Hospital mortality from covid-19 in children and adolescents in Brazil in 2020–2021

Authors

DOI:

https://doi.org/10.11606/s1518-8787.2023057005172

Keywords:

COVID-19, epidemiology, Severe Acute Respiratory Syndrome, Child, Hospital Mortality

Abstract

OBJECTIVE: To describe cases, deaths, and hospital mortality from covid-19 in children and
adolescents in Brazil, according to age group, during the evolving phases of the pandemic in
2020 and 2021.
METHODS: Census of patients aged up to 19 committed with severe acute respiratory syndrome, due to covid-19 or unspecified, notified to the Brazilian Influenza Epidemiological Surveillance Information System, from January 1, 2020, to December 31, 2021. The two years were divided into six phases, covering the spread of the disease—first, second and third wave—as well as the impact of vaccination. The pediatric population was categorized into infants, preschoolers, schoolchildren, and adolescents. Hospital mortality was assessed by pandemic phase and age group.
RESULTS: A total of 144,041 patients were recorded in the two years, 18.2% of whom had confirmed cases of covid-19. Children under 5 years old (infants and preschoolers) accounted for 62.8% of those hospitalized. A total of 4,471 patients died, representing about 6.1 deaths per day. Infants were the ones who most progressed to the intensive care unit (24.7%) and had the highest gross number of deaths (n = 2,012), but mortality was higher among adolescents (5.7%), reaching 9.8% in phase 1. The first peak of deaths occurred in phase 1 (May/2020), and two other peaks occurred in phase 4 (March/2021 and May/2021). There was an increase in cases and deaths for younger ages since phase 4. Hospital mortality in the pediatric population was
higher in phases 1, 4, and 6, following the phenomena of dissemination/interiorization of the
virus in the country, beginning of the second wave and beginning of the third wave, respectively.
CONCLUSION: The absolute number of cases o f covid-19 in children and adolescents is significant. Although complete vaccination in descending order of age provided a natural deviation in age range, there was a greater gap between the curve of new hospitalized cases and the curve of deaths, indicating the positive impact of immunization.

References

Cruz FO. Boletim Observatório Covid-19: Balanço da pandemia em 2020, ed. especial, Rio de Janeiro, Fiocruz, 2021 [citado 12 out 2022]. Disponível em: https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos/boletim_covid_edicao_especial_2021.pdf

Word Health Organization. Coronavirus disease (COVID-19). Geneva: Word Health Organization; 2019 [citado 12 out 2022]. Disponível em: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Doença pelo Coronavírus COVID-19. Brasília, DF: Ministério da Saúde; 2022 [citado 12 out 2022] (Boletim epidemiológico especial, v. 131). Disponível em: https://www.gov.br/saude/pt-br/centrais-deconteudo/publicacoes/boletins/epidemiologicos/covid-19/2022/boletimepidemiologico-no-131-boletim-coe-coronavirus/view

Hong H, Wang Y, Chung HT, Chen CJ. Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children. Pediatr Neonatol. 2020 Apr;61(2):131-2. https://doi.org/10.1016/j.pedneo.2020.03.001

Bernardino FB, Alencastro LC, Silva RA, Ribeiro AD, Castilho GR, Gaíva MA. Perfil epidemiológico de crianças e adolescentes com COVID-19: uma revisão de escopo. Rev Bras Enferm. 2021;74(Suppl 1): e20200624. https://doi.org/10.1590/0034-7167-2020-0624

Martins MM, Prata-Barbosa A, Magalhães-Barbosa MC. Cunha AJLAD. Clinical and laboratory characteristics of sars-cov-2 infection in children and adolescents. Rev Paul Pediatr. 2020 Nov;39:e2020231. https://doi.org/10.1590/1984-0462/2021/39/2020231

Ministério da Saúde (BR). Guia de vigilância epidemiológica da covid 2021 [citado 30 set 2022]. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/guias-emanuais/2021/guia-de-vigilancia-epidemiologica-covid-19-3.pdf/view

Becerra M, Fiestas V, Tantaleán J, Mallma G, Alvarado M, Gutiérrez V, et al. Etiología viral de las infecciones respiratorias agudas graves en una unidad de cuidados intensivos pediátricos. Rev Peru Med Exp Salud Publica. 2019;36(2):231-8. https://doi.org/10.17843/rpmesp.2019.362.4081

Rosa MP, Silva WN, Baccega TM, Castro IB, Oliveira SV. Síndrome respiratória aguda grave em pacientes pediátricos no contexto da pandemia: uma análise epidemiológica do Brasil. Rev Pediatria SOPERJ. 2021;21(2):62-7. https://doi.org/10.31365/issn.2595-1769.v21i2p62-67

Sociedade Brasileira de Pediatria. Departamento Científico de Infectologia. Orientações a respeito da infecção pelo SARS-CoV-2 (conhecida como COVID-19) em crianças. 2020 [citado 12 set 2022]. Disponível em: https://www.sbp.com.br/fileadmin/user_upload/Covid-19-Pais-DC-Infecto-DS__Rosely_Alves_Sobral_-convertido.pdf

