born in India, 6.8% born in Afghanistan and 6.5% born in Sudan.

The TB notification rate in 2024 in children born outside the UK was 16.8 cases per 100,000 (CI: 14.5 to 19.5). This is similar to rates to observed in 2023 (15.2, CI: 13.0 to 17.8) but represents a 55.5% increase over the last 2 years (2022: 10.8 (CI: 8.9 to 13.1)). Rates remain higher compared to children born in the UK (1.1 per 100,000). In children born outside the UK, the highest rates were amongst those of Black-African ethnicity (30.3) followed by Pakistani (27.5) and Bangladeshi (22.9). In children born in the UK, the highest rates were reported amongst those of Pakistani ethnicity (5.5) followed by Black-African (5.4) and Indian (4.1).

Supplementary Table 3.5 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.

Table 1. The top 5 countries of birth for children with TB, England, 2024

Country of birth	Number of children	Proportion of children (%)
UK	120	41.1
India	28	9.6
Afghanistan	20	6.8
Sudan	19	6.5
Pakistan	14	4.8

Note to Table 1: there was no missing country of birth.

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

In 2024, there were more notifications of TB in children in males (54.5%, 159 out of 292) than females (45.5%,133 out of 292). Those aged 15 to 17 years old made up the highest proportion of notifications (46.6%, 136 out of 292) followed by 10 to 14 years old (25.7%, 75 out of 292).

When looking at notifications by place of birth and sex, numbers vary by age. The highest proportion of notifications was in non-UK born males aged 15 to 17 years old with 26.7% (78 out of 292). The lowest proportion were non-UK born males and females both with 0.3% (1 out of 292) of notifications.

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. 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 2024 are shown in Appendix Figures A5 and A6. Rates for children born in the UK are highest in those aged 0 to 1 years and 15 to 17 years (see Supplementary Table 5.5 of the accompanying data set). In children born outside the UK, rates are highest in those aged 15 to 17 years.

Clinical characteristics

Site of disease

Over two-thirds (68.2%) of children had pulmonary disease. The proportion differed by age group, being highest in the 0 to 1 year group (90.3%) and similar in all the other age groups (see Table 2).

There were 25 children (8.6%) classified as having severe TB disease (TB meningitis, cryptic disseminated or miliary TB). The proportion with severe disease was highest in the 0 to 1 year group.

Table 2. Site and severity of disease in children with TB, England, 2024

In this table [z] denotes where the calculation is not applicable.

Site of disease	0 to 1 years: number	0 to 1 years: percentage	2 to 4 years: number	2 to 4 years: percentage	5 to 9 years: number	5 to 9 years: percentage	10 to 14 years: number	10 to 14 years: percentage	15 to 17 years: number	15 to 17 years: percentage
Total number of children	31	[z]	19	[z]	31	[z]	75	[z]	136	[z]
Pulmonary TB	28	90.3	12	63.2	23	74.2	49	65.3	87	64.0
Extra pulmonary TB	10	32.3	9	47.4	12	38.7	42	56.0	75	55.1
Severe TB	5	16.1	0	0.0	3	9.7	6	8.0	11	8.1
Lymph node only	1	3.2	6	31.6	6	19.4	22	29.3	39	28.7
Other	0	0.0	1	5.3	1	3.2	5	6.7	9	6.6

Notes to Table 2:

• severe disease comprises TB meningitis, miliary TB or cryptic disseminated TB5.2
• 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 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 2024 (see Supplementary Table 1.5 of the accompanying data set).

Figure 3. The overall rate of TB notification in children (under 15 years) born in the UK, England, 2011 to 2024

Note to Figure 3: this is the first data release produced using the new ONS APS methodology, replacing the previous ONS Labour Force Survey (LFS) approach. A comparison of the two methods and underlying data is provided in Supplementary Table 1 and Supplementary Table 1.5.

Clinical comorbidities

In 2024, 4 out of 252 children notified with TB (1.6%) had immunosuppressive disorders. Five out of 236 (2.1%) had hepatitis B, all in the 15 to 17 year age group, and 10 out of 259 (3.9%) with a smoking history, again these were all in the 15 to 17 year age group. No children with TB were recorded with diabetes, hepatitis C or HIV in 2024 (see Supplementary table 6).

