cdc.gov/coronavirus

COVID-19 in pregnant people and infants ages 0-5 

months

Sascha Ellington, PhD, MSPH, CPH

Emergency Preparedness and Response Team Lead

Division of Reproductive Health

National Center for Chronic Disease Prevention and 

Health Promotion

Centers for Disease Control and Prevention
COVID-19 in Pregnant People
3

COVID-19 in Pregnant People

Assessing risk of COVID-19 in pregnancy 

1. Is pregnancy a risk factor for severe illness?

2. Is COVID-19 associated with increased risks for maternal complications 

and adverse pregnancy outcomes ?

3. Are infants born to people with COVID-19 during pregnancy at risk for 

adverse outcomes?
4

Living Systematic Review and Meta-Analysis: Assessing 

pregnancy as a risk factor for severe illness 

Outcomes # Studies

# with event/# in group (%)

Odds ratio (95% CI)

Pregnant with covid-19 Non-pregnant with 

COVID-19

All cause mortality 11 242/122 222 (0.2) 5252/2 138 726 (0.2) 1.48 (0.62 to 3.49)

ICU admission 10 912/118 403 (0.8) 11 513/1 908 957 (0.6) 2.61 (1.84 to 3.71)

Invasive ventilation 8 310/116 458 (0.3) 3607/1 772 716 (0.2) 2.41 (2.13 to 2.71)

ECMO 5 19/30 694 (0.1) 122/432 623 (0.0) 3.71 (0.71 to 19.41)

ARDS 4 22/197 (11.2) 45/418 (10.8) 1.19 (0.24 to 5.95)

Major organ failure 4 5/197 (2.5) 28/418 (6.7) 0.39 (0.15 to 1.04)

Allotey, J et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic 

review and meta-analysis. BMJ. 2020. Updated 7-May 2022 https://doi.org/10.1136/bmj.m3320

ECMO: extracorporeal membrane oxygenation; ARDS: Acute respiratory distress syndrome
5

Reported COVID-19 cases, ICU admission, and deaths among pregnant people

(National COVID-19 Case Surveillance Data; Jan 22, 2020–Jul 31, 2022)

0

10

20

30

40

50

60

70

0

5000

10000

15000

20000

25000

Total ICU admissions or deaths

Total laboratory-confirmed cases

ICU admission

Deaths

Pregnant people infected

Total: 226,263 cases

738 ICU Admissions

329 Deaths 
6

Living Systematic Review and Meta-Analysis: Assessing COVID-19 

as a risk factor for adverse maternal and perinatal outcomes 

Allotey, J et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic 

review and meta-analysis. BMJ. 2020. Updated 7-May 2022 https://doi.org/10.1136/bmj.m3320

Outcomes # Studies

# with event/# in group (%)

Odds ratio (95% CI)

Pregnant with COVID-19 Pregnant without 

COVID-19

Maternal outcomes:

All cause mortality 21 47/11 362 (0.4) 37/411 126 (0.0) 6.09 (1.82 to 20.38)

ICU admission 21 447/12 957 (3.4) 1962/459 359 (0.4) 5.41 (3.59 to 8.14)

Preterm birth <37 weeks 48 1306/12 076 (10.8) 26 068/436 964 (6.0) 1.57 (1.36 to 1.81)

Perinatal outcomes:

Stillbirth 25 76/9338 (0.8) 1397/414 139 (0.3) 1.81 (1.38 to 2.37)

Neonatal death 21 16/3153 (0.5) 28/9 263 (0.3) 2.35 (1.16 to 4.76)

Admission to neonatal unit 29 687/4072 (16.9) 6968/193 124 (3.6) 2.18 (1.46 to 3.26)

Fetal distress 6 131/1073 (12.2) 246/3933 (6.3) 2.22 (1.45 to 3.41)
7

SET-NET: Pregnancy and Infant Outcomes by Trimester of Infection, 

January 25, 2020–December 31, 2020

First or second trimester 

infection Third trimester infection Adjusted prevalence ratioa

Gestational age (N=27.430)

Term (≥37 weeks) 15,398 (88.2) 8,200 (82.2)

Preterm (<37 weeks) 2,061 (11.8) 1,771 (17.8) 1.44 (1.35–1.54)

NICU admission (N=32,319)

Yes 1,655 (10.2) 1,874 (11.6) 1.13 (1.06–1.21)

Term (≥37 weeks) 735 (4.5) 1,086 (6.7) 1.29 (1.16, 1.36)

Preterm (<37 weeks) 920 (5.7) 788 (4.9)

No 14,545 (89.8) 14,245 (88.4)

Small-for-gestational ageb(N=34,522)

Yes 827 (4.8) 1,017 (5.8) 1.16 (1.06–1.27)

No 16,274 (95.2) 16,404 (94.2)

a Adjusted for maternal age, race and ethnicity, health insurance, and underlying conditions

b<10th percentile for sex and gestational age per INTERGROWTH-21st

https://onlinelibrary.wiley.com/doi/10.1002/bdr2.2081
COVID-19 vaccination coverage among 

pregnant people
9

Percentage of pregnant people who have received a COVID-19 primary 

vaccine series and monovalent booster* from two data sources

NIS-ACM: National Immunization Survey-Adult COVID-19 Module. https://www.cdc.gov/vaccines/imz-managers/coverage/covidvaxview/interactive/adults.html. Accessed 10/5/2022

VSD: Vaccine Safety Datalink. https://covid.cdc.gov/covid-data-tracker/#vaccinations-pregnant-women. Accessed 10/5/2022

77

72

48

60

0

10

20

30

40

50

60

70

80

90

NIS-ACM (September 2022) VSD (October 2022)

Percentage

Completed Primary Series Boosted*

From VSD 

❖ Overall, 43% of pregnant people have 

received primary series PLUS monovalent 

booster

❖ Overall, 57% of pregnant people 

unvaccinated or under-vaccinated

*Percentage boosted among those who received COVID-19 vaccine series
COVID-19 in infants ages 0-5 months
11

COVID-19-associated hospitalizations by age group, 

COVID-NET, March 1, 2020 – September 10, 2022

Source: COVID-NET, https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html. Accessed October 1, 2022.

COVID-NET hospitalization data are preliminary and subject to change as more data become available.

