BACKGROUND:
Although tuberculosis (TB) is a preventable and curable disease, it continues to affect the lives and development of thousands of children in Brazil and around the world1,2. To analyze trends and the impact of COVID-19 on tuberculosis (TB) incidence rates and treatment outcomes among children in the state of São Paulo.

METHODS:
Ecological study3 conducted in the state of São Paulo including all TB cases in children (0–14 years), reported in the “TBWeb” system from 2015 to 2023. Monthly incidence, mortality, and treatment outcome rates were calculated5. Structural break detection techniques (95% confidence intervals) were applied for each indicator to identify structural changes in the time series during the pandemic period and were divided into two segments. For each segment, the Average Monthly Percentage Change (AMPC) was calculated. Analyses were performed using the R® programming language (version 4.0.3).

RESULTS:
A total of 4,752 TB cases in children and young adolescents were reported in the state of São Paulo. Structural breaks were identified in the incidence and cure indicators. Regarding incidence, the break was identified during the pandemic period (01/2015–03/2020), followed by an increasing trend in TB cases in the post-pandemic period, as demonstrated by the AMPC, which increased from 0.19 to 0.85 after 04/2020. The abrupt structural break in cure occurred in the post-pandemic period, with a decrease in AMPC from −0.07 (01/2015–08/2022) to −4.29 (08/2022–12/2023). The indicators of deaths and mortality showed fluctuations over the period, but without a significant trend.

CONCLUSIONS:
The results demonstrate that these changes in historical series may have long-term effects. It is necessary for municipal health management teams in the state of São Paulo to develop strategies that promote adherence and continuity of care and prevent treatment interruption, which may compromise TB elimination targets.