Comparison of Influenza and Coronavirus Disease 2019-Associated Hospitalizations Among Children Younger Than 18 Years Old in the United States: FluSurv-NET (October-April 2017-2021) and COVID-NET (October 2020-September 2021)

Miranda J Delahoy; Dawud Ujamaa; Christopher A Taylor; Charisse Cummings; Onika Anglin; Rachel Holstein; Jennifer Milucky; Alissa O'Halloran; Kadam Patel; Huong Pham; Michael Whitaker; Arthur Reingold; Shua J Chai; Nisha B Alden; Breanna Kawasaki; James Meek; Kimberly Yousey-Hindes; Evan J Anderson; Kyle P Openo; Andy Weigel; Kenzie Teno; Libby Reeg; Lauren Leegwater; Ruth Lynfield; Melissa McMahon; Susan Ropp; Dominic Rudin; Alison Muse; Nancy Spina; Nancy M Bennett; Kevin Popham; Laurie M Billing; Eli Shiltz; Melissa Sutton; Ann Thomas; William Schaffner; H Keipp Talbot; Melanie T Crossland; Keegan McCaffrey; Aron J Hall; Erin Burns; Meredith McMorrow; Carrie Reed; Fiona P Havers; Shikha Garg

doi:10.1093/cid/ciac388

Comparison of Influenza and Coronavirus Disease 2019-Associated Hospitalizations Among Children Younger Than 18 Years Old in the United States: FluSurv-NET (October-April 2017-2021) and COVID-NET (October 2020-September 2021)

Clin Infect Dis. 2023 Feb 8;76(3):e450-e459. doi: 10.1093/cid/ciac388.

Authors

Miranda J Delahoy^{1

2

3}, Dawud Ujamaa^{1

2}, Christopher A Taylor¹, Charisse Cummings^{1

2}, Onika Anglin¹, Rachel Holstein^{1

2}, Jennifer Milucky¹, Alissa O'Halloran^{1

2}, Kadam Patel¹, Huong Pham¹, Michael Whitaker¹, Arthur Reingold^{4

5}, Shua J Chai^{4

6}, Nisha B Alden⁷, Breanna Kawasaki⁷, James Meek⁸, Kimberly Yousey-Hindes⁸, Evan J Anderson^{9

10

11}, Kyle P Openo^{9

10

11}, Andy Weigel¹², Kenzie Teno¹², Libby Reeg¹³, Lauren Leegwater¹³, Ruth Lynfield¹⁴, Melissa McMahon¹⁴, Susan Ropp¹⁵, Dominic Rudin¹⁵, Alison Muse¹⁶, Nancy Spina¹⁶, Nancy M Bennett¹⁷, Kevin Popham¹⁸, Laurie M Billing¹⁹, Eli Shiltz¹⁹, Melissa Sutton²⁰, Ann Thomas²⁰, William Schaffner²¹, H Keipp Talbot²¹, Melanie T Crossland²², Keegan McCaffrey²³, Aron J Hall¹, Erin Burns², Meredith McMorrow¹, Carrie Reed², Fiona P Havers¹, Shikha Garg^{1

2}

Affiliations

¹ CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
² Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
³ Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁴ California Emerging Infections Program, Oakland, California, USA.
⁵ Berkeley School of Public Health, University of California, Berkeley, California, USA.
⁶ Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁷ Colorado Department of Public Health and Environment, Denver, Colorado, USA.
⁸ Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA.
⁹ Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁰ Georgia Department of Health, Georgia Emerging Infections Program, Atlanta, Georgia, USA.
¹¹ Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA.
¹² Iowa Department of Health, Des Moines, Iowa, USA.
¹³ Michigan Department of Health and Human Services, Lansing, Michigan, USA.
¹⁴ Minnesota Department of Health, Saint Paul, Minnesota, USA.
¹⁵ New Mexico Department of Health, New Mexico Emerging Infections Program, Santa Fe, New Mexico, USA.
¹⁶ New York State Department of Health, Albany, New York, USA.
¹⁷ University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
¹⁸ Rochester Emerging Infections Program, University of Rochester Medical Center, Rochester, New York, USA.
¹⁹ Ohio Department of Health, Columbus, Ohio, USA.
²⁰ Public Health Division, Oregon Health Authority, Salem, Oregon, USA.
²¹ Vanderbilt University Medical Center, Nashville, Tennessee, USA.
²² Salt Lake County Health Department, Salt Lake City, Utah, USA.
²³ Utah Department of Health, Salt Lake City, Utah, USA.

Abstract

Background: Influenza virus and SARS-CoV-2 are significant causes of respiratory illness in children.

Methods: Influenza- and COVID-19-associated hospitalizations among children <18 years old were analyzed from FluSurv-NET and COVID-NET, 2 population-based surveillance systems with similar catchment areas and methodology. The annual COVID-19-associated hospitalization rate per 100 000 during the ongoing COVID-19 pandemic (1 October 2020-30 September 2021) was compared with influenza-associated hospitalization rates during the 2017-2018 through 2019-2020 influenza seasons. In-hospital outcomes, including intensive care unit (ICU) admission and death, were compared.

Results: Among children <18 years, the COVID-19-associated hospitalization rate (48.2) was higher than influenza-associated hospitalization rates: 2017-2018 (33.5), 2018-2019 (33.8), and 2019-2020 (41.7). The COVID-19-associated hospitalization rate was higher among adolescents 12-17 years old (COVID-19: 59.9; influenza range: 12.2-14.1), but similar or lower among children 5-11 (COVID-19: 25.0; influenza range: 24.3-31.7) and 0-4 (COVID-19: 66.8; influenza range: 70.9-91.5) years old. Among children <18 years, a higher proportion with COVID-19 required ICU admission compared with influenza (26.4% vs 21.6%; P < .01). Pediatric deaths were uncommon during both COVID-19- and influenza-associated hospitalizations (0.7% vs 0.5%; P = .28).

Conclusions: In the setting of extensive mitigation measures during the COVID-19 pandemic, the annual COVID-19-associated hospitalization rate during 2020-2021 was higher among adolescents and similar or lower among children <12 years compared with influenza during the 3 seasons before the COVID-19 pandemic. COVID-19 adds substantially to the existing burden of pediatric hospitalizations and severe outcomes caused by influenza and other respiratory viruses.

Keywords: COVID-19; SARS-CoV-2; children; influenza; surveillance.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adolescent
Aged
Aged, 80 and over
COVID-19* / complications
COVID-19* / epidemiology
Child
Hospitalization
Humans
Influenza, Human* / complications
Influenza, Human* / epidemiology
Pandemics
SARS-CoV-2
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding