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.

Obesity prevalence is lower in Northeast than Southeast among children with age from 2 to 17 years old. Overweight prevalence among adolescents was also lower in Northeast than in Southeast. The prevalence of obesity among younger than 2 and older than 18 years old was the same. Obesity prevalence is higher among breast-fed females. Among other age groups prevalence of obesity and overweight was the same for males and females. It is difficult to compare these results with other studies, since there are few populational studies and the criteria used to define overweight and obesity in children and adolescents varies in each study.

The Child Health Record (CHR)

(11-58 months), the estimated probability of relapse free survival was 41% (7%) for the whole group. After adjustment in the Cox's multivariate model, malnutrition was the most significant adverse factor affecting duration of complete remission. Age above 8 years and high peripheral white celi count were also significant adverse factors. Among the nutritional indices, the height for age and weight for age z scores were both significant, whether the cut off points of z-2 or z=-1*28 were chosen to define malnutrition. A strong statistical association between the two indices was found; the contribution of height for age z score to the prediction of relapse free survival was more significant. Children with height for age z score <-2 had a relapse risk of 8*2 (95Gb confidence interval 3*1 to 21-9) relative to children with z score > -2. The results of this study suggest that socioeconomic and nutritional factors should be considered in the prognostic evaluation of children with leukaemia in developing countries. (Arch Dis Child 1994; 71: 304-3 10)

Objectives: To investigate the progress of rheumatic fever (RF) and the predictors of severe chronic valvar disease. Design: Patients prospectively followed up since their first attack of acute RF (ARF). Setting: Universidade Federal de Minas Gerais, Brazil. Patients: 258 children and adolescents who met the revised Jones criteria for RF. The follow up period ranged from 2-15 years. Main outcome measures: The presence and severity of mitral or aortic valvar disease were determined by both clinical and Doppler echocardiographic examinations. The variables associated with severe chronic valvar disease were initially identified by the Kaplan-Meier method and, later, by multivariate analysis. Results: Doppler echocardiography of 258 patients studied showed that 186 (72.1%) developed chronic valvar disease and 41 (15.9%) progressed to severe chronic mitral or aortic lesions. Of 146 patients who developed carditis, 49 (33.6%) had a normal clinical examination in the chronic phase but only nine (6.2%) had normal Doppler echocardiographic findings-that is, 40 (27.4%) patients progressed to chronic subclinical valvar disease. Moderate or severe carditis, recurrences of ARF, and mother's low educational level were risk factors in predicting severe chronic valvar diseases. Conclusion: The increased risk of progressing to severe chronic valvar disease was associated with moderate or severe carditis, recurrences of ARF, and mother's low educational level. Hence, in a country such as Brazil, the options available for disease control are mainly primary and secondary prophylaxis.

Adherence was a dynamic event and rates decreased progressively for all methods over the 12-month follow-up. Canister weight and electronic monitoring measures were more accurate than self/parent reports and pharmacy records. Rates obtained by these two methods were very close and statistical analysis also showed a substantial agreement between them. As measurements by canister weight are less costly compared with currently available electronic devices, it should be considered as an alternative method to assess adherence in both clinical research and practice.

Prevalence of overweight and obesity joined is higher among females. More than half of the women among 50 and 69 years old, from Northeast and Southeast regions of Brazil have overweight or obesity. There are few studies of overweight and obesity among children and adolescents and a lot of definition for obesity in children which makes more difficult the comparison of studies of prevalence among children.

Abstract. Cellular and humoral immune responses to Schistosoma mansoni antigen preparations were evaluated in individuals presumed to be susceptible or resistant to reinfection after chemotherapeutic cure. A consistent proliferative increase in the response to soluble egg antigen (SEA) was observed post-treatment in both the susceptible and resistant groups. However, this change was not related to resistance. Isotype studies showed that IgM antibody levels to soluble worm antigen preparation (SWAP) and cercariae antigens were significantly higher in the resistant group than in the susceptible group. Post-treatment, an increase in IgE anti-SWAP and anti-schistosomular tegument (STEG) responses and a decrease in IgG4 anti-SEA and anti-STEG responses were observed in the resistant group. These finding are similar to those we have reported previously for a putative resistant group termed endemic normals, and are compatible with immunologic studies in different endemic areas. Together, these findings indicate that even on the population level, high IgE specificities coupled with low IgG4 specificities correlate well with documented resistance to reinfection.Based on field studies following curative chemotherapy of either Schistosoma mansoni 1-3 or S. haematobium, 4,5 individuals are often categorized as being either susceptible or resistant to natural reinfection by schistosomes. These studies have shown that resistance to reinfection is an age-related phenomenon, with most people in endemic areas becoming resistant, or expressing their resistance during their second decade of life. When determined directly or by estimation, resistance appears to be unrelated to the degree of contact that the susceptible and resistant groups have with cercariaecontaining water, and is usually attributed to immunity rather than physiologic or behavioral changes with age. 4,6,7 These studies have cataloged a variety of humoral immune responses, and are in agreement with several of the correlations demonstrated between given immune responses and susceptible or resistant groups. 8,9 A number of studies have shown associations between resistance status and a balance between the level of effective anti-schistosomula antibodies and the presence of blocking antibodies. 5,[10][11][12] The latter are sometimes most easily demonstrated as antibodies to egg antigens that cross-react with epitopes present in the schistosomula tegument. 3,10The most common features that show relationships to resistance to reinfection include high levels of IgE against adult worm or larval antigens, while high levels of IgG4 and IgM antibodies against egg antigens generally parallel susceptibility. 5,9,[11][12][13][14][15] Recent studies have also reported correlations between resistance and elevated levels of IgA against a schistosome vaccine candidate (Sm 28 glutathione-S-transferase). 16,17 Further studies with other antigens have demonstrated that higher levels of IgE against a 22-kD schistosomula moiety 9 and higher levels of IgM against a 68-kD adult schistos...