For more information: www.cdc.gov/COVID19

CDC Coronavirus Disease 2019 Response

Epidemiology of 

COVID-19 in Children 

and Teens

Angela Campbell, MD, MPH, FPIDS, FIDSA

Virtual ACIP Emergency Meeting

January 27, 2021
Outline

 Overview of U.S. COVID-19 Epidemiology

 Epidemiology of COVID-19 in Children and Teens

 Multisystem Inflammatory Syndrome in Children (MIS-C)

2
Overview of U.S. COVID-19

Epidemiology
0

50000

100000

150000

200000

250000

300000

350000

Jan 22 2020 Mar 7 2020 Apr 21 2020 Jun 5 2020 Jul 20 2020 Sep 3 2020 Oct 18 2020 Dec 2 2020 Jan 16 2021

Trends in Number of COVID-19 Cases in the United States

January 22, 2020, to January 24, 2021 Number of COVID-19 Cases

4 https://www.cdc.gov/covid-data-tracker/index.html#trends
5

0

1000

2000

3000

4000

5000

6000

7000

Jan 22 2020 Mar 7 2020 Apr 21 2020 Jun 5 2020 Jul 20 2020 Sep 3 2020 Oct 18 2020 Dec 2 2020 Jan 16 2021

Number of COVID-19 Deaths

Trends in Number of COVID-19 Deaths in the United States

January 22, 2020, to January 24, 2021

https://www.cdc.gov/covid-data-tracker/index.html#trends
Epidemiology of COVID-19 in Children 

and Teens
7 https://www.cdc.gov/covid-data-tracker/index.html#demographics

Updated as of 1/24/21. Data are based on COVID-19 case-level data reported by state and territorial jurisdictions to CDC. The numbers are confirmed and probable COVID-19 

cases as reported by U.S. states, territories, New York City, and the District of Columbia from the previous day. 

1800

3140

8062

7012

6809

6031

4528

4698

7243

0 1000 2000 3000 4000 5000 6000 7000 8000 9000

0-4

5-17

18-29

30-39

40-49

50-64

65-74

75-84

85+

COVID-19 Incidence per 100,000 Population

Age Group (Years)

COVID-19 Reported Incidence by Age Group: Lowest in 

Children <18 Years

National Estimate of COVID-19 Incidence per 100,000 Population, 

by Age Group – Data through Jan 24, 2021
Estimated SARS-CoV-2 Infection Rates per 100,000 

Population Adjusting for Under Detection

15,333

27,218

30,602

22,966

16,722

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

0-4 yrs 5-17 yrs 18-49 yrs 50-64 yrs >=65 yrs

Infection rate per 100,000

Age group

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burden.html 8
Estimated SARS-CoV-2 Seroprevalence in Children <18 

Years, Mississippi, May–Sept 2020

 Residual serum samples from 

routine laboratory testing

 University of Mississippi 

Medical Center

C. Hobbs, et al. CDC COVID-19 

Response Team, unpublished data 9

SARS-CoV-2 Serology Results

Characteristic No. Positive %

Overall 1,603 175 10.9

Race/Ethnicity

Black, non-Hispanic 901 117 13.0

Hispanic 69 16 23.2

Other, non-Hispanic 44 7 15.9

White, non-Hispanic 565 30 5.3

Dates of specimen collection

May 17-31, 2020 174 6 3.5

June 1-30, 2020 447 28 6.3

July 1-31, 2020 339 35 10.3

August 1-31, 2020 368 56 15.2

September 1-19, 2020 275 50 18.2
Estimated SARS-CoV-2 Seroprevalence in Children <18 

Years, Mississippi, May–Sept 2020

10

SARS-CoV-2 Serology Results

Characteristic No. Positive %

Overall 1,603 175 10.9

Race/Ethnicity

Black, non-Hispanic 901 117 13.0

Hispanic 69 16 23.2

Other, non-Hispanic 44 7 15.9

White, non-Hispanic 565 30 5.3

Dates of specimen collection

May 17-31, 2020 174 6 3.5

June 1-30, 2020 447 28 6.3

July 1-31, 2020 339 35 10.3

August 1-31, 2020 368 56 15.2

September 1-19, 2020 275 50 18.2

 Residual serum samples from 

routine laboratory testing

 University of Mississippi 

Medical Center

C. Hobbs, et al. CDC COVID-19 

Response Team, unpublished data
Estimated SARS-CoV-2 Seroprevalence in Children <18 

