{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T07:24:34Z","timestamp":1776756274812,"version":"3.51.2"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T00:00:00Z","timestamp":1736208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The study aimed to describe the characteristics and risk factors associated with disease severity across six waves of COVID-19 in the pediatric population in Mexico.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cohort study was conducted using data from the Mexican Ministry of Health, covering the period from March 2020 to March 2023. The dataset included patients under 18 years of age with confirmed SARS-CoV-2 infection. Univariate, bivariate, and logistic regression analyses were performed to determine demographic and clinical characteristics, mortality across waves, and age group distributions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the total cohort, 9.5% were children, with 497,428 confirmed cases. Among these, 50% were male, 4.4% required hospitalization, and there were 1,447 (0.03%) deaths. The highest prevalence was observed in the 12\u201317-year age group (52%), followed by the 5\u201311-year age group (32%), with incidence rates peaking towards the end of 2021 and the early 2022. Although the 0\u20132-year age group represented 9.6% of cases, it had higher hospitalization (40%), ICU admission (58%), and case fatality rate (CFR) (44%). Cardiovascular disease, hypertension, diabetes and immunosuppression were identified as risk factors for severe outcomes. The initial wave displayed the highest CFR (OR 5.28) especially in children aged 0\u20132 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Children were less affected during the pandemic compared to adults; however, children under two years-old experienced more severe outcomes. Currently, with 95% of the population estimated to be immune due to vaccination and\/or prior infection, children under 2 years of age are now at higher risk of severe disease and should be evaluated for vaccination as a public health policy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2024.1440107","type":"journal-article","created":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T04:11:28Z","timestamp":1736223088000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Epidemiological characterization of COVID-19 in children under 18 years old in Mexico: an analysis of the pandemic"],"prefix":"10.3389","volume":"12","author":[{"given":"Isamu Daniel","family":"Takane-Cabrera","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fanny Yasmin","family":"Ortega-Vargas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilen Adriana","family":"D\u00edaz-Torres","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aldo Agustin","family":"Herrera-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio R.","family":"Villa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel Leonardo","family":"Garc\u00eda-Le\u00f3n","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Bautista-Carbajal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel A.","family":"P\u00e9rez-Sastre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Alberto","family":"Cortazar-Maldonado","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge Baruch","family":"D\u00edaz-Ram\u00edrez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosa Maria","family":"Wong-Chew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1660","DOI":"10.1093\/cid\/ciaa1095","article-title":"A pediatric infectious disease perspective on COVID-19","volume":"72","author":"Wald","year":"2021","journal-title":"Clin Infect Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1186\/s12916-020-01719-2","article-title":"Epidemiological and clinical features of pediatric COVID-19","volume":"18","author":"Guo","year":"2020","journal-title":"BMC Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2019","DOI":"10.1007\/s00431-021-03993-5","article-title":"Multisystem inflammatory syndrome in children related to COVID-19: a systematic review","volume":"180","author":"Hoste","year":"2021","journal-title":"Eur J Pediatr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1080\/17512433.2021.1902303","article-title":"Epidemiology, pathogenesis, clinical presentations, diagnosis and treatment of COVID-19: a review of current evidence","volume":"14","author":"Rahman","year":"2021","journal-title":"Expert Rev