cdc.gov/coronavirus

COVID-19 epidemiology in 

children ages 6 months–

4 years

Katherine E. Fleming-Dutra, MD

National Center for Immunization and Respiratory Diseases

Centers for Disease Control and Prevention

June 17, 2022
Overview

 COVID-19 incidence and burden

 Emergency department visits

 Hospitalization rates and severity

 COVID-19-associated mortality

 Multisystem Inflammatory Syndrome 

in Children (MIS-C)

 Post-COVID conditions

 Other impacts of the pandemic on 

children and families
Currently eligible for COVID-19 

vaccination

6 months–4 years 5–11 years 12–17 years
COVID-19 incidence and burden
Trends in number of COVID-19 cases in the United 

States among persons of all ages

January 23, 2020 – June 14, 2022

Cases: 85,681,615

Source: COVID Data Tracker, https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases. Accessed June 16, 2022 
Trends in number of COVID-19 cases in the United 

States among persons of all ages

January 23, 2020 – June 14, 2022

Cases: 85,681,615

Source: COVID Data Tracker, https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases. Accessed June 16, 2022 

Omicron surge 

started in 

December 2021
Trends in number of COVID-19 cases in the United 

States among persons of all ages

January 23, 2020 – June 14, 2022

Cases: 85,681,615

Source: COVID Data Tracker, https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases. Accessed June 16, 2022 

Omicron surge 

started in 

December 2021

7-day 

average: 

103,935

cases
0

200

400

600

800

1000

1200

1400

1600

1800

2000

Incident cases per 100,000 population

Case earliest date by end of week

<1 year

1–4 years

5–11 years

12–17 years

COVID-19 weekly cases per 100,000 population among 

children ages 0–17 years by age group — United States 

March 1, 2020 – June 12, 2022

Reporting may be incomplete for the most recent two weeks of data, denoted by the grey box. 

Source: COVID Data Tracker, https://covid.cdc.gov/covid-data-tracker/#demographicsovertime. Accessed June 16, 2022
0

200

400

600

800

1000

1200

1400

1600

1800

2000

Incident cases per 100,000 population

Case earliest date by end of week

<1 year

1–4 years

5–11 years

12–17 years

COVID-19 weekly cases per 100,000 population among 

children ages 0–17 years by age group — United States 

March 1, 2020 – June 12, 2022

Reporting may be incomplete for the most recent two weeks of data, denoted by the grey box. 

Source: COVID Data Tracker, https://covid.cdc.gov/covid-data-tracker/#demographicsovertime. Accessed June 16, 2022

Total number of COVID-19 cases

<1 year 578,168

1–4 years 1,945,389

5–11 years 5,106,673

12–17 years 5,691,196
Seroprevalence of infection-induced SARS-CoV-2 

antibodies among children ages 6 months–17 years —

National Commercial Lab Seroprevalence Study 

September 2021– April 2022

Shading indicates confidence intervals for each trend line.

Data updated for March/April 2022, based on Clarke K, Kim Y, Jones J et al. Pediatric Infection-Induced SARS-CoV-2 Seroprevalence Estimation Using Commercial Laboratory 

Specimens: How Representative Is It of the General U.S. Pediatric Population? (April 26, 2022). SSRN: https://ssrn.com/abstract=4092074 or http://dx.doi.org/10.2139/ssrn.4092074
COVID-19-associated emergency 

department (ED) visits
Dashed line, on December 19, 2021, represents the first date when >50% of nationally sequenced SARS-CoV-2 specimens were Omicron variant. Data contains emergency 

department visits from NSSP ED data feeds consistently reporting data from 2020-2022. The data contains visits with an ICD-10 or SNOMED code for COVID-19. 

Weekly percent of emergency department visits 

diagnosed with COVID-19 among children ages 1–17 

years, National Syndromic Surveillance Program 

May 3, 2020–May 14, 2022 Omicron period
COVID-19-associated hospitalizations

Burden and severity of disease
COVID-19-associated hospitalizations among children 

and adolescents 6 months–17 years, COVID-NET

March 2020 – March 2022

Source: COVID-NET, https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html. Accessed May 21, 2022. 

