Changes in the incidence and profile of pediatric tuberculosis in France from 2014 to 2023: impact of COVID-19 non-pharmaceutical interventions implementation and lifting.

UNLABELLED: While the COVID-19 pandemic led to important variations in numerous community-acquired bacterial infections, very few data concerning pediatric tuberculosis evolution during this period are available. We aimed to assess the impact of COVID-19 related non-pharmaceuticals interventions (NPI) and their lifting on the epidemiology of active tuberculosis in children in France. We conducted a national, population-based surveillance study in France. All patients under 18 years of age hospitalized for active TB between January 2014 and December 2023 were included. The primary outcome was the evolution of the incidence of active TB in France, analyzed using a quasi-Poisson model. Over the study period, 8503 children were hospitalized for active TB in France. The implementation of NPIs in March 2020 was associated with a significant decrease in TB incidence (- 33.7%, 95% confidence interval [CI]: - 42.7 to - 24.7). This decline was followed by a resurgence beginning in November 2022 (+ 22.9%, 95% CI: 4.0 to 41.8). This resurgence was particularly pronounced for respiratory and miliary TB (+ 31.6%, 95% CI: 11.4 to 51.9 and + 64.6%, 95% CI: 11.3 to 117.8 respectively). CONCLUSIONS: Our study highlights the impact of NPI implementation and subsequent lifting on the incidence of active TB in children, with changes in the clinical spectrum of the disease. WHAT IS KNOWN: • The impact of COVID-19-related non-pharmaceutical interventions (NPIs) on tuberculosis epidemiology has been documented in adults, but data in children remain scarce. WHAT IS NEW: • This nationwide study shows changes in both the incidence and clinical presentation of childhood tuberculosis following the implementation and subsequent lifting of COVID-19-related NPIs.