{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T19:36:52Z","timestamp":1789414612564,"version":"build-2803163510"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T00:00:00Z","timestamp":1683590400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T00:00:00Z","timestamp":1683590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007195","name":"Universit\u00e0 degli Studi di Napoli Federico II","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007195","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The outbreak of COVID-19 resulted in a decrease in tuberculosis notification rates globally. We compared tuberculosis incidence rates and disease severity in children seen in our centre prior and during COVID-19 pandemic.We performed a cohort study enrolling children aged under 18\u00a0years who received a diagnosis of tuberculosis (January 1st, 2010-December 31st, 2021) at our Pediatric Infectious Diseases Unit. Disease severity was evaluated based on: the classification proposed by Wiseman et al., smear positivity, presence of symptoms at presentation, lung cavitation, extrapulmonary disease, respiratory failure and need for intensive care support. Overall, 168 children (50.6% female, median age 69\u00a0months, IQR 95.4) received a diagnosis of tuberculosis, 156 (92.8%) between 2010\u20132019, before COVID-19 outbreak, and 12 (7.2%) between 2020\u20132021, during the pandemic. The annual tuberculosis notification rate dropped by 73% in 2021 (0.38\/100000, 95%CI 0.1\u20130.96) compared with 2019 (1.46\/100000, 95%CI 0.84\u20132.37). Compared to the pre-pandemic period, the proportion of children classified as severe was higher in 2020\u20132021 (5, 41.6% vs 23, 15.7%, p\u2009=\u20090.006) with a higher rate of respiratory failure (2, 16.7%, vs 4, 2.6%, p\u2009=\u20090.01) and an increased need for intensive care support (1, 8.3% vs 1, 0.6%, p\u2009=\u20090.01).<\/jats:p><jats:p>\u00a0 \u00a0<jats:italic>Conclusion<\/jats:italic>: During COVID-19 pandemic we observed a reduction in tuberculosis notification rate in pediatric population and a significant increase in disease severity. This scenario may be the consequence of a delay in diagnosis and an underreporting of cases, rather than the effect of a reduced transmission of tuberculosis. Children reached health-care services only in the need of urgent medical attention.<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022 COVID-19 pandemic had a huge impact on national health care systems, resulting in a reduction of access to medical care.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022 In Campania Region, Italy, a low tuberculosis incidence country, we witnessed a 75% reduction in tuberculosis notification rate during pandemic. In parallel we demonstrated a significant increase in disease severity, suggesting that the reduction in notification rate may be attributed to an underreporting of cases and consequential diagnostic delay, rather than a reduced transmission of infection.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-023-04981-7","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T05:20:55Z","timestamp":1683782455000},"page":"3281-3285","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Effects of COVID-19 pandemic on pediatric tuberculosis: decrease in notification rates and increase in clinical severity"],"prefix":"10.1007","volume":"182","author":[{"given":"Andrea","family":"Lo Vecchio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Maria","family":"Scarano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Amato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Immacolata","family":"Spagnuolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenia","family":"Bruzzese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Guarino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,5,9]]},"reference":[{"issue":"11","key":"4981_CR1","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1097\/INF.0000000000002831","volume":"39","author":"A Lo Vecchio","year":"2020","unstructured":"Lo Vecchio A, Smarrazzo A, Amato C, Palladino R, Scarano SM, Spagnuolo MI, Bruzzese E, Guarino A (2020) Increasing Tuberculosis Rates and Association With Migration in Children Living in Campania Region, Southern Italy: A 10-Year Cohort Study. Pediatr Infect Dis J 39(11):1017\u20131022. https:\/\/doi.org\/10.1097\/INF.0000000000002831. PMID: 32740455","journal-title":"Pediatr Infect Dis J"},{"key":"4981_CR2","doi-asserted-by":"publisher","unstructured":"Graham SM, Cuevas LE, Jean-Philippe P, Browning R, Casenghi M, Detjen AK, Gnanashanmugam D, Hesseling AC, Kampmann B, Mandalakas A et al (2015) Clinical Case Definitions for Classification of Intrathoracic Tuberculosis in Children: An Update. Clin Infect Dis 61(Suppl 3):S179\u201387. https:\/\/doi.org\/10.1093\/cid\/civ581. PMID: 26409281; PMCID: PMC4583568","DOI":"10.1093\/cid\/civ581"},{"issue":"4","key":"4981_CR3","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1097\/INF.0b013e318243e27b","volume":"31","author":"CA Wiseman","year":"2012","unstructured":"Wiseman CA, Gie