Elsevier

Current Paediatrics

Volume 14, Issue 3, June 2004, Pages 258-262
Current Paediatrics

The epidemiology of paediatric tuberculosis in Europe

https://doi.org/10.1016/j.cupe.2004.02.009Get rights and content

Abstract

Tuberculosis is one of the major infections affecting children world-wide. The epidemiology of paediatric tuberculosis in Europe reflects world-wide trends, with significant differences in rates of disease between resource-poor nations and those with well-funded tuberculosis control programmes. The highest rates of disease occur in Eastern European countries, with increasing rates of disease in children resulting from increasing numbers of infectious adults within communities. Western European nations continue to have low rates of tuberculosis, with a large proportion of disease occurring in recent immigrants from high-burden countries, particularly those in Sub-Saharan Africa.

Introduction

Tuberculosis (TB) continues to be one of the most devastating and widespread infections in the world. In Europe there is a huge disparity in the rates of TB between the western and eastern nations, and this appears to be worsening. Young children are often the worst affected by TB epidemics, as they are the most likely to develop disease after infection, and are at greatest risk of developing extrapulmonary and severe disseminated disease.1 Children also develop disease sooner after infection than adults, and thus the incidence of disease in children provides an early indication of the overall patterns of transmission and disease within communities. This review will focus on the epidemiology of paediatric TB in Europe.

Section snippets

Tuberculosis notifications to the world health organisation

The recently published World Health Organisation (WHO) Global Report on tuberculosis shows that TB case notifications in the WHO European region make up less than 10% of worldwide notifications to the WHO.2 While these are an excellent source of information on adult disease, an accurate description of the burden of TB in children is very difficult to obtain. The WHO notification criteria include only cases that are sputum-smear-positive. Fewer than 15% of children with culture-proven TB will be

Paediatric TB in Eastern Europe

Information from Eastern European countries on paediatric TB is limited. The WHO had 601 notifications of smear-positive children aged 0–14 years in the European region for 2001, with one in five of these children living in Kazakhstan. These figures are likely to significantly underestimate the true rate of smear-positive TB in children for several reasons. Firstly, in Kazakhstan the total numbers of paediatric notifications makes up just over 1% of all notifications, with even lower reported

TB in low-prevalence countries

In most of the low-prevalence countries in Europe, such as the UK, notification rates for TB have declined over the last 20 years.2 National survey data from the UK show a decrease in TB rates in all age groups from 1978/1979 onwards, reaching their lowest levels in the mid-1980s before beginning to rise again. Rates in children and young people overall have remained relatively constant over the last 5 years.6

However, there have been specific changes in the pattern and distribution of

TB and immigration

During the latter half of last century there has been an unprecedented movement of people between nations. Molecular epidemiological studies undertaken in Norway and the UK both suggest that many of the new TB cases in immigrants are due to reactivation of infections acquired abroad.11., 12. Immigrant children born in countries with high rates of TB are at much higher risk of developing TB for several reasons. Firstly, those who are recent arrivals may have been exposed to TB in their home

Human immunodeficiency virus and TB

Human immunodeficiency virus (HIV) infection has had a profound effect on the incidence of TB globally, particularly in Sub-Saharan Africa where HIV/AIDS has been the major driving force behind the recent increases in the incidence of adult TB. HIV is known to greatly increase the annual risk of progression from TB infection to active disease. Increased rates of TB in children have been associated with increased rates of disease among HIV-infected adults in the community.13 This effect may be

Conclusion

Although TB in Europe makes up a small percentage of the disease globally, its epidemiology reflects worldwide trends. There are major disparities between the rates of disease between resource-poor Eastern countries and those nations in Western Europe who have the resources to fund TB control programmes. In the countries of Western Europe increasing rates of paediatric TB in some areas can be largely attributed to transmission of infection from immigrants who developed infection in other

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