Regional divergence in pediatric tuberculosis and implications for achieving End TB targets, 2013-2023.

OBJECTIVE: Pediatric tuberculosis (TB) remains an important part of the global TB burden; however progress in this population has been slower and less consistent than that in adults. The influence of recent epidemiological shifts, including those following the COVID-19 pandemic, on progress toward the World Health Organization (WHO) End TB milestones remains unclear.

METHODS: Using age-specific WHO data for 209 countries and territories from 2013 to 2023, we examined global, regional, and national trends in pediatric TB incidence. We assessed progress toward the 2025 End TB milestone, evaluated changes relative to 2019, and summarized treatment outcomes and TB preventive treatment (TPT) coverage for child household contacts in high-burden countries (HBCs).

RESULTS: In 2023, the pediatric TB incidence reached 62.74 per 100,000, representing a 14% increase since 2015. Regional patterns differed markedly; the incidence rose steadily in South-East Asia and accounted for >50% estimated cases among the 30 highest-burden countries, while Africa showed a sustained decline. Over half of the HBCs moved further from the 2025 milestone, and TPT coverage for children under five < 5 years remained well below target levels.

CONCLUSIONS: Global progress in pediatric TB control has plateaued. Stronger child-focused prevention and surveillance are essential to regain momentum toward End TB targets.