{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T16:32:56Z","timestamp":1770309176702,"version":"3.49.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T00:00:00Z","timestamp":1767398400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T00:00:00Z","timestamp":1767398400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"FCT \u2013 Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia, I.P.","award":["EXPL\/SAU-EPI\/0067\/2021"],"award-info":[{"award-number":["EXPL\/SAU-EPI\/0067\/2021"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"DOI":"10.1007\/s00431-025-06704-6","type":"journal-article","created":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T08:28:25Z","timestamp":1767428905000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tuberculosis in children under 5\u00a0years of age in a low-burden setting: sociodemographic and epidemiological characteristics and healthcare utilization over a 10-year period (2010\u20132021)"],"prefix":"10.1007","volume":"185","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1406-4585","authenticated-orcid":false,"given":"In\u00eas","family":"Fronteira","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3036-474X","authenticated-orcid":false,"given":"Matilde","family":"Pacheco","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0138-4336","authenticated-orcid":false,"given":"Ivinildo","family":"Vilichane","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0984-1779","authenticated-orcid":false,"given":"Edgar","family":"Ricardo","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0074-7732","authenticated-orcid":false,"given":"Pedro","family":"Aguiar","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2257-3099","authenticated-orcid":false,"given":"Raquel","family":"Duarte","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3722-0803","authenticated-orcid":false,"given":"Paulo","family":"Ferrinho","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2026,1,3]]},"reference":[{"key":"6704_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(19)30625-5","volume":"20","author":"LK Schrager","year":"2020","unstructured":"Schrager LK, Vekemens J, Drager N et al (2020) The status of tuberculosis vaccine development. Lancet Infect Dis 20:e28\u2013e37. https:\/\/doi.org\/10.1016\/S1473-3099(19)30625-5","journal-title":"Lancet Infect Dis"},{"key":"6704_CR2","unstructured":"World Health Organization Global Tuberculosis Report (2025) https:\/\/www.who.int\/teams\/global-programme-on-tuberculosis-and-lung-health\/tb-reports\/global-tuberculosis-report-2025. Accessed 27 Nov 2025"},{"key":"6704_CR3","unstructured":"World Health Organization (2023) Roadmap towards ending TB in children and adolescents, 3rd edn.\u00a0World Health Organization, Geneva.\u00a0https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/e424cff9-d253-451e-9ded-b1ce4a5a7759\/content"},{"key":"6704_CR4","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/S0140-6736(20)30166-5","volume":"395","author":"L Martinez","year":"2020","unstructured":"Martinez L, Cords O, Horsburgh CR et al (2020) The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis. Lancet 395:973\u2013984. https:\/\/doi.org\/10.1016\/S0140-6736(20)30166-5","journal-title":"Lancet"},{"key":"6704_CR5","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0106-2018","volume":"28","author":"MI Gr\u00f6schel","year":"2019","unstructured":"Gr\u00f6schel MI, van den Boom M, Migliori GB, Dara M (2019) Prioritising children and adolescents in the tuberculosis response of the WHO European Region. Eur Respir Rev 28:180106. https:\/\/doi.org\/10.1183\/16000617.0106-2018","journal-title":"Eur Respir Rev"},{"key":"6704_CR6","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.15167\/2421-4248\/jpmh2020.61.1s1.1489","volume":"61","author":"M Martini","year":"2020","unstructured":"Martini M, Barberis I, Gazanniga V, Icardi G (2020) The fight to end tuberculosis: a global challenge in strong partnership. J Prev Med Hyg 61:E1\u2013E2. https:\/\/doi.org\/10.15167\/2421-4248\/jpmh2020.61.1s1.1489","journal-title":"J