Social risk factors (SRFs) in children with TB

In 2024 there was one report of a child drinking alcohol and no reports of drug misuse. There were 10 children aged 15 to 17 years old who reported smoking (see Supplementary Table 7 in the accompanying data set). This broadly aligns with previous years’ observations.

Homelessness and asylum seeker status in children notified with TB

The following data is the first-time homelessness or asylum seeker status has been reported for children in the TB annual report. In 2024, 6.7% of children under 18 years old reported a history of homelessness (18 out of 267 with information recorded), all of whom were aged 15 to 17 years old (14.3%, 18 out of 126). The proportion for all children is similar to the 6.0% of all people notified with TB reported a history of homelessness (see the Incidence and Epidemiology chapter).

Figure 4. Proportion reporting homelessness by age group, England, 2019 to 2024

Notes to Figure 4:

• proportions are calculated for those with reported values
• history of homelessness was missing in 3.3% in 2019, 1.6% in 2020, 5.0% in 2021, 6.1% in 2022, 7.3% in 2023 and 8.6% in 2024 of children

The data used in this graph can be found in Supplementary Table 7 of the accompanying data set.

In 2024, 30.6% of all children with TB who were born outside of the UK (45 out of 147 with information recorded) were reported to be asylum seekers. The majority of these children were aged 15 to 17 years old (95.6%, 43 out of 45).

The number of children with TB recorded as asylum seekers has doubled since 2021 (21). The proportion of children reporting asylum seeker status decreased, however, from 45% in 2021. In all years, the majority of these children were in the 15 to 17 year age group (see Figure 5 and Supplementary table 7 in the accompanying data set).

Figure 5. Proportion of asylum seekers by age group, England, 2019 to 2024

Notes to Figure 5:

• 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 29.3% in 2021, 2.2% in 2022, 5.4% in 2023 and 8.6% in 2024 of children

The data used in this graph can be found in Supplementary Table 7 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 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 45 days in 2024, which was similar to that observed in 2023 (42 days) (see Supplementary Table 8). This is lower than in the population with TB as a whole (73 days).

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 3 days in 2024 (see Supplementary Table 8). 59.1% of children with pulmonary TB were notified within 3 days of diagnosis. This is higher than levels observed prior to the COVID-19 pandemic (around 51%) (see Supplementary Table 9) and similar to that seen in adults (59.8%) (see the Detect chapter of this report and Supplementary Table 2).

Culture confirmation

In 2024, 51.7% (151 out of 292) of children had TB disease confirmed by culture. The proportion was higher in pulmonary (54.3%) than non-pulmonary (46.2%) disease (see Supplementary Table 10).

Figure 6. Proportion of all notifications and pulmonary notifications that were confirmed by culture in England, 2019 to 2024

Data for this chart is available in Supplementary Table 11.

It is harder to obtain samples from children to confirm the diagnosis of TB by culture. This is reflected by much lower culture confirmation rates in children than adults (51.7% in 2024, 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).

Table 3. Culture confirmation by age-group in England from 2019 to 2024

Age group	2019	2020	2021	2022	2023	2024	Total cultured
0 to 1 years	23.1	28.0	33.3	26.7	57.7	25.8	46
2 to 4 years	21.2	14.3	5.9	15.4	20.8	21.1	25
5 to 9 years	21.1	16.7	22.7	30.4	29.2	19.4	40
10 to 14 years	38.0	47.2	42.9	52.8	32.3	50.7	179
15 to 17 years	51.8	75.0	54.7	64.2	60.8	69.9	425

Data for this table is available in Supplementary Table 11.

