COVID-19 in Children Aged 0-18 years, March 1, 2020- March 31, 2021, Jerusalem District, Israel

Background: The impact of COVID-19 infection in children and the overall pediatric outcomes are important to estimate the global disease burden. COVID-19 studies showed that, compared to adults, children show milder clinical presentations, better prognosis, and lower mortality. Until March 31, 2021, 853,346 confirmed COVID-19 cases with 6,219 fatalities were notified in Israel (population 9.2 million)

Methods: The population group aged 0-18 years in the Jerusalem district included 563,390 children and adolescents (2019). During the 13 months (March 1, 2020 – March 31, 2021), 185,104 confirmed COVID-19 cases were notified in the Jerusalem district (population 1.3 million), of whom 65,675 (35.4%) were aged 0-18 years old. We studied the age-specific population-based COVID-19 epidemiology and clinical characteristics in the 0-18 years’ group, in the Jerusalem district. Logistic regression models were used to assess the hospitalization risk in 0-18-years-olds and the risk for moderate to severe disease in hospitalized infants, while adjusting for demographic, clinical, and epidemiological factors.

Results: COVID-19 infection was diagnosed in 11.7% (65,675/563,390) of the district’s 0-18-years-olds. Incidence rates increased with age (fig. 1). Hospitalization rates differed with age – 5.3% in infants under 1 year and 0.5% in children 1-18 years [Odds Ratio 10.8, 95%CI 8.8-13.2, p<0.0001]. Among hospitalized infants, infants aged 3-11-months had higher odds for moderate to severe disease vs. infants aged 0-3-months [adjusted Odds ratio 3.98, 95% CI 1.4-11.0].

Conclusions: The disease burden found in children is considerable. Primary prevention by encouraging COVID-19 vaccinations (currently offered to children aged 5 years and above) is essential.