Prev Med Hyg"},{"key":"6704_CR7","doi-asserted-by":"publisher","first-page":"178","DOI":"10.3390\/microorganisms13010178","volume":"13","author":"S Basu","year":"2025","unstructured":"Basu S, Chakraborty S (2025) A comprehensive review of the diagnostics for pediatric tuberculosis based on assay time, ease of operation, and performance. Microorganisms 13:178. https:\/\/doi.org\/10.3390\/microorganisms13010178","journal-title":"Microorganisms"},{"key":"6704_CR8","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00730-2022","volume":"9","author":"A Cherchi","year":"2023","unstructured":"Cherchi A, Vaz A, Coelho A et al (2023) Tuberculosis medicines for children in Europe: an unmet medical need. ERJ Open Res 9:00730\u201302022. https:\/\/doi.org\/10.1183\/23120541.00730-2022","journal-title":"ERJ Open Res"},{"key":"6704_CR9","unstructured":"Diretorate General of Health (2023) Tuberculosis vaccination strategy with the BCG vaccine. Ministry of Health, Portugal"},{"key":"6704_CR10","unstructured":"Diretorate General of Health (2025) Report on surveillance and monitoring of tuberculosis in Portugal - 2023 data. Directorate General of Health, Lisbon,\u00a0p 56. [cited 2025 Jan 12].\u00a0Available from: https:\/\/www.dgs.pt\/em-destaque\/tuberculose-emportugal-mantem-se-estavel-pdf.aspx"},{"key":"6704_CR11","unstructured":"World Health Organization (2022) Definitions. In: WHO consolidated guidelines on tuberculosis: Module 5: Management of tuberculosis in children and adolescents. World Health Organization. [cited 2025 Dec 1]. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK579383\/"},{"key":"6704_CR12","doi-asserted-by":"publisher","DOI":"10.2196\/55332","volume":"13","author":"I Fronteira","year":"2024","unstructured":"Fronteira I, Pacheco M, Schaltz-Buchholzer F, Ferrinho P (2024) Nonspecific effects of the BacillusCalmette-Gu\u00e9rin vaccine in Portuguese children under 5 years of age: protocol for a population-based historical birth cohort study. JMIR Res Protoc 13:e55332. https:\/\/doi.org\/10.2196\/55332","journal-title":"JMIR Res Protoc"},{"key":"6704_CR13","unstructured":"Statistics Portugal (2025) Data Base. In: Indicators. https:\/\/www.ine.pt\/xportal\/xmain?xpid=INE&xpgid=ine_base_dados&contexto=bd&selTab=tab2. Accessed 1 Dec 2025"},{"key":"6704_CR14","first-page":"1","volume":"19","author":"J de Almeida Simoes","year":"2017","unstructured":"de Almeida Simoes J, Augusto GF, Fronteira I, Hernandez-Quevedo C (2017) Portugal: health system review. Health Syst Transit 19:1\u2013184","journal-title":"Health Syst Transit"},{"key":"6704_CR15","unstructured":"Autoridade de supervis\u00e3o de seguros e fundos de pens\u00f5es [Health Insurance Portal]. https:\/\/portalsegurossaude.pt\/. Accessed 1 Dec 2025"},{"key":"6704_CR16","unstructured":"Directorate General of Health (2024) Reference for the diagnosis of tuberculosis in children. Dire\u00e7\u00e3o Geral da Sa\u00fade, Lisbon. [cited 2025 Nov 27]. Available from:\u00a0https:\/\/www.dgs.pt\/em-destaque\/dgs-publica-referencial-para-o-diagnostico-detuberculose-em-criancas.aspx"},{"key":"6704_CR17","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.rppnen.2017.10.007","volume":"24","author":"I Carvalho","year":"2018","unstructured":"Carvalho I, Goletti D, Manga S et al (2018) Managing latent tuberculosis infection and tuberculosis in children. Pulmonology 24:106\u2013114. https:\/\/doi.org\/10.1016\/j.rppnen.2017.10.007","journal-title":"Pulmonology"},{"key":"6704_CR18","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 et al (2012) A proposed comprehensive classification of tuberculosis disease severity in children. Pediatr Infect Dis J 31:347\u2013352. https:\/\/doi.org\/10.1097\/INF.0b013e318243e27b","journal-title":"Pediatr Infect Dis J"},{"key":"6704_CR19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-007462","volume":"7","author":"S Lancione","year":"2022","unstructured":"Lancione S, Alvarez JV, Alsdurf H et al (2022) Tracking changes in national BCG vaccination