cdc.gov/coronavirus

Jefferson Jones, MD, MPH, FAAP

Medical Officer

Epidemiology Task Force

CDC COVID-19 Public Health 

Response

ACIP Meeting

November 2, 2021

Epidemiology of COVID-19 in Children Aged 5 – 11 years
Overview of COVID-19 in Children Aged 5 – 11 

Years

 Incidence and seroprevalence 

estimates

 COVID-19-associated 

hospitalization rates and mortality

 Multisystem Inflammatory 

Syndrome in Children (MIS-C)

 Post-COVID conditions

 Transmission
Incidence and Seroprevalence
COVID-19 Weekly Cases per 100,000 Population by Age

— United States, March 1, 2020–October 10, 2021

https://covid.cdc.gov/covid-data-tracker/#demographicsovertime

>1.9 million 

cases among 

children 5-11 

years of age

0

100

200

300

400

500

600

Incident cases per 100,000 population

Date

0-4 years 5-11 years 12-17 years 18-49 years 50-64 years ≥65 years
0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 - 4 Years 5 - 11 Years 12 - 17 Years 18 - 49 Years 50 - 64 Years 65 + Years

Proportion of Total COVID-19 Cases by Age Group

— United States, March 1, 2020–October 10, 2021

https://covid.cdc.gov/covid-data-tracker/#demographicsovertime

Children 5-11 

years are making 

up a greater 

proportion of total 

cases: 

10.6% of cases 

the week of 

October 10, 2021

12.4%

17.1%

47.2%

8.8%

10.6%

4.0%
Nationwide Commercial Laboratory SARS-CoV-2 

Seroprevalence Survey

 Every 2 weeks, ~50,000 specimens 

tested for SARS-CoV-2 antibodies 

 De-identified residual sera collected by 

commercial laboratories for routine 

screening or acute clinical care

 Limited pediatric specimens

 Most common reasons for pediatric 

clinical visits include general 

examination (e.g., cholesterol screen), 

obesity, drug monitoring, and fatigue

https://covid.cdc.gov/covid-data-tracker/#national-lab

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/geographic-seroprevalence-surveys.html

Couture et al. Methods for Estimation of SARS-CoV-2 Seroprevalence and Reported COVID-19 Cases in U.S. Children, August 2020—May 2021. medRxiv. https://doi.org/10.1101/2021.09.26.2126375

Bajema et al. Estimated SARS-CoV-2 Seroprevalence in the US as of September 2020. JAMA Intern Med. 2021;181(4):450–460. 

*For Nov 2020–Jun 2021. For Sep 2021, states included even with <100 specimens. 
Weighted Infection-Induced SARS-CoV-2 Seroprevalence By 

Age Group — 47 U.S. Jurisdictions, Sept 2021

 Seroprevalence in children aged 5–11 years: 38% 

(95% CI: 36–40%)

– Higher than estimates among adults

– Similar to estimates in children aged 12–17 

years

 Range for jurisdiction-level estimates for children aged 

5–11 years: 11%–61%*

 Estimates lower than jurisdictions previously presented

 Number of infections per reported case†: 

– General population: Median 2.4 (Range: 2.0–3.9)

– Ages 0–17 years: Median 6.2 (Range: 4.7–8.9)

Data are preliminary and subject to change

*Restricted to 23 jurisdictions with ≥75 specimens from children aged 5–11 years:

†Jurisdiction-level May-June 2021 estimates restricted to jurisdictions that provided age data for >90% of individual cases: CA, IL, NV, NJ, NC, OH, SC, and TN

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

0–4 5–11 12–17 18–64 65+

Seroprevalence

Age (in years)
Infection-Induced Protection From Reinfection

 Based on data in adults, infected individuals have a low risk of reinfection for at least 6 

months, but protection is not 100% and likely lower against Delta variant

 Infection-induced antibody response is lower and less consistent compared with mRNA 

vaccine-induced antibody response

 Antibody titers generated after infection are lower in people with mild or no symptoms

 Vaccination after infection significantly enhances protection and further reduces risk of 

reinfection 

 CDC recommends vaccination regardless of history of infection

– Serologic testing to assess for prior infection is not recommended for the purpose of 

vaccine decision-making

CDC. Science Brief: SARS-CoV-2 Infection-induced and Vaccine-induced Immunity. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/vaccine-induced-immunity.html

