Tuberculous meningitis (TBM) is caused by Mycobacterium tuberculosis and accounts for 5% of extrapulmonary tuberculosis cases. Children under 5 years old who are not immunized with the BCG vaccine and individuals with comorbidities are at higher risk for TBM. Incidence and vaccine coverage are important health indicators of a population, underscoring the relevance of analyzing the distribution of cases and the characteristics of hospitalizations among different populations in the state of São Paulo (SP). To characterize the epidemiological profile of hospitalizations for TBM and relate it to BCG vaccine coverage in the state of SP between January 2014 and December 2024. In this descriptive epidemiological study, data from SIH/SUS and SI–PNI (DATASUS) were used. All hospitalizations from January 2014 to December 2024 with TBM as the primary diagnosis were selected, using the following variables: sex, race, and age group. In addition, specific hospitalization rates per 100,000 inhabitants were calculated. BCG vaccine coverage during the period was also analyzed. Between 2014 and 2024, 868 hospitalizations for TBM were recorded in the state of SP. The lowest number occurred in 2014 (6.2%), whereas the highest number was recorded in 2024, totaling 12.7% of hospitalizations. Among hospitalizations, there was predominance of males (65.5%), White individuals (46.7%), and the 30–39-year age group (25.4%). In the pediatric population, the highest percentage was among 1–4 years of age, with the lowest hospitalization rate in 2014 and the highest in 2020. When calculating specific hospitalization rates per 100,000 inhabitants, the highest and lowest occurred, respectively, in 2020 (4.27) and 2014 (2.28). Finally, regarding BCG vaccine coverage, the highest number of immunizations was recorded in 2014 (103.46%), whereas the lowest coverage occurred in 2021 (68.76%). Hospitalizations of children were more frequent in 2024 and less frequent in 2014, suggesting a possible relationship between the drop in vaccine coverage and the rise in cases. These results emphasize the importance of appropriate follow-up of patients with pulmonary tuberculosis, given the risk of progression to extrapulmonary forms involving the central nervous system, and highlight the need for public policies to expand and sustain BCG vaccination coverage in Brazil.
Mariusso et al. (Sun,) studied this question.