Pre-Delta Delta Omicron BA.1 Omicron BA.2 Omicron BA.5

0

20

40

60

80

100

120

10 14 18 22 26 30 34 38 42 46 50 1 5 9 13 17 21 25 29 33 37 41 45 49 1 5 9 13 17 21 25 29 33

2020 2021 2022

Hospitalizations per 100,000 population

MMWR week

65+ yr

0-5 mo

50-64 yr

18-49 yr

6 mo-4 yr

5-17 yr
12

Cumulative influenza- and COVID-19-associated 

hospitalization rates per 100,000 among infants 0-5 months, 

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. 

▪ October 2020 to September 2021: 

Cumulative COVID-19-associated 

hospitalization rates were similar to 

influenza-associated hospitalization rates 

during the 2017-18, 2018-19, and 2019-20 

influenza seasons

▪ October 2021 to April 2022: Cumulative 

COVID-19-associated hospitalization rates 

were higher than influenza-associated 

hospitalization rates during those same prepandemic influenza seasons 

COVID-19 Oct 2021-Apr 2022

COVID-19 Oct 2020-Sep 2021

0

40

80

120

160

200

240

280

320

360

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

Cumulative Rates per 100,000 population

MMWR Week
13

▪ Among infants 0-5 months of age with COVID-19-associated hospitalizations:1

– 84% of infants had COVID-19 symptoms (including 97% of those >1 month age)

– 24% have an underlying health condition (prematurity was the most frequent)

– 18% were admitted to the intensive care unit (ICU)

▪ Cumulative COVID-19-associated hospitalization rates by race and ethnicity are 

highest in infants ages 0-5 months who are non-Hispanic American Indian and Alaska 

Native, Hispanic, and non-Hispanic Black. 2

▪ According to death certificate data from January 1, 2020 through October 1, 2022:

– 265 deaths involving COVID-19 have been reported among infants ages 0-5 

months, accounting for 0.5% of all-cause deaths in this age group.3

COVID-19 epidemiology in infants ages 0-5 months

For more details, please see extra slides.

1. March 20 – August 31, 2022. Data source: Coronavirus Disease 2019–Associated Hospitalization Surveillance Network. Accessed October 10, 2022.

2. Data source: Coronavirus Disease 2019–Associated Hospitalization Surveillance Network. Accessed September 28, 2022.

3. Source: https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Age-in-Years-/3apk-4u4f/data. Accessed 10/12/2022.
For more information: www.cdc.gov/COVID19

Updates on COVID-19 vaccine safety in pregnancy:

• Vaccine Safety Datalink 

• v-safe COVID-19 Vaccine Pregnancy Registry

Advisory Committee on Immunization Practices

October 19, 2022

Elyse O. Kharbanda, MD, MPH, HealthPartners Institute 

Christine Olson MD, MPH, CDC
Disclaimer

▪ 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)

▪ Mention of a product or company name is for identification purposes 

only and does not constitute endorsement by CDC

15
Overview

▪ Vaccine Safety Datalink

• Present analyses of spontaneous abortion (case) and ongoing pregnancy 

(control) surveillance following COVID-19 booster vaccination

• Provide summary of VSD studies of COVID-19 vaccine safety in pregnancy 

▪ v-safe COVID-19 Vaccine Pregnancy Registry

• Describe Pregnancy Registry participant cohort

• Present preliminary data on pregnancy and infant outcomes

16
Vaccine Safety Datalink (VSD)

▪ Established in 1990

▪ Collaborative project between CDC and 9 integrated healthcare organizations, as of Sept 2022

▪ VSD expanding in 2022 to include additional sites

▪ https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/vsd/index.html

17
Objectives – case-control surveillance, 8 VSD sites

▪ Primary: To conduct “monthly” surveillance of spontaneous abortion (cases) 

and ongoing pregnancy (controls), in order to estimate the odds ratio for 

receiving a 3rd mRNA COVID-19 vaccine dose in the 28 days prior to the 

spontaneous abortion

▪ Secondary: To evaluate odds ratios for receiving a 3rd mRNA COVID-19 

vaccine in a 42-day window and for receiving any COVID-19 booster in a 28-

or 42-day window

Spontaneous abortion (SAB) defined as an intrauterine pregnancy ending in fetal demise before 20 weeks’ gestation

18
Definition of a COVID-19 vaccine booster

▪ Booster dose defined as a COVID-19 vaccine dose administered at least 28 

days after completion of the COVID-19 vaccine primary series*

▪ Primary analyses evaluated 3rd mRNA COVID-19 vaccine dose, after 2 prior 

mRNA COVID-19 vaccine doses

▪ Secondary analyses evaluated any COVID-19 vaccine booster dose

– 2nd Janssen/J&J

– mRNA vaccine after Janssen/J&J

– 4th or subsequent mRNA vaccine dose

19

*Primary vaccine series: 2 mRNA COVID vaccine doses or 1 Janssen/J&J dose

mRNA COVID-19 vaccines are mRNA-1273, Moderna or BNT162b2, Pfizer-BioNTech
Spontaneous abortion (case) and 3rd COVID-19 mRNA 

vaccine (booster) in 28-day exposure window 

Pregnancy start 

or LMP

28-day Surveillance period

SAB date SAB date – 28 

days

SAB Cases

28-day window for 

3rd mRNA COVID-19 dose

Index date (midpoint 

28- (or 42-) day 

surveillance period)

28 (or 42-) day window for 

COVID-19 booster vaccination

Surveillance period 

start date

Pregnancy start 

or LMP

Ongoing 

pregnancyperiod 

controls

Spontaneous abortions (SAB) and Ongoing pregnancies 6-19 weeks’ gestation; Stratified by gestational age groups 

(6-8, 9-13, 14-19 weeks), maternal age group, number of antenatal visits, race/ethnicity and VSD site

20
Spontaneous abortion (case) and 3rd COVID-19 mRNA 

vaccine (booster) in 28-day exposure window 

Pregnancy start 

or LMP

28-day Surveillance period

SAB date SAB date – 28 

days

SAB Cases

28-day window for 

3rd mRNA COVID-19 dose

Index date (midpoint 

28- (or 42-) day 

surveillance period)