Ministério da Saúde (BR). Datasus. SRAG 2021 e 2022: Banco de Dados de Síndrome Respiratória Aguda Grave: incluindo dados da COVID-19. Disponível em: https://opendatasus.saude.gov.br/dataset/srag-2021-e-2022

Lima EJ, Faria SM, Kfouri RA. Reflexões sobre o uso de vacina de COVID-19 em crianças e adolescentes. Epidemiol Serv Saúde. 2021;30(4):e2021957. http://https://doi.org/10.1590/S1679-49742021000400028

Fundação Oswaldo Cruz. Notícias: crianças menores de 5 anos são quase metade dos hospitalizados no Brasil. Rio de Janeiro: Fiocruz, 2022 [citado 28 set 2022]. Disponível em: https://portal.fiocruz.br/noticia/covid-19-criancas-menores-de-5-anos-sao-quase-metadedos-hospitalizados-no-brasil

Barbosa AP, Cunha AJ, Carvalho ER, Portella AF, Andrade MP, Barbosa MC. Terapia intensiva neonatal e pediátrica no Rio de Janeiro: distribuição de leitos e análise de equidade. Rev Assoc Med Bras. 2002;48(4):303-11. https://doi.org/10.1590/S0104-42302002000400035

Carvalho WB, Rodriguez IS, Motta EH, Delgado AF. Ventilatory support recommendations in children with Sars-CoV-2. Rev Assoc Med Bras. 2020 Apr;66(4):528-33. https://doi.org/10.1590/1806-9282.66.4.528

Ministério da Saúde (BR). Agência Nacional de Vigilância Sanitária. Nota técnica GVIMS/GGTES/ANVISA Nº 04/2020. Orientações para serviços de saúde: medidas de prevenção e controle que devem ser adotadas durante a assistência aos casos suspeitos ou confirmados de infecção pelo novo coronavírus (SARS-CoV-2). Brasília, DF: Ministério da Saúde; 2020 [citado 1 out 2022]. Disponível em:

https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/2020/nota-tecnica-gvims_ggtes_anvisa-04_2020-25-02-para-o-site.pdf/view

Swann OV, Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. BMJ. 2020 Aug;370:m3249. https://doi.org/10.1136/bmj.m3249

Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020 Sep;174(9):868-73. https://doi.org/10.1001/jamapediatrics.2020.1948

Kitano T, Kitano M, Krueger C, Jamal H, Al Rawahi H, Lee-Krueger R, et al. The differential impact of pediatric COVID-19 between high-income countries and low- and middle-income countries: a systematic review of fatality and ICU admission in children worldwide. PLoS One. 2021 Jan;16(1):e0246326. https://doi.org/10.1371/journal.pone.0246326. eCollection 2021

Oliveira EA, Colosimo EA, Simões E Silva AC, Mak RH, Martelli DB, Silva LR, et al. Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database. Lancet Child Adolesc Health. 2021 Aug;5(8):559-68. https://doi.org/10.1016/S2352-4642(21)00134-6

Wang JG, Zhong ZJ, Mo YF, Wang LC, Chen R. Epidemiological features of coronavirus disease 2019 in children: a meta-analysis. Eur Rev Med Pharmacol Sci. 2021 Jan;25(2):1146-1157. https://doi.org/10.26355/eurrev_202101_24685

Ladhani SN, Amin-Chowdhury Z, Davies HG, Aiano F, Hayden I, Lacy J, et al. COVID-19 in children: analysis of the first pandemic peak in England. Arch Dis Child. 2020 Dec;105(12):1180-5. https://doi.org/10.1136/archdischild-2020-320042

Figueiredo AM. Da ponte AC, Figueiredo DCMM, Gil Garcia E, Kalache A. Letalidad de la COVID-19: ausencia de patrón epidemiológico. Gac Sanit. 2021 Jul-Aug;35(4):355-57. https://doi.org/10.1016/j.gaceta.2020.04.001

Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Calò Carducci FI, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health. 2020 Sep;4(9):653-61.

https://doi.org/10.1016/S2352-4642(20)30177-2

McCormick DW, Richardson LC, Young PR, Viens LJ, Gould CV, Kimball A, et al. Deaths in children and adolescents associated with COVID-19 and MIS-C in the United States. Pediatrics. 2021 Nov;148(5):e2021052273. https://doi.org/10.1542/peds.2021-052273

Tsankov BK, Allaire JM, Irvine MA, Lopez AA, Sauvé LJ, Vallance BA, et al. Severe COVID-19 infection and pediatric comorbidities: a systematic review and meta-analysis. Int J Infect Dis. 2021 Feb;103:246-56. https://doi.org/10.1016/j.ijid.2020.11.163

Published

2023-09-14

Issue

Section

Original Articles

How to Cite

Silva, A. C. C. A. C. da, Luiz, R. R., Moraes, J. R. de, Rocha, P. H. V., Zeitoune, R. C. G., Barbosa, A. P., & Moreira, J. P. de L. (2023). Hospital mortality from covid-19 in children and adolescents in Brazil in 2020–2021. Revista De Saúde Pública, 57(1), 56. https://doi.org/10.11606/s1518-8787.2023057005172

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