This Monday (7), Hospital Pequeno Príncipe, located in Curitiba (PR), the largest Brazilian health institution exclusively specialized in children, registered 22 admissions for Covid-19, 7 of them in the ICU. It is the largest number of children and adolescents hospitalized in the entity since the beginning of pandemic.

According to Cláudia Collucci, a reporter for Folha de S. Paulo, even though the proportion of hospitalizations and deaths of people under 18 in relation to the general public (1,5% of hospitalizations and 0,33% of deaths) remains stable in the country since March 2020, the increase in the absolute number of hospitalizations has drawn attention and opened discussions on the urgency of vaccination for this age group.

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At Hospital Pequeno Príncipe, from the beginning, most hospitalized patients had at least one comorbidity, according to pediatrician Victor Horácio de Souza Costa Junior. “These are children with neurological, kidney, diabetic and heart disease. It is noteworthy that these children are being contaminated at home. They weren't going to school,” he says.

Pediatrician Victor Horácio de Souza Costa Junior says that most of those admitted to Hospital Pequeno Príncipe have some type of comorbidity. Image: Disclosure – Hospital Pequeno Príncipe

There were 84 admissions for Covid-19 between March and December 2020, with five deaths. In the first five months of this year alone, the hospital has registered 125 hospitalizations and six deaths.

Vaccination of children and adolescents is more than necessary

Israel and the US are already vaccinating 12 to 15 year olds. The United Kingdom and Switzerland have also approved the application of doses of the Pfizer/BioNTech vaccine in this age group, but immunization has not yet started.

According to infectious disease physician Francisco Ivanildo Oliveira, medical manager of Sabará Hospital Infantil, in São Paulo, the trend is that we will see more cases in children and young people as vaccination progresses in older groups, exactly as happened in the US and in the United Kingdom.

The US and Israel have already started immunizing children and young people over 12 years of age. Image: Studio Romantic – Shutterstock

Renato Kfouri, infectious disease and president of the Department of Immunizations of the Brazilian Society of Pediatrics, says that the increase in hospitalizations and deaths in children indicates the growth of the disease in all age groups. "There are 1.500 deaths, there are a lot of children dying, but they continue to represent 0,3% of the total number of deaths”.

Kfouri advocates that children and adolescents with comorbidities have priority when immunizing young people. “We have a group of young transplant patients, cancer patients, diabetic patients who will need to be vaccinated earlier. Who is more at risk: a healthy 30-year-old young adult or a 12-year-old child with heart disease or diabetes?”, he asks.

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Among young people killed by Covid-19, half had comorbidities, according to the infectologist. He claims that the highest death rates are among those under the age of one year and those between 18 and 19 years old. “Prematurity and obesity in adolescence are among the risk factors”, he explains.

“We hope that the vaccine reaches this group. At the beginning of the pandemic, we did not have the view that obese children were such an important risk group. Among the comorbidities, obesity draws a lot of attention as a complicating factor”, reinforces the pediatrician Costa Júnior, from the Pequeno Príncipe hospital.

Is the vaccine safe for young people?

There is a discussion about the safety of the vaccine for the youngest. There are reports of side effects such as myoperiocarditis (simultaneous inflammation of the pericardium and myocardium), especially in men aged between 16 and 24 years.

For this reason, Kfouri has the following opinion regarding the indiscriminate vaccination of children and adolescents without risk factors for Covid: “We have to weigh what is tolerable for adverse events and risks. If you have a thrombosis or myocarditis for every 100 doses applied to elderly people or adults at higher risk, the same frequency of adverse events cannot be tolerated in children, whose chance of dying from Covid is very rare. The risk of the vaccine may outweigh the benefit.”

Another issue raised by experts is that infected children and adolescents may have cardiac involvement after infection with Covid-19, just as it occurs with adults. “We have been guiding parents to repeat the electrocardiogram two to three weeks after the end of the acute phase of the disease, in order to be able to release them for physical activities”, says Costa Júnior.

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