Comparison of Influenza and Coronavirus Disease 2019–Associated Hospitalizations Among Children Younger Than 18 Years Old in the United States: FluSurv-NET (October–April 2017–2021) and COVID-NET (October 2020–September 2021)
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Abstract
Background
Influenza virus and SARS-CoV-2 are significant causes of respiratory illness in children.
Methods
Influenza- and COVID-19–associated hospitalizations among children <18 years old were analyzed from FluSurv-NET and COVID-NET, 2 population-based surveillance systems with similar catchment areas and methodology. The annual COVID-19–associated hospitalization rate per 100 000 during the ongoing COVID-19 pandemic (1 October 2020–30 September 2021) was compared with influenza-associated hospitalization rates during the 2017–2018 through 2019–2020 influenza seasons. In-hospital outcomes, including intensive care unit (ICU) admission and death, were compared.
Results
Among children <18 years, the COVID-19–associated hospitalization rate (48.2) was higher than influenza-associated hospitalization rates: 2017–2018 (33.5), 2018–2019 (33.8), and 2019–2020 (41.7). The COVID-19–associated hospitalization rate was higher among adolescents 12–17 years old (COVID-19: 59.9; influenza range: 12.2–14.1), but similar or lower among children 5–11 (COVID-19: 25.0; influenza range: 24.3–31.7) and 0–4 (COVID-19: 66.8; influenza range: 70.9–91.5) years old. Among children <18 years, a higher proportion with COVID-19 required ICU admission compared with influenza (26.4% vs 21.6%; P < .01). Pediatric deaths were uncommon during both COVID-19– and influenza-associated hospitalizations (0.7% vs 0.5%; P = .28).
Conclusions
In the setting of extensive mitigation measures during the COVID-19 pandemic, the annual COVID-19–associated hospitalization rate during 2020–2021 was higher among adolescents and similar or lower among children <12 years compared with influenza during the 3 seasons before the COVID-19 pandemic. COVID-19 adds substantially to the existing burden of pediatric hospitalizations and severe outcomes caused by influenza and other respiratory viruses.
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SciScore for 10.1101/2022.03.09.22271788: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Sites participating in FluSurv-NET and COVID-NET obtained human subjects and ethics approvals from their respective state and local health department and academic partner Institutional Review Boards as needed. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Influenza occurs seasonally in the United States with low detection during May–September [15,16], suggesting few influenza-associated hospitalizations are missed outside the October–April surveillance window. May–Septembersuggested: NoneStatistical analyses were performed in SAS version 9.4 (SAS Institute). SAS …SciScore for 10.1101/2022.03.09.22271788: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Sites participating in FluSurv-NET and COVID-NET obtained human subjects and ethics approvals from their respective state and local health department and academic partner Institutional Review Boards as needed. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Influenza occurs seasonally in the United States with low detection during May–September [15,16], suggesting few influenza-associated hospitalizations are missed outside the October–April surveillance window. May–Septembersuggested: NoneStatistical analyses were performed in SAS version 9.4 (SAS Institute). SAS Institutesuggested: (Statistical Analysis System, RRID:SCR_008567)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Several limitations should be considered. First, children meeting COVID-NET and FluSurv-NET criteria may have been hospitalized for reasons other than COVID-19 [2] or influenza. This may have been more common for COVID-19 compared with influenza due to SARS-CoV-2 screening practices, which were universal among hospitalized patients at some facilities during certain time periods. While COVID-19 or influenza may not have been the primary reason for admission for all hospitalizations, such cases were included in rate calculations because use of a standard and consistent surveillance case definition allows for robust monitoring of trends over time. Among cases with influenza or SARS-CoV-2 incidentally identified, it is unclear what impact the infection ultimately had on the decision to hospitalize a patient, the hospitalization course, or in-hospital outcomes. In sensitivity analyses limited to hospitalizations where children had ≥ 1 symptom at admission or COVID-19 as the primary reason for admission, the proportions of children with severe outcomes were similar to proportions with severe outcomes when all hospitalizations were included. Second, COVID-19- and influenza-associated hospitalizations might have been missed because case identification was reliant on clinician-directed or facility-based testing practices and test availability, which varied across time and facilities. Under-detection of influenza was likely greater than for COVID-19 due to under-utilization of seasonal...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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