28-day window for 

3rd mRNA COVID-19 dose

Surveillance period 

start date

Pregnancy start 

or LMP

Ongoing 

pregnancyperiod 

Controls

Spontaneous abortions (SAB) and Ongoing pregnancies 6-19 weeks’ gestation; Stratified by gestational age groups 

(6-8, 9-13, 14-19 weeks), maternal age group, number of antenatal visits, race/ethnicity and VSD site

21
Spontaneous abortion (case) and ongoing pregnancyperiod (control) surveillance and COVID-19 vaccine 

boosters in 28 (or 42) day exposure window 

Spontaneous abortions (SAB) and Ongoing pregnancies 6-19 weeks’ gestation; Stratified by gestational age groups 

(6-8, 9-13, 14-19 weeks), maternal age group, number of antenatal visits, race/ethnicity and VSD site

Pregnancy start 

or LMP

28- (or 42-) day Surveillance period

SAB date SAB date – 28 

(or 42) days

SAB Cases

28- (or 42-) day window for 

COVID-19 booster vaccination

Index date (midpoint 

28- (or 42-) day 

surveillance period)

28 (or 42-) day window for 

COVID-19 booster vaccination

Surveillance period 

start date

Pregnancy start

or LMP

Ongoing 

pregnancyperiod 

Controls

22
Results: Receipt of 3rd COVID-19 mRNA COVID-19 

vaccine dose in pregnancy

Nov 1, 2021 – June 12, 2022 

112,718 unique pregnancies 6-19 weeks’ gestation

Eight 28-day surveillance 

periods

Ongoing

Pregnancies 

N (%)

Spontaneous 

abortions

N (%)

All included pregnancies 98,492 14,226

Vaccine type

mRNA-1273, Moderna 4350 (4.4) 371 (2.6)

BNT162b2, Pfizer 6135 (6.2) 476 (3.3)

Total 10,485 (10.6) 847 (6.0)

23

Secondary analyses: 11,293 ongoing pregnancies and 904 pregnancies ending in 

spontaneous abortion received any COVID-19 vaccine booster in pregnancy
Adjusted Odds Ratios for 3rd mRNA COVID-19 vaccine in 

28 days prior to SAB, overall and by vaccine type

Nov 1, 2021–Jun 12, 2022, 285,079 pregnancy-periods

aOR = adjusted odds ratio; SAB= spontaneous abortion

*GEE models included covariates for gestational age group, surveillance period, VSD site, maternal age group, 

number of antenatal visits, and race/ethnicity and accounted for unique pregnancies that contributed data to ≥1 

pregnancy-period 

*aOR (95% CI) 

Primary analyses

3

rd mRNA COVID-19 vaccine in 28-day 

window

0.94 (0.86-1.03)

By vaccine type

mRNA-1273, Moderna 0.93 (0.81–1.07)

BNT162b2, Pfizer-BioNTech 0.95 (0.84–1.07)

24
Adjusted Odds Ratios for primary and secondary 

analyses

aOR = adjusted odds ratio

*GEE models included covariates for gestational age group, surveillance period, VSD site, maternal age group, 

number of antenatal visits, and race/ethnicity and accounted for unique pregnancies that contributed data to ≥1 

pregnancy-period

**Any COVID-19 vaccine booster includes 2nd Janssen/J&J dose, mRNA COVID-19 vaccine dose after 

Janssen/J&J, or 4th or subsequent mRNA COVID-19 vaccine dose

*aOR (95% CI) 

Primary analyses

3

rd mRNA COVID-19 vaccine in 28-day 

window

0.94 (0.86-1.03)

Secondary analyses 

3rd mRNA COVID-19 vaccine in 42-day 

window 0.97 (0.90-1.05) 

Any COVID-19 vaccine booster** in 28-day 

window 0.94 (0.86-1.02) 

Any COVID-19 vaccine booster in 42-day 

window 0.96 (0.89-1.04)

25
Current VSD studies on COVID-19 vaccine safety in pregnancy

Short title Exposure Outcome(s) Status (as of 9/21/22)

Spontaneous abortion 

case-control surveillance

Primary vaccine series Spontaneous abortion – based on 

automated data

Published in JAMA 9/2021

Presented at ACIP 9/2021

Booster vaccination* Topic of presentation today

Stillbirth and 

Spontaneous abortion 

case-control study

Primary vaccine series 

Spontaneous abortion and stillbirth –

based on chart review and expert 

adjudication

Chart reviews and expert 

adjudication of cases ongoing

Acute maternal outcomes 

(within 42 days of 

vaccination)

Primary vaccine series Fever and other acute local and systemic 

reactions

Published in NEJM 7/2022

Booster vaccination* Analyses ongoing

Pregnancy complications 

and birth outcomes Primary vaccine series

Gestational diabetes, hypertensive 

disorders of pregnancy Analyses ongoing

Small-for-gestational age, preterm birth Published in MMWR 1/2022

Birth defects, infant infections Analyses ongoing

Growth and developmental outcomes Planning analyses – awaiting 

infants to reach 2 years of age

*Monovalent booster vaccines; bivalent booster vaccines can be evaluated in the future 26
Summary

• COVID-19 booster vaccination in early pregnancy was 

not associated with increased risk for spontaneous 

abortion

• The Vaccine Safety Datalink is continuing 

comprehensive surveillance of COVID-19 vaccine safety 

in pregnancy

• No safety signals have been identified

• Future studies will evaluate long-term outcomes and newer 

COVID-19 vaccines

27
Our team

HealthPartners

• Elyse Kharbanda, Co-Project Director

• Malini DeSilva

• Gabriela Vazquez-Benitez

• Robyn Kaiser

• Jim Nordin

• Leslie Kuckler

• Jingyi Zhu

• Jacob Haapala

• Sunita Thapa

• Sheryl Kane

• Nicole Trower

• Elisabeth Seburg

Yale/Cornell University

• Heather Lipkind, Co-Project Director 

• Sangini Sheth

• Annalies Denoble

Kaiser Northwest

• Kimberly Vesco

• Allison Naleway

• Stephanie Irving

• Brad Crane

CDC

• Christine Olson

• Mike McNeil

• Eric Weintraub

• Elizabeth Quincer

Other VSD sites

• Ousseny Zerbo

• Nicola Klein

• Matt Daley

• Darios Getahun

• Lisa Jackson

• Jennifer Nelson

• Joshua Williams

• Simon Hambidge

• Jim Donahue

• Tom Boyce

• Candace Fuller

This work was funded by CDC, 

contract: 200-2012-53526

28
v-safe COVID-19 Vaccine Pregnancy Registry enrollment & data collection

*Pregnancy questions in v-safe assessments on first survey after each dose and on post-vaccination days 21 and 42 and months 3, 6, and 12