CDC. Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid19-vaccines-us.html
Seroprevalence Summary 

 Seroprevalence data suggest infections in children less likely to be reported compared with 

adults 

 Seroprevalence estimates in children 5–11 years were 38% in September 2021

 Seroprevalence indicates that children are at least as likely as adults to be infected with 

SARS-CoV-2

 Limitation: Seroprevalence estimates may not be representative of the general pediatric 

population

– Antibody tests cannot determine if a person is protected from reinfection or not

– Assay used for analysis good for detecting previous infection but unlikely to correlate 

with protection from infection
Hospitalization
COVID-19-Associated Weekly Hospitalizations per 100,000 —

COVID-NET by Age Group, March 21, 2020–October 23, 2021

https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covid-net/purpose-methods.html, Data are preliminary and subject to change

0

0.5

1

1.5

2

2.5

3

3.5

3/21/20

4/4/20

4/18/20

5/2/20

5/16/205/30/206/13/206/27/207/11/207/25/20

8/8/20

8/22/20

9/5/20

9/19/2010/3/20

10/17/2010/31/2011/14/2011/28/2012/12/2012/26/20

1/9/21

1/23/21

2/6/21

2/20/21

3/6/21

3/20/21

4/3/21

4/17/21

5/1/21

5/15/215/29/216/12/216/26/217/10/217/24/21

8/7/21

8/21/21

9/4/21

9/18/2110/2/21

10/16/21

Hospitalizations per 100,000 

population

Surveillance week end date

0-4

5-11

12-17
Cumulative COVID-19-Associated Hospitalization Rates by Race and Ethnicity 

among Children 5-11 Years of Age — COVID-NET, March 1, 2020–October 23, 2021

https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covid-net/purpose-methods.html, Data are preliminary and subject to change

0

10

20

30

40

50

60

70

Overall Black, nonHispanicHispanic American

Indian/Alaska

Native

White, nonHispanicAsian, nonHispanic

Hospitalization rate per 100,000 

population
0

5

10

15

20

25

30

35

40

45

50

40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38

Rate per 100,000 population

MMWR Week - Month†

Flu 2017-2018 Flu 2018-2019 Flu 2019-2020

Cumulative Influenza- and COVID-19-Associated 

Hospitalizations Among Children Ages 5–11 Years

*Mitigation measure in place during 2020–2021

†

Influenza seasons: MMWR week 40 of the earlier year to MMWR week 18 of the 

later year. The COVID period: Oct 2020-Sep 2021 goes from MMWR week 40 of 

year 2020 to MMWR week 39 of year 2021. MMWR Week 53 for MMWR Year 2020 

is combined with MMWR Week 52 for consistency with other years. 

COVID-NET-California, Colorado, Connecticut, Georgia, Iowa, Maryland (entire state), 

Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah.

FluSurv-NET: California, Colorado, Connecticut, Georgia, Maryland (Baltimore Metropolitan 

Area), Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah. 

Oct Jan Apr Sep
0

5

10

15

20

25

30

35

40

45

50

40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38

Rate per 100,000 population

MMWR Week - Month†

Flu 2017-2018 Flu 2018-2019 Flu 2019-2020 Flu 2020-2021*

9 pediatric influenza 

hospitalizations 

reported 2020-2021

Cumulative Influenza- and COVID-19-Associated 

Hospitalizations Among Children Ages 5–11 Years

COVID-NET-California, Colorado, Connecticut, Georgia, Iowa, Maryland (entire state), 

Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah.

FluSurv-NET: California, Colorado, Connecticut, Georgia, Maryland (Baltimore Metropolitan 

Area), Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah. 

*Mitigation measure in place during 2020–2021

†

Influenza seasons: MMWR week 40 of the earlier year to MMWR week 18 of the 

later year. The COVID period: Oct 2020-Sep 2021 goes from MMWR week 40 of 

year 2020 to MMWR week 39 of year 2021. MMWR Week 53 for MMWR Year 2020 

is combined with MMWR Week 52 for consistency with other years. 

*Mitigation measures in place 

during 2020-2021

Oct Jan Apr Sep
0

5

10

15

20

25

30

35

40

45

50

40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38

Rate per 100,000 population

MMWR Week - Month†

Flu 2017-2018 Flu 2018-2019 Flu 2019-2020 Flu 2020-2021* COVID Oct 2020-Sep 2021*

9 pediatric influenza 

hospitalizations 

reported 2020-2021

Cumulative Influenza- and COVID-19-Associated 

Hospitalizations Among Children Ages 5–11 Years

COVID-NET-California, Colorado, Connecticut, Georgia, Iowa, Maryland (entire state), 

Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah.

FluSurv-NET: California, Colorado, Connecticut, Georgia, Maryland (Baltimore Metropolitan 

Area), Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah. 

*Mitigation measure in place during 2020–2021

Annualized COVID-NET surveillance period: Oct 1, 2020–Sept 30, 2021

†

Influenza seasons: MMWR week 40 of the earlier year to MMWR week 18 of the later 

year. The COVID period: Oct 2020-Sep 2021 goes from MMWR week 40 of year 2020 to 

MMWR week 39 of year 2021. MMWR Week 53 for MMWR Year 2020 is combined with 

MMWR Week 52 for consistency with other years. 

Annualized COVID-NET 

surveillance period: Oct 1, 

2020-Sept 30, 2021

*Mitigation measures in place 

during 2020-2021

Oct Jan Apr Sep
Clinical Interventions and Outcomes of Children Aged 5-11 

Years with COVID-19 or Influenza-Associated Hospitalizations, 

COVID-NET1 and FluSurv-NET2

FluSurv-NET 

2017-2018, 2018-2019, 

and 2019-2020

(N = 1,874),3 n (%)

COVID-NET 

March 1, 2020–August 

31, 2021

(N = 696),4 n (%)

Hospital length of stay (median, IQR) 2 (1-4) 3 (2-6)

ICU admission 398 (21.2) 222 (31.9)

Invasive mechanical ventilation 87 (4.6) 50 (7.2)

Died during hospitalization 11 (0.6) 4 (0.6)

1 COVID-NET-California, Colorado, Connecticut, Georgia, Iowa, Maryland (entire state), Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah.

2 FluSurv-NET: California, Colorado, Connecticut, Georgia, Maryland (Baltimore Metropolitan Area), Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, 

Tennessee, and Utah. Surveillance conducted from October 1-April 30 each season

3 Includes those with complete clinical data (~97% of pediatric cases) on hospital length of stay, ICU admission, invasive mechanical ventilation, and disposition discharge 

(i.e., discharged alive or died in-hospital). 

4 Includes those with complete clinical data (~90% of pediatric cases) on hospital length of stay, ICU admission, invasive mechanical ventilation, and disposition discharge 

(i.e., discharged alive or died in-hospital). 
Children Aged 5–11 Years Hospitalized with COVID-19—

COVID-NET, March 2020–August 2021

N (%)

Total 562 (100)

Age (yrs) ‒ median 

(IQR)*

8 (6–10)

Sex – Male 320 (57)

Race/ethnicity

Black, non-Hispanic 207 (37)

Hispanic 177 (31)

White, non-Hispanic 124 (22)

Asian, non-Hispanic 23 (4)

Other, non-Hispanic 31 (6)

Severe disease† 200 (36)

≥1 underlying condition 381 (68)

*Interquartile range; †Requiring intensive care unit admission or mechanical ventilation

COVID-NET is a population-based surveillance system that collects data on laboratory-confirmed COVID-19-associated hospitalizations among children and 

adults through a network of over 250 acute-care hospitals in 14 states. Methods described in: Woodruff RC, et al. Risk factors for Severe COVID-19 in Children. 

Pediatrics. ePub October 2021.

Demographic and clinical characteristics

 68% were Black, non-Hispanic or Hispanic

 32% had no underlying conditions

 Most common underlying medical 

conditions were chronic lung disease 

(primarily asthma) and obesity
Mortality
0

20

40

60

80

100

120

140

<1 year 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

COVID-19 deaths

Age in years

COVID-19 Deaths by Age Group, NCHS

— United States. January 1, 2020–October 16, 2021 

*Lag in reporting of deaths might result in underestimate

https://data.cdc.gov/NCHS/Provisional-COVID-19-Deaths-Counts-by-Age-in-Years/3apk-4u4f/data

Children 5-11 years: 

94 COVID-19 deaths*

(1.7% of all deaths among

U.S. children 5–11 years)
Leading Causes of Death in Children 5-11 Years of Age, 

NCHS, 2019 Causes of Death Death 

(n)

Crude rate 

per 100,000

Accidents (unintentional injuries) 969 3.4

Malignant neoplasms 525 1.8

Congenital malformations, deformations 

and chromosomal abnormalities 274 1.0

Assault (homicide) 207 0.7

Diseases of the heart 115 0.4

Chronic lower respiratory diseases 107 0.4

Influenza and pneumonia 84 0.3

Intentional self-harm (suicide) 66 0.2

Cerebrovascular diseases 56 0.2

Septicemia 48 0.2

CDC NCHS WONDER Online Database. Accessed at http://wonder.cdc.gov/ucd-icd10.html on May 6, 2021

66 COVID-19 

associated deaths 

in children 5–11 

10/3/20-10/2/2021

Total population 5-17 years, 2019: 52,715,248
MIS-C and Additional Post-COVID 

Conditions
Multisystem Inflammatory Syndrome in Children 

(MIS-C)

 Severe hyperinflammatory syndrome occurring 2-6 weeks after 

acute SARS-CoV-2 infection, resulting in a wide range of clinical 

manifestations and complications

 Incidence has been estimated as 1 MIS-C case in approximately 

3,200 SARS-CoV-2 infections

 60-70% of patients are admitted to intensive care, 1-2% die

• Bowen, et al. Demographic and Clinical Factors Associated With Death Among Persons <21 Years Old With Multisystem Inflammatory Syndrome in Children—United States, February 2020–March 

2021, Open Forum Infectious Diseases, Volume 8, Issue 8, August 2021,, https://doi.org/10.1093/ofid/ofab388

• Payne AB, et al. Incidence of Multisystem Inflammatory Syndrome in Children Among US Persons Infected With SARS-CoV-2. JAMA Netw Open. 2021;4(6):e2116420. Published 2021 Jun 1. 

doi:10.1001/jamanetworkopen.2021.16420

• Feldstein LR, et al. Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19. JAMA. 

2021;325(11):1074-1087. doi:10.1001/jama.2021.2091

• Belay ED, et al. Trends in Geographic and Temporal Distribution of US Children With Multisystem Inflammatory Syndrome During the COVID-19 Pandemic [published online ahead of print, 2021 Apr 

6]. JAMA Pediatr. 2021;e210630. doi:10.1001/jamapediatrics.2021.0630

• https://covid.cdc.gov/covid-data-tracker/#mis-national-surveillance
MIS-C in Children

 5,217 MIS-C cases reported to national 

surveillance with date of onset between 

February 19, 2020–September 23, 2021

– Median age of 9 years

– 2,316 (44%) of these cases 

occurred in children aged 5–11 

years

 61% occurred in children who are 

Hispanic/Latino or Black, Non-Hispanic

 Among children aged 5–11 years, 9 died 

(20% of MIS-C deaths)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

0–4 5–11 12–15 16–20

Percent of total MIS-C cases

Age (in years)

MIS-C patients by age group

Bowen, et al. Demographic and Clinical Factors Associated With Death Among Persons <21 Years Old With Multisystem Inflammatory Syndrome in Children—United States, February 2020–March 

2021, Open Forum Infectious Diseases, Volume 8, Issue 8, August 2021,, https://doi.org/10.1093/ofid/ofab388

https://covid.cdc.gov/covid-data-tracker/#mis-national-surveillance
Additional Post-COVID Conditions in Children

 Post-COVID conditions occur in children 

– Appear to be less common in children than in adults

– A national survey in the UK found 7-8% of children with COVID-19 reported 

continued symptoms >12 weeks after diagnosis1

– May appear after mild or severe infections, or after MIS-C

 Most common symptoms: Similar to adults, and include fatigue, headache, 

insomnia, trouble concentrating, muscle and joint pain, and cough2,3

 Impact on quality of life: Limitations of physical activity, feeling distressed about 

symptoms, mental health challenges, decreased school attendance/participation2

1Office for National Statistics United Kingdom. (2021) Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK. Retrieved on September 17, 2021 from Office for 

