and has been linked to host–microbe interactions and immunological responses that may persist even after treatment completion [72, 73]. The complications, which vary in severity, include airflow obstruction, restrictive ventilatory defects and impaired gas exchange, and may present as persistent respiratory symptoms, abnormal lung function and/or abnormal CXRs. A consensus definition has been proposed for children as “evidence of chronic respiratory impairment in an individual previously adequately treated for PTB in whom active TB is excluded, and in whom no other cause of chronic lung disease is the predominant cause” [73]. The limited data on PTLD that do exist in children suggest substantial impairment [74]. For adults, up to two-thirds of individuals with a previous TB episode may present with lung complications, and a recently published systematic review documented a high burden of PTLD in low–middle-income countries with a pooled prevalence of 41.0% for persistent respiratory symptoms, 46.7% for abnormal lung function and 64.6% for radiological abnormalities [75]. Considering the prevalence of severe and complicated TB forms in children, coupled with diagnostic delays, it is likely that children with a previous TB episode have substantial post-TB lung damage. There is an urgent need for child-specific data on PTLD to inform future directions. The routine assessment of children with respiratory symptoms after successful TB treatment should also include a review of PTLD. Research priorities Several groups have identified critical priorities for research that will impact child and adolescent TB. We have integrated and adapted these priorities as documented in table 6. Conclusion Although child and adolescent TB remains a challenge, important progress has been made in diagnosis and treatment. Active contact tracing, screening and TPT can prevent disease spread. Early diagnosis is crucial and can be substantially improved, even with existing tools. Effective therapy is available, with optimised regimens being developed recently. Treatment outcomes are usually excellent in children, but access remains a challenge and addressing social determinants is necessary. By implementing evidence-based interventions and a comprehensive approach, we can reduce the burden of child and adolescent TB and improve outcomes for this vulnerable and neglected population. References 1 WHO. The End TB Strategy. Geneva, WHO, 2015. 2 WHO. Global Tuberculosis Report 2022. Geneva, WHO, 2022. 3 Donald PR. Childhood tuberculosis: out of control? Curr Opin Pulm Med 2002 8: 178–182. 4 WHO. Global Tuberculosis Report 2012. Geneva, WHO, 2015. 5 Glaziou P, Arinaminpathy N, Dodd P, et al. Methods used by WHO to estimate the global burden of TB disease. Geneva, WHO, 2021. 6 Dodd PJ, Sismanidis C, Seddon JA. Global burden of drug-resistant tuberculosis in children: a mathematical modelling study. Lancet Infect Dis 2016 16: 1193–1201. 7 WHO. Roadmap Towards Ending TB in Children and Adolescents. Geneva, WHO, 2018. 8 Martinez L, Lo NC, Cords O, et al. Paediatric tuberculosis transmission outside the household: challenging historical paradigms to inform future public health strategies. Lancet Respir Med 2019 7: 544–552. 9 Nkereuwem E, Kampmann B, Togun T. The need to prioritise childhood tuberculosis case detection. Lancet 2021 397: 1248–1249. 10 Ranasinghe L, Achar J, Gröschel MI, et al. Global impact of COVID-19 on childhood tuberculosis: an analysis of notification data. Lancet Glob Health 2022 10: e1774–e1781. 11 Chiang SS, Waterous PM, Atieno VF, et al. Caring for adolescents and young adults with tuberculosis or at risk of tuberculosis: consensus statement from an international expert panel. J Adolesc Health 2023 72: 323–331. 12 Dodd PJ, Yuen CM, Sismanidis C, et al. The global burden of tuberculosis mortality in children: a mathematical modelling study. Lancet Glob Health 2017 5: e898–e906. https://doi.org/10.1183/2312508X.10025322 231 CHILDREN AND ADOLESCENTS |E. LÓPEZ-VARELA ET AL.