Global Epidemiology And Prevention Of COVID-19

CDC Coronavirus Disease 2019 ResponseEpidemiology ofCOVID-19 in Childrenand TeensAngela Campbell, MD, MPH, FPIDS, FIDSAVirtual ACIP Emergency MeetingJanuary 27, 2021For more information: www.cdc.gov/COVID19

Outline Overview of U.S. COVID-19 Epidemiology Epidemiology of COVID-19 in Children and Teens Multisystem Inflammatory Syndrome in Children (MIS-C)2

Overview of U.S. COVID-19Epidemiology

Trends in Number of COVID-19 Cases in the United StatesJanuary 22, 2020, to January 24, 2021350000Number of COVID-19 Cases300000250000200000150000100000500000Jan 22 2020 Mar 7 2020 Apr 21 2020 Jun 5 2020Jul 20 2020 Sep 3 2020 Oct 18 2020 Dec 2 2020 Jan 16 tml#trends4

Trends in Number of COVID-19 Deaths in the United StatesJanuary 22, 2020, to January 24, 20217000Number of COVID-19 Deaths6000500040003000200010000Jan 22 2020Mar 7 2020Apr 21 2020Jun 5 2020Jul 20 2020Sep 3 2020Oct 18 2020Dec 2 2020Jan 16 tml#trends5

Epidemiology of COVID-19 in Childrenand Teens

COVID-19 Reported Incidence by Age Group: Lowest inChildren 18 YearsNational Estimate of COVID-19 Incidence per 100,000 Population,by Age Group – Data through Jan 24, 202185 7243Age Group 1218-2980625-1731400-41800010002000 3000 4000 5000 6000 7000COVID-19 Incidence per 100,000 Population80009000Updated as of 1/24/21. Data are based on COVID-19 case-level data reported by state and territorial jurisdictions to CDC. The numbers are confirmed and probable COVID-19cases as reported by U.S. states, territories, New York City, and the District of Columbia from the previous tml#demographics7

Estimated SARS-CoV-2 Infection Rates per 100,000Population Adjusting for Under Detection35,00030,602Infection rate per 5,00010,0005,00000-4 yrs5-17 yrs18-49 yrs50-64 yrs 65 yrsAge es-updates/burden.html8

Estimated SARS-CoV-2 Seroprevalence in Children 18Years, Mississippi, May–Sept 2020SARS-CoV-2 Serology ResultsCharacteristic Residual serum samples fromroutine laboratory testing University of MississippiMedical CenterNo.Positive%1,60317510.9Black, non-Hispanic90111713.0Hispanic691623.2Other, non-Hispanic44715.9White, non-Hispanic565305.3May 17-31, 202017463.5June 1-30, 2020447286.3July 1-31, 20203393510.3August 1-31, 20203685615.2September 1-19, 20202755018.2OverallRace/EthnicityDates of specimen collectionC. Hobbs, et al. CDC COVID-19Response Team, unpublished data9

Estimated SARS-CoV-2 Seroprevalence in Children 18Years, Mississippi, May–Sept 2020SARS-CoV-2 Serology ResultsCharacteristic Residual serum samples fromroutine laboratory testing University of MississippiMedical CenterNo.Positive%1,60317510.9Black, non-Hispanic90111713.0Hispanic691623.2Other, non-Hispanic44715.9White, non-Hispanic565305.3May 17-31, 202017463.5June 1-30, 2020447286.3July 1-31, 20203393510.3August 1-31, 20203685615.2September 1-19, 20202755018.2OverallRace/EthnicityDates of specimen collectionC. Hobbs, et al. CDC COVID-19Response Team, unpublished data10

Estimated SARS-CoV-2 Seroprevalence in Children 18Years, Mississippi, May–Sept 2020SARS-CoV-2 Serology ResultsCharacteristic Residual serum samples fromroutine laboratory testing University of MississippiMedical CenterNo.Positive%1,60317510.9Black, non-Hispanic90111713.0Hispanic691623.2Other, non-Hispanic44715.9White, non-Hispanic565305.3May 17-31, 202017463.5June 1-30, 2020447286.3July 1-31, 20203393510.3August 1-31, 20203685615.2September 1-19, 20202755018.2OverallRace/EthnicityDates of specimen collectionC. Hobbs, et al. CDC COVID-19Response Team, unpublished data11

