Clinical, Epidemiological and Vaccination Characteristics in Children and Adolescents of Severe Acute Respiratory Syndrome Due to Covid-19 in Brazil (2020 to 2024)

Although less susceptible to severe forms of COVID-19, children and adolescents were also impacted by Severe Acute Respiratory Syndrome (SARS), with hospitalizations and deaths. Brazil recorded one of the highest pediatric mortality rates from COVID-19, exposing structural inequalities and failures in the healthcare system. The objective of this study was to analyze the clinical, epidemiological, and vaccination characteristics of children and adolescents with COVID-19 associated SARS in Brazil (2020 to 2024). This retrospective observational cohort study analyzed public data from 34,369 SARS cases, revealing disparities in the case fatality rate (CFR): the North (13.02%) and Northeast (11.6%) regions, Indigenous populations (22.54%), rural residents (14.34%), municipalities with a low human development index (9.41%), and the 15 to 19 age group had higher CFRs. The circulation of the Gamma and Delta variants (2021) was associated with peaks in incidence and mortality; however, during the circulation of Omicron (2022 to 2024), there was high incidence with reduced mortality. The sustained occupancy of pediatric intensive care units (ICUs) (25 to 32%) after 2022, and the significant increase in the proportion of children aged 0 to 4 years in ICU admissions, rising from approximately 52% in 2020 to 2021 to over 78% in 2024, under scores the demand for targeted strategies for the pediatric population. Comorbidities such as immunosuppression (OR: 4.44) and Down syndrome (OR: 3.13) were independent predictors of death. Vaccination demonstrated a protective effect; however, vaccination coverage was uneven: children under 5 years and the North/Northeast regions had the lowest rates. This study demonstrated that COVID-19 associated SARS in the pediatric population was marked by sociodemographic, regional, clinical, and vaccination disparities. Therefore, there is a clear need for integrated policies that include regionalized strategies for vulnerable populations, strengthening of pediatric ICUs, and equitable expansion of vaccination. Keywords: COVID-19; severe acute respiratory syndrome; mortality; case fatality rate.