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Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases
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COVID -19–Associated Hospitalizations among
Children and Adults — COVID -NET
ACIP Meeting
Fiona P . Havers, MD, MHS
RESP -NET Hospitalization Surveillance Team
Surveillance and Prevention Branch
Coronavirus and Other Respiratory Viruses Division
▪RESP -NET: COVID -NET, RSV -NET, FluSurv -NET
▪>300 acute -care hospitals
▪98 counties in 13 states
▪In 9 of 10 HHS regions
▪~10% of U.S. population
▪Positive SARS -CoV-2 within 14 days of or
during hospitalization
▪Screening or clinician -driven testing
▪Clinical data: representative sample of
COVID -NET patientsCOVID -NET: A RESP -NET population -based hospitalization
surveillance platform
Population -Based Rates of COVID -19-Associated
Hospitalizations — COVID -NET, March 2020 –May 2024
020406080100120140160
3/7/2020
5/7/2020
7/7/2020
9/7/2020
11/7/2020
1/7/2021
3/7/2021
5/7/2021
7/7/2021
9/7/2021
11/7/2021
1/7/2022
3/7/2022
5/7/2022
7/7/2022
9/7/2022
11/7/2022
1/7/2023
3/7/2023
5/7/2023
7/7/2023
9/7/2023
11/7/2023
1/7/2024
3/7/2024
5/7/2024Rate per 100,000 population
Week Ending DateWeekly Rates: March 2020 –May 2024
<6 months 6 months –4 years 5–11 years 12–17 years
18–49 years 50–64 years 65–74 years ≥75 yearsRates highest in ≥75 years, followed by
infants <6 months and adults 65 –74 years01002003004005006007008009001000Rate per 100,000 populationCumulative Rates: Oct 2023 –May 2024
020406080100120140160180200
10/7/2023 11/7/2023 12/7/2023 1/7/2024 2/7/2024 3/7/2024 4/7/2024 5/7/2024COVID -19-Associated Hospitalization Rate
per 100,000 population
Week ending date
White, non-Hispanic Black, non-Hispanic
American Indian/Alaska Native, non-Hispanic Asian/Pacific Islander, non-Hispanic
HispanicAge -Adjusted Cumulative Rates of COVID -19-Associated Hospitalizations
by Race and Ethnicity, All Ages — COVID -NET, October 2023 –May 2024
Percent of Weekly Hospitalizations by Age Group —
COVID -NET, March 2020 –May 2024
0%10%20%30%40%50%60%70%80%90%100%
3/7/2020
4/11/2020
5/16/2020
6/20/2020
7/25/2020
8/29/2020
10/3/2020
11/7/2020
12/12/2020
1/16/2021
2/20/2021
3/27/2021
5/1/2021
6/5/2021
7/10/2021
8/14/2021
9/18/2021
10/23/2021
11/27/2021
1/1/2022
2/5/2022
3/12/2022
4/16/2022
5/21/2022
6/25/2022
7/30/2022
9/3/2022
10/8/2022
11/12/2022
12/17/2022
1/21/2023
2/25/2023
4/1/2023
5/6/2023
6/10/2023
7/15/2023
8/19/2023
9/23/2023
10/28/2023
12/2/2023
1/6/2024
2/10/2024
3/16/2024
4/20/2024Percent of COVID -19-associated hospitalizations
Week ending date
≤17 years 18–49 years 50–64 years 65–74 years 75–84 years ≥85 yearsDuring
October 2023 –
May 2024:
•≥65: 67% of COVID -19
hospitalizations
•<65: 33% of COVID -19
hospitalizations
•≥75: 46% of COVID -19
hospitalizations
•≤17: 4% of COVID -19
hospitalizations
Epidemiology of COVID -19–associated
hospitalizations among infants, children
and adolescents
0102030405060708090100Rate per 100,000 population
Week Ending Date
<6 months 6 months –4 years 5–11 years 12–17 yearsPopulation -Based Rates of COVID -19-Associated
Hospitalizations among Children and Adolescents Ages
≤17 Years — COVID -NET, March 2020 –May 2024
050100150200250300350 Weekly Rates, March 2020 –May 2024 Cumulative Rates
October 2023 –May 2024
024681012Rate per 100,000 population
Week Ending Date
6 months –4 years 5–11 years 12–17 yearsPopulation -Based Rates of COVID -19-Associated
Hospitalizations among Children and Adolescents Ages
6 months –17 Years — COVID -NET, March 2020 –May 2024
0102030405060 Weekly Rates, March 2020 –May 2024 Cumulative Rates
October 2023 –May 2024
Underlying Medical Conditions among Infants and Children Ages ≤4
Years with COVID -19-associated Hospitalization, by Age Group —
COVID -NET, July 2023 –March 2024
051015202530354045
<6 months 6–<2 years 2–4 yearsWeighted % of hospitalizations
Asthma/Reactive airway disease Neurologic disorders Feeding tube dependence
Cardiovascular disease Obesity Immunocompromising condition
Chronic lung disease* Blood disorders Prematurity
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission.
