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

Disruptions to essential health services during the coronavirus disease 2019 (COVID-19) pandemic have raised concerns about their indirect effects on tuberculosis control, particularly among vulnerable paediatric populations. This research article examines the impact of the pandemic on tuberculosis notifications and mortality among children and young adolescents aged 0–14 years in Brazil, using an ecological design with interrupted time series analysis of national surveillance data from 2008 to 2023, with children serving as a sentinel population for detecting system disruptions.

The study compares pre-pandemic and post-pandemic periods across multiple outcomes, including overall active tuberculosis, laboratory-confirmed cases, severe forms such as miliary and meningeal tuberculosis, and tuberculosis-related deaths. Findings indicate a marked decline in notifications during the pandemic, followed by significant increases thereafter, with post-pandemic notification rates exceeding pre-pandemic levels and rises observed across all forms of disease and mortality. These trends are interpreted as reflecting underdiagnosis and disruption of the tuberculosis care cascade during the pandemic, alongside increased household transmission linked to delays in adult diagnosis and treatment. The analysis highlights implications for tuberculosis control policies, emphasizing the need to strengthen diagnostic, preventive and patient-centred care strategies, particularly for children, to support progress towards the End TB Strategy targets.