Culture confirmation proportions for children differed by UKHSA region (see Supplementary Table 12). 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 2024, amongst the 151 children with culture-confirmed TB:

• 4 had isoniazid resistance (2.6%), without MDR TB, at diagnosis
• 7 (4.6 %) had MDR or rifampicin-resistant (RR) TB at diagnosis
• there were no children with pre-extensively drug-resistant TB (pre-XDR) at diagnosis

A total of 9 children were treated for MDR or pre-XDR TB (3.1% of children with TB in 2024). This is similar to 2023 where there were 5 (1.9%) children treated for MDR TB or pre-XDR. This number includes children who 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)

Treatment delay is defined as the interval between onset of symptoms and start of treatment. For this analysis, this has been categorised into ‘2 to 4 months’ post-symptom onset and ‘greater than 4 months’ post-symptom onset. Please note that only the delays for children with pulmonary disease are described in the following section. In 2024, over half (75 out of 126 children, 59.5%) of children with pulmonary disease were treated within 2 months of symptom onset. 23.0% were treated between 2 to 4 months and 17.5% experienced a delay of more than 4 months.

In 2024 the median treatment delay for children notified with pulmonary TB was 46 days (IQR: 26 to 95 days) compared with 44 days in 2023 (see Supplementary Table 8).

Over a third of children (36.4%) had missing information on treatment delays in 2024, which is similar to that observed in 2023 (32.1%) and mainly due to missing dates of symptom onset.

Table 4. 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 2024, England

Year	Total (number)	0 to 2 months delay: number	0 to 2 months delay: percentage	2 to 4 months delay: number	2 to 4 months delay: percentage	over 4 months delay: number	over 4 months delay: percentage	Missing: percentage	Pulmonary: number
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	88	50	56.8	21	23.9	17	19.3	27.9	122
2022	103	60	58.3	23	22.3	20	19.4	29.9	147
2023	106	68	64.2	18	17.0	20	18.9	32.1	156
2024	126	75	59.5	29	23.0	22	17.5	36.4	198

Notes to Table 4:

• ‘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

Treatment delay attributable to pre-healthcare or in-healthcare factors in children notified with pulmonary TB

Treatment delay can be further broken up into: (a) delay from onset of symptoms to presentation at healthcare service and (b) delay from presentation to treatment start. Amongst those with dates available for symptom onset and presentation at healthcare (126 children) the median delay was 18 days, which is a reduction compared to 2023 (22 days) and similar to levels seen between 2021 and 2022 (Figure 7) (see Supplementary Table 8).

126 notifications had dates available for presentation at healthcare and treatment start, of which the median delay was 19 days. This represents a decrease compared to 2023 (23 days) and a return to levels seen between 2021 and 2022 but remains higher than pre-pandemic years.

Figure 7. 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, 2019 to 2024

Notes to figure 7:

• 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 small 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, data has been aggregated for the last 5 years (2019 to 2024). During the period, there were 719 notifications out of 1555 (46.2%) with dates available for both symptom onset and treatment start. Appendix Table A1 shows the proportion of children notified with pulmonary TB between 2019 to 2024 who experienced treatment delay by age group and length of delay. Appendix Table A2 shows the same by sex for those who experience a treatment delay of over 2 months. Appendix Table A3 presents the same data by place of birth.

A delay of 2 to 4 months was most prevalent in children aged 15 to 17 years old (13.5%) followed by 10 to 14 (5.3%). This was a similar observation for delays over 4 months with 9.2% of 15 to 17 year olds experiencing the delay, followed by 4.3% of 10 to 14 year olds (Appendix table A1). This was also similar when examining the data by sex, which showed a clear association between older age groups and treatment delay regardless of sex (Appendix Table A2). Analysis by place of birth shows that treatment delays of over 2 months were similar in children born outside of the UK (51.4%) and in the UK (48.9%) (Appendix Table A3).

Enhanced support for children undergoing TB treatment

Enhanced case management (ECM) is a package of tailored supportive care all children notified with TB should be offered to at least level 1, as described below. 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 observed treatment (VOT) and may include people experiencing homelessness, multidrug-resistant (MDR) 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)

In 2024 and 2023, most children notified with TB were assessed as requiring some level of enhanced case management (83.9% and 86.9% respectively). In 2024, over 40% of notifications received level 1 ECM (43.5%), which is similar to that observed in 2023 (43.2%) (Table 5). Stratified data shows no significant variation in ECM management by age, place of birth, sex or site of disease (see Supplementary Table 13).

