Perfil clínico e fatores associados ao óbito por COVID-19 em crianças antes e depois da vacinação: estudo transversal

Abstract

Introduction: The Covid-19 pandemic was officially declared in March 2020 by the World Health Organization, with rapid spread in Brazil after the first confirmed case. Vaccination began in January 2021, but the pediatric public (6 months to 4 years) was only included in 2022. Despite the advances, the Ministry of Health's 2023 Epidemiological Bulletin showed an increase in cases and deaths in this age group. Objective: To verify the clinical profile and factors associated with death from COVID-19 in children and adolescents before and after the start of vaccination. Method: Cross-sectional, population-based study using a secondary database. Included were cases registered in Brazil, of children aged 1 to 4 years, with positive RT-PCR for SARS-CoV-2, divided into two groups - Group 1: before the vaccination period; Group 2: after the availability of vaccine for the age group. Results: In both periods there was a prevalence of white and brown people living in urban areas. There was a reduction in mortality in urban areas in the post-vaccination period (3.5%/2.4%), although rural areas maintained a higher proportion of deaths (8.8%/7.3%). Hospitalization rates fell slightly after vaccination (99.3% to 97.8%), as did the need for invasive ventilation (8.8%/6.8%) and the death rate (3.8%/2.5%). There was a lower frequency of clinical symptoms such as fever (81.6%/75.3%), cough (79.7%/75.4%) and dyspnea (55.1%/50.6%). The absence of hospitalization was the main risk factor for death in both groups, along with the absence of cough. Group 1 also had rural area of residence as a risk factor, while Group 2 had indigenous race/color. The use of non-invasive ventilatory support, as well as not using it, was associated with a lower risk of mortality in both groups. For Group 1, other protective factors were not having O2 saturation < 95% and not having diarrhea. For Group 2, not having risk factors and not having respiratory discomfort were the variables that represented the lowest risk of mortality. Conclusion: Findings from this study shed light on the clinical and epidemiological profile of children aged 1 to 4 years, who remain a vulnerable group to covid-19. Therefore, healthcare teams should be alert to patients within this profile to prioritize actions and early care, preventing adverse outcomes.