Discussion
In this cross-sectional study, the characteristics of the population of
children up to 12 years of age hospitalized and diagnosed with COVID-19
in HSP were evaluated. It is noteworthy that patients treated and
hospitalized in the HSP are very complex. In this analysis, it was found
that a portion of the population was eligible to be vaccinated, but none
had completed vaccination during hospitalization. vaccination for
children between 5 and 11 years of age had not been approved until the
beginning of 2022 and for children between 6 months and four years of
age until the end of last year. Since the onset of this pandemic,
children have not been as susceptible to the virus as adults or the last
pandemic in 2009, which was caused by the H1N1 influenza virus and
severely affected children at the time. (5).
However, this scenario has changed, possibly due to the high vaccination
coverage in the adult and elderly population, immunization of children
older than 12 years until the end of 2021, the end of quarantine and the
emergence of new variants.
In this new context, our study children up to 11 years of age became
more susceptible to the new circulating variant of omicron. A recent
study reported a change in the current pandemic scenario, showing a
significant increase in the proportion of pediatric cases after the
emergence of the Omicron variant, rising from > 2% at the
beginning of the pandemic to 25% by March 2022 (4).
As observed in our study, most patients were hospitalized for other
causes or underlying diseases with an influenza-like illness. Only a few
cases required more intensive treatment or had a more severe clinical
outcome.
Other studies, such as Zhu’s, report that although most cases are
lighter, children with underlying conditions are at higher risk of
developing severe symptoms of the disease. (4) In Brazil, one study
reported that approximately 40% of the pediatric population had at
least one chronic condition, 14.6% (associated with neurological
conditions) and 14.2% of children diagnosed with two or more chronic
conditions as a risk factor for COVID-19. (5)
Evaluating this population, our findings show that the most affected
individuals were children older than five years of age. As age
increases, so does the likelihood of infection. This is consistent with
other studies, such as Siegel et al., which have shown over time that
children aged 12 to 17 years are more susceptible to this infection,
followed by the age group of 5 to 11 years and those under four years of
age. (6) In the United States, the percentage of general
hospitalizations related to COVID-19 in children was 36%, with the
highest rate in the > 2 age group (32.7%), followed by 2
to 4 years (8.7%), 5 to 11 years (16.8%). The highest rate was in the
age group from 12 to 17 years (41.8%). The rate of ICU admissions was
approximately 33%, with only one death. (7)
Data released by the CDC in March of this year through the COVID-NET
network, which conducts surveillance of hospitalizations in the United
States, show an increase in hospitalizations in the 0-4 age group, with
85% of these cases attributable to COVID -19. Among these cases, 37%
had one or more underlying conditions. (8) This differs from our data,
which showed that detection was more common in the < 5 age
group, and the incidence of underlying disease or comorbidities was
approximately 69%.
The cases of coinfection we presented were low (11%) compared with
other studies. Wu et al. analyzed COVID -19 coinfections in 74 confirmed
children positive for this pathogen. As a result, 34 (45.95%) patients
were positive for the cold virus, and 19 (51.35%) had coinfection with
pathogens other than SARS-CoV-2. (9).
Our study showed that children older than five years are more likely to
test positive for COVID-19. The group with the lowest frequency of this
infection was between 1 -| 2 years old. Kolla’s study et.al.
2022, suggests that, in children between these ages, vaccines against
the tuna virus may confer a protective factor against other viruses,
such as SARS-CoV-2, so this probably influenced the lower frequency of
cases. The main aged virus vaccines used in this range are quadrivalent
viral and poliomyelitis 1 and 3. (10)
Results in the literature usually show a lighter form of the disease in
most cases. However, it is worth mentioning that additional research is
needed in this population, as the number of cases has changed
significantly from the beginning of this pandemic to the current
scenario. With the natural evolution of SARS-CoV-2, due to evolutionary
pressure, the emergence of new variants and subtypes and the increase in
cases among children, such as what happened after the Omicron variant.
Therefore, it is difficult to predict the impact of this disease on
children over time and its effect on the seasonality of other
respiratory viruses and epidemiological control in this population.”
In conclusion, after the evolution of SARS-CoV-2, children were finally
impacted, as expected compared to other respiratory viruses. We
demonstrated that most of the hospitalized cases presented with
comorbidities especially patients with sickle cell anemia, a group that
was frequently readmitted suggesting that those children should be
contemplated with strong program of immunization. Omicron variant caused
the highest rate of hospitalization which is implicated in the best
formulation should be used among children. In this sense, the new
monovalent vaccine with Ômicron XBB, may be the best options for them
particularly for those with comorbidities.