Hospitalization of Infants and Children Aged 0–4 Years With Laboratory-Confirmed COVID-19

COVID-NET, 14 States, March 2020-February 2022

Kristin J. Marks, PhD; Michael Whitaker, MPH; Nickolas T. Agathis, MD; Onika Anglin, MPH; Jennifer Milucky, MSPH; Kadam Patel, MPH; Huong Pham, MPH; Pam Daily Kirley, MPH; Breanna Kawasaki, MPH; James Meek, MPH; Evan J. Anderson, MD; Andy Weigel, MSW; Sue Kim, MPH; Ruth Lynfield, MD; Susan L. Ropp, PhD; Nancy L. Spina, MPH; Nancy M. Bennett, MD; Eli Shiltz, MPH; Melissa Sutton, MD; H. Keipp Talbot, MD; Andrea Price; Christopher A. Taylor, PhD; Fiona P. Havers, MD


Morbidity and Mortality Weekly Report. 2022;71(11):429-436. 

In This Article


Weekly COVID-19–associated hospitalization rates among U.S. infants and children aged 0–4 years have declined since the peak of January 8, 2022; however, peak rates during Omicron predominance were approximately five times those of the peak during Delta predominance. Similarly, ICU admission rates during Omicron predominance peaked at approximately 3.5 times the peak rate during Delta predominance. The proportion of hospitalized infants and children with severe illness during all variant periods of predominance, coupled with the potential for longer-term sequelae including multisystem inflammatory syndrome,[6,7] highlight the importance of preventing COVID-19 among infants and children aged 0–4 years. Strategies to prevent COVID-19 among infants and young children are important and include vaccination of currently eligible populations[2] such as pregnant women,[3] family members, and caregivers of infants and young children.[4]

The proportion of patients with codetections of RSV was higher during Delta predominance than Omicron predominance. RSV circulation was low during the first year of the pandemic (pre-Delta predominance). The pattern of RSV codetections during 2021–2022 correlated with trends in RSV circulation observed in other surveillance systems: RSV circulation increased during the summer and fall of 2021 (Delta predominance) and declined during Omicron predominance††††.[8] These limited data suggest that the surge in hospitalizations during Omicron predominance was not driven by coinfections. The highest proportion of hospitalized infants and children requiring ICU admission occurred during Delta predominance, and the lowest occurred during Omicron predominance. Although the proportion of hospitalized infants and children admitted to an ICU was higher during Delta predominance, the rate of pediatric ICU admissions during Omicron predominance was approximately 3.5 times as high as that during Delta predominance, driven by the overall higher disease incidence.

Throughout the pandemic, infants aged <6 months have been hospitalized with laboratory-confirmed COVID-19 at higher rates than have infants and children aged 6 months–4 years. Infants aged <6 months were hospitalized with RSV codetections in higher proportions but required ICU admission and respiratory support in similar proportions to other age groups. Future studies are needed to understand the possible long-term consequences of COVID-19 infection among infants. Although infants aged <6 months are not currently eligible for vaccination, evidence suggests that this age group can receive protection through passive transplacental transfer of maternal antibodies acquired through vaccination.[9] CDC recommends that women who are pregnant, breastfeeding, trying to become pregnant, or might become pregnant get vaccinated and stay up to date with COVID-19 vaccination.

The findings in this report are subject to at least four limitations. First, COVID-19–associated hospitalizations and viral coinfections might have been missed because of testing practice differences and test availability; this analysis could not account for changes in viral testing practices over time. Second, periods of variant predominance are not exclusive to a given variant; other variants might be circulating while one predominates. Third, it was not possible to account for seasonality or changes in public health policies and treatment practices over time; for example, the proportion of ICU admissions might reflect changing hospital capacity during the period of variant predominance rather than disease severity. Finally, the COVID-NET catchment areas include approximately 10% of the U.S. population; thus, these findings might not be nationally generalizable.

Coinciding with Omicron predominance, COVID-19–associated hospitalization rates among infants and children aged 0–4 years reached the current highest level of the pandemic during early January 2022. All persons who are eligible for vaccination,[2] including pregnant women,[3] should receive and stay up to date with COVID-19 vaccination to reduce the risk for severe disease for themselves and others with whom they come into contact,[10] including infants and children aged 0–4 years who are currently not eligible for vaccination.[4]