Looking at the epidemiology of COVID-19 in pediatrics


A new study examines the epidemiology of pediatric COVID-19 cases in a large cohort.

The complete toll of COVID-19 will not be known for quite some time. However, a study in JAMA Pediatrics offers some insight into the epidemiology of the disease in pediatric patients across the United States.1

Investigators ran a retrospective cohort study that used data from electronic health records. They looked for patients aged younger than 25 years who had been tested for SARS-CoV-2, the virus that causes COVID-19, from January 1, 2020 through September 8, 2020. They used data from PEDSnet, which is a network of 7 US pediatric hospital systems, which covers 6.5 patients from 11 states.

A total of 135,795 patients were tested for SARS-CoV-2; 5374 of those tested were found to be infected with COVID-19 (12 per 10 000 population [range, 7-16 per 10 000 population]). When compared to white patients, Black, hispanic, and Asian children and young adults were found to have lower rates of testing (Black: odds ratio [OR], 0.70 [95% CI, 0.68-0.72]; hispanic: OR, 0.65 [95% CI, 0.63-0.67]; Asian: OR, 0.60 [95% CI, 0.57-0.63]). Unfortunately, these race/ethnicity groups are also significantly more likely to have positive test results (Black: OR, 2.66 [95% CI, 2.43-2.90]; Hispanic: OR, 3.75 [95% CI, 3.39-4.15]; Asian: OR, 2.04 [95% CI, 1.69-2.48]). Increased risk of infection was linked to public payer (OR, 1.43 [95% CI, 1.31-1.57]), emergency department testing (OR, 3.16 [95% CI, 2.72-3.67]), older age 5-11 years: OR, 1.25 [95% CI, 1.13-1.38]; 12-17 years: OR, 1.92 [95% CI, 1.73-2.12]; 18-24 years: OR, 3.51 [95% CI, 3.11-3.97]), and outpatient testing (OR, 2.13 [1.86-2.44]). Following univariate analysis, the researchers found that nonmalignant chronic disease was linked to lower likelihood of testing and preexisiting respiratory conditions were linked to a lower risk of positive test results (standardized ratio [SR], 0.78 [95% CI, 0.73-0.84]). A higher risk of positive test results were linked to a number of diagnosis groups, including:

  • cardiac disorders (SR, 1.18 [95% CI, 1.05-1.32]),
  • endocrinologic disorders (SR, 1.52 [95% CI, 1.31-1.75]),
  • gastrointestinal disorders (SR, 2.00 [95% CI, 1.04-1.38]),
  • genetic disorders (SR, 1.19 [95% CI, 1.00-1.40]),
  • hematologic disorders (SR, 1.26 [95% CI, 1.06-1.47]),
  • malignant disorders (SR, 1.54 [95% CI, 1.19-1.93]),
  • mental health disorders (SR, 1.20 [95% CI, 1.10-1.30]),
  • metabolic disorders (SR, 1.42 [95% CI, 1.24-1.61]), and
  • musculoskeletal disorders (SR, 1.18 [95% CI, 1.07-1.30])

Among the patients who were found to be positive for COVID-19, 359 patients were hospitalization for hypotensive, respiratory, or COVID-19 specific illness. Intensive care unit services were needed for 99 of those who were hospitalized and 33 needed mechanical ventilation. The overall case fatality rate in this cohort was 0.2%.

The researchers concluded that COVID-19 infection rates were low and often mild in pediatric cases. Additionally, a number of factors were linked to identified infection such as nonrespiratory chronic medical conditions as well as adolescence and young adulthood.


1. Bailey L, Razzaghi H, Burrows E, et al. Assessment of 135,794 pediatric patients tested for severe acute respiratory syndrome coronavirus 2 across the United States. JAMA Pediatr. November 23, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.5052

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Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief, Contemporary Pediatrics, professor of pediatrics, Feinberg School of Medicine, Northwestern University, pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago
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