Estimated SARS-CoV-2 Seroprevalence in Children 18Years, Mississippi, May–Sept 2020SARS-CoV-2 Serology ResultsCharacteristic Residual serum samples fromroutine laboratory testing University of MississippiMedical CenterNo.Positive%1,60317510.9Black, non-Hispanic90111713.0Hispanic691623.2Other, non-Hispanic44715.9White, non-Hispanic565305.3May 17-31, 202017463.5June 1-30, 2020447286.3July 1-31, 20203393510.3August 1-31, 20203685615.2September 1-19, 20202755018.2OverallRace/EthnicityDates of specimen collectionC. Hobbs, et al. CDC COVID-19Response Team, unpublished data12

Case-Ascertained Household Transmission Study,Tennessee and Wisconsin,* April–Nov 2020Short-term follow-up:Periodic/dailyfollow-up andsample collection* Vanderbilt University Medical Center;Marshfield Clinic Research Institute Non-infected InfectedFLUTES-C Study. Grijalva, et al. MMWR 2020;69(44):1631-3413

Case-Ascertained Household Transmission Study,Tennessee and Wisconsin: Enrolled Participants 147 index cases enrolled, median 3.5 days after onset (IQR: 3–4 days) 306 household contacts enrolled 12 years18–49 years12–17 years50–64 years 65 yearsIndex cases (22 children)Household contacts(118 children)0%10%20%30%40%50%60%70%80%90%100%FLUTES-C Study. Preliminary data, subject to change14

Younger Children Were Less Likely to Be Symptomatic andHave Fewer Symptoms than Adults100% 12 years12–17 years 18 seNasalFatiguecongestionShortness Loss of Headacheof breath taste/smellSymptoms reported during follow-upSample size for each category: 12 years, n 14; 12-17 years, n 8; 18 years, n 56FLUTES-C Study. Preliminary data, subject to change15

Secondary Infection Rates: Symptomatic Children Seemto Transmit SARS-CoV-2 Less than Adults(excluding possible co-primary and tertiary cases)FLUTES-C Study. Preliminarydata, subject to change16

Children Exposed in the Household Had Similar Risk ofSARS-CoV-2 Infection as Adults(excluding possible co-primary and tertiary cases)FLUTES-C Study. Preliminarydata, subject to change17

Secondary Infection Rates Similar Among Pediatric and AdultHousehold Contacts: Utah and Wisconsin, March–May 2020N 188Laws RL, et al. Pediatrics. 2020; doi:10.1542/peds.2020-02726818

COVID-19 Hospitalization Ratesper 100,000 populationChildren 18 years have the Lowest Cumulative Rate ofCOVID-19 Associated Hospitalizations500March 1, 2020 – January 2, 202118 years45040035030025020015010050010 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52MMWR Week10-4 years5-17 yearsCOVID-19 associated hospitalizations reported to Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) surveillance systembetween March 1 and January 2, 2021. COVID-NET is a population-based surveillance system that collects data on laboratory-confirmed COVID-19-associatedhospitalizations among children and adults through a network of over 250 acute-care hospitals in 14 states.https://gis.cdc.gov/grasp/COVIDNet/COVID19 3.html19

Children with Certain Underlying Conditions May Be MoreLikely to Have Severe Illness from COVID-19 Asthma or chronic lung disease Diabetes Genetic, neurologic, or metabolicconditions Sickle cell disease Heart disease since birth Immunosuppression Medical complexity aily-life-coping/children/symptoms.html20

52% of Children 18 Years Hospitalized with COVID-19Had an Underlying ConditionMarch 1 – September 30, 2020ObesityAsthmaImmunocompromisedChronic lung diseaseCardiovascular diseaseSickle cell diseaseDiabetesCerebral palsyDown syndromeHypertensionRenal disease051015202530354045Weighted Percent of Hospitalized Persons Aged 18N 823, COVID-19-associated hospitalizations reported to Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) surveillancesystem between March 1 and September 30, 2020. COVID-NET is a population-based surveillance system that collects data on laboratory-confirmed COVID-19-associatedhospitalizations among children and adults through a network of over 250 acute-care hospitals in 14 states.https://gis.cdc.gov/grasp/COVIDNet/COVID19 5.html21

