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Factors associated with severity and fatality of COVID-19 in Brazilian children and adolescents (2020-2023): a

Ana Luiza Magalhães de Andrade Lima1, Guilherme Jorge Costa1,2, Maria Júlia Gonçalves de Mello1,2

  • 1Stricto Sensu postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) Rua dos Coelhos, Recife-Pernambuco, 50070-550, Brazil.

Journal of Tropical Pediatrics
|July 23, 2026
PubMed

Insights

COVID-19 significantly impacted Brazilian children and adolescents, with adolescents facing severe outcomes. Expanding pediatric vaccination is crucial to reduce hospitalizations and deaths from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Area of Science:

  • Public Health
  • Epidemiology
  • Pediatric Infectious Diseases

Background:

  • The COVID-19 pandemic has had a significant global impact, particularly on pediatric populations.
  • In Brazil, hospitalizations and deaths among children and adolescents due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have persisted despite vaccination efforts.

Purpose of the Study:

  • To analyze the sociodemographic background, clinical presentation, and outcomes of hospitalized Brazilian individuals under 20 years with confirmed SARS-CoV-2 infection.
  • To identify risk factors for disease severity and death across different pediatric age groups.

Main Methods:

  • A population-based cross-sectional study utilizing secondary data from the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) in Brazil (March 2020–December 2023).
  • Inclusion criteria: Hospitalized individuals under 20 years with confirmed SARS-CoV-2 infection.
  • Statistical analyses included Cox proportional hazards models for intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and fatality, alongside Kaplan-Meier analysis for 30-day survival.

Main Results:

  • A total of 123,382 hospitalizations were recorded. Children under five constituted 56.2% of cases and 43.3% of deaths.
  • Adolescents (11–19 years) exhibited the most severe outcomes: higher ICU admission (30.9%), IMV use (11.8%), fatality (6.5%), and lower overall survival (48.3%).
  • Hospitalization in the North/Northeast regions and IMV were associated with increased mortality risk. Only 10.4% of the study population received at least one vaccine dose.

Conclusions:

  • While younger children accounted for more absolute hospitalizations and deaths, adolescents experienced a disproportionately higher frequency of severe clinical outcomes and lower survival rates.
  • These findings highlight the critical need to prioritize and expand pediatric vaccine coverage in Brazil to mitigate the impact of SARS-CoV-2 on this vulnerable population.

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