Characteristics and Clinical Outcomes of Vaccine-Eligible US Children Under-5 Years Hospitalized for Acute COVID-19 in a National Network

Laura D. Zambrano, Margaret M. Newhams, Regina M. Simeone, Katherine E. Fleming-Dutra, Natasha Halasa, Michael Wu, Amber O. Orzel-Lockwood, Satoshi Kamidani, Pia S. Pannaraj, Kathleen Chiotos, Melissa A. Cameron, Aline B. Maddux, Jennifer E. Schuster, Hillary Crandall, Michele Kong, Ryan A. Nofziger, Mary A. Staat, Samina S. Bhumbra, Katherine Irby, Julie A. BoomLeila C. Sahni, Janet R. Hume, Shira J. Gertz, Mia Maamari, Cindy Bowens, Emily R. Levy, Tamara T. Bradford, Tracie C. Walker, Stephanie P. Schwartz, Elizabeth H. Mack, Judith A. Guzman-Cottrill, Charlotte V. Hobbs, Matt S. Zinter, Natalie Z. Cvijanovich, Katherine E. Bline, Saul R. Hymes, Angela P. Campbell, Adrienne G. Randolph

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background and objectives: In June 2022, the mRNA COVID-19 vaccination was recommended for young children. We examined clinical characteristics and factors associated with vaccination status among vaccine-eligible young children hospitalized for acute COVID-19. Methods: We enrolled inpatients 8 months to <5 years of age with acute community-Acquired COVID-19 across 28 US pediatric hospitals from September 20, 2022 to May 31, 2023. We assessed demographic and clinical factors, including the highest level of respiratory support, and vaccination status defined as unvaccinated, incomplete, or complete primary series [at least 2 (Moderna) or 3 (Pfizer-BioNTech) mRNA vaccine doses ≥14 days before hospitalization]. Results: Among 597 children, 174 (29.1%) patients were admitted to the intensive care unit and 75 (12.6%) had a life-Threatening illness, including 51 (8.5%) requiring invasive mechanical ventilation. Children with underlying respiratory and neurologic/neuromuscular conditions more frequently received higher respiratory support. Only 4.5% of children hospitalized for COVID-19 (n = 27) had completed their primary COVID-19 vaccination series and 7.0% (n = 42) of children initiated but did not complete their primary series. Among 528 unvaccinated children, nearly half (n = 251) were previously healthy, 3 of them required extracorporeal membrane oxygenation for acute COVID-19 and 1 died. Conclusions: Most young children hospitalized for acute COVID-19, including most children admitted to the intensive care unit and with life-Threatening illness, had not initiated COVID-19 vaccination despite being eligible. Nearly half of these children had no underlying conditions. Of the small percentage of children who initiated a COVID-19 primary series, most had not completed it before hospitalization.

Original languageEnglish (US)
Pages (from-to)242-249
Number of pages8
JournalPediatric Infectious Disease Journal
Issue number3
StatePublished - Mar 1 2024

Bibliographical note

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© 2024 Lippincott Williams and Wilkins. All rights reserved.


  • COVID-19
  • clinical outcomes
  • under-5 years
  • vaccination
  • vaccine coverage


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