Information on the risk factors for COVID-19 mortality in low- and middle-income countries is still scarce. In this retrospective cohort study, we analyzed the factors associated with COVID-19 mortality in hospitalized patients in a poor area of Brazil. Logistic regression was used to identify factors independently associated with mortality, including gender, age, and the presence of underlying medical conditions. A total of 1,207 patients were included in the analysis, and a 1.5-fold increase in COVID-19 mortality was found among patients aged > 65 years with hypertension and diabetes (odds ratio [OR]: 1.50, 95% CI: 1.02–2.19). Moreover, infectious disease (OR: 4.31, 95% CI: 1.39–13.39), kidney disease (OR: 2.59, 95% CI: 1.27–5.27), and heart disease (OR: 2.00, 95% CI: 1.31–3.04) were also predictive for COVID-19 in-hospital death. This large cohort provides important data on potential factors associated with COVID-19 mortality in Brazil.

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Population-based seroprevalence studies on COVID-19 in low-and middle-income countries are lacking. We investigated the seroprevalence of SARS-CoV-2 antibodies in Sergipe state, Northeast Brazil, using rapid IgM-IgG antibody test and fluorescence immunoassay. The seroprevalence was 9.3% (95%CI 8.5-10.1), 10.2% (95% CI 9.2-11.3) for women and 7.9% (IC 95% 6.8-9.1) for men (p = 0.004). We found a decline in the prevalence of SARS-CoV-2 antibodies according to age, but the differences were not statistically significant: 0-19 years (9.9%; 95% CI 7.8-12.5), 20-59 years (9.3%; 95% CI 8.4-10.3), and ≥60 years (9.0%; 95% CI 7.5-10.8) (p = 0.517). The metropolitan area had a higher seroprevalence (11.7%, 95% CI 10.3-13.2) than outside municipalities (8.0%, 95%CI 7.2-8.9) (p < 0.001). These findings highlight the importance of serosurveillance to estimate the real impact of the COVID-19 outbreak and thereby provide data to better understand the spread of the virus, as well as providing information to guide stay-at-home measures and other policies. In addition, these results may be useful as basic data to follow the progress of COVID-19 outbreak as social restriction initiatives start to be relaxed in Brazil.

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There is a lack of real-world surveillance studies on reports of adverse events associated with COVID-19 vaccination, as well as comparative analyses of adverse events from vaccines with different platforms. This observational, descriptive, retrospective study based on secondary data describes the adverse events following immunization (AEFIs) related to the first 145 000 doses of COVID-19 vaccines delivered in Aracaju municipality, Sergipe state, northeast Brazil. Records of AEFIs were collected using the e-SUS Notifica database for January 19 to April 30, 2021. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for AEFIs and the type of COVID-19 vaccine, either CoronaVac (Sinovac–Butantan) or Oxford–AstraZeneca (Fiocruz). A total of 474 AEFIs (32.7 events/10 000 doses) from 254 individuals were reported and analyzed, and all of them were classified as non-serious. There was an association between the use of the CoronaVac vaccine and headache (OR = 2.1; 95% CI: 1.4–3.2), pain at the injection site (OR = 9.6; 95% CI: 3.9–23.8), lethargy (OR = 5.2; 95% CI: 1.8–14.8), fatigue (OR = 10.1; 95% CI: 2.4–42.3), diarrhea (OR = 4.4; 95% CI: 1.5–12.5) and cold-like symptoms (OR = 8.0; 95% CI: 1.9–34.0). However, the proportion of individuals reporting fever was higher among those who received the Oxford–AstraZeneca vaccine (OR = 3.1; 95% CI 1.5–6.4). This population-based observational study strengthens the evidence for the safety and tolerability of the CoronaVac and Oxford–AstraZeneca vaccines used against COVID-19.

India, the second-largest population globally, has a rural-based and growing-urban developing economy and has suffered COVID-19 since January 2020. India reached its first peak with 100,000 infective cases on 18 May 2020, and as of 13 October 2021, the overall cases in India has exceeded 34 million. A four-phased lockdown from 24 March 2020 to 31 May 2020 was enforced to deal with COVID-19. During the pandemic, a few issues significantly attributed to psychological distress among people, especially children, include isolation, fear and uncertainty. It was possible to analyse the psychological impact on parents and their children in a developing country like India during the pandemic.The psychological impact of COVID-19 among the parents was assessed by a questionnaire with the IES-R scale, while the CRIES-13 scale was used to assess the psychological impact on their children among the 8-to 16-year-old age group. 2 The parents of children with special health care needs were excluded from the study.It was observed that 75th percentile participants had a minimal psychological impact while most displayed average range values. The non-parametric Mann-Whitney statistical analysis found significant differences in IES-R of hyperarousal and intrusion scores between HCW and non-health-care workers (NHCW). In children, the CRIES-13 median score was 9, which indicates no risk of post-traumatic stress disorder. No significant differences were found between children of HCW and NHCW (P > 0.05).We looked for factors associated with psychological distress in parents, females and HCW associated with higher IES-R scores P < 0.05 (Pearson Chi-square test). CRIES-13 scores of children were related to parents 0 IES scoring. Additionally, siblings 0 CRIES-13 scores were correlated, suggesting a possible family effect for distress. A correlation between parent and child ratings was expected, reflecting a commonality of contextual factors related to COVID-19 and a similarity in temperamental traits and emotional communication capacity that are likely to be genetically and environmentally influenced. It was observed that many parents and their children had a psychological impact due to COVID-19.Though concerns have been raised that children might be susceptible to the psychological effects of COVID-19, the role of parents becomes essential for attenuating the detrimental psychological effects of confinement. Fear of infection and home confinement could be particularly stressful for young people. The close link between parent and child-reported distress suggests that interventions to prevent and manage COVID-19-related anxiety in children should consider parental distress.