Globally, COVID-19 pandemic was devastating. Children were seemingly spared at the beginning of the pandemic, where by October 2021, according to the World Health Organization (WHO), those under the age of five accounted for 2% of the cases and 0.1% of global deaths.¹However, the epidemiological scenario hás under gone major changes with an increase in cases among children and adolescents in 2022. Global data reveals that children under the age of five and between five and 14 years old currently account for 2.47% and 10.44% of the cases of COVID-19, respectively.²

The highest mortality of the disease in pediatrics occurred in low and middle income countries, especially those under one year of age³ reflecting once again how the income markedly affects child health, and it was not different with COVID-19, where the worst Access to medical care also determined mortality indicators.⁴

Brazil accounted for about one in Five of these deaths in the pediatric age in the world and the vírus killed about two children under Five years of age per day, where as the Northeast region concentrated almost half of these deaths.⁵

Pediatric manifestations of Covid were found to appear at a frequency of 25.24%, with mood swings (16.50%), fatigue (9.66%), and sleep disturbances (8.42%) being the main ones.⁶ However, the hidden side of the pandemic was even more dramatic for our children. There were important osses of caring parents and grandparents leading to psychological suffering that is difficult to measure. With the absence of regular classes in school, there was also the loss of nutritional support offered by school meals and reduced physical activities. In addition, the occurrence of mistreatment, sexual violence, and associated teenage pregnancy accentuated theal ready existing social inequalities.⁷

Vaccination has played an essential role in the fight against COVID-19, making it possible to reduces ever e illness and mortality rates, and contain the spread of the disease.⁸ Children may play an important role in the transmission of this new respiratory disease by being a possible reservoir of the virus.^9,10

Children and adolescents safely were excluded from the initial clinical trials, and vaccination was only introduced laterin this group.¹¹ In Brazil, the inactivated vírus vaccine from the pharmaceutical company, Sinovac Biotech (CoronaVac) received approval for immunization of the pediatric population over three years of age, and the messenger RNA (mRNA) vaccine BNT162b2, developed in collaboration by Pfizer and BioNTech laboratories, was authorized for adolescentes, 12 to 18 years old. Subsequently, children aged five to 11 years old with a special presentation containing one-third of the standard dose and in September 2022, another pediatric presentation, corresponding to one-tenth of the adult dose, was used in children aged six months to three years of age.^11-13

The late introduction of vaccines in children combined with the emergence of new variants and sub-variants with greater transmission capacity have resulted in a proportional increase in infections in younger children.¹³ Inequalities in vaccine distribution, vaccine hesitancy, misinformation, and political complexities meanth at vaccine coverageis still insufficient for pandemic containment.⁹

Prevention on SARS-CoV-2 infection in infants includes protection induced by maternal vaccination. Effectiveness studies in pregnant women have shown that this group benefited significantly from the vaccination.^14-16 Mothers Who were vaccinated before or during pregnancy also transfer specific antibodies to their babies transplacentally and through breastmilk to protect them.^17,18 It is noteworthy that infants are one of the pediatric populations most frequently hospitalized for SARS-CoV-2 infection,¹⁹ and most of these children have no comorbidities.¹⁸

The safety ofusing new vaccines and monitoring adverse events will always be a major concern. The rare cases of myocarditis and pericarditis that have been observed in adolescents and Young adults receive especially mRNA platform vaccines seem to bein dose and in dependent interval and were not yet been reported with lower dose pediatric vaccines in younger populations.^20-24

Considering the overall benefits to the society and to the children, there is an urgent need to streng then measures to support COVID-19 vaccination in pediatrics and expand the protected groups.^25,26 The benefits of childhood vaccination with SARS-CoV-2 vaccines over come the risks of acquiring the infection than the unvaccinate dones, placing the vaccine among the most important for child health as other routine vaccines.²⁷

Parental fears about safety are an important influencing factor in the decision to vaccinate children. Governments should have effective communication for reducing the various aspects surrounding vaccine hesitancy.^28,29

Children have been a major weak link in this pandemic, being hit directly and indirectly with losses that Will have their consequences for years to come. Weneed a truly committed look at this cause.


References

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3. Kitano T, Kitano M, Krueger C, Jamal H, Al Rawahi H, Lee-Krueger R, et al. The differential impact of pediatric COVID-19 between high-income countries and low- and middle-income countries: a systematic review of fatality and ICU admission in children worldwide. PLoS One. 2021 Jan; 16 (1): e0246326.

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22. Ahmed SK. Myocarditis after BNT162b2 and mRNA-1273 COVID-19 vaccination: A report of 7 cases. Ann Med Surg (Lond). 2022; 77: 103657.

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24.Patel T, Kelleman M, West Z, Peter A, Dove M, Butto A, et al. Comparison of multisystem inflammatory syndrome in children-related myocarditis, classic viral myocarditis, and COVID-19 vaccine-related myocarditis in children. J Am Heart Assoc. 2022 May; 11 (9): e024393.

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