Characteristics and Clinical Outcomes of Vaccine-Eligible US Children Under-5 Years Hospitalized for Acute COVID-19 in a National Network

Author:

Zambrano Laura D.1ORCID,Newhams Margaret M.2ORCID,Simeone Regina M.1ORCID,Fleming-Dutra Katherine E.1ORCID,Halasa Natasha3ORCID,Wu Michael1ORCID,Orzel-Lockwood Amber O.2,Kamidani Satoshi4ORCID,Pannaraj Pia S.5ORCID,Chiotos Kathleen6ORCID,Cameron Melissa A.7ORCID,Maddux Aline B.8ORCID,Schuster Jennifer E.9ORCID,Crandall Hillary10ORCID,Kong Michele11ORCID,Nofziger Ryan A.12ORCID,Staat Mary A.13ORCID,Bhumbra Samina S.14ORCID,Irby Katherine15ORCID,Boom Julie A.16ORCID,Sahni Leila C.16ORCID,Hume Janet R.17ORCID,Gertz Shira J.18ORCID,Maamari Mia19ORCID,Bowens Cindy19ORCID,Levy Emily R.20ORCID,Bradford Tamara T.21ORCID,Walker Tracie C.22ORCID,Schwartz Stephanie P.22ORCID,Mack Elizabeth H.23ORCID,Guzman-Cottrill Judith A.24ORCID,Hobbs Charlotte V.25ORCID,Zinter Matt S.26,Cvijanovich Natalie Z.27ORCID,Bline Katherine E.28ORCID,Hymes Saul R.29ORCID,Campbell Angela P.1ORCID,Randolph Adrienne G.23031ORCID,

Affiliation:

1. From the Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia;

2. Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts;

3. Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee;

4. The Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta and the Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia;

5. Division of Infectious Diseases, Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Children’s Hospital Los Angeles, Los Angeles, California;

6. Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;

7. Division of Pediatric Hospital Medicine, UC San Diego-Rady Children’s Hospital, San Diego, California;

8. Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado;

9. Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri;

10. Division of Pediatric Critical Care, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah;

11. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama;

12. Division of Critical Care Medicine, Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio;

13. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;

14. Department of Pediatrics, The Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana;

15. Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children’s Hospital, Little Rock, Arkansas;

16. Department of Pediatrics, Baylor College of Medicine, Immunization Project, Texas Children’s Hospital, Houston, Texas;

17. Division of Pediatric Critical Care, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota;

18. Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey;

19. Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children’s Medical Center Dallas, Texas;

20. Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota;

21. Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children’s Hospital of New Orleans, New Orleans, Louisiana;

22. Department of Pediatrics, University of North Carolina at Chapel Hill Children’s Hospital, Chapel Hill, North Carolina;

23. Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina;

24. Division of Infectious Diseases, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon;

25. *Division of Infectious Diseases, Department of Pediatrics, and Department of Cell and Molecular Biology, Children’s of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi;

26. †Divisions of Critical Care Medicine and Allergy, Immunology, and Bone Marrow Transplant, Department of Pediatrics, University of California San Francisco, San Francisco, California;

27. ‡Division of Critical Care Medicine, UCSF Benioff Children’s Hospital Oakland, California;

28. §Division of Pediatric Critical Care Medicine, Nationwide Children’s Hospital Columbus, Ohio;

29. ¶Division of Pediatric Infectious Diseases, Department of Pediatrics, Bernard and Millie Duker Children’s Hospital, Albany Med Health System, Albany, New York;

30. ‖Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; and

31. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.

Abstract

Background and objectives: In June 2022, the mRNA COVID-19 vaccination was recommended for young children. We examined clinical characteristics and factors associated with vaccination status among vaccine-eligible young children hospitalized for acute COVID-19. Methods: We enrolled inpatients aged 8 months to <5 years with acute community-acquired COVID-19 across 28 US pediatric hospitals from September 20, 2022 to May 31, 2023. We assessed demographic and clinical factors, including the highest level of respiratory support, and vaccination status defined as unvaccinated, incomplete, or complete primary series [at least 2 (Moderna) or 3 (Pfizer-BioNTech) mRNA vaccine doses ≥14 days before hospitalization]. Results: Among 597 children, 174 (29.1%) patients were admitted to the intensive care unit and 75 (12.6%) had a life-threatening illness, including 51 (8.5%) requiring invasive mechanical ventilation. Children with underlying respiratory and neurologic/neuromuscular conditions more frequently received higher respiratory support. Only 4.5% of children hospitalized for COVID-19 (n = 27) had completed their primary COVID-19 vaccination series and 7.0% (n = 42) of children initiated but did not complete their primary series. Among 528 unvaccinated children, nearly half (n = 251) were previously healthy, 3 of them required extracorporeal membrane oxygenation for acute COVID-19 and 1 died. Conclusions: Most young children hospitalized for acute COVID-19, including most children admitted to the intensive care unit and with life-threatening illness, had not initiated COVID-19 vaccination despite being eligible. Nearly half of these children had no underlying conditions. Of the small percentage of children who initiated a COVID-19 primary series, most had not completed it before hospitalization.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Infectious Diseases,Microbiology (medical),Pediatrics, Perinatology and Child Health

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