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

Research output: Contribution to journalResearch articleContributedpeer-review


  • Marietta Jank - , Heidelberg University  (Author)
  • Anna Lisa Oechsle - , Ludwig Maximilian University of Munich (Author)
  • Jakob Armann - , Department of Paediatrics (Author)
  • Uta Behrends - , Technical University of Munich (Author)
  • Reinhard Berner - , Department of Paediatrics (Author)
  • Cho Ming Chao - , Witten/Herdecke University, Universities of Giessen and Marburg Lung Center (UGMLC) (Author)
  • Natalie Diffloth - , Department of Paediatrics (Author)
  • Maren Doenhardt - , Department of Paediatrics (Author)
  • Gesine Hansen - , German Research Foundation (Author)
  • Markus Hufnagel - , University of Freiburg (Author)
  • Fabian Lander - , Department of Paediatrics (Author)
  • Johannes G. Liese - , University of Würzburg (Author)
  • Ania C. Muntau - , University of Hamburg (Author)
  • Tim Niehues - , Helios Hospital Group (Author)
  • Ulrich von Both - , Ludwig Maximilian University of Munich (Author)
  • Eva Verjans - , RWTH Aachen University (Author)
  • Katharina Weil - , Heinrich Heine University Düsseldorf (Author)
  • Rüdiger von Kries - , Ludwig Maximilian University of Munich (Author)
  • Horst Schroten - , Heidelberg University  (Author)


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.


Original languageEnglish
Pages (from-to)1357-1367
Number of pages11
Issue number5
Publication statusPublished - Oct 2023

External IDs

PubMed 36787015


Sustainable Development Goals


  • 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