Life-Threatening Complications of Influenza vs Coronavirus Disease 2019 (COVID-19) in US Children

Natasha B. Halasa, Andrew J. Spieker, Cameron C. Young, Samantha M. Olson, Margaret M. Newhams, Justin Z. Amarin, Kristin L. Moffitt, Mari M. Nakamura, Emily R. Levy, Vijaya L. Soma, Rana Talj, Scott L. Weiss, Julie C. Fitzgerald, Elizabeth H. Mack, Aline B. Maddux, Jennifer E. Schuster, Bria M. Coates, Mark W. Hall, Stephanie P. Schwartz, Adam J. SchwarzMichele Kong, Philip C. Spinella, Laura L. Loftis, Gwenn E. McLaughlin, Charlotte V. Hobbs, Courtney M. Rowan, Melania M. Bembea, Ryan A. Nofziger, Christopher J. Babbitt, Cindy Bowens, Heidi R. Flori, Shira J. Gertz, Matt S. Zinter, John S. Giuliano, Janet R. Hume, Natalie Z. Cvijanovich, Aalok R. Singh, Hillary A. Crandall, Neal J. Thomas, Melissa L. Cullimore, Manish M. Patel, Adrienne G. Randolph

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Clinical differences between critical illness from influenza infection vs coronavirus disease 2019 (COVID-19) have not been well characterized in pediatric patients. Methods: We compared demographics, clinical characteristics, and outcomes of US children (aged 8 months to 17 years) admitted to the intensive care or high-acuity unit with influenza or COVID-19. Using mixed-effects models, we assessed the odds of death or requiring life support for influenza vs COVID-19 after adjustment for age, sex, race and Hispanic origin, and underlying conditions including obesity. Results: Children with influenza (n = 179) were younger than those with COVID-19 (n = 381; median, 5.2 years vs 13.8 years), less likely to be non-Hispanic Black (14.5% vs 27.6%) or Hispanic (24.0% vs 36.2%), and less likely to have ≥1 underlying condition (66.4% vs 78.5%) or be obese (21.4% vs 42.2%), and a shorter hospital stay (median, 5 days vs 7 days). They were similarly likely to require invasive mechanical ventilation (both 30.2%), vasopressor support (19.6% and 19.9%), or extracorporeal membrane oxygenation (2.2% and 2.9%). Four children with influenza (2.2%) and 11 children with COVID-19 (2.9%) died. The odds of death or requiring life support in children with influenza vs COVID-19 were similar (adjusted odds ratio, 1.30; 95% confidence interval,. 78-2.15; P =. 32). Conclusions: Despite differences in demographics and clinical characteristics of children with influenza or COVID-19, the frequency of life-threatening complications was similar. Our findings highlight the importance of implementing prevention measures to reduce transmission and disease severity of influenza and COVID-19.

Original languageEnglish (US)
Pages (from-to)E280-E290
JournalClinical Infectious Diseases
Issue number3
StatePublished - Feb 1 2023
Externally publishedYes


  • COVID-19
  • SARS-CoV-2
  • children
  • influenza
  • intensive care units

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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