Years, Mississippi, May–Sept 2020

11

SARS-CoV-2 Serology Results

Characteristic No. Positive %

Overall 1,603 175 10.9

Race/Ethnicity

Black, non-Hispanic 901 117 13.0

Hispanic 69 16 23.2

Other, non-Hispanic 44 7 15.9

White, non-Hispanic 565 30 5.3

Dates of specimen collection

May 17-31, 2020 174 6 3.5

June 1-30, 2020 447 28 6.3

July 1-31, 2020 339 35 10.3

August 1-31, 2020 368 56 15.2

September 1-19, 2020 275 50 18.2

 Residual serum samples from 

routine laboratory testing

 University of Mississippi 

Medical Center

C. Hobbs, et al. CDC COVID-19 

Response Team, unpublished data
Estimated SARS-CoV-2 Seroprevalence in Children <18 

Years, Mississippi, May–Sept 2020

12

SARS-CoV-2 Serology Results

Characteristic No. Positive %

Overall 1,603 175 10.9

Race/Ethnicity

Black, non-Hispanic 901 117 13.0

Hispanic 69 16 23.2

Other, non-Hispanic 44 7 15.9

White, non-Hispanic 565 30 5.3

Dates of specimen collection

May 17-31, 2020 174 6 3.5

June 1-30, 2020 447 28 6.3

July 1-31, 2020 339 35 10.3

August 1-31, 2020 368 56 15.2

September 1-19, 2020 275 50 18.2

 Residual serum samples from 

routine laboratory testing

 University of Mississippi 

Medical Center

C. Hobbs, et al. CDC COVID-19 

Response Team, unpublished data
= Infected

= Non-infected

Periodic/daily 

follow-up and 

sample collection

Short-term follow-up:

Case-Ascertained Household Transmission Study, 

Tennessee and Wisconsin,* April–Nov 2020

13 FLUTES-C Study. Grijalva, et al. MMWR 2020;69(44):1631-34

* Vanderbilt University Medical Center;

Marshfield Clinic Research Institute
FLUTES-C Study. Preliminary data, subject to change 14

Case-Ascertained Household Transmission Study, 

Tennessee and Wisconsin: Enrolled Participants

 147 index cases enrolled, median 3.5 days after onset (IQR: 3–4 days)

 306 household contacts enrolled

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Index cases

Household contacts

<12 years 12–17 years 18–49 years 50–64 years ≥65 years

(22 children)

(118 children)
Younger Children Were Less Likely to Be Symptomatic and 

Have Fewer Symptoms than Adults

Symptoms reported during follow-up

0%

20%

40%

60%

80%

100%

None Fever Cough Sore

Throat

Runny

nose

Nasal

congestion

Fatigue Shortness

of breath

Loss of

taste/smell

Headache

<12 years 12–17 years ≥18 years

Sample size for each category: <12 years, n=14; 12-17 years, n=8; ≥18 years, n=56 15 FLUTES-C Study. Preliminary data, subject to change
Secondary Infection Rates: Symptomatic Childre

to Transmit SARS-CoV-2 Less than Adults

(excluding possible co-primary and tertiary cases)

n Seem 

16 FLUTES-C Study. Preliminary 

data, subject to change
Children Exposed in the Household Had Similar 

SARS-CoV-2 Infection as Adults

Risk of 

(excluding possible co-primary and tertiary cases) 17 FLUTES-C Study. Preliminary 

data, subject to change
Secondary Infection Rates Similar Among Pediatric and Adult 

Household Contacts: Utah and Wisconsin, March–May 2020

Laws RL, et al. Pediatrics. 2020; doi:10.1542/peds.2020-027268

N = 188

18
Children <18 years have the Lowest Cumulative Rate of 

COVID-19 Associated Hospitalizations

18+ years

0-4 years

5-17 years

March 1, 2020 – January 2, 2021

0

50

100

150

200

250

300

350

400

450

500

10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 1

COVID-19 Hospitalization Rates 

per 100,000 population

MMWR Week

19

COVID-19 associated hospitalizations reported to Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) surveillance system

between March 1 and January 2, 2021. 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 hospitalsin 14 states. https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html
Children with Certain Underlying Conditions May Be More 

Likely to Have Severe Illness from COVID-19

20

 Asthma or chronic lung disease

 Diabetes

 Genetic, neurologic, or metabolic 

conditions

 Sickle cell disease

 Heart disease since birth

 Immunosuppression 

 Medical complexity 

 Obesity

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/symptoms.html
21

52% of Children <18 Years Hospitalized with COVID-19 

Had an Underlying Condition

March 1 – September 30, 2020

0 5 10 15 20 25 30 35 40 45

Obesity

Asthma

Immunocompromised

Chronic lung disease

Cardiovascular disease

Sickle cell disease

Diabetes

Cerebral palsy

Down syndrome

Hypertension

Renal disease

Weighted Percent of Hospitalized Persons Aged < 18 

N=823, COVID-19-associated hospitalizations reported to Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) surveillance 

system between March 1 and September 30, 2020. 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. https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html
22