Table 5. Enhanced case management (ECM) in children notified with TB by year, England, 2019 to 2024

Year	Total	Any ECM	ECM percentage	ECM Level 1: number of notifications	ECM Level 1: percentage	ECM Level 2: number of notifications	ECM Level 2: percentage	ECM Level 3: number of notifications	ECM Level 3: percentage	ECM Unknown level: number of notifications	ECM Unknown level: percentage
2019	307	139	45.3	11	3.6	4	1.3	77	25.1	47	15.3
2020	244	144	59.0	30	12.3	7	2.9	68	27.9	39	16.0
2021	222	138	62.2	57	25.7	18	8.1	43	19.4	20	9.0
2022	231	196	84.8	123	53.2	26	11.3	47	20.3	0	0.0
2023	259	225	86.9	112	43.2	30	11.6	82	31.7	1	0.4
2024	292	245	83.9	127	43.5	41	14.0	77	26.4	0	0.0

Directly observed treatment (DOT) or video observed treatment (VOT)

According to National Institute for Health and Care Excellence (NICE) guidelines, DOT (which includes video observed treatment (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 (MDR) TB
• request DOT after discussion with the clinical team
• are too ill to administer the treatment themselves

In 2024, just over a quarter of individuals were offered DOT or VOT (25.7%, 75 out of 292), representing a decrease compared to 2023 (31.7%) but broadly in line with that observed in 2021 and 2022. 4.8% of notifications had missing data on whether DOT or VOT had been offered. Amongst those offered DOT or VOT, 84.0% received it (63 out of 75), which is higher than that observed in adults in 2024 (64.7%) and broadly in line with previous years’ observations (see Supplementary Table 14), (see the Treatment chapter and Supplementary Table 10).

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 2023 as that is the latest year of notifications for which treatment completion is expected within the 2024 data.

For children treated for MDR or RR TB, outcomes are reported for those notified up to and including 2022 as treatment can be up to 24 months (see Supplementary Table 25 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. Amongst 233 children with non-MDR or non-RR TB notified in 2023 with non-severe disease, 214 (91.8%) had completed treatment within 12 months. At the time of data extraction (September 2025) 224 (96.1%) 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 under 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
Died	0	0.0	0	0.0
Lost to follow up	1	0.4	1	0.4
Not Evaluated	12	5.2	4	1.7
Still on treatment	3	1.3	1	0.4
Treatment completed	214	91.8	224	96.1
Treatment stopped	3	1.3	3	1.3
Total	233	100.0	233	99.9

Notes to Table 6:

• 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 TB 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 under 12 months. This target has been largely met for children over the last 10 years, with slightly lower completion rates in 2023 (see Figure 8 and Supplementary Tables 13 and 14). Treatment completion rates at 12 months is higher in children compared with all people with TB, 91.8% versus 84.4% (see the TB treatment and outcomes chapter and Supplementary Table 11).

Figure 8. Proportion of children treated for non-MDR or non-RR TB with expected treatment duration under 12 months who completed treatment within 12 months

The data used in this graph can be found in Supplementary Table 15 of the accompanying data set. Figure 9 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 2023 cohort is expected to decrease as more missing values are entered. Data 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 2023. From 2011 to 2023, 2 deaths were reported.

Figure 9. 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 under 12 months, England, 2011 to 2023

The data used in this graph can be found in Supplementary Table 15 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 2023 in Supplementary Table 17 of the accompanying data set
• by age and sex for notifications in 2023 in Supplementary Table 18 of the accompanying data set

In 2023, 94.4% of 0 to1 year olds, 91.3% of 2 to 4 year olds, 90.9% of 5 to 9 year olds, 93.3% of 10 to 14 year olds and 90.9% of 15 to 17 year olds completed treatment at 12 months. Treatment completion was similar between males and females at 93.0% and 90.0%, respectively. Numbers are too small to provide an overview of TB treatment outcomes among children by geographical regions.

