Characteristics and Clinical Outcomes of Children and Adolescents Aged <18 Years Hospitalized with COVID-19 - Six Hospitals, United States, July-August 2021.

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 emergence of the Delta variant and peaked in September 2021. ^§ As of May 12, 2021, CDC recommended COVID-19 vaccinations for persons aged ≥12 years, ^¶ and on November 2, 2021, COVID-19 vaccinations were recommended for persons aged 5-11 years.** 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. CDC partnered with six children's hospitals to review medical record data for patients aged <18 years with COVID-19-related hospitalizations during July-August 2021. ^†† Among 915 patients identified, 713 (77.9%) were hospitalized for COVID-19 (acute COVID-19 as the primary or contributing reason for hospitalization), 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 aged <1 year, 17.1% were aged 1-4 years, 20.1% were aged 5-11 years, and 38.1% were aged 12-17 years. 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 coinfection ^¶¶ (66.4% of whom had respiratory syncytial virus [RSV] infection). Approximately one third (33.9%) of patients aged <5 years hospitalized for COVID-19 had a viral coinfection. 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 aged ≥5 years and other prevention strategies to protect children and adolescents from COVID-19, particularly those with underlying medical conditions.
Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Ila R. Singh reports funding from the National Institutes of Health (NIH) as a coinvestigator for grant no. R61HD105593 to characterize pediatric COVID-19. Roberta L. DeBiasi reports grant support and contracts for COVID-19 and MIS-C, unrelated to the current work; consulting fees from I-ACT for Children; honoraria from the Infectious Diseases in Children Conference (NYC) and Children’s Hospital Colorado Infectious Diseases Conference (Denver); and unpaid membership on the board of the Pediatric Infectious Diseases Society. Larry K. Kociolek reports a grant from the Walder Foundation Chicago Coronavirus Assessment Network Initiative, institutional support from Merck and NIH/NIAID; and honoraria for educational events at Northwest Community Hospital and Nemours/duPont Children’s Hospital. Jessica Snowden reports institutional support from NIH Office of the Director–ECHO program and NIH/NHLBI–RECOVER program, unrelated to the current work. Frederick E. Barr reports application of patent 17364280 with Asklepion Pharmaceuticals for L-citrulline to prevent or treat endothelial dysfunction. Sapna Bamrah Morris and Sophia K. Chiu report membership on a data safety monitoring board in a study of ivermectin for treatment of severe COVID-19 in Ghana. Sophia Hsu reports ownership of 5 shares of Moderna stock and 7 shares of Novavax stock, and ownership within the past 36 months (but no current ownership) of stock in BioNTech, Gilead Sciences, and Pfizer. Theresa M. Dulski reports that her husband receives restricted stock units as part of his compensation from his employer, a cancer diagnostics company that also performs COVID-19 testing. No other potential conflicts of interest were disclosed.