National Statistics’ website. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronavirus

covid19infectionintheuk/1april2021

2Buonsenso D, Munblit D, De Rose C, et al. Preliminary evidence on long COVID in children. Acta Paediatr. 2021;110(7):2208-2211. doi:10.1111/apa.15870. 3Molteni 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 Health 2021; 5: 708–18. 

https://www.thelancet.com/action/showPdf?pii=S2352-4642%2821%2900198-X 
SARS-CoV-2 Transmission
Children and Transmission of SARS-CoV-2

 Transmission of SARS-CoV-2 virus is influenced by presence and type of 

symptoms, type and timing of exposure, viral load, and variant

 Some studies reported similar rates of transmission from infected children as 

from adults, while others observed lower rates of transmission from infected 

children compared with rates from infected adults1,2,3

 Secondary transmission from children occurs in both household3 and school 

settings2,4,5,6

 Studies have shown that vaccination decreases transmission7

1. Bi Q et al. Lancet Infect Dis. 2020;20(8):911-919

2. CDC Science Brief: Transmission of SARS-CoV-2 in K-12 schools. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/transmission_k_12_schools.html

3. McLean, et al. Household Transmission and Clinical Features of SARS-CoV-2 Infections by Age in 2 US Communities. medRxiv. https://doi.org/10.1101/2021.08.16.21262121

4. Chu VT, Yousaf AR, Chang K, et al. Household Transmission of SARS-CoV-2 from Children and Adolescents. N Engl J Med. 2021;NEJMc2031915. 

5. Goldstein E et al. On the Effect of Age on the Transmission of SARS-CoV-2 in Households, Schools, and the Community. J Infect Dis. 2021 Feb 13;223(3):362-369.

6. Larosa E et al. Secondary transmission of COVID-19 in preschool and school settings in northern Italy after their reopening in September 2020. Euro Surveill. 2020;25(49):2001911.

7. CDC Science Brief. COVID-19 Vaccines and Vaccination. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html
Children and Transmission of SARS-CoV-2

 Outbreak investigations have demonstrated efficient transmission among 

children and adults

Lam-Hine et al. MMWR Morb Mortal Wkly Rep ePub: 27 August 2021.
Summary: COVID-19 Epidemiology in Children 

Aged 5–11 years

 Children aged 5–11 years are at least as likely to be infected with SARS-CoV-2 as adults

– Over 1.9 million reported cases; seroprevalence estimated to be ~38% in September 2021

– Seroprevalence data suggests that infections in children less likely to be reported as cases than infections in 

adults

 Children aged 5–11 years are at risk of severe illness from COVID-19

– >8,300 hospitalizations to date

• Hospitalization rates are 3x times higher for non-Hispanic Black, non-Hispanic American Indian/Alaska 

Native, and Hispanic children compared with non-Hispanic White children

• Hospitalization rates are similar to pre-pandemic influenza-associated hospitalization rates

• Severity was comparable among children hospitalized with influenza and COVID-19

• Approximately 1/3 of hospitalized children aged 5–11 years require ICU admission

– At least 94 COVID-19-associated deaths occurred in children aged 5–11 years

– MIS-C was most frequent among children aged 5–11 years

– Post-COVID conditions have been reported in children

– All might have been more numerous had pandemic mitigation measures not been implemented

 Secondary transmission from young school-aged children occurs in household and school settings
For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily 

represent the official position of the Centers for Disease Control and Prevention.

• CDC

– Kate Woodworth

– Alexia Couture 

– Hannah Kirking

– Melissa Rolfes

– Angela Campbell

– Melissa Briggs-Hagen

– Sara Oliver

– Kristie Clarke

– Tina Benoit

– Myrna Charles

– Brendan Flannery

– Carrie Reed

– Casey Lyons

– Farida Ahmad

– Nicole Zviedrite

– Laura Zambrano

• Laboratories and state health departments 

participating in seroprevalence surveys

• Site PIs and staff for COVID-NET and FluSurv-NET

• Many others 

CDC COVID-NET team

– Fiona Havers

– Christopher Taylor

– Huong Pham

– Michael Whitaker

– Kadam Patel

– Jenny Milucky

– Rebecca Woodruff

– Anita Kambhampati

CDC FluSurv-NET Team: 

– Shikha Garg

– Dawud Ujamaa

– Alissa O’Halloran

– Charisse 

Cummings

– Rachel Holstein

Acknowledgements