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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
Infants, Children and Adults —COVID -NET, January –
August 2023
ACIP , September 12, 2023
Fiona P . Havers, MD, MHS
Team Lead, 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
2
Weekly Population -Based Rates of COVID -19-Associated
Hospitalizations —COVID -NET, March 2020 –August 26,
2023
020406080100120140
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
7/7/2023Rate per 100,000 population
Week Ending DateMarch 1, 2020 –August 26, 2023
<6 months 6 months –4 years 5–11 years 12–17 years
18–49 years 50–64 years 65–74 years ≥75 years020406080100120140Rate per 100,000 population
Week Ending DateJanuary 1 –August 26, 2023
Gray boxes indicate potential reporting delays. Interpretation of trends should be excluded from these weeks. Rates highest in ≥75 years, followed by
infants <6 months and adults 65 –74 years
3
Epidemiology of COVID -19–associated
hospitalization among children
01020304050607080Rate per 100,000 population
Week Ending Date
<6 months 6 months –4 years 5–11 years 12–17 years
Gray boxes indicate potential reporting delays. Interpretation of trends should be excluded from these weeks. Weekly Population -Based Rates of COVID -19-Associated
Hospitalizations among Infants, Children, and Adolescents
≤17 Years —COVID -NET, March 2020 –August 26, 2023
5
Gray boxes indicate potential reporting delays. Interpretation of trends should be excluded from these weeks. 02468101214161820
3/7/2020 6/7/2020 9/7/2020 12/7/2020 3/7/2021 6/7/2021 9/7/2021 12/7/2021 3/7/2022 6/7/2022 9/7/2022 12/7/2022 3/7/2023 6/7/2023Rate per 100,000 population
Week Ending Date
6-23 months 2-4 years 5–11 years 12–17 yearsFocus on 6 months -17 years of ageWeekly COVID -19-Associated Hospitalization Rates among
Infants, Children and Adolescents Ages 6 months –≤17 Years
—COVID -NET, March 2020 –August 26, 2023
6
Percent of COVID -19-Associated Hospitalizations with Underlying
Medical Conditions among Children and Adolescents Ages 5 –17 Years
by Age Group —COVID -NET, January –June 2023
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission. Figure displays underlying medical conditions present in ≥5% in ≥1 age group.•54% of hospitalized
infants, children, and
adolescents ages
≤17 years have no
underlying medical
conditions .
•Hospitalizations
children and
adolescents ages ≥5
years are more
likely to have
underlying medical
conditions relative
to children and
infants ages ≤4
years.0510152025303540
<6 months 6–<2 years 2–4 years 5–11 years 12–17 yearsWeighted % of COVID -19 associated
hospitalizations
Prematurity Asthma
Neurologic disorders Obesity
Immunocompromising condition Cardiovascular disease
Feeding tube dependence Chronic lung disease, not including asthma
Blood disorders Chronic metabolic diseases, including diabetes34% with no
underlying
conditions59% with no
underlying
conditions42% with no
underlying
conditions23% with no
underlying
conditions75% with no
underlying
conditions
7
050100150200250
10/9/2021 1/9/2022 4/9/2022 7/9/2022Rate per 100,000 population
Week Ending Date
≤4 years (COVID -19) ≤4 years (Influenza)
5–11 years (COVID -19) 5–11 years (Influenza)
12–17 years (COVID -19) 12–17 years (Influenza)050100150200250
10/8/2022 11/26/2022 1/14/2023 3/4/2023 4/22/2023 6/10/2023Rate per 100,000 population
Week Ending Date
≤4 years (COVID -19) ≤4 years (Influenza)
5–11 years (COVID -19) 5–11 years (Influenza)
12–17 years (COVID -19) 12–17 years (Influenza)Cumulative Weekly Rates of COVID -19-and Influenza -Associated
Hospitalizations among Infants, Children, and Adolescents Ages
≤17 Years —COVID -NET and FluSurv -NET*, October 2021 —July 2023
October 2022 –July 2023 October 2021 –September 2022
* Influenza Hospitalization Surveillance Network. Seasonal FluSurv -NET surveillance was extended into June for the 2021 -2022 season. Surveillance ended on April 30, 2023, for the 2022 –2023
season. Hospitalization rates are among those with laboratory -confirmed influenza and SARS -CoV-2 and are not adjusted for likely reason for admission. 8
212726 2532
1619
17 1723
05101520253035
<6 months 6 months –<2 years 2–4 years 5–11 years 12–17 yearsPercent of Hospitalizations
COVID-19 InfluenzaPercent of COVID -19-and Influenza -Associated Hospitalizations
with ICU Admission among Infants, Children, and Adolescents
by Age Group —COVID -NET and FluSurv -NET*, October 2022 –
April 2023
•Influenza Hospitalization Surveillance Network
Limited to COVID -NET hospitalizations with COVID -19-related illness as likely reason for admission9
Vaccination Status by Age Group among Infants, Children and
Adolescents Ages ≤17 Years Hospitalized for COVID -19 —
COVID -NET, January –June 2023
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission. Unvaccinated : No recorded doses of COVID -19 vaccine. Vaccinated, but no bivalent booster :
Completed a primary series with or without ≥1 booster dose but did not receive an updated bivalent booster dose. Updated bivalent booster : Received updated bivalent booster dose.
