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Hospitalizations Associated with COVID-19 Among Children and Adolescents — COVID-NET, 14 States, March 1, 2020–August 14, 2021
Open accessAbstract
Although COVID-19-associated hospitalizations and deaths have occurred more frequently in adults,† COVID-19 can also lead to severe outcomes in children and adolescents (1,2). Schools are opening for in-person learning, and many prekindergarten children are returning to early care and education programs during a time when the number of COVID-19 cases caused by the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, is increasing.§ Therefore, it is important to monitor indicators of severe COVID-19 among children and adolescents. This analysis uses Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET)¶ data to describe COVID-19-associated hospitalizations among U.S. children and adolescents aged 0-17 years. During March 1, 2020-August 14, 2021, the cumulative incidence of COVID-19-associated hospitalizations was 49.7 per 100,000 children and adolescents. The weekly COVID-19-associated hospitalization rate per 100,000 children and adolescents during the week ending August 14, 2021 (1.4) was nearly five times the rate during the week ending June 26, 2021 (0.3); among children aged 0-4 years, the weekly hospitalization rate during the week ending August 14, 2021, was nearly 10 times that during the week ending June 26, 2021.** During June 20-July 31, 2021, the hospitalization rate among unvaccinated adolescents (aged 12-17 years) was 10.1 times higher than that among fully vaccinated adolescents. Among all hospitalized children and adolescents with COVID-19, the proportions with indicators of severe disease (such as intensive care unit [ICU] admission) after the Delta variant became predominant (June 20-July 31, 2021) were similar to those earlier in the pandemic (March 1, 2020-June 19, 2021). Implementation of preventive measures to reduce transmission and severe outcomes in children is critical, including vaccination of eligible persons, universal mask wearing in schools, recommended mask wearing by persons aged ≥2 years in other indoor public spaces and child care centers,†† and quarantining as recommended after exposure to persons with COVID-19.§§.
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“With the prioritization of older age groups for vaccination, school-age children now account for an increasing proportion of cases and hospitalizations as compared with their proportion early in the pandemic,10,22,23,24 and school outbreaks are occurring.14,25”
From Evaluation of the BNT162b2 Covid-19 Vaccine in Children 5 to 11 Years of Age (2022) · cites this paper as [22]
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Multisystem Inflammatory Syndrome in U.S. Children and Adolescents
Feldstein, L. R., Rose, E. B., Horwitz, S. M., Collins, J. P., Newhams, M. M., Son, M. B. F., Newburger, J. W., Kleinman, L. C., Heidemann, S. M., Martin, A., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2021680 · Cited by 2,691
Kim, L., WHITAKER, M. D., O’Halloran, A. C., Kambhampati, A. K., Chai, S. J., Reingold, A. L., Armistead, I., Kawasaki, B., Meek, J. I., Yousey-Hindes, K. M., et al. (2020) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6932e3 · Cited by 513
Self-citationPreliminary evidence on long COVID in children
Buonsenso, D., Munblit, D., Rose, C. D., Sinatti, D., Ricchiuto, A., Carfì, A., & Valentini, P. (2021) · Acta Paediatrica · doi:10.1111/apa.15870 · Cited by 508
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Siegel, D. A., Reses, H. E., Cool, A. J., Shapiro, C. N., Hsu, J., Boehmer, T. K., Cornwell, C. R., Gray, E. B., Henley, S. J., Lochner, K., et al. (2021) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7036e1 · Cited by 147
Wallace, M. M., Woodworth, K. R., Gargano, J. W., Scobie, H. M., Blain, A. E., Moulia, D., Chamberland, M. E., Reisman, N., Hadler, S. C., MacNeil, J. R., et al. (2021) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7020e1 · Cited by 141
Self-citationHavers, F. P., WHITAKER, M. D., Self, J. L., Chai, S. J., Kirley, P. D., Alden, N. B., Kawasaki, B., Meek, J. I., Yousey-Hindes, K. M., Anderson, E. J., et al. (2021) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7023e1 · Cited by 110
Self-citationMurthy, B. P., Zell, E. R., Saelee, R., Murthy, N. C., Meng, L. M., Meador, S. A., Reed, K., Shaw, L., Gibbs‐Scharf, L., McNaghten, A. D., et al. (2021) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7035e1 · Cited by 50
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Evaluation of the BNT162b2 Covid-19 Vaccine in Children 5 to 11 Years of Age
Walter, E. B., Talaat, K. R., Sabharwal, C., Gurtman, A., Lockhart, S., Paulsen, G. C., Barnett, E. D., Muñoz, F. M., Maldonado, Y., Pahud, B. A., et al. (2022) · New England Journal of Medicine · doi:10.1056/nejmoa2116298 · Cited by 593