Children <18 Years Hospitalized with COVID-19 Are Less Likely 

Than Adults to Experience Mechanical Ventilation or InHospital Death

0

5

10

15

20

25

30

35

Intensive care unit Mechanical ventilation In-hospital death

Weighted Percent of Hospitalized Persons

0-4 years 5-17 years All ages

March 1 – September 30, 2020

N=823, COVID-19-associated hospitalizations reported to Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) surveillance 

system between March 1 and September 30, 2020. 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. https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html
COVID-19 Mortality Rates Are Lowest Among Children 

<18 Years

0.4

0.3

2.9

8.0

20.4

66.9

194.6

501.2

1,514.8

0 200 400 600 800 1,000 1,200 1,400 1,600

0-4

5-17

18-29

30-39

40-49

50-64

65-74

75-84

85+

Death Rate per 100,000 Population

Age Group (Years)

National Estimate of COVID-19 Deaths per 100,000 Population, by Age Group –

Data through Jan 24, 2021

https://www.cdc.gov/covid-data-tracker/index.html#demographics

Updated as of 1/24/21. Data are based on COVID-19 case-level data reported by state and territorial jurisdictions to CDC. The numbers are confirmed and probable COVID-19 

cases as reported by U.S. states, territories, New York City, and the District of Columbia from the previous day. 

23
Multisystem Inflammatory Syndrome in 

Children (MIS-C)
Multisystem Inflammatory Syndrome in Children

 April 2020 – Severe inflammatory syndrome recognized in the UK, occurring 

in children with current or recent infection with SARS-CoV-2

 May 2020 – Cases reported in New York City and New York State

 May 14 – Healthcare providers requested to report patients <21 years old 

meeting MIS-C criteria to local, state, or territorial health departments

25
https://emergency.cdc.gov/han/2020/han00432.asp https://www.cdc.gov/mis-c/hcp/ 26
Godfred-Cato, et al. MMWR 3030;69:1074-80

 Class 1 (n=203), “typical” MIS-C

– 98% serology positive

– 100% cardiovascular and 98% GI manifestations

– Markedly elevated laboratory markers of inflammation

– 84% ICU admission

 Class 2 (n=169), acute COVID-19/MIS-C combo

– 100% RT-PCR positive, 16% serology positive

– More respiratory involvement 

– 62% ICU admission

 Class 3 (n=198), milder illness 

– Younger, median age 6 years

– Higher frequency of rash, mucocutaneous lesions

– 97% serology positive, 36% RT-PCR; 44% ICU admission

Three classes 

of patients:

27
Health Department-Reported Cases of Multisystem 

Inflammatory Syndrome in Children (MIS-C)

 1,659 cases

 26 deaths

 47 states, New York City, 

and Washington, DC, 

have reported >1 case

 Average age 8 years

 57% male

 33% Hispanic/Latino; 

30% Black, non-Hispanic

https://www.cdc.gov/mis-c/cases/index.html; last updated January 8, 2021

February 19 – December 29, 2020

28
Daily MIS-C Cases, March–December 2020

N=1659; Gray area on right represents most recent 6 weeks of data, for which case reports are likely incomplete.

https://www.cdc.gov/mis-c/cases/index.html; last updated January 8, 2021 29
Estimated Incidence of MIS-C Cases, 7 Jurisdictions, 

April–June 2020

Adjusted Incidence per Million 

SARS-CoV-2 Infections in Children 

(95% CI)

Adjusted Incidence 

Rate Ratio 

(95% CI)

Race and Ethnicity

White 110 (77–156) reference

Black/African American 616 (481–790) 6 (4–9)

Hispanic/Latino 467 (371–588) 4 (3–6)

Asian/Pacific Islander 315 (169–589) 3 (1–6)

A. Payne, et al, CDC COVID-19 Response Team, unpublished data

 Population-based incidence estimates (denominator was population of persons <21 

years): 

– 1 to 8.5 MIS-C cases per million person-months 

 Using denominator of estimated SARS-CoV-2 infections, incidence was higher among 

Black/African American and Hispanic/Latino children compared with White children

30
Summary
Summary

 As of January 24, >24 million cases of COVID-19 and >410,000 COVID-19-

associated deaths were reported in the United States.

 Children <18 years have lower rates of COVID-19 incidence, hospitalization, and 

mortality than adults.

 Children are susceptible to SARS-CoV-2, though younger children tended to have 

fewer respiratory symptoms than adults.

 MIS-C is a complication of COVID-19 and has varied clinical presentations.

 MIS-C is highest, and disproportionately so, among Black/African American 

children and Hispanic/Latino children.

 Further studies are needed to fully understand the role of children and teens in 

SARS-CoV-2 transmission and risk factors for severe illness and complications of 

COVID-19.

32
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.