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

The study “Characteristics and Clinical Outcomes of Vaccine-Eligible US Children Under-5 Years Hospitalized for Acute COVID-19 in a National Network” conducted between September 2022 and May 2023, investigated the vaccination status and clinical outcomes of young children hospitalized with COVID-19 across 28 US pediatric hospitals.

Here’s a detailed summary:

Background and Objective

  • The study aimed to understand the clinical characteristics and factors related to the vaccination status of children under 5 years hospitalized for acute COVID-19.
  • This research was pertinent given the high incidence of pediatric hospitalizations due to COVID-19, particularly during the Omicron peak​​.


  • Children aged 8 months to under 5 years with acute community-acquired COVID-19 were enrolled.
  • The study focused on demographic, clinical factors, the highest level of respiratory support, and vaccination status​​.


  • A total of 597 children were enrolled, with 62.1% aged 8 months to under 2 years, and 37.9% aged 2 to under 5 years.
  • Of these, 29.1% were admitted to the ICU, and 12.6% experienced life-threatening illness.
  • Only 4.5% had completed their primary COVID-19 vaccination series, and 7.0% had initiated but not completed it. A significant number (88.4%) were not vaccinated despite being eligible.
  • Children with underlying respiratory and neurologic/neuromuscular conditions often required more extensive respiratory support.
  • Nearly half of the unvaccinated children were previously healthy, with three requiring extracorporeal membrane oxygenation (ECMO) and one resulting in death​​.

Discussion and Conclusions

  • The study highlighted the low vaccination coverage among hospitalized children under 5 years, even those eligible for vaccination.
  • Most children with critical illness, including those requiring ICU admission, invasive mechanical ventilation, and ECMO, were not vaccinated.
  • The research underscored the need to improve COVID-19 vaccination coverage among young children and to raise awareness of severe COVID-19 illness in this age group.
  • Children with underlying conditions experienced more severe COVID-19, requiring higher levels of respiratory support​​.

Relevance and Context

  • This study provides a crucial insight into the COVID-19 hospitalization landscape among young children, emphasizing the importance of vaccination in preventing severe outcomes in this vulnerable age group​​.

The study serves as a critical reminder of the ongoing impact of COVID-19 on children and the importance of vaccination in mitigating severe outcomes, particularly among young and vulnerable populations.

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