Síndrome Respiratória Aguda Grave por COVID-19 em crianças e adolescentes no Brasil (2020 a 2024) : análise das características clínicas, epidemiológicas e vacinais

Abstract

The COVID-19 pandemic underscored the critical importance of epidemiological surveillance of Severe Acute Respiratory Syndrome (SARS) in children and adolescents. Although this demographic is less susceptible to severe forms of the disease, it was not exempt from complications, hospitalizations, and fatalities. Brazil recorded one of the highest rates of pediatric mortality from COVID-19 globally. Within this context, this study aims to elucidate the determinants of morbidity and mortality in children and adolescents (0-19 years) between

2020 and 2024 through a comprehensive and detailed analysis of SARS cases due to COVID- 19. This is a retrospective cohort study conducted using publicly available secondary data.

Among the 34,369 cases analyzed, disparities in case fatality rates (CFR) were observed. Higher CFRs were identified in the North (13.02%) and Northeast (11.6%) regions, among Indigenous populations (22.54%), rural residents (14.34%), municipalities with a low Human Development Index (HDI) (9.41%), and the 15-19 age group. The circulation of the Gamma and Delta variants (2021) was associated with peaks in incidence and mortality, whereas during the Omicron variant period (2022–2024), mortality decreased despite periods of high

incidence. Nosocomial cases had a significantly higher CFR (14.6%) than community- acquired cases (5.3%), particularly among adolescents (15-19 years) and in the North and

Northeast regions. Sustained pediatric intensive care unit (ICU) occupancy rates (25–32%) after 2022, coupled with a sharp increase in ICU admissions among children aged 0-4 years (from approximately 52% in 2020–2021 to over 78% in 2024), highlight the critical demand for targeted strategies focused on the pediatric population. Comorbidities such as immunosuppression (OR: 4.44) and Down syndrome (OR: 3.13) were critical predictors of severe outcomes. Vaccination demonstrated a significant protective effect; however, a marked disparity in vaccination coverage was observed, with children under 5 years (95.9% unvaccinated) and the North/Northeast regions showing the lowest rates. This study demonstrated that SARS due to COVID-19 in children and adolescents in Brazil was characterized by significant sociodemographic, regional, clinical, and vaccination disparities. Consequently, the findings emphasize the necessity for integrated public health policies to reduce pediatric morbidity and mortality in future health emergencies. These should include regionalized strategies for vulnerable populations, the strengthening of pediatric ICU capacity, enhanced hospital infection control, and the equitable expansion of vaccination programs.