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A Series of Severe and Critical COVID-19 Cases in Hospitalized, Unvaccinated Children: Clinical Findings and Hospital
Vânia Chagas da Costa1,2,3, Ulisses Ramos Montarroyos1, Katiuscia Araújo de Miranda Lopes2
1Postgraduate Program in Health Sciences, Universidade de Pernambuco, Recife 50100-130, Brazil.
Insights
Severe COVID-19 in unvaccinated Brazilian children, particularly those under two and with asthma, required significant hospital care. Parental vaccine hesitancy remains a concern for pediatric COVID-19 risk.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Public Health
Background:
- The COVID-19 pandemic impacted all age groups, including children, who faced risks of severe illness.
- Unvaccinated children, especially those with severe asthma, were susceptible to severe and critical COVID-19.
- Limited availability of pediatric vaccines in Brazil during the study period heightened vulnerability.
Purpose of the Study:
- To characterize clinical findings, laboratory results, and imaging in severe/critical COVID-19 cases among unvaccinated children.
- To describe hospital care, including intensive care unit (ICU) utilization, for these pediatric patients.
- To analyze the impact of comorbidities like severe asthma on severe COVID-19 outcomes in children.
Main Methods:
- A case series study was conducted in a public referral hospital in Pernambuco, Brazil.
- Data were collected from March 2020 to June 2021, focusing on hospitalized, unvaccinated children with severe or critical COVID-19.
- Included children aged 1 month to 11 years, with or without severe asthma.
Main Results:
- Eighty unvaccinated children were included; 58.8% were under two years old, and 65% were male.
- Respiratory diseases, including severe asthma (73.8%), were common; 15% developed pediatric multisystem inflammatory syndrome.
- Oxygen therapy (65%), mechanical ventilation (15%), and ICU care (33.7%) were frequently required; chest imaging showed infiltrates and ground-glass opacities.
Conclusions:
- Key characteristics of severe COVID-19 in unvaccinated Brazilian children were identified.
- Low vaccination coverage and parental vaccine hesitancy contribute to ongoing pediatric vulnerability.
- Findings can inform public health plans and clinical protocols for pediatric COVID-19 management.
Background/Objective:
The COVID-19 pandemic profoundly transformed social life worldwide, indiscriminately affecting individuals across all age groups. Children have not been exempted from the risk of severe illness and death caused by COVID-19.
Objective:
This paper sought to describe the clinical findings, laboratory and imaging results, and hospital care provided for severe and critical cases of COVID-19 in unvaccinated children, with or without severe asthma, hospitalized in a public referral service for COVID-19 treatment in the Brazilian state of Pernambuco.
Methods:
This was a case series study of severe and critical COVID-19 in hospitalized, unvaccinated children, with or without severe asthma, conducted in a public referral hospital between March 2020 and June 2021.
Results:
The case series included 80 children, aged from 1 month to 11 years, with the highest frequency among those under 2 years old (58.8%) and a predominance of males (65%). Respiratory diseases, including severe asthma, were present in 73.8% of the cases. Pediatric multisystem inflammatory syndrome occurred in 15% of the children, some of whom presented with cardiac involvement. Oxygen therapy was required in 65% of the cases, mechanical ventilation in 15%, and 33.7% of the children required intensive care in a pediatric intensive care unit. Pulmonary infiltrates and ground-glass opacities were common findings on chest X-rays and CT scans; inflammatory markers were elevated, and the most commonly used medications were antibiotics, bronchodilators, and corticosteroids.
Conclusions:
This case series has identified key characteristics of children with severe and critical COVID-19 during a period when vaccines were not yet available in Brazil for the study age group. However, the persistence of low vaccination coverage, largely due to parental vaccine hesitancy, continues to leave children vulnerable to potentially severe illness from COVID-19. These findings may inform the development of public health emergency contingency plans, as well as clinical protocols and care pathways, which can guide decision-making in pediatric care and ensure appropriate clinical management, ultimately improving the quality of care provided.
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