Bhimraj, A., Morgan, R. L., Shumaker, A. H., Baden, L. R., Cheng, V. C., Edwards, K. M., Gallagher, J. C., Gandhi, R. T., Muller, W. J., Nakamura, M., et al. (2022) · Clinical Infectious Diseases · doi:10.1093/cid/ciac724 · Cited by 240
Effectiveness of BNT162b2 Vaccine against Critical Covid-19 in Adolescents
Olson, S. M., Newhams, M. M., Halasa, N., Price, A. M., Boom, J. A., Sahni, L. C., Pannaraj, P. S., Irby, K., Walker, T. C., Schwartz, S. P., et al. (2022) · New England Journal of Medicine · doi:10.1056/nejmoa2117995 · Cited by 196
Marks, K. J., WHITAKER, M. D., Anglin, O., Milucky, J., Patel, K., Pham, H., Chai, S. J., Kirley, P. D., Armistead, I., McLafferty, S., et al. (2022) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7107e4 · Cited by 195
Self-citationImmunology of SARS-CoV-2 infection in children
Chou, J. S., Thomas, P. G., & Randolph, A. G. (2022) · Nature Immunology · doi:10.1038/s41590-021-01123-9 · Cited by 176
Metadata
- Authors
- Delahoy, M. J., Ujamaa, D., Whitaker, M., O'Halloran, A., Anglin, O., Burns, E., Cummings, C., Holstein, R., Kambhampati, A. K., Milucky, J., Patel, K., Pham, H., Taylor, C. A., Chai, S. J., Reingold, A., Alden, N. B., Kawasaki, B., Meek, J., Yousey-Hindes, K., Anderson, E. J., Openo, K. P., Teno, K., Weigel, A., Kim, S., Leegwater, L., Bye, E., Como-Sabetti, K., Ropp, S., Rudin, D., Muse, A., Spina, N., Bennett, N. M., Popham, K., Billing, L. M., Shiltz, E., Sutton, M., Thomas, A., Schaffner, W., Talbot, H. K., Crossland, M. T., McCaffrey, K., Hall, A. J., Fry, A. M., McMorrow, M., Reed, C., Garg, S., Havers, F. P., COVID-NET Surveillance Team, COVID-NET Surveillance Team, Kirley, P. D., McLafferty, S., Armistead, I., Fawcett, E., Ward, K., Lynfield, R., Danila, R., Khanlian, S., Angeles, K., Engesser, K., Rowe, A., Felsen, C., Bushey, S., Abdullah, N., West, N., Markus, T., Hill, M., & George, A.
- Affiliations
- Centers for Disease Control and Prevention (US)
- General Dynamics (United States) (US)
- Georgia Department of Public Health (US)
- Minnesota Department of Health (US)
- University of California, Berkeley (US)
- Colorado Department of Public Health and Environment (US)
- Yale University (US)
- Michigan Department of Health and Human Services (US)
- New Mexico Department of Health (US)
- University of New Mexico (US)
- New York State Department of Health (US)
- University of Rochester Medicine (US)
- Ohio Department of Health (US)
- Oregon Health Authority (US)
- Vanderbilt University Medical Center (US)
- Utah Department of Health (US)
- Atlanta VA Medical Center (US)
- Emory University (US)
- Corresponding author
- Delahoy, Miranda J.
- ORCID
- Delahoy, Miranda J.
- Whitaker, Michael
- Holstein, Rachel
- Kambhampati, Anita K.
- Milucky, Jennifer
- Pham, Huong
- Taylor, Christopher A.
- Chai, Shua J.
- Alden, Nisha B.
- Kawasaki, Breanna
- Meek, James
- Yousey-Hindes, Kimberly
- Anderson, Evan J.
- Openo, Kyle P.
- Kim, Sue
- Leegwater, Lauren
- Bennett, Nancy M.
- Sutton, Melissa
- Thomas, Ann
- Schaffner, William
- Talbot, H. Keipp
- Hall, Aron J.
- Fry, Alicia M.
- McMorrow, Meredith
- Reed, Carrie
- Garg, Shikha
- Havers, Fiona P.
- Lynfield, Ruth
- Engesser, Kerianne
- Felsen, Christina
- Markus, Tiffanie
- Hill, Mary
- Venue
- MMWR. Morbidity and Mortality Weekly Report
- Published
- 2021-09-10
- Volume
- 70
- Issue
- 36
- Pages
- 1255-1260
- ISSN
- 0149-2195 (ISSN-L)
- 1545-861X
- PMC
- PMC8437052
- OpenAlex
- W3197266611
- Cited by
- 273
- References
- 8
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 29 · 2023: 56 · 2022: 140 · 2021: 34
- FWCI
- 20.51
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- MMWR Morbidity and Mortality Weekly Report (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- U.S. Department of Health and Human Services
- U.S. Department of Veterans Affairs
- Pfizer
- Sanofi
- New York State Department of Health
- Minnesota Department of Health
- Yale University
- Council of State and Territorial Epidemiologists
- Vanderbilt University
- Utah Department of Health
- Emory University
- Colorado Department of Public Health and Environment
- University of Rochester
- Michigan Department of Health and Human Services
- Ohio Department of Health
- Vanderbilt University Medical Center
- Moderna
- National Institutes of Health (COVID-19)
- Centers for Disease Control and Prevention
- School of Medicine, Emory University
- Medical Center, University of Rochester
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pandemic, hospitalization, children, adolescents, pediatric COVID-19, COVID-NET, SARS-CoV-2
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Vaccines, Adolescent, Child, Child, Preschool, Hospitalization, Humans, Infant, Infant, Newborn, Severity of Illness Index, United States, Vaccination
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