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Deaths announced in Brazil – A dark sweetness: COVID-19 among children and adolescents

Published:February 03, 2022DOI:https://doi.org/10.1016/j.pedn.2021.12.029

      Highlights

      • Brazil has registered 3561 deaths of children and adolescents up to 19 years old per COVID-19.
      • The Brazil ranks second with the most deaths of children from the coronavirus in the world.
      • 65 deaths in Brazil were reported from Pediatric Multisystem Inflammatory Syndrome (P-SIM).

      Abstract

      While the Ministry of Health of Brazil postpones the inclusion of children aged 5–12 years in the National Immunization Plan against COVID-19, current evidence highlights that the number of hospitalizations and deaths caused by COVID-19 in the pediatric population, of in general, including the group of children aged 5–11 years, it is not within acceptable levels. Unfortunately, child mortality and fatality rates in Brazil are among the highest in the world. In 2020, there were 1203 deaths from Severe Acute Respiratory Syndrome (SRAG). In 2021, there were 2293. Also 65 deaths were reported from Pediatric Multisystem Inflammatory Syndrome (P-SIM); an aggressive manifestation of the virus in children.
      The context of health tragedy in Brazil takes on darker tones when analyzing the impact of COVID-19 on children. Although they are less affected by the disease in general, it does not imply that care should be abandoned. The return to school and the government's disregard for the fight against the virus make this group especially fragile. The disease can affect children and adolescents of all ages (
      • Comitê Científico do Núcleo Ciência pela Infância
      Repercussões da Pandemia de COVID-19 no Desenvolvimento Infantil [livro eletrônico].
      ). In this situational framework, Brazil has registered 3561 deaths of children and adolescents up to 19 years old per COVID-19 since the beginning of the outbreak, in March 2020. Of these, 326 were infants up to 1-year-old. As a result, the country ranks second with the most deaths of children from the coronavirus in the world, just behind Peru, in proportional terms. In 2020, there were 1203 deaths from Severe Acute Respiratory Syndrome (SRAG). In 2021, there were 2293. Also 65 deaths were reported from Pediatric Multisystem Inflammatory Syndrome (P-SIM); an aggressive manifestation of the virus in children (
      • BRASIL
      Ministério da Saúde. Secretaria de Vigilância em Saúde.
      ;
      • Rede Brasil Atual
      Brasil é um dos piores do mundo em mortes de crianças por covid-19.
      ).
      For the
      • Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente – IFF/FIOCRUZ
      the probability of death among children in the country is higher than in the international community due to the demographic composition of the Brazilian population with a high number of children and adolescents; contingent of children with chronic conditions with insufficient control; challenges in access and quality of care in Primary Health Care; challenges in the access and quality of more complex pediatric care, particularly in times of great pressure on the health system, even leading to the deactivation of pediatric beds; Increased social vulnerability. Thus, the number of hospitalizations and deaths caused by COVID-19 in the pediatric population, in general, including the group of children aged 5–11 years, is not within acceptable levels. In this scenario, for the
      • Sociedade Brasileira de Pediatria -SBP
      Vacinação contra Covid em crianças avança no mundo, mas e o Brasil?.
      , the vaccine against COVID-19 presents itself as a real alternative for the control and prevention of these disease outcomes, which is within reach of those responsible for public health policies in our country. The vaccine was associated with high efficacy in the prevention of COVID-19, not only in controlled clinical studies, but also in real-world experiences, with effectiveness against the disease and hospitalizations demonstrated in adolescents.
      In this perspective, vaccinating teenagers, among the application of sanitary measures, would allow them to go back to school in a safer environment and meet with peers, reducing feelings of anxiety, insecurity and sadness. Unvaccinated children and adolescents may become the niche of new variants and may even emerge variants that are more adapted and harmful to them (). In Brazil, the National Health Surveillance Agency (Anvisa) authorized on December 16 the application of the Pfizer vaccine to children aged 5 to 11 years. Now, the immunization of this public, in practice, depends on the Ministry of Health. However, even before the arrival of children and adolescents, vaccines are already being victims of a smear campaign. Directors of the National Health Surveillance Agency (Anvisa) were threatened to deny authorization to Pfizer even before the formalization of the request (
      • Sociedade Brasileira de Imunizações
      Posicionamento SBIm/SBI/SBP sobre a vacinação de crianças de 5 a 11 anos contra a Covid-19 com a vacina Pfizer/BioNTech – 20/12/2021.
      ).
      In this context, childhood vaccination is a full plate for misinformation, since deciding for the children is even more difficult than deciding for yourself. This can make people more hesitant and, therefore, vulnerable to Fake News (
      • Instituto de Infectologia Emílio Ribas
      O enfrentamento do Covid-19 no.
      , ). Importantly, regulatory agencies and experts point out that the benefits of childhood vaccination against Covid outweigh any risks. Vaccinating children is also part of the collective strategy to try to reduce the circulation of the virus and control the pandemic. The states that no other vaccine-preventable disease killed as many children and adolescents in 2021 as COVID-19. Thus, although Anvisa has pointed out scientific evidence to approve childhood vaccination, the federal government decided that it will await public consultation and public hearing to make its decision. While the federal government's open consultation on pediatric coronavirus vaccination is taking place, Brazil's Minister of Health, Marcelo Queiroga, declared that the application of the dose may be accompanied by the requirement of a medical prescription and informed consent form (
      • CNN Brasil
      Covid-19 matou quatro crianças e adolescentes por dia no Brasil.
      ).
      Several researchers considered the Minister's decision as “wrong” and that this stance puts Brazil's own National Immunization Program in check (BBC
      • BBC News
      Vacina contra covid para crianças: 6 fatos a favor.
      ). For the National Health Surveillance Agency (Anvisa), putting the decision on vaccination for public consultation is “an aberration”. Expert committees that advise the immunization program to decide whether or not to include a new vaccine - whether for children, adults, seniors or pregnant women – are available. This decision reflects the explicit will of the Brazilian government to block, hinder the vaccination of children against Covid in Brazil (
      • Agência Nacional de Vigilância Sanitária – Anvisa
      ).

