Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 18;12(3):128-134.
doi: 10.1093/jpids/piad002.

Changing Epidemiology of COVID-19 in Children and Adolescents Over Four Successive Epidemic Waves in South Africa, 2020-2022

Nicola Chiwandire  1 , Waasila Jassat  1   2 , Michelle Groome  1   3 , Tendesayi Kufa  1   4 , Sibongile Walaza  1   4 , Nicole Wolter  1   3 , Anne von Gottberg  1   3 , Heather J Zar  5   6 , Gary Reubenson  7 , Stefano Tempia  1   4 , Joy Ebonwu  1 , Nevashan Govender  1 , Genevie Ntshoe  1   8 , Andronica Moipone Shonhiwa  1 , Lucille Blumberg  1   2 , Cheryl Cohen  1   4
Affiliations

Changing Epidemiology of COVID-19 in Children and Adolescents Over Four Successive Epidemic Waves in South Africa, 2020-2022

Nicola Chiwandire et al. J Pediatric Infect Dis Soc. .

Abstract

Background: South Africa experienced four waves of SARS-CoV-2 infection, dominated by Wuhan-Hu, Beta, Delta, and Omicron (BA.1/BA.2). We describe the trends in SARS-CoV-2 testing, cases, admissions, and deaths among children and adolescents in South Africa over successive waves.

Methods: We analyzed national SARS-CoV-2 testing, case, and admissions data from March 2020 to February 2022 and estimated cumulative rates by age group for each endpoint. The severity in the third versus the fourth wave was assessed using multivariable logistic regression.

Results: Individuals ≤18 years comprised 35% (21,008,060/60,142,978) of the population but only 12% (424,394/3,593,644) of cases and 6% (26,176/451,753) of admissions. Among individuals ≤18 years, infants had the highest admission (505/100,000) rates. Testing, case, and admission rates generally increased successively in the second (Beta) and third (Delta) waves among all age groups. In the fourth (Omicron BA.1/BA.2) wave, the case rate dropped among individuals ≥1 year but increased among those <1 year. Weekly admission rates for children <1 year (169/100,000) exceeded rates in adults (124/100,000) in the fourth wave. The odds of severe COVID-19 in all admitted cases were lower in the fourth wave versus the third wave in each age group, but they were twice as high in admitted cases with at least one comorbidity than those without.

Conclusions: The admission rate for children <5 years was higher in the fourth wave than in previous waves, but the overall outcomes were less severe. However, children with at least one comorbidity had increased odds of severe disease, warranting consideration of prioritizing this group for vaccination.

Keywords: COVID-19; South Africa; admissions; adolescents; children.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
SARS-CoV-2 (a) testing rate, (b) percent testing positive, (c) laboratory-confirmed case rate, and (d) hospital admission rate per 100,000 population by epidemiologic week (e-h), South Africa, 1 March 2020 to 5 February 2022. Error bars specify 95% CI. CI, confidence interval.
Figure 2.
Figure 2.
Percentage of COVID-19 admissions (a) who had severe disease and (b) who died in hospital within each age group by epidemic wave, South Africa, DATCOV, 1 March 2020 to 5 February 2022. Error bars specify 95% CI. CI, confidence interval.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Fernández-Rojas MA, Luna-Ruiz Esparza MA, Campos-Romero A, et al. . Epidemiology of COVID-19 in Mexico: symptomatic profiles and presymptomatic people. Int J Infect Dis 2021 Mar 1; 104:572–9. - PMC - PubMed
    1. Kufa T, Jassat W, Cohen C, et al. . Epidemiology of SARS-CoV-2 infection and SARS-CoV-2 positive hospital admissions among children in South Africa. Influenza Other Respi Viruses 2022 Jan 1; 16:34–47. - PMC - PubMed
    1. Molteni E, Sudre CH, Canas LS, et al. . Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. Lancet Child Adolesc Heal 2021 Oct 1; 5:708–18. - PMC - PubMed
    1. Wang L, Berger NA, Kaelber DC,et al. . Incidence rates and clinical outcomes of SARS-CoV-2 infection with the omicron and delta variants in children younger than 5 years in the US. JAMA Pediatr. 2022 Aug 1. [cited 2022 Nov 14]; 176:811–3. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2790793. - PMC - PubMed
    1. Jassat W, Abdool Karim SS, Mudara C, et al. . Clinical severity of COVID-19 in patients admitted to hospital during the omicron wave in South Africa: a retrospective observational study. Lancet Glob Heal. 2022 May 18; 10:e961–69. https://linkinghub.elsevier.com/retrieve/pii/S2214109X22001140. - PMC - PubMed