{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:10:34Z","timestamp":1789017034133,"version":"build-2803163510"},"reference-count":66,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"CNPq","doi-asserted-by":"crossref","award":["405731\/2023-0"],"award-info":[{"award-number":["405731\/2023-0"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003593","name":"CNPq","doi-asserted-by":"crossref","award":["301522\/2025-1"],"award-info":[{"award-number":["301522\/2025-1"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003593","name":"CNPq","doi-asserted-by":"crossref","award":["409331\/2026-0"],"award-info":[{"award-number":["409331\/2026-0"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]},{"award":["405731\/2023-0"],"award-info":[{"award-number":["405731\/2023-0"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"publisher"}]},{"award":["301522\/2025-1"],"award-info":[{"award-number":["301522\/2025-1"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"publisher"}]},{"award":["409331\/2026-0"],"award-info":[{"award-number":["409331\/2026-0"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004901","name":"FAPEMIG","doi-asserted-by":"crossref","award":["APQ-03205-24"],"award-info":[{"award-number":["APQ-03205-24"]}],"id":[{"id":"10.13039\/501100004901","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004901","name":"FAPEMIG","doi-asserted-by":"crossref","award":["APQ-04839-24"],"award-info":[{"award-number":["APQ-04839-24"]}],"id":[{"id":"10.13039\/501100004901","id-type":"DOI","asserted-by":"crossref"}]},{"award":["APQ-03205-24"],"award-info":[{"award-number":["APQ-03205-24"]}],"id":[{"id":"https:\/\/ror.org\/00nc55f03","id-type":"ROR","asserted-by":"publisher"}]},{"award":["APQ-04839-24"],"award-info":[{"award-number":["APQ-04839-24"]}],"id":[{"id":"https:\/\/ror.org\/00nc55f03","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/00x0ma614","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>In the post-pandemic era, identifying children who are most susceptible to severe illness and COVID-19-related mortality is essential for guiding public health policies. This study examined the risk factors for COVID-19-related severe illness and mortality from 2023 to mid-2025. We conducted a population-based cohort study using nationwide Brazilian data from patients aged &lt;18 years with laboratory-confirmed SARS-CoV-2 infection between January 2023 and June 2025. The primary outcomes were COVID-19-related severity and death. Separate binary multivariable logistic regression models were developed for each of the outcomes. Among 465,689 children, 1.3% (n = 5963) developed severe illness, and 0.18% (n = 847) died. Factors associated with an increased risk of severe illness included age &lt; 2 years, presence of comorbidities, Indigenous ethnicity, and lack of vaccination. Neurological disorders conferred the highest risk among the clinical conditions (adjusted odds ratio [aOR] = 34.1; 95% CI: 27.9\u201341.8). Regional differences were also observed; the North and Northeast regions showed higher mortality (aOR = 2.3; 95% CI: 1.8\u20133.0) than the Central-West region. Compared with White ethnicity, non-White ethnicities had higher mortality: Indigenous (aOR = 23.5; 95% CI: 13.5\u201339.3), Black (aOR = 1.95; 95% CI: 1.29\u20132.92), and Brown (aOR = 1.43; 95% CI: 1.18\u20131.73) ethnicities. Lack of any vaccine dose was associated with a significantly increased risk of severe illness (aOR = 1.39; 95% CI: 1.15\u20131.67. p &lt; 0.001) and death (aOR = 2.1; 95% CI: 1.3\u20133.5; p &lt; 0.001). In the post-pandemic era, younger age, comorbidities, sociodemographic disparities, and lack of vaccination were associated with an increased risk of severe illness and COVID-19-related death in the pediatric population.<\/jats:p>","DOI":"10.3390\/microorganisms14091984","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:23:51Z","timestamp":1788866631000},"page":"1984","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors of COVID-19 Severity and Related Death in Children in the Post-Pandemic Era"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2479-4429","authenticated-orcid":false,"given":"Laura G.","family":"Coelho","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, University Federal of Minas Gerais (UFMG), Belo Horizonte 31310-100, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7802-4377","authenticated-orcid":false,"given":"Lilian M.","family":"Diniz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, University Federal of Minas Gerais (UFMG), Belo Horizonte 31310-100, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5790-1136","authenticated-orcid":false,"given":"Stella C.","family":"Galante","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, University Federal of Minas Gerais (UFMG), Belo Horizonte 31310-100, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6559-3300","authenticated-orcid":false,"given":"Cristiane S.","family":"Dias","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, University Federal of Minas Gerais (UFMG), Belo Horizonte 31310-100, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2511-6769","authenticated-orcid":false,"given":"Maria Christina L.","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, University Federal of Minas Gerais (UFMG), Belo Horizonte 31310-100, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Enrico A.","family":"Colosimo","sequence":"additional","affiliation":[{"name":"Department of Statistics, Federal University of Minas Gerais (UFMG), Belo Horizonte 31270-901, MG, 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Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Julia O.","family":"Zavitoski","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, University Federal of Minas Gerais (UFMG), Belo Horizonte 31310-100, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3979-7497","authenticated-orcid":false,"given":"Daniella R. 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