Purpose To describe the sociodemographic and epidemiological characteristics and healthcare utilization patterns—primary healthcare (PHC) use, emergency department (ED) visits, and hospital admissions—of children under 5 years of age born in Portugal between July 1, 2010, and June 30, 2021, and diagnosed with TB during the same period. Methods This is a quantitative, observational cohort study of 58 children diagnosed with TB and reported to the National Epidemiological Surveillance System (SINAVE) before age 5. Data were obtained through linkage of five population-based databases. Descriptive statistics and bivariate analyses were conducted. Incidence rates of PHC, ED visits, and hospital admissions were calculated per 1000 person-days. Results Most TB cases (81.0%) were diagnosed between ages 1 and 5; 55.2% were male, and 72.2% resided in metropolitan areas. Over half (58.6%) were unvaccinated with BCG. Unvaccinated children were diagnosed earlier than vaccinated peers (p < 0.01), though no significant differences were found in the clinical presentation of TB, risk factors, or healthcare utilization. Pulmonary TB was most common (51.7%), and 68.4% of children were hospitalized. PHC services were underutilized (32.7%), while ED visits were more frequent, primarily for infectious and respiratory conditions. One child died, with TB diagnosed post-mortem. Conclusions: TB in young children remains a public health concern in Portugal, especially in unvaccinated populations. Strengthening PHC access and preventive care is essential to improve early detection and outcomes. <Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> What is known: • TB causes substantial morbidity and mortality, particularly in children under 5 years of age. • Pediatric TB remains underdiagnosed and underrepresented in research, surveillance, and national policies. </entry> </row> <row> <entry align="left" colname="c1"> What is new: • BCG vaccination was associated with later onset of TB. • Children under five with TB represent a particularly vulnerable group; thus, it is critical to promote preventive care to ensure early diagnosis and effective follow-up. </entry> </row> </tbody> </tgroup> </Table>

Tuberculosis in children under 5 years of age in a low-burden setting: sociodemographic and epidemiological characteristics and healthcare utilization over a 10-year period (2010–2021)

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2026年1月3日

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Inês Fronteira,
Matilde Pacheco,
Ivinildo Vilichane,
Edgar Ricardo,
Pedro Aguiar,
Raquel Duarte,
Paulo Ferrinho

摘要

Purpose

To describe the sociodemographic and epidemiological characteristics and healthcare utilization patterns—primary healthcare (PHC) use, emergency department (ED) visits, and hospital admissions—of children under 5 years of age born in Portugal between July 1, 2010, and June 30, 2021, and diagnosed with TB during the same period.

Methods

This is a quantitative, observational cohort study of 58 children diagnosed with TB and reported to the National Epidemiological Surveillance System (SINAVE) before age 5. Data were obtained through linkage of five population-based databases. Descriptive statistics and bivariate analyses were conducted. Incidence rates of PHC, ED visits, and hospital admissions were calculated per 1000 person-days.

Results

Most TB cases (81.0%) were diagnosed between ages 1 and 5; 55.2% were male, and 72.2% resided in metropolitan areas. Over half (58.6%) were unvaccinated with BCG. Unvaccinated children were diagnosed earlier than vaccinated peers (p < 0.01), though no significant differences were found in the clinical presentation of TB, risk factors, or healthcare utilization. Pulmonary TB was most common (51.7%), and 68.4% of children were hospitalized. PHC services were underutilized (32.7%), while ED visits were more frequent, primarily for infectious and respiratory conditions. One child died, with TB diagnosed post-mortem.

Conclusions: TB in young children remains a public health concern in Portugal, especially in unvaccinated populations. Strengthening PHC access and preventive care is essential to improve early detection and outcomes.

What is known:

• TB causes substantial morbidity and mortality, particularly in children under 5 years of age.

• Pediatric TB remains underdiagnosed and underrepresented in research, surveillance, and national policies.

What is new:

• BCG vaccination was associated with later onset of TB.

• Children under five with TB represent a particularly vulnerable group; thus, it is critical to promote preventive care to ensure early diagnosis and effective follow-up.