0

1

2

3

4

5

6

7

8

9

10

3/21/20 6/21/20 9/21/20 12/21/20 3/21/21 6/21/21 9/21/21 12/21/21 3/21/22

Hospitalization rate per 100,000 population

Week End Date

6 months-4 years

5-11 years

12-17 years
Cumulative COVID-19-associated hospitalizations 

among children and adolescents 6 months–17 years, 

COVID-NET

March 2020 – March 2022

0

20

40

60

80

100

120

140

3/21/20 6/21/20 9/21/20 12/21/20 3/21/21 6/21/21 9/21/21 12/21/21 3/21/22

Cumulative hospitalization rate per 100,000 

population

Week Ending Date

6 months-4 years

5-11 years

12-17 years

Source: COVID-NET, https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html. May 21, 2022. 
Rates of monthly COVID-19-associated hospitalizations 

by vaccination status among children and adolescents 

5–17 years, COVID-NET

June 2021 – March 2022

Source: CDC COVID Data Tracker: COVID-NET Hospitalizations by Vaccination Status. Accessed May 12, 2022.

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

Jun-21 Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21 Jan-22 Feb-22 Mar-22

Hospitalization Rate per 100,000

Adolescents ages 12–17 years who are unvaccinated

Adolescents ages 12–17 years vaccinated with at least primary series

Children ages 5–11 years who are unvaccinated

Children ages 5–11 years vaccinated with primary series
Proportion of children ages 6 months–4 years with 

COVID-19 associated hospitalization who were 

primarily admitted for COVID-19, COVID-NET

March 2020 – March 2022

All children in COVID-NET had a positive SARS-CoV-2 test within 14 days of or during hospital admission. “Primarily admitted for COVID-19” was defined 

based on the “Reason for admission” field from the case report form. If the chief complaint or history of present illness in the medical chart documents 

fever/respiratory illness, COVID-19-like illness, or a suspicion for COVID-19, a case is categorized as having COVID-19 as the primary reason for 

admission. Examples of other non-COVID-19-related reasons for admission seen in this age group include admissions for trauma or inpatient surgeries. 

Source: COVID-NET data, Accessed May 21, 2022.

87.3%

86.1%

12.8%

13.9%

Pre-Omicron (March 1, 2020-December 18, 2021)

Omicron (December 19, 2021-March 31, 2022)

Primarily admitted for COVID-19 Other reason for admission
Percent of children ages 6 months–4 years with 

COVID-19 associated hospitalization with underlying 

health conditions

Source: 1. New Vaccine Surveillance Network. Preliminary data as of May 25, 2022, reflecting data from March 2020–April 2022

2. COVID-NET data. Accessed May 21, 2022, reflecting data from March 2020–March 2022

49%

46%

51%

54%

COVID-NET, March 2020 – March 2022 

New Vaccine Surveillance Network, March 2020 

– April 2022

At least 1 underlying medical conditions No underlying medical conditions
Severity of COVID-19-associated hospitalizations among 

children and adolescents 6 months–17 years, COVID-NET, 

December 19, 2021 – March 31, 2022 (Omicron period)

BiPAP: bilevel positive pressure, CPAP: continuous positive pressure

Source: COVID-NET data. Accessed May 21, 2022.

23.6%

16.2%

6.4% 6.4%

0.0%

19.6%

6.8%

5.8% 5.2%

0.0%

18.6%

4.9%

3.3%

4.5%

0.9%

0%

5%

10%

15%

20%

25%

30%

Intensive care unit (ICU)

admission

High flow nasal cannula BiPaP or CPAP use Mechanical ventilation In-hospital death

6 months–4 years (N=535)

5–11 years (N=260)

12–17 years (N=256)
COVID-19-associated hospitalizations

Comparisons to other pediatric infectious diseases
Cumulative influenza- and COVID-19-associated 

hospitalization rates per 100,000 children ages 6 months‒4 

years, FluSurv-NET and COVID-NET, 2017–2022

Source: Delahoy MJ, Ujamaa D, Taylor CA, et al. Comparison of influenza and COVID-19-associated hospitalizations among children < 18 years old in the United States-FluSurv-NET (October-April 

2017-2021) and COVID-NET (October 2020-September 2021). Clin Infect Dis. 2022 May 20:ciac388. doi: 10.1093/cid/ciac388. 

COVID-19 Oct 21-Apr 22

COVID-19 Oct 20-Sep 21
Cumulative influenza- and COVID-19-associated 

hospitalization rates per 100,000 children ages 6 months‒4 

years, FluSurv-NET and COVID-NET, 2017–2022

Source: Delahoy MJ, Ujamaa D, Taylor CA, et al. Comparison of influenza and COVID-19-associated hospitalizations among children < 18 years old in the United States-FluSurv-NET (October-April 

2017-2021) and COVID-NET (October 2020-September 2021). Clin Infect Dis. 2022 May 20:ciac388. doi: 10.1093/cid/ciac388. 