* Not including not asthma or reactive airway disease. Among children <2 years old, chronic lung disease includes bronchopulm onary dysplasia and chronic lung disease of prematurity. •50% of infants,
children, and
adolescents ages ≤17
years with COVID -19-
associated
hospitalization have
no underlying
medical conditions .<6 months:
75% with no underlying
conditions6 months –<2 years:
58% with no underlying
conditions2–4 years:
36% with no underlying conditions
Percent of COVID -19-Associated Hospitalizations with Underlying Medical
Conditions among Children and Adolescents Ages 5 –17 Years with COVID -19-
associated Hospitalizations, by Age Group — COVID -NET, July 2023 –March 2024
47
303836
21191822
19
131517
1311
814
05101520253035404550
5–11 years 12–17 yearsWeighted % of hospitalizations
Asthma Neurologic disorders
Feeding tube dependence Cardiovascular disease
Obesity Immunocompromising condition
Chronic lung disease, not including asthma Blood disorders
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission.
Only the most common underlying conditions are presented.•50% of infants,
children, and
adolescents ages ≤17
years with COVID -19-
associated
hospitalization have
no underlying medical
conditions .
•Among COVID -19-
associated
hospitalizations,
children and
adolescents ages ≥5
years are more likely
to have underlying
medical conditions
relative to infants and
children ages ≤4 years.5–11 years:
20% with no underlying
conditions12–17 years:
22% with no underlying
conditions
Age categoryAmong all
hospitalized
children, % with
no underlying
conditionsAmong those
admitted to ICU, %
with no underlying
conditions
(n=363)
<6 months 75% 56%
6–23 months 58% 52%
2–4 years 32% 28%
5–11 years 16% 4%
12–17 years 18% 19%
Overall ≤17 Years 50% 40%Underlying Medical Conditions among Patients Admitted to ICU among
Children and Adolescents Ages ≤17 Years with COVID -19-associated
Hospitalization, July 2023 –March 2024
Among those with no
underlying conditions,
what % were admitted
to ICU?
(n=791)
18%
17%
20%
5%
28%
18%
Hospitalizations are limited to those with COVID -19 as a likely primary reason for admission.
Vaccination Status among Children and Adolescents Ages ≤17
Years with COVID -19-associated Hospitalizations, by Age Group
— COVID -NET, October 2023 –March 2024
No record of bivalent or 2023 –2024 vaccine dose : No recorded doses of COVID -19 bivalent or the 2023 -2024 vaccine dose since August 2022. Bivalent booster, but no 2023 –2024 vaccine
dose : Received COVID -19 bivalent booster vaccination but no record of receiving 2023 -2024 vaccine dose since August 2022. 2023–2024 vaccine dose: Received 2023 -2024 vaccine dose.
Persons with unknown vaccination status are excluded. Hospitalizations are limited to those with COVID -19 as the presenting complaint upon admission.86
80 79
917 18
63 3
0102030405060708090
6 months –4 years 5–11 years 12–17 yearsPercent of hospitalizations
No record of bivalent or 2023 –2024 vaccine dose
Bivalent booster, but no 2023 –2024 vaccine dose
2023 –2024 vaccine dose•5% of children and
adolescents ages
≤17 years with
COVID -19-
associated
hospitalizations
received a 2023 –
2024 vaccine dose.
Epidemiology of COVID -19–associated
hospitalizations among adults
Weekly Population -Based Rates of COVID -19-Associated
Hospitalizations among Adults Ages ≥18 Years — COVID -NET,
March 2020 –May 2024
020406080100120140160
3/7/2020 3/7/2021 3/7/2022 3/7/2023 3/7/2024Rate per 100,000 population
Week Ending Date
18–49 years 50–64 years 65–74 years ≥75 years020040060080010001200
10/7/2023
11/7/2023
12/7/2023
1/7/2024
2/7/2024
3/7/2024
4/7/2024
5/7/2024Rate per 100,000 populationWeekly Rates, March 2020 –May 2024 Cumulative Rates
October 2023 –May 2024
1521
1722
191824
1623
0510152025
Jan-Mar 2022 Apr-Jun 2022 Jul-Sep 2022 Oct-Dec 2022 Jan-Mar 2023 Apr-Jun 2023 Jul-Sep 2023 Oct-Dec 2023 Jan-Mar 2024Weighted % of COVID -19-Associated HospitalizationsPercent of COVID -19-associated hospitalizations admitted from a long -term care facility
among adults ages ≥65 years, by quarter — COVID -NET, January 2022 –March 2024During January 2022 –March 2024, 19% of COVID -19-associated hospitalizations
among adults ages ≥65 years were residents of a long -term care facility.
