COVID-19 and social distancing among children and adolescents in Brazil




Coronavirus Infections, prevention & control, Child, Adolescent, Social Isolation, Socioeconomic Factors


OBJECTIVE To estimate the prevalence of SARS-CoV-2 antibodies and the adherence to measures of social distancing in children and adolescents studied in three national surveys conducted in Brazil between May–June 2020. METHODS Three national serological surveys were conducted in 133 sentinel cities located in all 27 Federative Units. Multistage probability sampling was used to select 250 individuals per city. The total sample size in age ranges 0–9 and 10–19 years old are of 4,263 and 8,024 individuals, respectively. Information on children or adolescents was gathered with a data collection app, and a rapid point-of-case test for SARS-CoV-2 was conducted on a finger prick blood sample. RESULTS The adjusted prevalence of antibodies was 2.9% (2.2–3.6) among children 0–9 years, 2.2% (1.8–2.6) among adolescents 10-19 years, and 3.0% (2.7–3.3) among adults 20+years. Prevalence of antibodies was higher among poor children and adolescents compared to those of rich families. Adherence to social distancing measures was seen in 72.4% (71.9–73.8) of families with children, 60.8% (59.6–61.9) for adolescents, and 57.4% (56.9–57.8) for adults. For not leaving the house except for essential matters the proportions were 81.7% (80.5–82.9), 70.6% (69.6–61.9), and 65.1% (64.7–65.5), respectively. Among children and adolescents, social distancing was strongly associated with socioeconomic status, being much higher in the better-off families. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 showed comparable levels among children, adolescents, and adults. Adherence to social distancing measures was more prevalent in children, followed by adolescents. There were important socioeconomic differences in the adherence to social distancing among children and adolescents.


Cao Q, Chen YC, Chen CL, Chiu CH. SARS-CoV-2 infection in children: transmission dynamics and clinical characteristics. J Formos Med Assoc. 2020;119(3):670-3. [ Links ]

CDC COVID-19 Response Team. Coronavirus Disease 2019 in children — United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):422-6. [ Links ]

Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42. [ Links ]

Rostami A, Sepidarkish M, Leeflang MMG, Riahi SM, Nourollahpour Shiadeh M, Esfandyari S, et al. SARS-CoV-2 seroprevalence worldwide: a systematic review and meta-analysis. Clin Microbiol Infect. 2021;27(3):331-40. [ Links ]

Viner RM, Mytton OT, Bonell C, Melendez-Torres GJ, Ward J, Hudson L, et al. Susceptibility to SARS-CoV-2 infection among children and adolescents compared with adults: a systematic review and meta-analysis. JAMA Pediatr. 2021;175(2):143-56. [ Links ]

Ministerio de Ciencia e Innovacion (ES); Ministerio de Salud(ES). Spain. Estudio ENE-COVID19: Primera Ronda - Estudio Nacional de Sero-Epidemiologia de la Infección por SARS-CoV-2 en España: informe preliminar 13 mayo de 2020. Madrid (ES); 2020 [cited 2021 May13].Available from: [ Links ]

Gudbjartsson DF, Helgason A, Jonsson H, Magnusson OT, Melsted P, Norddahl GL, et al. Spread of SARS-CoV-2 in the Icelandic population. N Engl J Med. 2020;382:2302-15. [ Links ]

Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr. 2020;174(9):882-9. [ Links ]

Feldstein LR, Tenforde MW, Friedman KG, Newhams M, Rose EB, Dapul H, et al. Characteristics and outcomes of US children and adolescents with Multisystem Inflammatory Syndrome in Children (MIS-C) compared with severe acute COVID-19. JAMA. 2021;325(11):1074-7. [ Links ]

Zimmermann P, Curtis N. Why is COVID-19 less severe in children? A review of the proposed mechanisms underlying the age-related difference in severity of SARS-CoV-2 infections. Arch Dis Child. 2020:archdischild-2020-320338. [ Links ]

Ng KW, Faulkner N, Cornish GH, Rosa A, Harvey R, Hussain S, et al. Preexisting and de novo humoral immunity to SARS-CoV-2 in humans. Science. 2020;370(6522):1339-43. [ Links ]