RP, Starke JR, Schaaf HS, Donald PR, Cotton MF, Hesseling AC (2012) A proposed comprehensive classification of tuberculosis disease severity in children. Pediatr Infect Dis J 31(4):347\u2013352. https:\/\/doi.org\/10.1097\/INF.0b013e318243e27b. PMID: 22315002","journal-title":"Pediatr Infect Dis J"},{"key":"4981_CR4","unstructured":"European Centre for Disease Prevention and Control (2022) WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 \u2013 2020 data. Copenhagen: WHO Regional Office for Europe and Stockholm: European Centre for Disease Prevention and Control. License: CC BY 3.0 IGO"},{"key":"4981_CR5","unstructured":"Global Tuberculosis Report 2021 (2021)\u00a0Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0"},{"key":"4981_CR6","doi-asserted-by":"publisher","unstructured":"Driessche KV, Mahlobo PZ, Venter R, Caldwell J, Jennings K, Diacon AH, Cotton MF, de Groot R, Hens N, Marx FM et al (2021) Face masks in the post-COVID-19 era: a silver lining for the damaged tuberculosis public health response? Lancet Respir Med 9(4):340\u2013342. https:\/\/doi.org\/10.1016\/S2213-2600(21)00020-5. Epub 2021 Jan 22. Erratum in: Lancet Respir Med. 2021 Dec;9(12):e114. PMID: 33493446; PMCID: PMC7826055.IGO.","DOI":"10.1016\/S2213-2600(21)00020-5"},{"issue":"11","key":"4981_CR7","doi-asserted-by":"publisher","first-page":"2709","DOI":"10.3201\/eid2611.203163","volume":"26","author":"GB Migliori","year":"2020","unstructured":"Migliori GB, Thong PM, Akkerman O, Alffenaar JW, \u00c1lvarez-Navascu\u00e9s F, Assao-Neino MM, Bernard PV, Biala JS, Blanc FX, Bogorodskaya EM et al (2020) Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January-April 2020. Emerg Infect Dis 26(11):2709\u20132712. https:\/\/doi.org\/10.3201\/eid2611.203163. (Epub 2020 Sep 11. PMID: 32917293; PMCID: PMC7588533)","journal-title":"Emerg Infect Dis"},{"key":"4981_CR8","doi-asserted-by":"publisher","unstructured":"McQuaid CF, McCreesh N, Read JM, Sumner T, CMMID COVID-19 Working Group, Houben RMGJ, White RG, Harris RC (2020) The potential impact of COVID-19-related disruption on tuberculosis burden. Eur Respir J 56(2):2001718.\u00a0https:\/\/doi.org\/10.1183\/13993003.01718-2020. PMID: 32513784; PMCID: PMC7278504","DOI":"10.1183\/13993003.01718-2020"},{"key":"4981_CR9","unstructured":"Italian Institute of Statistics (ISTAT). Available at http:\/\/dati.istat.it\/?lang=en, Accessed on May 2023"},{"key":"4981_CR10","unstructured":"World Health Organization. Impact of the COVID-19 Pandemic on TB Detection and mortality in 2020. Geneva, relesed on March 22nd 2021. Available at https:\/\/www.who.int\/publications\/m\/item\/impact-of-the-covid-19-pandemic-on-tb-detection-and-mortality-in-2020#:~:text=Provisional%20data%20compiled%20by%20the,reduction%20of%2021%25%20from%202019. Accessed on May 2023."},{"key":"4981_CR11","doi-asserted-by":"publisher","unstructured":"Magro P, Formenti B, Marchese V et al (2020) Impact of the SARS-CoV-2 epidemic on tuberculosis treatment outcome in Northern Italy. Eur Respir J 56:2002665.\u00a0https:\/\/doi.org\/10.1183\/13993003.02665-2020","DOI":"10.1183\/13993003.02665-2020"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-023-04981-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-023-04981-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-023-04981-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T13:09:57Z","timestamp":1689685797000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-023-04981-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,9]]},"references-count":11,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["4981"],"URL":"https:\/\/doi.org\/10.1007\/s00431-023-04981-7","relation":{},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,9]]},"assertion":[{"value":"29 November 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 March 2023","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 April 2023","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 May 2023","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in accordance with the 1964 Helsinki Declaration and its later amendments, and with the ethical standards of the institutional research committee (Ethic Committee University \u201cFederico II\u201d). Patient\u2019s data were extrapolated from a pre-existing database created in 2009 and used to prospectively record data of children with TB seen at the PIDU. The Campania Reference Centre\u2019s dataset is part of the Italian Register of Paediatric Tuberculosis, a larger national database created and implemented by the Italian Society of Paediatric Infectious Diseases and approved by the Institutional Review Board of the University of Florence. The same database was previously used to report trends in the local paediatric population []. The present analysis did not undergo new formal approval by the Ethical Committee. All patients\u2019 data were registered, analyzed and reported anonymously.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Legal guardians signed a specific informed consent to collect and process data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}