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September 19, 2025Open Access

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

Key Points

Higher case fatality rates in children and adolescents from specific regions and vulnerable groups signify systemic health disparities.
Significant comorbidities, such as immunosuppression and Down syndrome, were found to be strong predictors of death in this population.
The analysis of public data from over 34,000 SARS cases reveals a complex interplay of vaccination, incidence, and mortality across age groups.
Vaccination coverage among younger children and in under-resourced regions remains low, indicating an urgent need for targeted healthcare interventions.

Abstract

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.

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