By Stan Deresinski, MD, FACP, FIDSA

Clinical Professor of Medicine, Stanford University

SYNOPSIS: The need for hospitalization because of COVID-19 is significantly less in adolescents than in older age groups, but nearly one-third of those hospitalized require intensive care unit admission.

SOURCE: Havers FP, Whitaker M, Self JL, et al. Hospitalization of adolescents aged 12-17 years with laboratory-confirmed COVID-19 — COVID-NET, 14 States, March 1, 2020-April 24, 2021. MMWR Morb Mortal Wkly Rep 2021; June 4. doi: http://dx.doi.org/10.15585/mmwr.mm7023e1

Havers and colleagues examined the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-19) to assess hospitalizations of individuals 12-17 years of age with positive SARS-CoV-2 tests in the United States. From January 1 to March 31, 2021, they identified 376 such cases, of whom 204 were likely to have been admitted primarily because of COVID-19. Of these, 52.5% were female, 31.4% were Hispanic, and 35.8% were non-Hispanic Black. Comorbidities were present in 70.1%, with the most frequent being obesity (35.8%), chronic lung disease including asthma (30.9%), and neurologic disorders (14.2%). Although no patient died, 31.4% required intensive care and 4.9% needed mechanical ventilation.

Hospitalizations for COVID-19 in adolescents 12-17 years of age were 12.5 times lower than in adults > 18 years of age but were similar to those patients 4 years of age and higher than in children 5-11 years of age. (See Figure 1.) Hospitalizations for COVID-19 in this age group were 2.5 to 3.0 times higher from Oct. 1, 2020, to April 24, 2021, than those for influenza virus infections over three recent influenza seasons.

Figure 1: Three-Week Moving Average COVID-19-Associated Hospitalization Rates* Among Children and Adolescents Aged < 18 Years, by Group — COVID-NET, 14 States, March 1, 2020-April 24, 2021

Abbreviation: COVID-NET = Coronavirus Disease 2019–Associated Hospitalization Surveillance Network.

* Number of patients with laboratory-confirmed COVID-19–associated hospitalizations per 100,000 population.

† COVID-NET sites are in the following 14 states: California, Colorado, Connecticut, Georgia, Iowa, Maryland, Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah.

Source: Centers for Disease Control and Prevention

COMMENTARY

The Pfizer-BioNTech COVID-19 mRNA vaccine is highly effective in adolescents 12 through 15 years of age with no signal of significant adverse effects in its pivotal clinical trial.1 It received Emergency Use Authorization for administration to individuals 12 through 15 years of age on May 19, 2021, and two days later it was recommended for this use by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices.2 The Moderna mRNA vaccine also has been submitted for review by the Food and Drug Administration for Emergency Use Authorization.

This survey demonstrates that, while the need for hospitalization is significantly less frequent in adolescents with COVID-19 than it is in older age groups, it is greater than that seen with influenza and is potentially serious, requiring intensive care unit admission in close to one-third and even mechanical ventilation in some. This was true despite the fact that 29.9% had no associated comorbidity.

These data provide support to the recommended vaccination of this age group. However, the issue has become complicated because of recent reports of the development of myocarditis/pericarditis after vaccination in individuals 16-24 years of age, particularly in males.3,4 

REFERENCES

  1. Frenck RW Jr, Klein NP, Kitchin N, et al; C4591001 Clinical Trial Group. Safety, immunogenicity, and efficacy of the BNT162b2 Covid-19 vaccine in adolescents. N Engl J Med 2021; May 27. doi: 10.1056/NEJMoa2107456. [Online ahead of print].
  2. Wallace M, Woodworth KR, Gargano JW, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine in Adolescents Aged 12-15 Years - United States, May 2021. MMWR Morb Mortal Wkly Rep 2021;70:749-752.
  3. Centers for Disease Control and Prevention. COVID-19 VaST Work Group Report – May 24, 2021. https://www.cdc.gov/vaccines/acip/work-groups-vast/report-2021-05-24.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Facip%2Fwork-groups-vast%2Ftechnical-report-2021-05-24.html
  4. Vogel G, Couzin-Frankel J. Israel reports link between rare cases of heart inflammation and COVID-19 vaccination in young men. Science June 1, 2021. https://www.sciencemag.org/news/2021/06/israel-reports-link-between-rare-cases-heart-inflammation-and-covid-19-vaccination