Gold JE, Baumgartl WH, Okyay RA, Licht WE, Fidel PL Jr, Noverr MC, et al. Analysis of Measles-Mumps-Rubella (MMR) titers of recovered COVID-19 patients. mBio. 2020;11:e02628-20. [ Links ]

Lee PI, Hu YL, Chen PY, Huang YC, Hsueh PR. Are children less susceptible to COVID-19? J Microbiol Immunol Infect. 2020;53(3):371-2. [ Links ]

Konstantinou C. Andrianou XD, Constantinou A, Perikkou A, Markidou E, Christophi CA, et al. Exposome changes in primary school children following the wide population non-pharmacological interventions implemented due to COVID-19 in Cyprus: a national survey. EClinicalMedicine. 2021;32:100721. [ Links ]

Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of COVID-19 and lockdown on mental health of children and adolescents: a narrative review with recommendations. Psychiatry Res. 2020;293:113429. [ Links ]

Oosterhoff B, Palmer CA, Wilson J, Shook N. Adolescents’ motivations to engage in social distancing during the COVID-19 pandemic: associations with mental and social health. J Adolesc Health. 2020;67(2):179-85. [ Links ]

UNICEF. The State of the World´s Children 2019. Children, food and nutrition: growing well in a changing world. New York; 2019. [ Links ]

Hallal PC, Hartwig FP, Horta BL, Silveira MF, Struchiner CJ, Vidaletti LP, et al. SARS-CoV-2 antibody prevalence in Brazil: results from two successive nationwide serological household surveys. Lancet Glob Health. 2020;8(11):e1390-8. [ Links ]

Barros AJD, Victora CG, Menezes AMB, Horta BL, Hartwig F, Victora G, et al. Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study. Rev Saude Publica. 2020;54:75. [ Links ]

Barros AJD, Victora CG. A nationwide wealth score based on the 2000 Brazilian demographic census. Rev Saude Publica. 2005;39(4):523-9. [ Links ]

Pellanda LC, Wendland EMR, McBride AJA, Tovo-Rodrigues L, Ferreira MRA, Dellagostin OA, et al. Sensitivity and specificity of a rapid test for assessment of exposure to SARS-CoV-2 in a community-based setting in Brazil. medRxiv [Preprint]. 2020. [ Links ]

Silveira MF, Barros AJD, Horta BL, Pellanda LC, Victora GD, Dellagostin OA, et al. Population-based surveys of antibodies against SARS-CoV-2 in Southern Brazil. Nat Med. 2020;26:1196-9. [ Links ]

Silveira MF, Mesenburg M, Dellagostin OA, Oliveira N, Maia MAC, Santos FDS, et al. Time-dependent decay of detectable antibodies against SARS-CoV-2: a comparison of ELISA with two batches of a lateral-flow test. The Lancet SSRN First Look [Preprint]; 2021 [posted 22 Jan 2021]. [ Links ]

Lumley T. Analysis of complex survey samples. J Stat Softw. 2004;9(8):1-19. [ Links ]

Lumley T. Survey: analysis of complex survey samples. Version 4.0. Vienna (AT): Cran R Package Documentation; 2020 [cited 2021May 24]. Available from: [ Links ]

Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36(3):1-48. [ Links ]

Horta BL, Silveira MF, Barros AJD, Barros FC, Hartwig FP, Dias MS, et al. Prevalence of antibodies against SARS-CoV-2 according to socioeconomic and ethnic status in a nationwide Brazilian survey. Rev Panam Salud Publica. 2020;44:e135. [ Links ]

Zar HJ, Dawa J, Fischer GB, Castro-Rodriguez JA. Challenges of COVID-19 in children in low- and middle-income countries. Paediatr Respir Rev. 2020;35:70-4. [ Links ]






Original Articles

How to Cite

Barros, F. C., Hartwig, F. P., Barros, A. J. D. ., Menezes, A. M. B. ., Horta, B. L., Struchiner, C. J., Vidaletti, L. P., Silveira, M. F. ., Mesenburg, M. A., Delagostin, O. A., Hallal, P. C., & Victora, C. G. . (2021). COVID-19 and social distancing among children and adolescents in Brazil. Revista De Saúde Pública, 55, 42.

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