Rise in Pediatric COVID-19 Hospitalizations

The United States is facing a critical pediatric health event–increasing infections, hospitalizations, and deaths in children due to COVID-19, RSV (respiratory syncytial virus) and other seasonal infections. Hospitals are overwhelmed and begging for assistance as this early spike in RSV is stressing pediatric units. What though, are we seeing in hospitalization for those youngest children, less than 6 months, who cannot be fully vaccinated?

A new publication from the Center for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR), addressed COVID-19 related hospitalizations in those infants less than 6 months who were unable to be vaccinated. The researchers utilized the COVID-NET data system, which is population-based surveillance for lab-confirmed COVID-19 hospitalizations. Reviewing data from June 2021 to August 2022 across 13 states, there was an increase in hospitalizations for this age group during the Omicron periods when compared to Delta. Thankfully, those indicators for severe disease did not mirror this increase despite the hospitalizations.

The authors noted that “Among 473 infants aged <6 months hospitalized during the Omicron BA.2/BA.5 variant-predominant period, 397 (84%) had COVID-19–related symptoms. Among all 473 infants, 174 (38%) were aged <1 month; 69 (39%) of these were birth hospitalizations. Among infants who received a positive SARS-CoV-2 test result during the birth hospitalization, 60 (87%) were asymptomatic. Excluding birth hospitalizations, similar proportions were hospitalized with COVID-19–related symptoms among infants aged <1 month (94%), 1–2 months (97%) and 3–5 months (96%). At least one underlying medical condition was present in 26% of hospitalized infants aged 1–2 months and 36% of those aged 3–5 months. Prematurity was the most frequently reported underlying condition (20% and 25% of infants aged 1–2 months and 3–5 months, respectively). Most infants aged 1–2 months (74%) and 3–5 months (68%) had fever on admission.”

This information is a helpful reminder that even if disease severity has not increased, hospitalizations can still occur and grow with higher rates of transmission, especially in those unable to be vaccinated. Hospitalizations, especially longer stays and/or those that involve invasive medical devices such as central-lines or catheters, increase the risk for healthcare-associated infections (HAIs). These types of infections have increased throughout the COVID-19 pandemic and while it’s still too early to tell if this spike in pediatric hospitalizations will mirror that trend, children are not immune to HAIs. Moreover, HAIs can lead to longer hospital stays, severe disease, and even death, meaning that the prevention of infection and subsequent hospitalization due to COVID is important for more reasons than people realize. As such, the CDC has reiterated that infants under six months of age have high COVID-19-assocated hospitalization rates and encourages pregnant people to stay up to date during pregnancy to help protect themselves and the child.

As we move towards a winter surge and cases slowly start to trend up (4% across the United States in the last two weeks), it’s that much more important to stay up to date on COVID vaccines, wear a mask, stay home when sick, and improve ventilation when possible.