Clin Pharmacol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1080\/10408363.2020.1783198","article-title":"The COVID-19 pandemic","volume":"57","author":"Ciotti","year":"2020","journal-title":"Crit Rev Clin Lab Sci"},{"key":"B6","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1186\/s12887-022-03624-4","article-title":"A systematic review and meta-analysis of the epidemiological characteristics of COVID-19 in children","volume":"22","author":"Vosoughi","year":"2022","journal-title":"BMC Pediatr"},{"key":"B7","article-title":"Secretaria de salud. Subsecretar\u00eda de Prevenci\u00f3n y Promoci\u00f3n de la Salud","year":"2023"},{"key":"B8","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1146\/annurev-med-042921-020956","article-title":"COVID-19: challenges of viral variants","volume":"74","author":"Jacobs","year":"2023","journal-title":"Annu Rev Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0106021","DOI":"10.1128\/mbio.01060-21","article-title":"The new SARS-CoV-2 variants and their epidemiological impact in Mexico","volume":"13","author":"Garc\u00eda-L\u00f3pez","year":"2022","journal-title":"mBio"},{"key":"B10","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.anpedi.2021.07.014","article-title":"Clinical characteristics and mortality risk factors in patients aged less than 18 years with COVID-19 in Mexico and Mexico city","volume":"97","author":"Wong-Chew","year":"2022","journal-title":"An Pediatr"},{"key":"B11","doi-asserted-by":"publisher","first-page":"05013","DOI":"10.7189\/jogh.11.05013","article-title":"Risk of infection and transmission of SARS-CoV-2 among children and adolescents in households, communities and educational settings: a systematic review and meta-analysis","volume":"11","author":"Irfan","year":"2021","journal-title":"J Glob Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"S120","DOI":"10.24875\/gmm.m2100048","article-title":"COVID-19 en el paciente pedi\u00e1trico","volume":"157","author":"Del Campo-Mart\u00ednez","year":"2021","journal-title":"Gac Med Mex"},{"key":"B13","article-title":"COVID-19 M\u00e9xico","year":"2023"},{"key":"B14","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/s00508-022-02122-y","article-title":"Diabetes mellitus: definition, classification, diagnosis, screening and prevention (update 2023)","volume":"135","author":"Harreiter","year":"2023","journal-title":"Vienna Klin Wochenschr"},{"key":"B15","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.cpcardiol.2007.01.002","article-title":"Systemic hypertension","volume":"32","author":"Elliott","year":"2007","journal-title":"Curr Problems in Cardiology"},{"key":"B16","first-page":"s176","article-title":"Obesity: definition, comorbidities, causes, and burden","volume":"22","author":"Apovian","year":"2016","journal-title":"Am J Manag Care"},{"key":"B17","doi-asserted-by":"publisher","first-page":"S2","DOI":"10.1002\/alr.21609","article-title":"Asthma: definitions and pathophysiology","volume":"5","author":"Mims","year":"2015","journal-title":"Int Forum Allergy Rhinol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.anai.2021.08.413","article-title":"Secondary immunodeficiencies: an overview","volume":"127","author":"Tuano","year":"2021","journal-title":"Ann Allergy Asthma Immunol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"704","DOI":"10.3390\/ijerph18020704","article-title":"Environmental risk factors and health: an Umbrella review of meta-analyses","volume":"18","author":"Rojas-Rueda","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B20","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1007\/s12012-020-09596-0","article-title":"COVID-19: a concern for cardiovascular disease patients","volume":"205","author":"Sharma","year":"2020","journal-title":"Cardiovasc Toxicol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1016\/S0140-6736(16)32064-5","article-title":"Chronic kidney disease","volume":"389","author":"Webster","year":"2017","journal-title":"Lancet"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ccm.2013.10.010","article-title":"COPD: definitions and phenotypes","volume":"35","author":"Vestbo","year":"2014","journal-title":"Clin Chest Med"},{"key":"B23","article-title":"Standardized Guidelines for Epidemiological and Laboratory Surveillance of Viral Respiratory Disease","year":"2020"},{"key":"B24","article-title":"Clinical Guidelines for COVID-19 treatment in