Cumulative In -Hospital Death Rate during COVID -19-Associated
Hospitalization per 100,000 Population by Age Group —
COVID -NET, October 2023 –March 2024
0.562762
010203040506070
18–49 years 50–64 years 65–74 years ≥75 yearsIn-hospital death rate per
100,000 population
Age group
18–49 years 50–64 years 65–74 years ≥75 years
3% 15% 32% 50%Weighted
percent of in -
hospital deaths
by age group
Vaccination Status among Adults Ages ≥18 Years with COVID -19-
associated Hospitalization, by Age Group — COVID -NET, October
2023 –March 2024
78
65
58
48
19293436
36816
0102030405060708090
18–49 years 50–64 years 65–74 years ≥75 yearsPercent of hospitalizations
No record of bivalent or 2023 –2024 vaccine dose
Bivalent booster, but no 2023 –2024 vaccine dose
2023 –2024 vaccine dose
No record of bivalent or 2023 –2024 vaccine dose : No recorded doses of COVID -19 bivalent or 2023 -2024 vaccine dose since August 2022. Bivalent booster, but no 2023 –2024 vaccine dose :
Received COVID -19 bivalent booster vaccination but no record of receiving 2023 –2024 vaccine dose since August 2022. 2023–2024 vaccine dose: Received 2023 -2024 vaccine dose. Persons
with unknown vaccination status are excluded. •11% of adults ages
≥18 years with
COVID -19-associated
hospitalizations
received a 2023 –
2024 vaccine dose.
•57% of COVID -19-
associated
hospitalizations
among adults ages
≥18 years had not
received a COVID -19
vaccine after August
2022.
Percent of COVID -19-associated Hospitalizations among Adults Ages ≥18 Years with
Underlying Medical Conditions, by Age Group, with Top 4 Categories Highlighted —
COVID -NET, July 2023 –March 2024
Condition 18–49 years 50–64 years 65–74 years ≥75 years
Chronic lung disease 26 41 51 40
Asthma 19 17 17 10
COPD/Bronchitis 4 19 30 19
Cardiovascular disease 26 56 65 72
CAD/CABG/MI 4 18 34 32
CHF/Cardiomyopathy 8 23 29 29
Stroke/TIA 5 18 13 20
Diabetes 19 41 40 34
Immunocompromising condition 12 22 22 11
Neurologic condition 23 32 29 46
Renal Disease 12 25 25 33
Severe obesity (BMI ≥40 kg/m²) 16 14 6 3
COPD: chronic obstructive pulmonary disease; CAD: coronary artery disease; CABG: coronary artery bypass graft; TIA: transient ischemic attack
Pink cells indicate the 4 most common underlying medical conditions within each age group; dark pink cells indicate the most com mon condition.
We used 3 data sources to calculate COVID -19–associated
hospitalization rates by chronic condition and age group
Numerator
Denominator
•COVID -19–Associated Hospitalization
Surveillance Network (COVID –NET)•Behavioral Risk Factor Surveillance
System (BRFSS)
•Census population counts
Prevalence of chronic conditions among hospitalized adults in COVID -NET,
adults in COVID -NET states, and adults in the United States aged ≥18 years, 2022
Data are preliminary and subject to change. Obesity is defined as BMI 30 –39 kg/m²; severe obesity is defined as BMI ≥40 kg/m². O nly includes community dwelling residents. Non -community
dwelling persons, including those who resided in a long -term care facility upon admission, are excluded. COVID -19-related admiss ions are those where the primary reason for admission is
COVID -19-related illness. Prevalence data from COVID -NET states and United states are obtain from the Behavioral Risk Factor Sur veillance System, 2022 data.
•Except for asthma and obesity,
unadjusted prevalence is higher
among hospitalized COVID -19
patients relative to the general
population
•In adjusted models, except for
obesity, all other 8 conditions
examined were found to increase
the risk for COVID -19-associated
hospitalization.
•Magnitude of increased risk
varied by condition and age
group.
•Age ≥75 remains a strong risk
factor for hospitalization even in
adjusted models
•Results are limited to community -
dwelling adultsUnadjusted prevalence (%)
with 95% confidence intervals
▪Rates of COVID -19-associated hospitalizations highest among those
≤4 years
▪Rates highest among infants ages <6 months who are not vaccine
eligible and require a different approach for prevention (e.g.,
maternal vaccination)
▪50% have no underlying medical conditions
•Among children with no underlying medical conditions, 18% were
admitted to the ICU
▪October 2023 –March 2024: 5% of hospitalized children 6 months – ≤
17 years had received a 2023 –2024 vaccine prior to admissionSummary – Infants, Children, and Adolescents
▪2/3 of all COVID -19-associated hospitalizations among those aged
≥65 years
▪During October 2023 –March 2024, 11% of hospitalized adult patients
had received a 2023 –2024 vaccine dose prior to admission
▪Underlying conditions increase risk for hospitalization, but age
remains strongly associated with the risk for hospitalizationSummary – Adults
Coronavirus and Other Respiratory
Viruses Division
Chris Taylor
Huong Pham
Sarah Hamid
Gordana Derado
Megan Wallace
Lakshmi Panagiotakopoulos
Katherine Fleming -DutraOther CDC staff
Rebecca Woodruff
RESP -NET Site investigators and staffAcknowledgements
For more information, contact CDC
1-800 -CDC -INFO (232 -4636)
TTY: 1 -888 -232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation
use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.