COVID-19 Oct 21-Apr 22

COVID-19 Oct 20-Sep 21

Among children ages 6 months–4 years

 Oct 2020–Sep 2021 COVID-19 hospitalization 

rates were lower than influenza hospitalization 

rates during 2017–18 through 2019–20 (prepandemic) influenza seasons

 Oct 2021–Apr 2022 COVID-19 hospitalization 

rates were as high or higher than influenza 

hospitalization rates during 2017–18 through 

2021–22 influenza seasons
Other Pediatric Vaccine Preventable Diseases: 

Hospitalizations per Year Prior to Recommended Vaccines 

1 https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5603a1.htm

2Davis MM, Patel MS, Gebremariam A. Decline in varicella-related hospitalizations and expenditures for children and adults after introduction of varicella vaccine in the United States. Pediatrics. 2004;114(3):786-

792. doi:10.1542/peds.2004-0012

3 Centers for Disease Control and Prevention (CDC). Direct and indirect effects of routine vaccination of children with 7-valent pneumococcal conjugate vaccine on incidence of invasive pneumococcal disease--

United States, 1998-2003. MMWR Morb Mortal Wkly Rep. 2005 Sep 16;54(36):893-7. PMID: 16163262.

4 COVID-NET data, Accessed May 21, 2022.

5 Vaccine-type invasive pneumococcal disease annual rate for children <5 years in 1998-1999 was 80 per 100,000, of which about 50% were hospitalized. 

Hepatitis A1 Varicella2

(Chickenpox)

Vaccine-type 

Invasive 

Pneumococcal 

Disease3

COVID-194

Age 5–14 years 0–4 years 0–4 years 6 months–4 years

Time period 2005 1993–1995 1998–1999

Year 1: April 2020–March 

2021 

Year 2: April 2021–March 

2022

Hospitalization 

Burden

(Annual rate per 

100,000 population)

<1 29-42 40 5 Year 1: 29.8

Year 2: 89.3
COVID-19-associated mortality
0

50

100

150

200

250

0-5

months

6-11

months

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

COVID-19 deaths

Age in years

COVID-19 deaths in children and adolescents by age 

based on death certificate data, National Center for 

Health Statistics, January 1, 2020–May 11, 2022

Source: https://data.cdc.gov/NCHS/Provisional-COVID-19-Deaths-Counts-by-Age-in-Years/3apk-4u4f/data. Accessed May 14, 2022. 

Children 6 months–4 years: 

202 COVID-19 deaths

1.7% of all deaths in this age group
COVID-19 is a leading cause of death among children 

ages 0–19 years

March 1, 2020–April 30, 2022

Based on death certificate data from the National Center for Health Statistics. COVID-19 based on cumulative total incidence of COVID-19 deaths from 

March 1, 2020-April 30, 2022.

Source: Flaxman S, Whittaker C, Semenova E et al. Covid-19 is a leading cause of death in children and young people ages 0-19 years in the United 

States. medRxiv 2022.05.23.22275458; doi: https://doi.org/10.1101/2022.05.23.22275458

Age group Rank of COVID-19 among causes 

of death 

<1 year 4

1–4 years 5

5–9 years 5

10–14 years 4

15–19 years 4
Pediatric vaccine preventable diseases: Deaths per 

year in the United States prior to recommended vaccines 

Hepatitis A1 Meningococcal 

(ACWY)2 Varicella3 Rubella4 Rotavirus5 COVID-196

Age <20 years 11–18 years 5–9 

years All ages <5 years 6 months –

4 years

Time 

period 1990–1995 2000–2004 1990–1994

1966–

1968

1985–

1991

Jan 2020–

May 2022

Average 

deaths 

per year

3 8 16 17 20 86

1Vogt TM , Wise ME, Bell BP, Finelli L. Declining hepatitis A mortality in the United States during the era of hepatitis A vaccination. J Infect Dis2008; 197:1282–8.

2National Notifiable Diseases Surveillance System with additional serogroup and outcome data from Enhanced Meningococcal Disease Surveillance for 2015-2019.

3Meyer PA, Seward JF, Jumaan AO, Wharton M. Varicella mortality: trends before vaccine licensure in the United States, 1970-1994. J Infect Dis. 2000;182(2):383-390. 

doi:10.1086/315714

4Roush SW , Murphy TV; Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. JAMA 2007; 298:2155–63.

5 Glass RI, Kilgore PE, Holman RC, et al. The epidemiology of rotavirus diarrhea in the United States: surveillance and estimates of disease burden. J Infect Dis. 1996 Sep;174 

Suppl 1:S5-11.