Mexico","year":""},{"key":"B25","article-title":"Nextstrain Team. COVID 19 variants in Mexico","year":""},{"key":"B26","doi-asserted-by":"publisher","first-page":"e054292","DOI":"10.1136\/bmjopen-2021-054292","article-title":"School closures and reopenings during the COVID-19 pandemic: a scoping review protocol","volume":"12","author":"Li","year":"2022","journal-title":"BMJ Open"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e137","DOI":"10.1097\/INF.0000000000003043","article-title":"Risk factors for severe COVID-19 in children","volume":"40","author":"Graff","year":"2021","journal-title":"Pediatr Infect Dis J"},{"key":"B28","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1542\/hpeds.2022-006833","article-title":"Incidence and risk factors for severe outcomes in pediatric patients with COVID-19","volume":"13","author":"Ho","year":"2023","journal-title":"Hosp Pediatr"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e2111182","DOI":"10.1001\/jamanetworkopen.2021.11182","article-title":"Underlying medical conditions associated with severe COVID-19 illness among children","volume":"4","author":"Kompaniyets","year":"2021","journal-title":"JAMA Netw Open"},{"key":"B30","article-title":"Gu\u00eda cl\u00ednica para el tratamiento de la COVID-19 en M\u00e9xico. M\u00e9xico","year":"2021"},{"key":"B31","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/j.jaci.2020.06.001","article-title":"Association of asthma and its genetic predisposition with the risk of severe COVID-19","volume":"146","author":"Zhu","year":"2020","journal-title":"J Allergy Clin Immunol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"738423","DOI":"10.3389\/fpubh.2021.738423","article-title":"COVID-19 incidence and mortality by age Strata and comorbidities in Mexico city: a focus in the pediatric population","volume":"9","author":"Gonz\u00e1lez-Garc\u00eda","year":"2021","journal-title":"Front Public Health"},{"key":"B33","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1007\/s12016-022-08921-5","article-title":"Risk and protective factors for COVID-19 morbidity, severity, and mortality","volume":"64","author":"Zhang","year":"2022","journal-title":"Clin Rev Allergy Immunol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1186\/s13054-020-03120-0","article-title":"Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19","volume":"24","author":"Ni","year":"2020","journal-title":"Crit Care"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e2023028","DOI":"10.1590\/S0104-59702023000100028","article-title":"COVID-19 in Latin America: conflicts, resistances and inequalities","volume":"30","author":"Agostoni","year":"2023","journal-title":"Hist Cienc Saude Manguinhos"},{"key":"B36","doi-asserted-by":"publisher","first-page":"969251","DOI":"10.3389\/fpubh.2022.969251","article-title":"Survival analysis and mortality predictors of COVID-19 in a pediatric cohort in Mexico","volume":"10","author":"Sol\u00f3rzano-Santos","year":"2022","journal-title":"Front Public Health"},{"key":"B37","article-title":"\u00cdndice de marginaci\u00f3n a nivel estatal 2020","year":"2020"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1007\/s15010-023-01982-4","article-title":"COVID-19-related deaths: a 2-year inter-wave comparison of mortality data from Germany","volume":"5","author":"Lampl","year":"2023","journal-title":"Infection"},{"key":"B39","doi-asserted-by":"publisher","first-page":"288","DOI":"10.21149\/12399","article-title":"Priorizaci\u00f3n inicial y consecutiva para la vacunaci\u00f3n contra SARS-CoV-2 en la poblaci\u00f3n mexicana. Recomendaciones preliminares","volume":"63","year":"2020","journal-title":"Salud Publica Mex"},{"key":"B40","doi-asserted-by":"publisher","first-page":"s135","DOI":"10.21149\/14834","article-title":"Prevalencia de anticuerpos y vacunaci\u00f3n contra SARS-CoV-2 en 2022 en M\u00e9xico","volume":"65","author":"Carnalla","year":"2023","journal-title":"Salud Publica Mex"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2024.1440107\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T04:11:32Z","timestamp":1736223092000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2024.1440107\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,7]]},"references-count":40,"alternative-id":["10.3389\/fped.2024.1440107"],"URL":"https:\/\/doi.org\/10.3389\/fped.2024.1440107","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,7]]},"article-number":"1440107"}}