Majority of hospitalized children with SARS-CoV-2 had COVID-19 as primary diagnosis

Jan. 4, 2022

Among children and adolescents with SARS-CoV-2 infection admitted to six hospitals during July-August 2021, 915 of them, or 77.9%, were hospitalized for acute COVID-19, the Centers for Disease Control and Prevention (CDC) reported in its Morbidity and Mortality Weekly Report (MMWR).

In addition, 177 (19.3%) had incidental positive SARS-CoV-2 test results (asymptomatic or mild infection unrelated to the reason for hospitalization), and 25 (2.7%) had multisystem inflammatory syndrome in children (MIS-C), a rare but serious inflammatory condition associated with COVID-19.

Among the 713 patients hospitalized for COVID-19, 24.7% were younger than 1 years old, 17.1% were 1-4 year of ages, 20.1% were 5-11 years of age, and 38.1% were 12-17 years of age. Approximately two thirds of patients (67.5%) had one or more underlying medical conditions, with obesity being the most common (32.4%); among patients aged 12-17 years, 61.4% had obesity.

Among patients hospitalized for COVID-19, 15.8% had a viral co-infection (66.4% of whom had respiratory syncytial virus [RSV] infection). Approximately one third (33.9%) of patients younger than 5 years hospitalized for COVID-19 had a viral co-infection. Among 272 vaccine-eligible (aged 12-17 years) patients hospitalized for COVID-19, one (0.4%) was fully vaccinated.

 Approximately one half (54.0%) of patients hospitalized for COVID-19 received oxygen support, 29.5% were admitted to the intensive care unit (ICU), and 1.5% died; of those requiring respiratory support, 14.5% required invasive mechanical ventilation (IMV). Among pediatric patients with COVID-19-related hospitalizations, many had severe illness and viral coinfections, and few vaccine-eligible patients hospitalized for COVID-19 were vaccinated, highlighting the importance of vaccination for those who are at least 5 years old and other prevention strategies to protect children and adolescents from COVID-19, particularly those with underlying medical conditions.

To date, clinical signs and symptoms, illness course, and factors contributing to hospitalizations during the period of Delta predominance have not been well described in pediatric patients. The CDC partnered with six children’s hospitals to review medical record data for patients younger than 18 years old with COVID-19-related hospitalizations during July-August 2021.

Data were collected from six U.S. children’s hospitals located in areas with high COVID-19 incidence during July-August 2021 (Arkansas, District of Columbia, Florida, Illinois, Louisiana, and Texas).

During June 2021, the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, became the predominant circulating strain in the United States. U.S. pediatric COVID-19-related hospitalizations increased during July-August 2021, following the emergence of the Delta variant and peaked in September 2021.

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