ŦEligibility determined from verbal interviews and responses to 3-question on web-based v-safe follow-up survey received prior to May 31, 2021. Eligible individuals received COVID19 vaccination during pregnancy or periconceptional period (≤ 30 days before the first day of the last menstrual period before pregnancy) 

Consent for registry 

enrollment and follow-up

Individual

Reporting 

Pregnancy*

Eligible 

Individuals • Active, smart-phone 

based monitoring system 

for COVID-19 vaccines

• Voluntary self-enrollment

• Started DEC 14, 2020

Eligibility ScreeningŦ

• Reported a pregnancy into v-safe 

DEC 14, 2020 – JUN 20, 2021

• 18+ years of age

• Speak English or Spanish

• Pregnant at time of vaccination 

or vaccinated during periconceptional period

• Phone interviews conducted

• Demographics, health over pregnancy

• Pregnancy outcome

• Birth hospitalization, postpartum 

• Infant health to 3 months of age

• Consent obtained for medical records 

❖ Interviews completed

JAN 2021 – AUG 2022

❖ Medical record review ongoing

29
30

Summary of eligibility & enrollment into 

the v-safe COVID-19 Pregnancy Registry

Refused

1%

Eligible

36%

Unreachable

60%

Not eligible

3%

Participation rate: 98%

Total enrolled: 22,953

Total pregnancies: 22,968

Mean age 33.9 yr

45% healthcare workers

Pfizer 

BioNTech

58%

Moderna

39%

J&J

3%

NH-white

79%

Hispanic

9%

NH-Asian

6%

NH-black

2%

Other

4%

Over 65,000 participants reported a pregnancy 

into v-safe during the eligibility period*

(Dec 2020-June 2021)

*Excludes v-safe participants who in a subsequent survey reported they were not 

pregnant or did not provide permission to contact for pregnancy registry eligibility.

Abbreviations: J&J = Janssen/Johnson & Johnson; NH=non-Hispanic
Periconceptional

N=2,245 

10%

Third 

Trimester

N=6,352

28%

N=9,074

40%

N=5,192

23%

Second 

Trimester

First 

Trimester

Timing of first eligible COVID-19 vaccination 

among v-safe Pregnancy Registry participants*

Definitions: Periconceptional: ≤30 days before the first day of the last menstrual period (LMP) before pregnancy; 

First trimester: 1st day of LMP to <14 weeks gestational age; Second trimester: 14-28 weeks; Third trimester: ≥28 weeks

*Total number of pregnancies excluding 35 participants who withdrew from the registry and 70 participants enrolled based on LMP, but later determined ineligible based on EDD. 31
At-A-Glance: Self-reported interview data

v-safe COVID-19 Pregnancy Registry

Pregnancy outcome among pregnancies 

with a known outcome* (n=21,703)

Pfizer BioNTech

(N=12,751)

Moderna

(N=8,365)

J&J

(N=587)

N % N % N %

Live birth 12253 96.1 7916 94.6 557 94.9

Miscarriage (<20 wk) 422 3.3 395 4.7 24 4.1

Stillbirth (≥20 wk)** 29 0.2 20 0.2 2 0.3

Induced Abortion 30 0.2 25 0.3 4 0.7

Other (e.g., ectopic) 17 0.1 10 0.1 0 0

*Analysis excludes 35 participants that withdrew and 70 deemed ineligible based on EDD. Pregnancy outcome unknown for 1160 pregnancies: 415 lost to follow up, and 

745 may be captured during extended follow-up.

**Stillbirths adjudicated, and re-classified based on medical records where possible. 1 twin pregnancy with both a live and stillbirth is counted under both. 

Pregnancy Registry

2.45

Stillbirth Rate

per 1,000 live births 

and still births

2017 NVSS Birth Data

5.89 overall

4.89 NH-white

32

Preliminary data

Abbreviations: J&J = Janssen/Johnson & Johnson; N=numerator; NH = non-Hispanic; NVSS = U.S. National Vital Statistics System, Birth Data 
At-A-Glance: Self-reported interview data

v-safe COVID-19 Pregnancy Registry

33

Pfizer BioNTech Moderna J&J Published 

Incidence (%)Ŧ

N % N % N %

Maternal conditions during pregnancy (n=22,863)*

Hypertensive disorders 

of pregnancy** 1,704 12.8 1,083 12.2 77 11.1 8.5-13

Gestational diabetes 1,205 9.1 810 9.1 58 8.4 8-10

COVID-19 infection 464 3.5 311 3.5 33 4.8 --

Pregnancy complications among pregnancies resulting in live birth (n=20,726)*

Preterm birth 865 7.1 553 7.0 43 7.7 8-15

SGA (<10th percentile) 203 1.7 149 1.9 8 1.5 10

Infant outcomes among live births (n=21,088)*

Infant death*** 12 0.1 15 0.2 1 0.2 <1

* Analyses excludes 35 participants that withdrew and 70 deemed ineligible based on EDD. Denominators for each vaccine type can be calculated by N/(%*0.01).

** Excludes preexisting hypertension.

***Infant deaths adjudicated with medical records where possible, 1 neonatal death re-classified as a stillbirth. 

Ŧ The populations from which these rates are derived are not matched to the current study population for age, race and ethnicity, or other demographic and clinical factors.

Abbreviations: J&J = Janssen/Johnson & Johnson; N=numerator. 

Preliminary data
No increased risk of 

spontaneous abortion (SAB) 

after COVID-19 vaccination 

during pregnancy.

