Comparing SARS-CoV-2 variants among children and adolescents in Germany: relative risk of COVID-19-related hospitalization, ICU admission and mortality

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung


  • Marietta Jank - , Universität Heidelberg (Autor:in)
  • Anna Lisa Oechsle - , Ludwig-Maximilians-Universität München (LMU) (Autor:in)
  • Jakob Armann - , Klinik und Poliklinik für Kinder- und Jugendmedizin (Autor:in)
  • Uta Behrends - , Technische Universität München (Autor:in)
  • Reinhard Berner - , Klinik und Poliklinik für Kinder- und Jugendmedizin (Autor:in)
  • Cho Ming Chao - , Witten/Herdecke University, Universities of Giessen and Marburg Lung Center (UGMLC) (Autor:in)
  • Natalie Diffloth - , Klinik und Poliklinik für Kinder- und Jugendmedizin (Autor:in)
  • Maren Doenhardt - , Klinik und Poliklinik für Kinder- und Jugendmedizin (Autor:in)
  • Gesine Hansen - , Deutsche Forschungsgemeinschaft (Autor:in)
  • Markus Hufnagel - , Albert-Ludwigs-Universität Freiburg (Autor:in)
  • Fabian Lander - , Klinik und Poliklinik für Kinder- und Jugendmedizin (Autor:in)
  • Johannes G. Liese - , Julius-Maximilians-Universität Würzburg (Autor:in)
  • Ania C. Muntau - , Universität Hamburg (Autor:in)
  • Tim Niehues - , Helios Kliniken Gruppe (Autor:in)
  • Ulrich von Both - , Ludwig-Maximilians-Universität München (LMU) (Autor:in)
  • Eva Verjans - , RWTH Aachen University (Autor:in)
  • Katharina Weil - , Heinrich Heine Universität Düsseldorf (Autor:in)
  • Rüdiger von Kries - , Ludwig-Maximilians-Universität München (LMU) (Autor:in)
  • Horst Schroten - , Universität Heidelberg (Autor:in)


Purpose: SARS-CoV-2 infections cause COVID-19 and have a wide spectrum of morbidity. Severe disease courses among children are rare. To date, data on the variability of morbidity in relation to variant of concern (VOC) in children has been sparse and inconclusive. We compare the clinical severity of SARS-CoV-2 infection among children and adolescents in Germany during the Wildtype and Alpha combined, Delta and Omicron phases of the COVID-19 pandemic. Methods: Comparing risk of COVID-19-related hospitalization, intensive care unit (ICU) admission and death due to COVID-19 in children and adolescents, we used: (1) a multi-center seroprevalence study (SARS-CoV-2-KIDS study); (2) a nationwide registry of pediatric patients hospitalized with SARS-CoV-2 infections; and (3) compulsory national reporting for RT-PCR-confirmed SARS-CoV-2 infections in Germany. Results: During the Delta predominant phase, risk of COVID-19-related hospitalization among all SARS-CoV-2 seropositive children was 3.35, ICU admission 1.19 and fatality 0.09 per 10,000; hence about halved for hospitalization and ICU admission and unchanged for deaths as compared to the Wildtype- and Alpha-dominant period. The relative risk for COVID-19-related hospitalization and ICU admission compared to the alpha period decreased during Delta [0.60 (95% CI 0.54; 0.67) and 0.51 (95% CI 0.42; 0.61)] and Omicron [0.27 (95% CI 0.24; 0.30) and 0.06 (95% CI 0.05; 0.08)] period except for the < 5-year-olds. The rate of case fatalities decreased slightly during Delta, and substantially during Omicron phase. Conclusion: Morbidity caused by SARS-CoV-2 infections among children and adolescents in Germany decreased over the course of the COVID-19 pandemic, as different VOCs) emerged.


Seiten (von - bis)1357-1367
Jahrgang51 (2023)
PublikationsstatusVeröffentlicht - 14 Feb. 2023

Externe IDs

PubMed 36787015


Ziele für nachhaltige Entwicklung


  • Adolescents, Burden of disease, COVID-19, Children, Pandemic, SARS-CoV-2, Seroprevalence, Variants of concern, Intensive Care Units, Pandemics, Humans, Child, Preschool, Germany/epidemiology, Risk, Seroepidemiologic Studies, Hospitalization, COVID-19/epidemiology, Adolescent, Child