Brazil loses two children under 5 a day to Covid, says study

Brazil has recorded an average of two daily deaths from Covid-19 among children under five, an age group that is not yet eligible for vaccination in the country and that has been filling pediatric hospitals.

In 2020 and 2021, there were 1,439 deaths in this group, with 48% of babies between 29 days and an incomplete year (post-neonatal), an average of 1.9 per day. In 2022, there are at least 291 more deaths under the age of five as of June 11, an average of 1.8 per day.

For comparison purposes, since the beginning of the pandemic, the United States, which is already immunizing this age group, has recorded 442 deaths among children under the age of five due to Covid, that is, almost a third (30.7%) of the total number of deaths. Brazilian deaths. The US has 3.6 million births a year, while Brazil has around 2.6 million.

The unprecedented analysis is from Observa Infância, a project linked to the Institute of Communication and Scientific and Technological Information in Health (Icict/Fiocruz). The 2020 and 2021 numbers were extracted from the SIM (Mortality Information System) and have already been reviewed by the Ministry of Health and the state health secretariats.

The Northeast accounted for most child deaths from Covid in these two years, with 43.9% of the total, on average. The region has only a third of the population of children under five. Then comes the Southeast, with 24.5% of deaths. Then, the North (18.1%), the Midwest (6.1%); and the South (7.3%).

Although the number of deaths of children up to five years old represents only 0.22% of the total deaths by Covid until December 2021 (668,074) in Brazil, the researcher of Observa Infância Cristiano Boccolini, the study’s lead author, says that the amount does not it is insignificant. “Almost 1,500 families have lost their babies and children. It’s a tragedy.”

Data from Observa Infância takes into account Covid as the underlying cause of death and also as a contributing cause. That is, the child already had a health problem, such as congenital heart failure, was infected by the coronavirus, had a worsening condition and died.

For Boccolini, the high number of deaths compared to other countries reflects the large number of infections and deaths from the disease in Brazil associated with unequal access to health services between regions of the country.

​The researcher says that more studies will be needed to identify the reason for the excess deaths of Brazilian children when compared to those in other countries, and the concentration of deaths in the North and Northeast and in the post-neonatal age group.

In absolute numbers, Brazilian infant deaths up to five years of age represent 26.8% of the 5,376 deaths of children in this group registered in 91 countries that have data disaggregated by age group, according to UNICEF (United Nations Children’s Fund).

As it considers Covid as the underlying cause and contributing cause, the total number of deaths measured by Observa Infância is 18.3% higher than that reported in the Ministry of Health bulletins, which only computes death from Covid as the underlying cause. In 2020 and 2021, official deaths total 1,175, according to bulletins released by the ministry.

“We have an excess of deaths from Covid in this age group under five years old. Every day we go without vaccination for children from six months onwards, Brazil loses two of them. This is unacceptable. Death from Covid can already be considered avoidable”, says Boccolini.

In the opinion of infectologist Munir Ayub, a member of the immunization committee of the SBI (Brazilian Society of Infectious Diseases), there is no doubt that the population under five is more vulnerable to Covid and needs to be vaccinated. “The question is which vaccine will be released in Brazil and when it will happen.”

The United States began on Tuesday (21) to immunize children between six months and five years of age with vaccines from Pfizer and Moderna.

Since March, Anvisa (National Health Surveillance Agency) has been analyzing the request from the Butantan Institute for the use of Coronavac between three and five years, but there is still no decision. On June 8, the agency heard experts from Brazilian societies of infectology, pediatrics and immunology, in addition to Abrasco (Brazilian Association of Collective Health).

Last week, pharmaceutical Pfizer reported that it is preparing documentation to request Anvisa authorization to vaccinate children between six months and five years, but there is still no deadline for this to occur. That is, at the moment there is no vaccine under analysis for the age group in which deaths have been concentrated, between 29 days and an incomplete year.

According to pediatrician Isabella Ballalai, vice president of SBIm (Brazilian Society of Immunizations), children under one year are more vulnerable to all infections. In the first few months of life, babies are protected due to antibodies transferred by mothers through the placenta and breast milk.

“We start the vaccine from six months so that, when the maternal antibodies run out, they are already protected by vaccines”, explains the doctor.

According to the pediatrician, it is very important that the immunization against Covid reaches children under five years old and that it advances between those aged 5 to 11 years. The vaccination rate in this range is 37%.

For the doctor, the anti-vaccination movement, by spreading rumors about serious adverse events that never existed, not only scared parents about immunization but also ended the perception of risk, with the false argument that Covid does not cause serious disease in children. children.

“That’s not what we’re seeing. We’ve always prioritized the elders, because they have a higher incidence rate, but with that, families understood that children are not at risk,” he says.

The infectious disease specialist Ayub also recalls that many parents of young children and even their older children do not have a complete vaccination schedule. With the high circulation of the omicron variant, associated with the abandonment of protective measures, the chances of becoming infected and transmitting it to their babies greatly increase.

“The virus is circulating and is taking over a population of children who have no protection at all. It already kills many more children than meningitis, a disease that all parents fear.”

Currently, the age group between zero and five years has become the one with the highest risk of hospitalization for the disease, except for the population over 60 years, according to another analysis by Fiocruz.

In November, this group did not represent 5% of the weekly cases of Srag (Severe Acute Respiratory Syndromes) by Covid-19 in the country. From April onwards, he accounted for up to 15% of registrations.

In addition to the acute cases that can complicate, another risk that children run is the development of pediatric multisystem inflammatory syndrome (P-SIM). The Brazilian mortality rate for this syndrome is 6%, four times higher than that recorded in the USA.