      Contributors

      IWMG,CGLS,AOAR,YTGP, JGJ and MLRN: conceptualization,; data curation; formal anlysis; funding acquisition. IWMG, AAGM, LMA,NNRL and MLRN:Investigation; methodology; Project administration; resources. NNRL, MLRN and IWMG: writing -review & editiom.

      Funding

      Experimental Pathology Laboratory (Lapex) – UFCA, Scientific Writing Laboratory - LABESCI of the Medicine Course – UFCA, Barbalha, Ceará, Brazil.

      Declaration of Competing Interest

      The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

      Acknowledgments

      Collective Mental Health Laboratory of the Faculty of Public Health of the University of São Paulo – USP, São Paulo, Brazil.

      References

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        Anvisa aprova vacina da Pfizer contra Covid para crianças de 5 a 11 anos.
        • BBC News
        Vacina contra covid para crianças: 6 fatos a favor.
        • BRASIL
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        in: Doença pelo Coronavírus COVID-19. Boletim Epidemiológico Especial. 78. 2021
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        Crianças e adolescentes não vacinados podem se tornar o nicho de novas variantes.
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        Covid-19 matou quatro crianças e adolescentes por dia no Brasil.
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        Repercussões da Pandemia de COVID-19 no Desenvolvimento Infantil [livro eletrônico].
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        • Instituto de Infectologia Emílio Ribas
        O enfrentamento do Covid-19 no.
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        • Instituto de Infectologia Emílio Ribas
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        • Sociedade Brasileira de Pediatria -SBP
        Vacinação contra Covid em crianças avança no mundo, mas e o Brasil?.