Treatment duration

Of 224 children notified without MDR or RR TB in 2023, 218 completed treatment. Of these, most completed treatment within the 6 to 8 months (67.0%, 146 out of 218). 208 completed treatment within 12 months. A small proportion (9.6%) completed in less than 6 months, shorter than the full duration of the standard course, which may occur if a child started treatment abroad or reflect the new guidelines from British Association for Paediatric Tuberculosis (BAPT) stating that a 4-month course should suffice for non-severe TB in children over 3 months of age (BAPT guidance, October 2024) and also see Supplementary Table 19).

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

Supplementary Table 20 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 2023. 21 children were notified, 19 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 2023 accompanying data set: by year (2011 to 2023) in Supplementary Table 21 and by site of disease (2023) in Supplementary Table 22.

Treatment completion as the last recorded outcome for the entire non-MDR or non-RR TB cohort was 95.7% in 2023. This has remained relatively stable over time, with peaks of 98.8% in 2015 and 2020 and an average of 97.1% between 2011 to 2023.

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

As shown in Supplementary Table 23 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, suggesting that observed differences in treatment completion occurred by chance.

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

Supplementary Table 24 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 2022 and totalling 55 children.

Supplementary Table 25 of the accompanying data set shows the last recorded treatment outcome for the same group, of whom 4 (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 2024

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 2024 (APS)

This is the first release of data using the new IF-APS approach. A comparison of the rates using previous ONS LFS data set denominator and current methods using the IF-APS data set denominator can be found in Supplementary Table 1 and Supplementary Table 1.5.

The data used in Figure A2 can be found in Supplementary Table 1.5 of the accompanying data set.

Figure A3. The number and proportion of TB notifications by place of birth sex and age group, England, 2024

The data used in Figure A3 can be found in Supplementary Table 4 of the accompanying data set.

Figure A4. Number of TB notifications by age for UK born and non-UK born children, 2011 to 2024 (aggregated data)

The data used in this graph can be found in Supplementary Table 5.5 of the accompanying data set.

Figure A5. Rates of TB by age for UK born and non-UK born children, 2011 to 2024 (aggregated data)

This is the first release of data using the new IF-APS approach. A comparison of the rates using previous ONS LFS data set denominator and current methods using the IF-APS data set denominator can be found in Supplementary Table 5 and Supplementary Table 5.5. The data used in this graph can be found in Supplementary Table 5.5 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 2024

In this table [z] denotes where the calculation is not applicable.

Time from symptom onset to treatment start	0 to 1 years: number	0 to 1 years: percentage	2 to 4 years: number	2 to 4 years: percentage	5 to 9 years: number	5 to 9 years: percentage	10 to 14 years: number	10 to 14 years: percentage	15 to 17 years: number	15 to 17 years: percentage	Total
0 to 2 months delay	48	6.7	47	6.5	53	7.4	106	14.7	184	25.6	438
2 to 4 months delay	5	0.7	9	1.3	9	1.3	38	5.3	97	13.5	158
over 4 months delay	9	1.3	6	0.8	10	1.4	31	4.3	66	9.2	122
Total	62	[z]	62	[z]	72	[z]	175	[z]	348	[z]	719

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 2024

Age group2	Female: number	Male: number	Female: percentage	Male: percentage	Total
0 to 1 years	11	3	3.9	1.1	14
2 to 4 years	9	6	3.2	2.1	15
5 to 9 years	7	12	2.5	4.3	19
10 to 14 years	47	22	16.8	7.9	69
15 to 17 years	62	101	22.1	36.1	163
All	136	144	48.6	51.4	280

Note to Table A2: 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 2024

In this table [z] denotes where the calculation is not applicable.

Time from symptom onset to treatment start	UK born: number	UK born: percentage	non-UK born: number	non-UK born: percentage	Total
0 to 2 months delay	223	50.9	214	48.9	438
2 to 4 months delay	74	46.8	83	52.5	158
over 4 months delay	62	50.8	60	49.2	122
Total	360	[z]	357	[z]	719

Notes to Table A3:

• 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