Tuberculosis notifications among children and young adolescents, 2008-2019 compared to 2020-2023, Brazil

To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on tuberculosis-related notifications and mortality in Brazilian children and young adolescents aged 0-14 years.

We conducted an ecological study using interrupted time series analysis with data from DATASUS, a nationwide open-access database of the Brazilian health ministry. We compared the notification rates of overall active tuberculosis, laboratory-confirmed tuberculosis, miliary and meningeal tuberculosis and tuberculosis-related deaths between the pre-pandemic (January 2008 to February 2020) and post-pandemic (January 2022 to December 2023) periods.

Between 2008 and 2023, 43 216 tuberculosis notifications were recorded among children and young adolescents. The average annual notification rate per 100 000 population rose from 5.75 pre-pandemic to 8.37 post-pandemic, a 45.6% increase. Children younger than 1 year consistently had the highest rates. Laboratory-confirmed tuberculosis notifications totalled 12 557, with rates increasing from 1.55 per 100 000 pre-pandemic to 3.01 per 100 000 post-pandemic (94.2% increase). The average annual notification rate for miliary and meningeal tuberculosis increased from 0.22 to 0.29 per 100 000 (31.8%), and for tuberculosis-related deaths from 0.09 to 0.14 per 100 000 (55.6%). In 2023, laboratory-confirmed tuberculosis and miliary and meningeal forms had the highest rates (3.37 and 0.33 per 100 000, respectively), while deaths were the second highest on record (0.15 per 100 000).

COVID-19 disruptions to tuberculosis services led to increased tuberculosis notification rates among Brazilian children and adolescents after the pandemic, due to higher transmission following a period of underdiagnosis. This setback hinders progress towards the End TB Strategy goals.