▪ 2,456 participants with at least one eligible mRNA vaccination

▪ Unadjusted cumulative risk of SAB after mRNA COVID-19 vaccination: 14.1%

▪ Age-standardized cumulative risk of SAB: 12.8% (95% CI: 10.8%–14.8%)

– Similar to previously published baseline estimates of SAB (11%–22%)

34

Lauren H Zauche, Bailey Wallace, Ashley N Smoots, Christine K Olson Titilope Oduyebo, 

Shin Y Kim, Emily E Petersen, Jun Ju, Jennifer Beauregard, Allen J Wilcox, Charles E 

Rose, Dana M Meaney-Delman, Sascha R Ellington, CDC v-safe Covid-19 Pregnancy 

Registry Team

v-safe COVID-19 Pregnancy Registry 2021 Oct 14;385(16):1533-1535. doi: 10.1056/NEJMc2113891. 
No increased risk of major birth defects

after COVID-19 vaccination during pregnancy

35

All birth defects, all vaccines, any 

time during pregnancy

All birth defects, mRNA vaccine 

preconceptionally or first trimester

All birth defects, mRNA vaccine >20 

weeks gestation

Background rate 3-5%

▪ 12,474 participants

▪ Singleton pregnancies

▪ Excluded those who reported 

COVID-19 during pregnancy

▪ Major birth defects reported for 

429 (3.5%) fetuses or infants

Analysis inclusion criteria: registry participants with reported pregnancy outcome Dec 14, 2020, through Jan 31, 2022. Excluded participants 

who reported a miscarriage, ectopic or molar pregnancy, non-singleton pregnancy, or who reported having had COVID-19 during pregnancy.

Preliminary data

v-safe COVID-19 Pregnancy Registry
SARS-CoV-2 infection after full vaccination not associated 

with increased risk of pregnancy-associated outcomes

No SARS-CoV-2 

infection reported 

(N=20,309)

referent

SARS-CoV-2 infection 

after full vaccination*

(N=325)

Prevalence 

ratio

Stillbirth 51 (0.3%) 1 (0.3%) 1.22 (0.17, 8.90)

Preterm birth (<37 weeks) 1,604 (7.9%) 30 (9.2%) 1.16 (0.83, 1.65)

Hypertensive disorder of 

pregnancy

2,817 (13.9%) 55 (16.9%) 1.22 (0.96, 1.56)

NICU admission 2,213 (10.9%) 37 (11.4%) 1.04 (0.77, 1.42)

Maternal ICU admission 102 (0.5%) 1 (0.3%) 0.61 (0.10, 4.38) 

Analysis excluded pregnancies ending <20 weeks gestation, all induced abortions regardless of gestational age, SARS-CoV-2 infection prior to full vaccination. 

* Fully vaccinated defined as 2 weeks after 1 dose of Janssen Covid-19 vaccine or 2 weeks after 2nd dose of Pfizer-BioNTech or Moderna Covid-19 vaccines 

Preliminary data

v-safe COVID-19 Pregnancy Registry
Conclusions and next steps

▪ The v-safe COVID-19 Vaccine Pregnancy Registry adds to the growing body 

of evidence on the safety of COVID-19 vaccination during pregnancy 

– No evidence of increased risk for participant or infant outcomes

– No evidence of any disproportionate outcomes by vaccine type or timing

▪ Early analyses will be replicated with the full registry cohort

▪ For select* participant and infant outcomes, participant-reported data are 

being confirmed with medical records to the extent possible

▪ CDC will continue to monitor the safety of COVID-19 vaccination during 

pregnancy with an extended follow-up through 15 months post-delivery

37

*e.g, possible birth defects/infant conditions, stillbirth, infant death, ICU admission, and hypertensive disorders of pregnancy. About 20% of participants 

have medical records requested.
▪ v-safe COVID-19 Vaccine Pregnancy Registry Participants

▪ v-safe COVID-19 Vaccine Pregnancy Registry staff and contributors

• Andrea Sharma

• Lauren Zauche

• Sabrina Madni

• Ansley Waters

• Tara Johnson

• John Nahabedian

• Reji Padathara Mathew

• Sam Wotiz

• Victoria Okereke

• Hayden Goodsir

Acknowledgements

• Sarah Sheets

• Jenna Chambless

• Kendra Norris

• Jennita Reefhuis

• Jan Cragan

• Cynthia Moore

• Shana Godfred Cato

• Sascha Ellington

• Aliza Machefsky

• David Shay
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.

Thank you
cdc.gov/coronavirus

Effectiveness of maternal COVID-19 vaccination among 

pregnant people and infants

Katherine E. Fleming-Dutra, MD

National Center for Immunization and 

Respiratory Diseases

Centers for Disease Control and Prevention
41

▪ CDC recommends everyone stay up to date with COVID-19 vaccination, including all 

primary series doses and the most recent booster dose recommended for them by 

CDC.

– People ages 5 years and older are recommended to receive 1 updated (bivalent) 

mRNA booster dose.*

▪ Staying up to date with COVID-19 vaccinations is recommended for everyone, 

including people who are pregnant, trying to get pregnant now, or who might 

become pregnant in the future, and people who are breastfeeding.

▪ People who are moderately or severely immunocompromised have different 

recommendations for COVID-19 vaccines.

Current COVID-19 vaccine recommendations

*Only bivalent Pfizer-BioNTech COVID-19 Vaccine is authorized for people age 5 years; both bivalent Moderna and Pfizer-BioNTech COVID-19 Vaccines are authorized for 

people ages 6 years and older.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html Accessed 10/12/2022

https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#pregnancy-fertility Accessed 9/27/2022
42

Composition of Monovalent (Original) and Bivalent (Updated) 

COVID-19 mRNA vaccines

Moderna COVID-19 vaccine

50μg mRNA for spike protein from

‘ancestral’ (‘original’) SARS-CoV-2

Monovalent (Original) mRNA COVID-19 vaccines

Pfizer-BioNTech COVID-19 vaccine

30μg mRNA for spike protein from

‘ancestral’ (‘original’) SARS-CoV-2

Moderna COVID-19 vaccine

25μg mRNA for spike protein from

‘ancestral’ (‘original’) SARS-CoV-2

Bivalent (Updated) mRNA COVID-19 vaccines

Pfizer-BioNTech COVID-19 vaccine

15μg mRNA for spike protein from

‘ancestral’ (‘original’) SARS-CoV-2

25μg mRNA for spike protein from

Omicron (BA.4/BA.5) SARS-CoV-2

15μg mRNA for spike protein from

Omicron (BA.4/BA.5) SARS-CoV-2

50μg

30μg

50μg

30μg
Monovalent mRNA vaccine effectiveness 

(VE) among pregnant people
44

VISION Multi-State Network of Electronic Health Records

▪ Test-negative design

▪ Assess monovalent mRNA VE 

against COVID-19-associated 

emergency department and 

urgent care visits and COVID19-associated hospitalization

▪ Included encounters from 

June 2021 to June 2022

▪ Delta and Omicron variant 

periods were determined by 

time when each variant 

predominated in study site

VISION Network includes sites across 10 states; individuals sites denoted by dots on map. 