6 https://data.cdc.gov/NCHS/Provisional-COVID-19-Deaths-Counts-by-Age-in-Years/3apk-4u4f/data. Accessed May 14, 2022 
Multisystem Inflammatory Syndrome 

in Children (MIS-C)
Multisystem Inflammatory Syndrome in Children 

(MIS-C)

 Severe illness in persons ages 0–20 years characterized by fever, 

multisystem organ involvement, laboratory evidence of inflammation, 

and SARS-CoV-2 infection with no alternative plausible diagnosis

 Occurring 2-6 weeks after acute SARS-CoV-2 infection 1

• 60–70% of patients are admitted to intensive care 2, 3, 4

• 1–2% die 2, 3, 4

1. https://www.cdc.gov/mis/mis-c/hcp/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmis%2Fhcp%2Findex.html. Accessed June 7, 2022. 

2. 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

3. 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

4. Miller AD, Zambrano LD, Yousaf AR, Abrams JY, Meng L, Wu MJ, Melgar M, Oster ME, Godfred Cato SE, Belay ED, Campbell AP; MIS-C Surveillance Authorship Group. Multisystem Inflammatory 

Syndrome in Children-United States, February 2020-July 2021. Clin Infect Dis. 2021 Dec 5:ciab1007. doi: 10.1093/cid/ciab1007. Epub ahead of print. Erratum in: Clin Infect Dis. 2022 Apr 27;: PMID: 

34864955; PMCID: PMC8689703.
Daily MIS-C and COVID-19 cases reported to CDC 

(7-day moving average), 

onset February 19, 2020–May 21, 2022

MIS-C cases are among individuals ages <21 years. COVID-19 cases reflect all cases reported to CDC (among individuals of all ages). The grayed-out area on the right side of the figure 

represents the most recent 6 weeks of data, for which reporting of MIS-C cases is still incomplete. Date of onset was missing for 1 of the 8,525 cases. 

https://covid.cdc.gov/covid-data-tracker/#mis-national-surveillance. Accessed June 7, 2022.

Total MIS-C cases: 8,525

69 deaths
Weekly MIS-C case counts among persons ages 0–20 

years by age group (N=8,525)

February 1, 2020 – May 31, 2022
Weekly MIS-C case counts among persons ages 0–20 

years by age group (N=8,525)

February 1, 2020 – May 31, 2022

Among children 6 months–4 years:

1,990 cases

9 deaths
MIS-C patients by race & ethnicity for children and 

adolescents ages 6 months–17 years by age group

February 1, 2020 – May 31, 2022

Age is missing for 1 case.

Source: CDC data. Accessed June 7, 2022 

31%

33% 32%

26%

30% 30%

27%

23%

26%

9%

8% 7% 6% 6% 5%

0%

5%

10%

15%

20%

25%

30%

35%

6 months–4 years 5–11 years 12–17 years

White, Non-Hispanic Black, Non-Hispanic Hispanic/Latino Other Unknown/Refused
Post-COVID Conditions in Children
Post-COVID conditions in children

 A range of new, returning or ongoing, health problems occurring 4 or more 

weeks after acute SARS-CoV-2 infection1

 Occur in adults2 and children <18 years3-4

 Children ages 0–5 years with SARS-CoV-2 infection are more likely than 

controls (without known SARS-CoV-2 infection) to experience the following 

symptoms lasting more than 4 weeks after acute infection4

– Fatigue 

– Loss of taste 

– Loss of smell

1. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-science.html. Accessed June 13, 2022.

2. Bull-Otterson L, Baca S, Saydah S, et al. Post–COVID Conditions Among Adult COVID-19 Survivors Aged 18–64 and ≥65 Years — United States, March 2020–November 2021. MMWR Morb

Mortal Wkly Rep 2022;71:713–717. DOI: http://dx.doi.org/10.15585/mmwr.mm7121e1

3. Rao S, Lee GM, Razzaghi H, et al. Clinical features and burden of post-acute sequelae of SARS-CoV-2 infection in children and adolescents: an exploratory EHR-based cohort study from the 

RECOVER program. medRxiv 2022.05.24.22275544; doi: https://doi.org/10.1101/2022.05.24.22275544

4. Borch L, Holm M, Knudsen M, et al. Long COVID symptoms and duration in SARS-CoV-2 positive children — a nationwide cohort study. European Journal of Pediatrics. 2022 

