Background COVID-19 is usually less severe and has lower case fatality in children than in adults. We aimed to characterise the clinical features of children and adolescents hospitalised with laboratory-confirmed SARS-CoV-2 infection and to evaluate the risk factors for COVID-19-related death in this population. MethodsWe did an analysis of all patients younger than 20 years who had quantitative RT-PCR-confirmed COVID-19 and were registered in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe, a nationwide surveillance database of patients admitted to hospital with severe acute respiratory disease in Brazil), between Feb 16, 2020, and Jan 9, 2021. The primary outcome was time to recovery (discharge) or in-hospital death, evaluated by competing risks analysis using the cumulative incidence function. FindingsOf the 82 055 patients younger than 20 years reported to SIVEP-Gripe during the study period, 11 613 (14•2%) had available data showing laboratory-confirmed SARS-CoV-2 infection and were included in the sample. Among these patients, 886 (7•6%) died in hospital (at a median 6 days [IQR 3-15] after hospital admission), 10 041 (86•5%) patients were discharged from the hospital, 369 (3•2%) were in hospital at the time of analysis, and 317 (2•7%) were missing information on outcome. The estimated probability of death was 4•8% during the first 10 days after hospital admission, 6•7% during the first 20 days, and 8•1% at the end of follow-up. Probability of discharge was 54•1% during the first 10 days, 78•4% during the first 20 days, and 92•0% at the end of follow-up. Our competing risks multivariate survival analysis showed that risk of death was increased in infants younger than 2 years (hazard ratio 2•36 [95% CI 1•94-2•88]) or adolescents aged 12-19 years (2•23 [1•84-2•71]) relative to children aged 2-11 years; those of Indigenous ethnicity (3•36 [2•15-5•24]) relative to those of White ethnicity; those living in the Northeast region (2•06 [1•68-2•52]) or North region (1•55 [1•22-1•98]) relative to those in the Southeast region; and those with one (2•96 [2•52-3•47]), two (4•96 [3•80-6•48]), or three or more (7•28 [4•56-11•6]) pre-existing medical conditions relative to those with none.Interpretation Death from COVID-19 was associated with age, Indigenous ethnicity, poor geopolitical region, and pre-existing medical conditions. Disparities in health care, poverty, and comorbidities can contribute to magnifying the burden of COVID-19 in more vulnerable and socioeconomically disadvantaged children and adolescents in Brazil.

Objective To evaluate the severity and clinical outcomes of the SARS-CoV-2 gamma variant in children and adolescents hospitalized with COVID-19 in Brazil. Study design In this observational retrospective cohort study, we performed an analysis of all 21,591 hospitalized patients aged < 20 years with confirmed SARS-CoV-2 infection registered in a national database in Brazil. The cohort was divided into two groups according to the predominance of SARS-CoV-2 lineages (WAVE1, n = 11,574 and WAVE2, n = 10,017). The characteristics of interest were age, sex, geographic region, ethnicity, clinical presentation, and comorbidities. The primary outcome was time to death, which was evaluated by competing-risks analysis, using cumulative incidence function. A predictive Fine-Gray competitive risks model was developed based on WAVE1 cohort with temporal validation in WAVE2 cohort. Results Children and adolescents admitted during the second wave had significantly more hypoxemia (52.5% vs. 41.1%, P < 0.0001), admission to ICU (28.3% vs. 24.9%, P < 0.0001), and needed more non-invasive ventilatory support (37.3% vs. 31.6%, P < 0.0001). The in-hospital deaths and death rates in the first and second waves were respectively 896 (7.7%) and 765 (7.6%) (P=0.07). The prediction model of death included age, ethnicity, region, respiratory symptoms, and comorbidities. In the validation set (WAVE2), the C statistics was 0.750 (95%CI, 0.741 to 0.758, P < 0.0001). Conclusions This large national study found a more severe spectrum of risk for pediatric patients with COVID-19 caused by the Gamma variant. However, there was no difference regarding the probability of death between the waves.

Summary objectIve. To assess the profile and scientific output of medical researchers supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) grants. Methods. Data were extracted from the Lattes curricula of 411 medical researchers with active grants for the 2006-2008 period. The variables of interest were gender, institutional affiliation, scientific output, and advisership of undergraduate research fellows and master's and doctoral candidates. results. Researchers were predominantly male (68%) and recipients of category 2 grants (55.7%). Four Brazilian states (São Paulo, Rio de Janeiro, Rio Grande do Sul, and Minas Gerais) accounted for 90% of all researchers. Eight institutions accounted for roughly 80% of researchers in the sample, particularly USP (30.7%) and UNIFESP (17%). The study identified 30 areas of expertise for researchers. Median scientific output was 4.13 published articles per year (interquartile range, IQ, 2.9-5.8), or 2.23 per year (IQ, 1.4-3.2) after adjusting for articles published in Web of Scienceindexed journals. The most productive areas in terms of indexed articles were Neuroscience (3.16 articles/year; IQ, 1.8-4.7) and Psychiatry (2.92; IQ, 1.73-4.5). conclusIon. Medical researchers are concentrated in the Southeast region of Brazil. The scientific output of most Brazilian researchers has increased over the past five years. An understanding of the profile of medical researchers in the country may aid development of effective strategies for qualitative improvement of scientific output.