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

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 of 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.

Hospital mortality from covid-19 in children and adolescents in Brazil in 2020-2021 / Mortalidade hospitalar por covid-19 em crianças e adolescentes no Brasil em 2020-2021

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 of 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.

RESUMO OBJETIVO Descrever casos, óbitos e mortalidade hospitalar por covid-19 em crianças e adolescentes no Brasil, conforme faixa etária, durante as fases de evolução da pandemia em 2020 e 2021. MÉTODOS Censo de pacientes de até 19 anos internados com síndrome respiratória aguda grave, por covid-19 ou não especificada, notificados ao Sistema de Informação de Vigilância Epidemiológica da Gripe do Brasil, entre 1 de janeiro de 2020 e 31 de dezembro de 2021. Os dois anos foram divididos em seis fases, abrangendo a disseminação da doença − primeira, segunda e terceira onda −, bem como o impacto da vacinação. A população pediátrica foi categorizada em lactentes, pré-escolares, escolares e adolescentes. A mortalidade hospitalar foi avaliada por fase da pandemia e faixa etária. RESULTADOS Foram contabilizados 144.041 pacientes nos dois anos, sendo 18,2% casos de covid-19 confirmados. Menores de 5 anos (lactentes e pré-escolares) corresponderam a 62,8% dos hospitalizados. Evoluíram a óbito 4.471, representando cerca 6,1 óbitos por dia. Os lactentes foram os que mais evoluíram para unidade de terapia intensiva (24,7%) e apresentaram o maior número bruto de óbito (n = 2.012), porém a mortalidade foi maior entre os adolescentes (5,7%), chegando a 9,8% na fase 1. O primeiro pico de óbitos ocorreu na fase 1 (maio/2020), e outros dois picos ocorreram na fase 4 (março/2021 e maio/2021). Verificou-se avanço de casos e óbitos para as idades inferiores desde a fase 4. A mortalidade hospitalar na população pediátrica foi maior nas fases 1, 4 e 6, acompanhando os fenômenos de disseminação/interiorização do vírus no país, início da segunda onda e início da terceira onda, respectivamente. CONCLUSÃO O número absoluto de casos de covid-19 em crianças e adolescentes é expressivo. Embora a vacinação completa em ordem decrescente de idade tenha proporcionado um desvio natural de faixa etária, ocorreu um distanciamento maior entre a curva de novos casos hospitalizados e a curva de óbitos, indicando o impacto positivo da imunização.