Schrag et al. Estimation of COVID-19 mRNA Vaccine Effectiveness Against Medically Attended COVID-19 in Pregnancy During Periods 

of Delta and Omicron Variant Predominance in the United States JAMA Netw Open. 2022;5(9):e2233273. 

doi:10.1001/jamanetworkopen.2022.33273
45

Vaccination status (days 

since last dose)

Delta

VE (95% CI)

Omicron

VE (95% CI)

Pregnant people—including those vaccinated either before or during pregnancy, by number of doses (days since last dose)

Unvaccinated Referent Referent

2 doses (14-149 days) 87 (78 to 92) 39 (13 - 58)

2 doses (≥150 days) 78 (64 to 87) 11 (-16 - 32)

3 doses (7-119 days) 82 (53 to 93) 81 (68 - 89)

3 doses (≥120 days) * *

Non-pregnant women ages 18-45 years, by number of doses (days since last dose)

Unvaccinated Referent Referent

2 doses (14-149 days) 88 (87 to 89) 36 (31 - 41)

2 doses (≥150 days) 77 (75 to 79) 18 (14 - 22)

3 doses (7-119 days) 90 (88 to 92) 69 (66 - 72)

3 doses (≥120 days) 96 (73 to 99) 16 (7 - 25)

-20 0 20 40 60 80 100

Vaccine Effectiveness (%)

VISION: Monovalent mRNA VE for emergency department and urgent care visits by number 

of doses and time since last dose receipt for pregnant people and non-pregnant women 

ages 18-45 years

2-dose VE

3-dose VE

*Estimates with 95% confidence intervals (CI) widths >50 points are considered imprecise and not shown. Adjusted for age, geographic region, calendar time, local virus circulation, and propensity to be vaccinated based on propensity score models, 

which included estimated gestational age. COVID-like illness: included acute respiratory illness (e.g., COVID-19, respiratory failure, or pneumonia) or related signs or symptoms of acute respiratory, acute febrile or acute non-respiratory illness 

(cough, fever, dyspnea, vomiting, or diarrhea). Schrag et al. Estimation of COVID-19 mRNA Vaccine Effectiveness Against Medically Attended COVID-19 in Pregnancy During Periods of Delta and Omicron Variant Predominance in the United States 

JAMA Netw Open. 2022;5(9):e2233273. doi:10.1001/jamanetworkopen.2022.33273

-20 0 20 40 60 80 100

Vaccine Effectiveness (%)
46

Vaccination status (days 

since last dose) 

Delta

VE (95% CI)

Omicron

VE (95% CI)

Pregnant people—including those vaccinated either before or during pregnancy, by number of doses (days since last dose)

Unvaccinated Referent Referent

2 doses (14-149 days) 99 (96 to 100) *

2 doses (≥150 days) 98 (92 to 99) *

3 doses (7-119 days) 98 (80 to 100) 94 (66 to 99)

3 doses (≥120 days) * *

Non-pregnant women ages 18-45 years, by number of doses (days since last dose)

Unvaccinated Referent Referent

2 doses (14-149 days) 95 (93 to 97) 64 (44 to 77)

2 doses (≥150 days) 90 (87 to 93) 50 (35 to 61)

3 doses (7-119 days) 99 (95 to 100) 73 (60 to 82)

3 doses (≥120 days) * *

VISION: Monovalent mRNA VE for hospitalization by number of doses and time since last 

dose receipt for pregnant people and non-pregnant women ages 18-45 years

2-dose VE

3-dose VE

*Estimates with 95% confidence intervals (CI) widths >50 points are considered imprecise and not shown. Adjusted for age, geographic region, calendar time, local virus circulation, and propensity to be vaccinated based on propensity score models, 

which included estimated gestational age. COVID-like illness: included acute respiratory illness (e.g., COVID-19, respiratory failure, or pneumonia) or related signs or symptoms of acute respiratory, acute febrile or acute non-respiratory illness 

(cough, fever, dyspnea, vomiting, or diarrhea). COVID-like illness for hospitalization did not include signs and symptoms of acute non-respiratory illness. Schrag et al. Estimation of COVID-19 mRNA Vaccine Effectiveness Against Medically Attended 

COVID-19 in Pregnancy During Periods of Delta and Omicron Variant Predominance in the United States JAMA Netw Open. 2022;5(9):e2233273. doi:10.1001/jamanetworkopen.2022.33273

-20 0 20 40 60 80 100

Vaccine Effectiveness (%)

-20 0 20 40 60 80 100

Vaccine Effectiveness (%)
47

▪ VE for emergency department and urgent care visits and hospitalizations is similar 

among pregnant people and non-pregnant women ages 18-45 years.

– VE was similar when stratified by doses given during pregnancy and doses given 

before or during pregnancy.

– Time since last dose affects VE more than whether doses were given before or 

during pregnancy.

▪ VE is lower during Omicron predominance compared to Delta predominance in both 

pregnant and non-pregnant people, and this is likely due to a combination of factors, 

including mismatch between monovalent vaccine and predominant circulating 

variant.

Summary: Maternal COVID-19 monovalent mRNA vaccine 

effectiveness (VE) among pregnant people

Schrag et al. Estimation of COVID-19 mRNA Vaccine Effectiveness Against Medically Attended COVID-19 in Pregnancy During Periods 

of Delta and Omicron Variant Predominance in the United States JAMA Netw Open. 2022;5(9):e2233273. 

doi:10.1001/jamanetworkopen.2022.33273
Effectiveness of maternal monovalent mRNA 

vaccination in prevention of hospitalization 

among infants ages 0-5 months
49

Overcoming COVID-19: Effectiveness of maternal monovalent mRNA primary 

series in prevention of hospitalization among infants ages 0-5 months by 

variant period and timing of vaccination during pregnancy

Halasa et al. Maternal Vaccination and Risk of Hospitalization for Covid-19 among Infants. N Engl J Med. 2022 Jul 14;387(2):109-119. doi: 10.1056/NEJMoa2204399. Epub 2022 Jun 22. PMID: 

35731908; PMCID: PMC9342588.