policies and practices using the BCG World Atlas. BMJ Glob Health 7:e007462. https:\/\/doi.org\/10.1136\/bmjgh-2021-007462","journal-title":"BMJ Glob Health"},{"key":"6704_CR20","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2021.26.11.1900711","volume":"26","author":"A Kontturi","year":"2021","unstructured":"Kontturi A, Kekom\u00e4ki S, Soini H et al (2021) Paediatric tuberculosis during universal and selective Bacillus Calmette-Gu\u00e9rin vaccination policy: a nationwide population-based retrospective study, Finland, 1995-2015. Euro Surveill 26:1900711. https:\/\/doi.org\/10.2807\/1560-7917.ES.2021.26.11.1900711","journal-title":"Euro Surveill"},{"key":"6704_CR21","doi-asserted-by":"publisher","DOI":"10.2807\/ese.16.12.19824-en","volume":"16","author":"JP Guthmann","year":"2011","unstructured":"Guthmann JP, Antoine D, Fonteneau L et al (2011) Assessing BCG vaccination coverage and incidence of paediatric tuberculosis following two major changes in BCG vaccination policy in France. Euro Surveill 16:19824","journal-title":"Euro Surveill"},{"key":"6704_CR22","doi-asserted-by":"publisher","first-page":"2099","DOI":"10.1016\/j.vaccine.2024.02.061","volume":"42","author":"S Jackson","year":"2024","unstructured":"Jackson S, Kabir Z, Comiskey C (2024) Retrospective cohort study exploring the impact of universal Tuberculosis (TB) vaccination cessation on the epidemiology of paediatric TB in Ireland, 2011\u20132021. Vaccine 42:2099\u20132105. https:\/\/doi.org\/10.1016\/j.vaccine.2024.02.061","journal-title":"Vaccine"},{"key":"6704_CR23","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1136\/thoraxjnl-2020-216794","volume":"76","author":"JM Trauer","year":"2021","unstructured":"Trauer JM, Kawai A, Coussens AK et al (2021) Timing of Mycobacterium tuberculosis exposure explains variation in BCG effectiveness: a systematic review and meta-analysis. Thorax 76:1131\u20131141. https:\/\/doi.org\/10.1136\/thoraxjnl-2020-216794","journal-title":"Thorax"},{"key":"6704_CR24","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.102332","volume":"66","author":"SMA Zaidi","year":"2023","unstructured":"Zaidi SMA, Coussens AK, Seddon JA et al (2023) Beyond latent and active tuberculosis: a scoping review of conceptual frameworks. eClinMed 66:102332. https:\/\/doi.org\/10.1016\/j.eclinm.2023.102332","journal-title":"eClinMed"},{"key":"6704_CR25","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1111\/imr.12965","volume":"301","author":"M Foster","year":"2021","unstructured":"Foster M, Hill PC, Setiabudiawan TP et al (2021) BCG-induced protection against Mycobacterium tuberculosis infection: evidence, mechanisms, and implications for next-generation vaccines. Immunol Rev 301:122\u2013144. https:\/\/doi.org\/10.1111\/imr.12965","journal-title":"Immunol Rev"},{"key":"6704_CR26","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1093\/cid\/ciab708","volume":"74","author":"N Fritschi","year":"2022","unstructured":"Fritschi N, Wind A, Hammer J, Ritz N (2022) Subclinical tuberculosis in children: diagnostic strategies for identification reported in a 6-year national prospective surveillance study. Clin Infect Dis 74:678\u2013684. https:\/\/doi.org\/10.1093\/cid\/ciab708","journal-title":"Clin Infect Dis"},{"key":"6704_CR27","first-page":"636","volume":"8","author":"LJ Nelson","year":"2004","unstructured":"Nelson LJ, Wells CD (2004) Global epidemiology of childhood tuberculosis. Int J Tuberc Lung Dis 8:636\u2013647","journal-title":"Int J Tuberc Lung Dis"},{"key":"6704_CR28","doi-asserted-by":"publisher","DOI":"10.2807\/ese.18.12.20436-en","volume":"18","author":"T Ducomble","year":"2013","unstructured":"Ducomble T, Tolksdorf K, Karagiannis I et al (2013) The burden of extrapulmonary and meningitis tuberculosis: an investigation of national surveillance data, Germany, 2002 to 2009. Euro Surveill 18:20436","journal-title":"Euro Surveill"},{"key":"6704_CR29","doi-asserted-by":"publisher","first-page":"117","DOI":"10.4103\/ijmr.IJMR_786_17","volume":"150","author":"BD