Partially vaccinated : Received at least one dose of COVID -19 but was not considered fully vaccinated at the time of a positive SARS -CoV-2 test. Pers ons with unknown vaccination status
are excluded. 86
63
268
28
634 6
0%10%20%30%40%50%60%70%80%90%100%
6 months –4 years 5–11 years 12–17 yearsPercent of COVID -19-asssoicated
hospitalizations
Unvaccinated Vaccinated, but no bivalent booster Updated bivalent booster Partially vaccinated
10
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 –August 2023
020406080100120140Rate per 100,000 population
Week Ending DateMarch 1, 2020 –August 26, 2023 (entire pandemic period)
18–49 years 50–64 years 65–74 years ≥75 years020406080100120140Rate per 100,000 population
Week Ending DateJanuary 1 –August 26, 2023
Gray boxes indicate potential reporting delays. Interpretation of trends should be excluded from these weeks. 12
Underlying Medical Conditions among Adults Ages ≥18 Years Hospitalized
for COVID -19, by Age Group —COVID -NET, January –June 2023
274966
2238 39
31
263640 41
29
23
17
102133 33
141716
814
614
7525 413 1224
92528
010203040506070
18–49 years 50–64 years ≥65 yearsWeighted % of hospitalizations
Cardiovascular disease Diabetes
Neurologic disorders Obesity
Asthma Chronic lung disease, not including asthma
Immunocompromising condition Gastrointenstinal/liver Disease
Blood disorders Autoimmune/inflammatory disease
Chronic metabolic disease, not including diabetes Renal disease
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission.18–49 years:
58% with ≥3 underlying
conditions50–64 years:
72% with ≥3 underlying
conditions≥65 years:
81% with ≥3 underlying
conditions
13
Cumulative Weekly Rates of COVID -19-and Influenza -
Associated Hospitalizations among Adults Ages ≥18 Years —
COVID -NET and FluSurv -NET*, October 2022 –July 2023
050100150200250
10/8/2022 12/8/2022 2/8/2023 4/8/2023 6/8/2023Rate per 100,000 population
Week Ending DateAdults ages 18 –64 years
18–49 years (COVID -19) 18–49 years (Influenza)
50–64 years (COVID -19) 50–64 years (Influenza)
* Influenza Hospitalization Surveillance Network. Seasonal FluSurv -NET surveillance ended on April 30, 2023, for the 2022 –2023 season.05001000150020002500
10/8/2022 12/8/2022 2/8/2023 4/8/2023 6/8/2023Rate per 100,000 population
Week Ending DateAdults ages ≥65 years
65–74 years (COVID -19) 65–74 years (Influenza)
75–84 years (COVID -19) 75–84 years (Influenza)
≥85 years (COVID -19) ≥85 years (Influenza)
14
Percent of COVID -19-and Influenza -Associated Hospitalizations with
ICU admission among Adults by Age Group —COVID -NET and FluSurv -
NET*, 13 States, October 2022 –April 2023
•Influenza Hospitalization Surveillance Network
Limited to COVID -NET hospitalizations with COVID -19-related illness as likely reason for admission1922
18
711141817
12
8
0510152025
18–49 years 50–64 years 65–74 years 75–84 years ≥85 yearsPercent of COVID -19-and
Influenza -associated Hospitalizations
COVID-19 Influenza
15
Percent of COVID -19-and Influenza -Associated Hospitalizations with in -
hospital death among Adults by Age Group —COVID -NET and FluSurv -
NET*, 13 States, October 2022 –April 2023
2.14.06.4
4.9
4.1
0.72.93.14.34.6
01234567
18–49 years 50–64 years 65–74 years 75–84 years ≥85 yearsPercent of COVID -19-and
Influenza -associated Hospitalizations
COVID-19 Influenza
•Influenza Hospitalization Surveillance Network
Limited to COVID -NET hospitalizations with COVID -19-related illness as likely reason for admission16
Vaccination Status by Age Group among Non -Pregnant
Adults Ages ≥18 Years Hospitalized for COVID -19 —COVID -
NET, January –June 2023
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission. Unvaccinated : No recorded doses of COVID -19 vaccine. Vaccinated, but no bivalent booster :
Completed a primary series with or without ≥1 booster dose but did not receive an updated bivalent booster dose. Updated bivalent booster : Received updated bivalent booster dose.
Partially vaccinated : Received at least one dose of COVID -19 but was not considered fully vaccinated at the time of a positive SARS -CoV-2 test. Pers ons with unknown vaccination status
are excluded. 3526171153
58
61698 131919
0%10%20%30%40%50%60%70%80%90%100%
18–49 years 50–64 years 65–74 years ≥75 yearsPercent of COVID -19-associated
hospitalizations
Unvaccinated Vaccinated, but no bivalent booster Updated bivalent booster Partially vaccinated
17
▪Hospitalization rates increased in all age groups since mid -July
▪Hospitalization rates highest in older adults and infants <6 months
▪Most children <5 years hospitalized with COVID -19 illness have no underlying medical
conditions
–A higher proportion of hospitalized children and adolescents 5 -17 years have
underlying medical conditions
–Most hospitalized adults have multiple underlying medical conditions
▪COVID -19 continues to cause severe illness; clinical outcomes generally comparable to
influenza -associated hospitalizations
▪Most children and adults hospitalized for COVID -19 since January 2023 had not
received an updated bivalent boosterCOVID -19-associated hospitalizations
18
Coronavirus and Other Respiratory
Viruses Division
Chris Taylor
Kadam Patel
Meredith McMorrow
Influenza Division
Shikha Garg
Catherine Bozio
Alissa O’Halloran
Dawud UjamaaRESP -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.