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. 2022 May 20:ciac388. doi: 10.1093/cid/ciac388

Comparison of influenza and COVID-19–associated hospitalizations among children < 18 years old in the United States—FluSurv-NET (October–April 2017–2021) and COVID-NET (October 2020–September 2021)

Miranda J Delahoy 1,2,3,*,✉, Dawud Ujamaa 1,2,*, Christopher A Taylor 1, Charisse Cummings 1,2, Onika Anglin 1, Rachel Holstein 1,2, Jennifer Milucky 1, Alissa O’Halloran 1,2, Kadam Patel 1, Huong Pham 1, Michael Whitaker 1, Arthur Reingold 4,5, Shua J Chai 4,6, Nisha B Alden 7, Breanna Kawasaki 7, James Meek 8, Kimberly Yousey-Hindes 8, Evan J Anderson 9,10,11, Kyle P Openo 9,10,11, Andy Weigel 12, Kenzie Teno 12, Libby Reeg 13, Lauren Leegwater 13, Ruth Lynfield 14, Melissa McMahon 14, Susan Ropp 15, Dominic Rudin 15, Alison Muse 16, Nancy Spina 16, Nancy M Bennett 17, Kevin Popham 18, Laurie M Billing 19, Eli Shiltz 19, Melissa Sutton 20, Ann Thomas 20, William Schaffner 21, H Keipp Talbot 21, Melanie T Crossland 22, Keegan McCaffrey 23, Aron J Hall 1, Erin Burns 2, Meredith McMorrow 1, Carrie Reed 2, Fiona P Havers 1, Shikha Garg 1,2,✉
PMCID: PMC9129156  PMID: 35594564

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, two 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 (October 1, 2020–September 30, 2021) was compared to influenza-associated hospitalization rates during the 2017–18 through 2019–20 influenza seasons. In-hospital outcomes, including intensive care unit (ICU) admission and death, were compared.

Results

Among children <18 years old, the COVID-19-associated hospitalization rate (48.2) was higher than influenza-associated hospitalization rates: 2017–18 (33.5), 2018–19 (33.8), and 2019–20 (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 old, a higher proportion with COVID-19 required ICU admission compared with influenza (26.4% vs 21.6%; p < 0.01). Pediatric deaths were uncommon during both COVID-19- and influenza-associated hospitalizations (0.7% vs 0.5%; p = 0.28).

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 old compared with influenza during the three 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, influenza, children, SARS-CoV-2, surveillance

Supplementary Material

ciac388_Supplementary_Data
Click here for additional data file. (1.3MB, docx)

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

ciac388_Supplementary_Data
Click here for additional data file. (1.3MB, docx)

Articles from Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America are provided here courtesy of Oxford University Press

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