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. 2023 Oct;51(5):1357-1367.
doi: 10.1007/s15010-023-01996-y. Epub 2023 Feb 14.

Comparing SARS-CoV-2 variants among children and adolescents in Germany: relative risk of COVID-19-related hospitalization, ICU admission and mortality

Marietta Jank #  1   2 , Anna-Lisa Oechsle #  3 , Jakob Armann  4 , Uta Behrends  5 , Reinhard Berner  4 , Cho-Ming Chao  6   7 , Natalie Diffloth  4 , Maren Doenhardt  4 , Gesine Hansen  8 , Markus Hufnagel  9 , Fabian Lander  4 , Johannes G Liese  10 , Ania C Muntau  11 , Tim Niehues  12 , Ulrich von Both  13 , Eva Verjans  14 , Katharina Weil  15 , Rüdiger von Kries #  3 , Horst Schroten #  16
Affiliations

Comparing SARS-CoV-2 variants among children and adolescents in Germany: relative risk of COVID-19-related hospitalization, ICU admission and mortality

Marietta Jank et al. Infection. 2023 Oct.

Abstract

Purpose: SARS-CoV-2 infections cause COVID-19 and have a wide spectrum of morbidity. Severe disease courses among children are rare. To date, data on the variability of morbidity in relation to variant of concern (VOC) in children has been sparse and inconclusive. We compare the clinical severity of SARS-CoV-2 infection among children and adolescents in Germany during the Wildtype and Alpha combined, Delta and Omicron phases of the COVID-19 pandemic.

Methods: Comparing risk of COVID-19-related hospitalization, intensive care unit (ICU) admission and death due to COVID-19 in children and adolescents, we used: (1) a multi-center seroprevalence study (SARS-CoV-2-KIDS study); (2) a nationwide registry of pediatric patients hospitalized with SARS-CoV-2 infections; and (3) compulsory national reporting for RT-PCR-confirmed SARS-CoV-2 infections in Germany.

Results: During the Delta predominant phase, risk of COVID-19-related hospitalization among all SARS-CoV-2 seropositive children was 3.35, ICU admission 1.19 and fatality 0.09 per 10,000; hence about halved for hospitalization and ICU admission and unchanged for deaths as compared to the Wildtype- and Alpha-dominant period. The relative risk for COVID-19-related hospitalization and ICU admission compared to the alpha period decreased during Delta [0.60 (95% CI 0.54; 0.67) and 0.51 (95% CI 0.42; 0.61)] and Omicron [0.27 (95% CI 0.24; 0.30) and 0.06 (95% CI 0.05; 0.08)] period except for the < 5-year-olds. The rate of case fatalities decreased slightly during Delta, and substantially during Omicron phase.

Conclusion: Morbidity caused by SARS-CoV-2 infections among children and adolescents in Germany decreased over the course of the COVID-19 pandemic, as different VOCs) emerged.

Keywords: Adolescents; Burden of disease; COVID-19; Children; Pandemic; SARS-CoV-2; Seroprevalence; Variants of concern.

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Conflict of interest statement

The participating pediatric hospitals received academic research funding from the Federal Ministry of Education and Research (BMBF) for study planning, study management and reimbursement for the assay of this study. No other relevant financial or non-financial conflicts were reported.

Figures

Fig. 1
Fig. 1
Flowchart displaying reported pediatric COVID-19 cases with COVID-19-related hospitalization, ICU admission and death from July to October 2021
Fig. 2
Fig. 2
Rate ratios of COVID-19-related hospitalization, ICU admission and death in children ≤ 17 years of age during the periods of the SARS-CoV-2 pandemic, in which Delta and Omicron were predominant with Wildtype/Alpha as reference (A). Rate Ratios of hospitalization for COVID-19 related therapy, COVID-19-related ICU admission and death for all age groups combined; the respective rate ratios per age groups are shown in (B) for hospitalization and (C) for ICU admission
See this image and copyright information in PMC

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Supplementary concepts