Peer-reviewed article
Factors associated with severity and fatality of COVID-19 in Brazilian children and adolescents (2020-2023): a population-based study.
Ana Luiza Magalhães de Andrade Lima, Guilherme Jorge Costa, Maria Júlia Gonçalves de Mello ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed 123,382 Brazilian children and adolescents hospitalized with COVID-19 between 2020 and 2023 to identify risk factors for severe disease and death. Children under five made up the majority of cases and deaths in absolute numbers, but adolescents aged 11-19 had the highest rates of ICU admission, mechanical ventilation, and death. Only 10.4% of the hospitalized children had received at least one vaccine dose. The findings highlight the need to increase COVID-19 vaccination coverage in Brazil's pediatric population.
Key points
- Children under 5 years accounted for 56.2% of hospitalizations and 43.3% of deaths
- Adolescents aged 11-19 had the highest severity rates: 30.9% ICU admission, 11.8% mechanical ventilation use, and 6.5% fatality
- Only 10.4% of hospitalized children had received at least one vaccine dose
- Being hospitalized in the North or Northeast regions and requiring invasive mechanical ventilation were associated with highest risk of death across all age groups
- Adolescents had lower 30-day overall survival (48.3%) compared to other age groups
Limitations
This is a cross-sectional study using secondary surveillance data, so it captures only hospitalized cases and cannot determine causal relationships between risk factors and outcomes. The study does not provide information about non-hospitalized COVID-19 cases or long-term outcomes beyond 30 days.
Abstract
COVID-19 pandemic posed significant health challenges worldwide, with substantial impact on pediatric populations. In Brazil, hospitalizations and deaths among children and adolescents have continued throughout the pandemic despite beginning of vaccination. The objective of this study was to analyze sociodemographic background, presentation, and clinical outcomes among hospitalized Brazilian individuals under 20 years with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, analyzing risk factors for severity and death according to age group. Consisted of a population-based cross-sectional study using secondary data from children and adolescents (<20 years) hospitalized with COVID-19 in Brazil (March 2020-December 2023). Data from Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) included sociodemographic, clinical, and vaccination information. Cox proportional hazards models assessed intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and fatality by age group; 30-day survival was estimated using Kaplan-Meier analysis. A total of 123 382 hospitalizations were recorded; children under five accounted for 56.2% of cases and 43.3% of deaths. Hospitalized adolescents (11-19 years) showed the most severe outcomes, with relatively higher ICU admission (30.9%), IMV use (11.8%), and fatality (6.5%), in addition to lower overall survival (48.3%). Across all age groups, being hospitalized in the North or Northeast and IMV were associated with the highest risk of death. Overall, only 10.4% of the study population had received at least one vaccine dose. Adolescents experienced a higher relative frequency of severe clinical outcomes and lowest survival, although, in absolute numbers, more children under 5 years of age were hospitalized and died. These findings underscore the urgency of expanding pediatric vaccine coverage as a public health priority in Brazil.