{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:53:18Z","timestamp":1792788798589,"version":"4.5.0"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Science and Technology Research Project of Henan Province","award":["LHGJ20220851"],"award-info":[{"award-number":["LHGJ20220851"]}]},{"name":"the Medical Science and Technology Research Project of Henan Province","award":["LHGJ20230737"],"award-info":[{"award-number":["LHGJ20230737"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>For a long time, eliminating tuberculosis (TB) has been an enormous challenge in global health. We aim to use the 2021 Global Burden of Disease Study (GBD 2021) to systematically analyze the TB burden in children and adolescents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used the 2021 GBD to retrieve TB incidence, mortality, and disability-adjusted life years (DALYs) data among people aged 0 to19 years in 204 countries and regions between 1990 to 2021. The data are reported as counts and ratios per 100,000 people and are analyzed by age, sex, location and socio-demographic index (SDI). To quantify the uncertainty of the estimations, we include 95% confidence interval (CI) for each indicator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Globally, the TB burden among people under the age of 20 has decreased significantly between 2019 and 2021. The overall incidence of TB among children and adolescents fell by 37.4%, from 2.21(95% UI:1.71\u20132.76) million in 1990 to 1.38(95% UI:1.06\u20131.76) million in 2021. Sub-Saharan Africa had the highest increase in TB incidence (302.88, 95% UI: 227.85-385.33). The age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of TB in females decreased faster than males. The incidence was higher in children under 5 years old and adolescents aged 15 to 19, showing a bimodal pattern. In addition, mortality caused by multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) have increased dramatically in several areas. The mortality rates for MDR-TB and XDR-TB in Eastern Europe are 0.04(95% UI:0.02-0.05) and 0.02(95% UI:0.01-0.03) respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although the burden of TB in children and adolescents has decreased globally, the disease remains a major public health concern, especially in countries with low SDI. To accomplish the ultimate aim of TB elimination, we should continue to invest in TB prevention and control, expand health-care infrastructure construction, and advance TB diagnostic, preventive, and treatment technologies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0317880","type":"journal-article","created":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T13:30:48Z","timestamp":1741613448000},"page":"e0317880","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Tuberculosis incidence, deaths and disability-adjusted life years in children and adolescence, 1990\u20132021: Results from the Global Burden of Disease Study 2021"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2904-9004","authenticated-orcid":true,"given":"Xue","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongyan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaobiao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanjuan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"pone.0317880.ref001","unstructured":"de Lima Corvino DF, Shrestha S, Hollingshead CM, Kosmin AR. 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Treasure Island (FL):StatPearls Publishing; 2023."},{"key":"pone.0317880.ref002","doi-asserted-by":"crossref","first-page":"503","DOI":"10.2147\/CLEP.S314802","article-title":"Burden of Respiratory Infection and Tuberculosis Among US States from 1990 to 2019","volume":"13","author":"W Zhong","year":"2021","journal-title":"Clin Epidemiol"},{"key":"pone.0317880.ref003"},{"issue":"1","key":"pone.0317880.ref004","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/S2352-4642(19)30337-2","article-title":"Adolescent tuberculosis","volume":"4","author":"KJ Snow","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"pone.0317880.ref005","doi-asserted-by":"crossref","first-page":"2946","DOI":"10.3389\/fimmu.2018.02946","article-title":"The Wonder Years: What Can Primary School Children Teach Us About Immunity to Mycobacterium tuberculosis?","volume":"9","author":"JA Seddon","year":"2018","journal-title":"Front 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Thakur","year":"2021","journal-title":"J Glob Infect Dis"},{"issue":"1","key":"pone.0317880.ref024","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1186\/s12889-019-7257-4","article-title":"Treatment outcomes among children, adolescents, and adults on treatment for tuberculosis in two metropolitan municipalities in Gauteng Province, South Africa","volume":"19","author":"KM Berry","year":"2019","journal-title":"BMC Public Health"},{"issue":"11","key":"pone.0317880.ref025","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1093\/aje\/kwy131","article-title":"A Bayesian Approach to Understanding Sex Differences in Tuberculosis Disease Burden","volume":"187","author":"KC Horton","year":"2018","journal-title":"Am J Epidemiol"},{"issue":"1","key":"pone.0317880.ref026","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1111\/brv.12243","article-title":"The effects of sex hormones on immune function: a meta-analysis","volume":"92","author":"YZ Foo","year":"2017","journal-title":"Biol Rev Camb Philos Soc"},{"issue":"6","key":"pone.0317880.ref027","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1002\/cpt.1221","article-title":"State-of-the-Art Review of HIV-TB Coinfection in Special