Children 18 Years Hospitalized with COVID-19 Are Less LikelyThan Adults to Experience Mechanical Ventilation or InHospital DeathMarch 1 – September 30, 2020Weighted Percent of Hospitalized Persons35302520151050Intensive care unitMechanical ventilation0-4 years5-17 yearsIn-hospital deathAll agesN 823, COVID-19-associated hospitalizations reported to Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) surveillancesystem between March 1 and September 30, 2020. COVID-NET is a population-based surveillance system that collects data on laboratory-confirmed COVID-19-associatedhospitalizations among children and adults through a network of over 250 acute-care hospitals in 14 states.https://gis.cdc.gov/grasp/COVIDNet/COVID19 5.html22

COVID-19 Mortality Rates Are Lowest Among Children 18 YearsNational Estimate of COVID-19 Deaths per 100,000 Population, by Age Group –Data through Jan 24, 202185 1,514.8Age Group 8.018-292.95-170.30-40.402004006008001,000 1,200Death Rate per 100,000 Population1,4001,600Updated as of 1/24/21. Data are based on COVID-19 case-level data reported by state and territorial jurisdictions to CDC. The numbers are confirmed and probable COVID-19cases as reported by U.S. states, territories, New York City, and the District of Columbia from the previous tml#demographics23

Multisystem Inflammatory Syndrome inChildren (MIS-C)

Multisystem Inflammatory Syndrome in Children April 2020 – Severe inflammatory syndrome recognized in the UK, occurringin children with current or recent infection with SARS-CoV-2 May 2020 – Cases reported in New York City and New York State May 14 – Healthcare providers requested to report patients 21 years oldmeeting MIS-C criteria to local, state, or territorial health departments25

ps://www.cdc.gov/mis-c/hcp/26

Three classesof patients: Class 1 (n 203), “typical” MIS-C– 98% serology positive– 100% cardiovascular and 98% GI manifestations– Markedly elevated laboratory markers of inflammation– 84% ICU admission Class 2 (n 169), acute COVID-19/MIS-C combo– 100% RT-PCR positive, 16% serology positive– More respiratory involvement– 62% ICU admission Class 3 (n 198), milder illness– Younger, median age 6 years– Higher frequency of rash, mucocutaneous lesions– 97% serology positive, 36% RT-PCR; 44% ICU admissionGodfred-Cato, et al. MMWR 3030;69:1074-8027

Health Department-Reported Cases of MultisystemInflammatory Syndrome in Children (MIS-C) 1,659 cases 26 deaths 47 states, New York City,and Washington, DC,have reported 1 case Average age 8 years 57% male 33% Hispanic/Latino;30% Black, non-HispanicFebruary 19 – December 29, 2020https://www.cdc.gov/mis-c/cases/index.html; last updated January 8, 202128

Daily MIS-C Cases, March–December 2020N 1659; Gray area on right represents most recent 6 weeks of data, for which case reports are likely tml; last updated January 8, 2021 29

Estimated Incidence of MIS-C Cases, 7 Jurisdictions,April–June 2020 Population-based incidence estimates (denominator was population of persons 21years):– 1 to 8.5 MIS-C cases per million person-months Using denominator of estimated SARS-CoV-2 infections, incidence was higher amongBlack/African American and Hispanic/Latino children compared with White childrenRace and EthnicityWhiteBlack/African AmericanHispanic/LatinoAsian/Pacific IslanderAdjusted Incidence per MillionSARS-CoV-2 Infections in Children(95% CI)Adjusted IncidenceRate Ratio(95% CI)110 (77–156)616 (481–790)467 (371–588)315 (169–589)reference6 (4–9)4 (3–6)3 (1–6)A. Payne, et al, CDC COVID-19 Response Team, unpublished data30

Summary

Summary As of January 24, 24 million cases of COVID-19 and 410,000 COVID-19associated deaths were reported in the United States. Children 18 years have lower rates of COVID-19 incidence, hospitalization, andmortality than adults. Children are susceptible to SARS-CoV-2, though younger children tended to havefewer respiratory symptoms than adults. MIS-C is a complication of COVID-19 and has varied clinical presentations. MIS-C is highest, and disproportionately so, among Black/African Americanchildren and Hispanic/Latino children. Further studies are needed to fully understand the role of children and teens inSARS-CoV-2 transmission and risk factors for severe illness and complications ofCOVID-19.32