Daniel","year":"2019","unstructured":"Daniel BD, Grace GA, Natrajan M (2019) Tuberculous meningitis in children: clinical management & outcome. Indian J Med Res 150:117\u2013130. https:\/\/doi.org\/10.4103\/ijmr.IJMR_786_17","journal-title":"Indian J Med Res"},{"key":"6704_CR30","doi-asserted-by":"publisher","first-page":"e59","DOI":"10.1016\/S2214-109X(24)00383-8","volume":"13","author":"K du Preez","year":"2025","unstructured":"du Preez K, Jenkins HE, Martinez L et al (2025) Global burden of tuberculous meningitis in children aged 0-14 years in 2019: a mathematical modelling study. Lancet Glob Health 13:e59\u2013e68. https:\/\/doi.org\/10.1016\/S2214-109X(24)00383-8","journal-title":"Lancet Glob Health"},{"key":"6704_CR31","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2019.00238","volume":"7","author":"A Soriano-Arandes","year":"2019","unstructured":"Soriano-Arandes A, Brugueras S, Rodr\u00edguez Chitiva A et al (2019) Clinical presentations and outcomes related to tuberculosis in children younger than 2 years of age in Catalonia. Front Pediatr 7:238. https:\/\/doi.org\/10.3389\/fped.2019.00238","journal-title":"Front Pediatr"},{"key":"6704_CR32","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1016\/S0140-6736(06)68507-3","volume":"367","author":"BB Trunz","year":"2006","unstructured":"Trunz BB, Fine PEM, Dye C (2006) Effect of BCG vaccination on childhood tuberculous meningitis and miliary tuberculosis worldwide: a meta-analysis and assessment of cost-effectiveness. Lancet 367:1173\u20131180. https:\/\/doi.org\/10.1016\/S0140-6736(06)68507-3","journal-title":"Lancet"},{"key":"6704_CR33","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2025.107909","volume":"156","author":"S Cai","year":"2025","unstructured":"Cai S, Luo Q, Zhou G et al (2025) Effect of Bacillus Calmette-Gu\u00e9rin vaccination against Mycobacterium tuberculosis infection in children: an updated systematic review and meta-analysis. Int J Infect Dis 156:107909. https:\/\/doi.org\/10.1016\/j.ijid.2025.107909","journal-title":"Int J Infect Dis"},{"key":"6704_CR34","doi-asserted-by":"publisher","first-page":"2333794X1559418","DOI":"10.1177\/2333794X15594183","volume":"2","author":"MJ Chisti","year":"2015","unstructured":"Chisti MJ, Ahmed T, Shahid ASMSB et al (2015) Sociodemographic, epidemiological, and clinical risk factors for childhood pulmonary tuberculosis in severely malnourished children presenting with pneumonia. Glob Pediatr Health 2:2333794X15594183. https:\/\/doi.org\/10.1177\/2333794X15594183","journal-title":"Glob Pediatr Health"},{"key":"6704_CR35","unstructured":"Diretorate General of Health (2013) National program child and youth health. Ministry of Health. [cited 2025 Jan 12]. Available from: https:\/\/www.dgs.pt\/directrizes-da-dgs\/normas-e-circulares-normativas\/norma-n-0102013-de-31052013-jpg.aspx"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-025-06704-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-025-06704-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-025-06704-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T02:30:48Z","timestamp":1770258648000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-025-06704-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,3]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["6704"],"URL":"https:\/\/doi.org\/10.1007\/s00431-025-06704-6","relation":{},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,3]]},"assertion":[{"value":"29 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 December 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 December 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 January 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Institute of Hygiene and Tropical Medicine (7th December 2023\/No. 11\/2023) (\n                      \n                      ).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"This study used secondary data from unidentified population-based databases. Consent to participate does not apply.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"49"}}