Tuberculosis in Children in Bulgaria in the period 2007-2022

<bold>Background:</bold> In 2021, globally 1.2 million children fell ill with tuberculosis, which represent 11% of all tuberculosis (TB) cases.<bold>Aims:</bold> This study aims to present the epidemiology of TB among children in Bulgaria for the period 2007 – 2022, also to determine the impact of Covid-19 epidemic on control of children TB. <bold>Methods:</bold> A cohort study was used to collect data of the number of TB cases among children, performed tests and registered treatment outcome, conducted by the health facilities for diagnosis and treatment of tuberculosis. <bold>Results:</bold> The total number of TB cases among children aged 0-14 years (2007-2022) is 2058. Epidemiological surveillance data presents a ratio of 2.29 between the age groups 0-4 to 5-14, which is in line with the World Health Organization TB surveillance standards. A decrease of 59.32% of the new registered TB cases among children aged 0-14 years in the condition of Covid–19 epidemic is observed. TB cases among children were 2.58% of all registered cases in 2020 and 2.62 % in 2021. A decrease to 44,4% of the covered with chemoprophylaxis from the total number of contact persons with positive tuberculin skin test (TST) in 2020 in the condition of Covid-19 epidemic is observed. For the first year of the Covid-19 pandemic 91.67 % of those that started the first-line of TB treatment in 2020 had a successful outcome. The treatment success rate was 77.22% for the cohort 2021, the same level as in 2007. In the conditions of the Covid-19 epidemic, there was no reduction in the scope of children with prophylactic immunizations with BCG vaccine. <bold>Conclusions:</bold> After the Covid –19 epidemic the activities included in the National Programs for Prevention and Control of Tuberculosis should intensify.