Populations","volume":"104","author":"ED Weld","year":"2018","journal-title":"Clin Pharmacol Ther"},{"issue":"11","key":"pone.0317880.ref028","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1093\/cid\/cis732","article-title":"Tuberculosis in pregnant and postpartum women: epidemiology, management, and research gaps","volume":"55","author":"JS Mathad","year":"2012","journal-title":"Clin Infect Dis"},{"issue":"Suppl 1","key":"pone.0317880.ref029","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1097\/QAI.0000000000001316","article-title":"Prevention of HIV in adolescent girls and young women: Key to an AIDS-free generation","volume":"75","author":"Q Abdool Karim","year":"2017","journal-title":"Journal of Acquired Immune 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Health"},{"issue":"4","key":"pone.0317880.ref033","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.jinf.2020.08.004","article-title":"Clinical metagenomic sequencing for diagnosis of pulmonary tuberculosis","volume":"81","author":"C-L Shi","year":"2020","journal-title":"J Infect"},{"issue":"12","key":"pone.0317880.ref034","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1093\/cid\/cix208","article-title":"Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis","volume":"64","author":"SM Marks","year":"2017","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pone.0317880.ref035","doi-asserted-by":"crossref","first-page":"e0147397","DOI":"10.1371\/journal.pone.0147397","article-title":"Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis Patients: A Systematic Review","volume":"11","author":"BE Thomas","year":"2016","journal-title":"PLoS One"},{"issue":"2","key":"pone.0317880.ref036","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.rppnen.2017.10.007","article-title":"Managing latent tuberculosis infection and tuberculosis in children","volume":"24","author":"I Carvalho","year":"2018","journal-title":"Pulmonology"},{"key":"pone.0317880.ref037","doi-asserted-by":"crossref","unstructured":"Wu XR, Yin QQ, Jiao AX, Xu BP, Sun L, Jiao WW, et al. Pediatric tuberculosis at Beijing Children\u2019s Hospital: 2002-2010. Pediatrics. 2012;130(6):e1433-40.","DOI":"10.1542\/peds.2011-3742"},{"key":"pone.0317880.ref038","doi-asserted-by":"crossref","unstructured":"Lamb GS, Starke JR. Tuberculosis in Infants and Children. Microbiology spectrum. 2017;5(2).","DOI":"10.1128\/microbiolspec.TNMI7-0037-2016"},{"issue":"6","key":"pone.0317880.ref039","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/S2213-2600(15)00095-8","article-title":"Xpert MTB\/RIF assay for the diagnosis of pulmonary tuberculosis in children: a systematic review and meta-analysis","volume":"3","author":"AK Detjen","year":"2015","journal-title":"Lancet Respir Med"},{"key":"pone.0317880.ref040","first-page":"310194","article-title":"Rapid diagnosis of childhood pulmonary tuberculosis by Xpert MTB\/RIF assay using bronchoalveolar lavage fluid","author":"Q-Q Yin","year":"2014","journal-title":"Biomed Res Int"},{"issue":"6","key":"pone.0317880.ref041","doi-asserted-by":"crossref","first-page":"e2021054663","DOI":"10.1542\/peds.2021-054663","article-title":"Tuberculosis Infection in Children and Adolescents: Testing and Treatment","volume":"148","author":"D Nolt","year":"2021","journal-title":"Pediatrics"},{"key":"pone.0317880.ref042"},{"issue":"7","key":"pone.0317880.ref043","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S1473-3099(24)00007-0","article-title":"Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021","volume":"24","author":"GBD 2021 Tuberculosis Collaborators","year":"2024","journal-title":"The Lancet Infectious Diseases"},{"key":"pone.0317880.ref044","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.puhe.2020.07.031","article-title":"Association between indoor air pollution, tobacco smoke and tuberculosis: an updated systematic review and meta-analysis","volume":"187","author":"N Obore","year":"2020","journal-title":"Public Health"},{"issue":"1","key":"pone.0317880.ref045","doi-asserted-by":"crossref","first-page":"1700216","DOI":"10.1183\/13993003.00216-2017","article-title":"Alcohol consumption as a risk factor for tuberculosis: meta-analyses and burden of disease","volume":"50","author":"S Imtiaz","year":"2017","journal-title":"Eur Respir J"},{"issue":"9728","key":"pone.0317880.ref046","doi-asserted-by":"crossref","first-page":"1814","DOI":"10.1016\/S0140-6736(10)60483-7","article-title":"Tuberculosis control and elimination 2010-50: cure, care, and social development","volume":"375","author":"K L\u00f6nnroth","year":"2010","journal-title":"Lancet"},{"key":"pone.0317880.ref047","doi-asserted-by":"crossref","first-page":"e069679","DOI":"10.1136\/bmj-2021-069679","article-title":"Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019","volume":"378","author":"S Safiri","year":"2022","journal-title":"BMJ"},{"issue":"2","key":"pone.0317880.ref048","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.pulmoe.2020.12.012","article-title":"Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects","volume":"27","author":"D Visca","year":"2021","journal-title":"Pulmonology"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0317880","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T13:31:09Z","timestamp":1741613469000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0317880"}},"subtitle":[],"editor":[{"given":"Seyed Aria","family":"Nejadghaderi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,3,10]]},"references-count":48,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0317880","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,10]]}}}