2022/04/01;181(4):1597-607. 
Post-COVID conditions in children

 Evidence regarding the prevalence and spectrum of post-COVID conditions 

among children, especially young children, is limited by1

– Inability of younger children to verbalize symptoms

– Few studies including children

– Lack of control groups

– Symptoms frequently occur in children without known SARS-CoV-2 

infection 

1. Zimmermann P, Pittet LF, Curtis N. The Challenge of Studying Long COVID: An Updated Review. The Pediatric infectious disease journal. 2022;41(5):424-6.
Other impacts of the COVID-19 

pandemic on children and families
Percent of parents who say: In the past year, they or 

another adult in their household left a job or changed 

work schedules to take care of their children

July 15, 2021–August 2, 2021 

Source: KFF COVID-19 Vaccine Monitor: The Impact Of The Coronavirus Pandemic On The Wellbeing Of Parents And Children | KFF. Accessed May 24, 

2022.

34%

44%

33%

45%

48%

39%

40 years and older

18-39 years

Parent of adolescent ages 12-17 years

Parent of child ages 5-11 years

Parent of child under age 5 years

Total parents

35%

35%

51%

32%

44%

53%

$90K or more

$40K-$89.9K

<$40K

White

Hispanic

Black

Parent age

Race/Ethnicity

Household income
Percent of parents who say: In the past year, they or 

another adult in their household left a job or changed 

work schedules to take care of their children

July 15, 2021–August 2, 2021 

Source: KFF COVID-19 Vaccine Monitor: The Impact Of The Coronavirus Pandemic On The Wellbeing Of Parents And Children | KFF. Accessed May 24, 

2022.

34%

44%

33%

45%

48%

39%

40 years and older

18-39 years

Parent of adolescent ages 12-17 years

Parent of child ages 5-11 years

Parent of child under age 5 years

Total parents

35%

35%

51%

32%

44%

53%

$90K or more

$40K-$89.9K

<$40K

White

Hispanic

Black

Parent age

Race/Ethnicity

Household income
- Worsening of mental or emotional health

- Widening of existing education gaps

- Decreased physical activity and increased body mass index (BMI)

- Decreased healthcare utilization

- Decreased routine immunizations

- Increase in Adverse Childhood Experiences (ACEs)

Other indirect impacts of COVID-19 pandemic on children
Conclusion
Summary: COVID-19 epidemiology in children 

and adolescents ages 6 months–4 years

 As of June 12, 2022, COVID-19 has caused >570,000 cases among infants 

age <1 year and >1.9 million cases among children ages 1–4 years 

 Omicron surge in the United States led to the highest numbers of COVID-19 

cases, emergency department visits, and hospitalization rates seen during 

the pandemic
Summary: COVID-19 epidemiology in children 

and adolescents ages 6 months–4 years

 Children ages 6 months–4 years are at risk of severe illness from COVID-19

– More than half of hospitalized children ages 6 months–4 years had no 

underlying conditions

– During Omicron predominance, COVID-19 associated hospitalizations 

among children ages 6 months–4 years have similar or increased 

severity compared to older children and adolescents

– Burden of COVID-19 hospitalization is similar to or exceeds that of 

other pediatric vaccine preventable diseases

 COVID-19 pandemic continues to have significant impact on families and 

increases disparities
Acknowledgements

 ACIP COVID-19 Workgroup Team: Sara Oliver, Evelyn Twentyman, Monica Godfrey, Danielle 

Moulia, Megan Wallace, Lauren Roper, Kate Woodworth 

 Epidemiology Task Force and Division of Viral Diseases

– Vaccine Effectiveness Team: Ruth Link-Gelles, Tamara Pilishvili

– COVID-NET: Fiona Havers, Chris Taylor, Rebecca Woodruff, Kristin Marks, Kadam Patel, 

Michael Whitaker, Huong Pham, Jenny Milucky, Onika Anglin, Dallas Shi

– Natural History Team: Jefferson Jones, Kristie Clarke, Sharon Saydah

– MIS-C unit: Angie Campbell, Laura Zambrano, Allison Miller

– NVSN: Heidi Moline, Meredith McMorrow, Ariana Perez, Benjamin Clopper, Aaron Curns

– Core Clinical Unit: David Siegel

 Data, Analytics and Visualization Task Force: Casey Lyons, Susan Wacaster, Kingsley Iyawe, 

Vaccine Data Section

 NSSP: Aaron Kite-Powell, Kelly Carey, Kathleen Hartnett, Karl Soetebier

 FluSurv-NET: Shikha Garg, Dawud Ujamaa, Miranda Delahoy

 Division of Vital Statistics, National Center for Health Statistics

 Many more... 
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.