Variant period and timing of 

second dose during pregnancy

Adjusted

VE (95% CI)

During Delta predominant period (July 1, 2021 to December 18, 2021)

Any time 80 (60 to 90)

First 20 weeks 68 (19 to 87)

After 20 weeks 88 (68 to 96)

During Omicron predominant period (December 19, 2021 to March 8, 2022)

Any time 38 (8 to 58)

First 20 weeks 25 (-26 to 56)

After 20 weeks 57 (25 to 75)

-40 -20 0 20 40 60 80 100

Vaccine Effectiveness (%)

Delta predominance

Omicron predominance

▪ Maternal COVID-19 primary series vaccination protected infants 

ages 0-5 months from hospitalization for COVID-19

▪ Protection was lower during Omicron than Delta predominance
50

▪ COVID-19 can cause severe disease in pregnant people and infants. 

▪ COVID-19 vaccination of pregnant people is safe for pregnant people and infants. 

▪ Maternal monovalent mRNA COVID-19 vaccination protects pregnant people and 

infants ages 0-5 months from COVID-19, including from severe disease and 

hospitalization.

▪ Monovalent vaccine effectiveness was lower during Omicron predominance, when 

there was mismatch between the vaccine and predominant circulating variant.

▪ Everyone, including people who are pregnant, trying to become pregnant, may 

become pregnant, and who are breastfeeding, should stay up to date with COVID-19 

vaccines and get the recommended updated (bivalent) booster, when eligible.

Summary
51

▪ COVID-19 vaccines may be administered without regard to timing of other vaccines.

– This includes simultaneous administration of COVID-19 vaccine and other vaccines, 

such as influenza vaccine and Tdap (pertussis) vaccine, on the same day. 

– However, there are additional considerations if administering an orthopoxvirus

vaccine, which can be found in the Clinical Guidance for COVID-19 Vaccination | 

CDC. 

CDC’s guidance on staying up to date with COVID-19 

vaccines and co-administration of vaccines applies to 

everyone, including pregnant people.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html Accessed 10/11/2022

https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#timing-spacing-interchangeability Accessed 10/11/2022 
52

▪ Vaccine Effectiveness and Policy Team: Sara Oliver, Evelyn Twentyman, Ruth Link-Gelles, Lauren Roper, Monica Godfrey, Elisha 

Hall, Danielle Moulia, Megan Wallace, Tamara Pilishvili, Meg Freedman, Ryan Wiegand, Amadea Britton, Morgan Najdowski, Bill 

Bentley, Hannah Rosenblum, and more 

▪ COVID-NET: Sarah Hamid, Fiona Havers, Chris Taylor, Kadam Patel, Michael Whitaker, Huong Pham, Jenny Milucky, Onika Anglin 

▪ VISION: Mark Tenforde, Stephanie Schrag, Jennifer Verani, Victoria Lazariu

▪ MIS Unit and Overcoming COVID: Angie Campbell, Laura Zambrano, Allison Miller, Michael Wu

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

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

▪ NDBDD: Kate Woodworth, Dana Meaney-Delman, Kara Polen

▪ DRH: Sascha Ellington, Romeo Galang

▪ Data, Analytics and Visualization Task Force: Nikki Sigalo, Casey Lyons, Susan Wacaster, Kingsley Iyawe, Vaccine Data Section

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

▪ Division of Vital Statistics, National Center for Health Statistics

▪ Many more... 

Acknowledgements
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.
Extra slides
55

Trimester of SARS-CoV-2 Infection Among Pregnant People with Known Pregnancy Outcomes — SETNET, 34 Jurisdictions, January 2020 – December 2021

n=26,263 

23%

n=37,363

33%

n=50,592

44%

Inclusion Criteria: Pregnant people with laboratory confirmed SARS-CoV-2 infection (PCR+) at any point during pregnancy

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/birth-data-on-covid-19.html

Surveillance for Emerging Threats to Mothers and 

Babies Network (SET-NET)
56

COVID-19 weekly cases per 100,000 population among children 

ages 0–17 years by age group — United States 

March 1, 2020 – September 18, 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 and CDC Line Level Data Team. Data accessed October 4, 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

Total number of COVID-19 cases

<1 year 747,894

1–4 years 2,299,590

5–11 years 5,719,747

12–17 years 6,291,719
57

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 ED visits diagnosed with COVID-19 

among children ages 0–17 years, National Syndromic 

Surveillance Program, May 3, 2020–September 24, 2022
58

Cumulative COVID-19-associated hospitalizations among infants ages 0-5 

months by race and ethnicity, COVID-NET, March 2020 – September 2022

Data source: Coronavirus Disease 2019–Associated Hospitalization Surveillance Network. Accessed September 28, 2022.

COVID-NET hospitalization data are preliminary and subject to change as more data become available.

0

200

400

600

800

1000

1200

1400

1600

1800

28-Mar

25-Apr

23-May

20-Jun

18-Jul

15-Aug

12-Sep

10-Oct

7-Nov

5-Dec

2-Jan

30-Jan

27-Feb

27-Mar

24-Apr

22-May

19-Jun

17-Jul

14-Aug

11-Sep

9-Oct

6-Nov

4-Dec

1-Jan

29-Jan

26-Feb

26-Mar

23-Apr

21-May

18-Jun

16-Jul

13-Aug

10-Sep

2020 2021 2022

Hospitalization rate per 100,000

Surveillance week end date

Pre-Delta

Delta

Omicron BA.1

Omicron BA.2

Omicron BA.5

American Indian/Alaskan

Native, non-Hispanic

Hispanic

Black, non-Hispanic

White, non-Hispanic

Asian, non-Hispanic

Pre-Delta Delta

Omicron

BA.1

Omicron

BA.5

Omicron

BA.2
Underlying conditions among infants ages 0-5 months with COVID-19-

associated hospitalization, COVID-NET, March 20 – August 31, 2022

* Defined as one or more of the following: prematurity, congenital heart disease, neurologic disorder, abnormality of airway, chronic lung disease, immunocompromised condition, chronic metabolic disease, and chronic 

lung disease of prematurity/bronchopulmonary dysplasia.

Data are from a weighted sample of hospitalized infants and children with completed medical record abstractions. Sample sizes presented are unweighted with weighted percentages.

COVID-NET hospitalization data are preliminary and subject to change as more data become available.

Source: COVID-NET data, October 11, 2022

24%

18%

5% 4%

2%

12%

10%

1% 1%

0%

26%

20%

6%

5% 3%

36%

25%

9%

7%

2%

0%

5%

10%

15%

20%

25%

30%

35%

40%

≥1 underlying medical 

condition*

Prematurity Congenital heart disease Neurologic disorders Abnormality of airway

PERCENTAGE OF COVID-19

—ASSOCIATED 

HOSPITALIZATIONS

All <6 months (n=473)

<1 month (n=174)

1-2 months (n=154)

3-5 months (n=145)
60

Severity of COVID-19-associated hospitalizations among 

infants and children 0-4 years, COVID-NET, March 20 -

August 31, 2022

BiPAP: bilevel positive pressure, CPAP: continuous positive pressure. Data are from a weighted sample of hospitalized infants and children with completed medical record abstractions. Data presented 

are weighted percentages.

COVID-NET hospitalization data are preliminary and subject to change as more data become available.

Source: COVID-NET data. Accessed October 11, 2022

18%

12%

3%

5%

0.6%

21% 21%

5%

4%

0.0%

20%

13%

5% 5%

0.3%

0%

5%

10%

15%

20%

25%

ICU admission High flow nasal cannula Invasive mechanical

ventilation

BiPAP or CPAP use In-hospital death

PERCENTAGE OF COVID-19

—ASSOCIATED

HOSPITALIZATIONS

0-5 months (n=473)

6-23 months (n=457)

2-4 years (n=315)
61

▪ Among infants and children age <5 

years, hospital length of stay did not 

vary by age

Length of stay among infants and children <5 years with 

COVID-19-associated hospitalizations, COVID-NET, March 20 

- August 31, 2022

COVID-NET hospitalization data are preliminary and subject to change as more data become available.

Source: COVID-NET data, Accessed: October 11, 2022

Age group No. Length of hospital stay, days, 

median (IQR)

0-5 months 472 1.5 (0.8, 2.6)

6-23 months 456 1.5 (0.6, 2.7)

2-4 years 315 1.6 (0.7, 2.8)
62

0

50

100

150

200

250

300

Number of Deaths

Age in years

Cumulative deaths involving COVID-19 in children by age 

based on death certificate data, National Center for Health 

Statistics, January 1, 2020–October 1, 2022

Source: https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Age-in-Years-/3apk-4u4f/data. Accessed 10/12/2022. The provisional counts for coronavirus disease (COVID-19) deaths are based on a current 

flow of mortality data in the National Vital Statistics System. National provisional counts include deaths occurring within the 50 states and the District of Columbia that have been received and coded as of the date specified. 

It is important to note that it can take several weeks for death records to be submitted to National Center for Health Statistics (NCHS), processed, coded, and tabulated. Therefore, the data shown on this page may be 

incomplete, and will likely not include all deaths that occurred during a given time period, especially for the more recent time periods. Death counts for earlier weeks are continually revised and may increase or decrease as 

new and updated death certificate data are received from the states by NCHS. COVID-19 death counts shown here may differ from other published sources, as data currently are lagged by an average of 1–2 weeks. 

https://www.cdc.gov/nchs/nvss/vsrr/covid19/tech_notes.htm

Among infants ages 0-5 months: 

265 Deaths involving COVID-19

0.5% of all deaths in this age group
63

▪ COVID-NET footnotes: The Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) hospitalization data are preliminary and 

subject to change as more data become available. In particular, case counts and rates for recent hospital admissions are subject to lag. Lag for COVID-NET case 

identification and reporting might increase around holidays or during periods of increased hospital utilization. As data are received each week, prior case counts and rates 

are updated accordingly. COVID-NET conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in children (less than 18 years 

of age) and adults. COVID-NET covers nearly 100 counties in the 10 Emerging Infections Program (EIP) states (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) and four Influenza 

Hospitalization Surveillance Project (IHSP) states (IA [March 2020-May 2022], MI, OH, and UT). Incidence rates (per 100,000 population) are calculated using the National 

Center for Health Statistics' (NCHS) vintage 2020 bridged-race postcensal population estimates for the counties included in the surveillance catchment area. The rates 

provided are likely to be underestimated as COVID-19 hospitalizations might be missed due to test availability and provider or facility testing practices. The NCHS bridgedrace data used for the denominator for race data provides population data for children ages 0–1 year. To calculate rates of hospitalization among children ages <6 months 

and 6 months to <12 months, the population for children ages 0–1 year is halved.

▪ Cumulative influenza- and COVID-19-associated hospitalization rates per 100,000 children, FluSurv-NET and COVID-NET, 2017–2022, FluSurv-NET = Influenza 

Hospitalization Surveillance Network; COVID-NET = COVID-19-Associated Hospitalization Surveillance Network. Each season, FluSurv-NET surveillance is conducted from 

around October 1 of one year to around April 30 of the subsequent year. The grayed-out area on each panel indicates weeks during which FluSurv-NET surveillance was 

not conducted but COVID-NET surveillance was conducted. FluSurv-NET rate lines were extended beyond week 18 for ease of comparison. For the 2021–22 influenza 

season, data were only included through the week ending April 9, 2022, the last week for which data were available at the time of submission. The COVID-NET surveillance 

period of October 2020–September 2021 begins at MMWR week 40 of year 2020 and ends at MMWR week 39 of year 2021. The COVID-NET surveillance period for 

October 2021–April 2022 includes MMWR week 40 of 2021 through MMWR week 14 of 2022 (the week ending April 9, 2022, the last week for which data were available 

at the time of submission). MMWR Week 53 for year 2020 is combined with MMWR Week 52 for consistency with other years.

Additional slide footnotes