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Younger teens may not be as likely to have severe COVID-19 as adults, but their hospitalization rates spiked early this year and left a large proportion in critical care, according to CDC COVID-NET surveillance data.

COVID-19 adolescent hospitalization rates were at their highest in early January 2021, with a peak of 2.1 per 100,000 youths ages 12 to 17.

That dropped to 0.6 per 100,000 in mid-March, but rose again to 1.3 per 100,000 in April, the last month with available data, reported Fiona P. Havers, MD, of the CDC COVID-19 Response Team, and colleagues in the .

These hospitalization rates were cumulatively 2.5 to 3.0 times higher than those seen with influenza over the three most recent flu seasons in national FluSurv-NET surveillance, the researchers pointed out.

Notably, nearly one-third of the adolescent hospitalizations for COVID-19 required intensive care unit (ICU) admission, while 5% required invasive mechanical ventilation. No patients died.

"Recent increases in COVID-19-associated hospitalization rates and the potential for severe disease requiring ICU admission, including invasive mechanical ventilation, among adolescents indicate an urgent need for vaccination," Havers and colleagues concluded.

In May, FDA expanded the Pfizer-BioNTech COVID-19 vaccine's emergency use authorization to include adolescents ages 12 to 15. The CDC's Advisory Committee on Immunization Practices quickly recommended the vaccine for that younger group, although there have been logistical challenges.

"At the time [of the CDC recommendation], there was a growing body of evidence that demonstrated the severe health impacts of COVID-19 on adolescents," noted CDC Director Rochelle Walensky, MD, MPH, in a statement.

These new numbers are "deeply" concerning, she said, reinforcing the call for vaccination, as well as continued masking and other basic precautions for those not yet vaccinated.

"I ask parents, relatives, and close friends to join me and talk with teens about the importance of these prevention strategies and to encourage them to get vaccinated," she added. "Vaccination is our way out of this pandemic. I continue to see promising signs in CDC data that we are nearing the end of this pandemic in this country; however, we all have to do our part and get vaccinated to cross the finish line."

Two of the areas covered by COVID-NET -- Maryland and Michigan -- actually showed their highest adolescent COVID hospitalization rates at the end of April rather than January.

"Increased hospitalization rates among adolescents might be related, in part, to circulation of particularly transmissible SARS-CoV-2 variants, the larger numbers of children returning to school or other in-person indoor activities, and changes in physical distancing, wearing masks, and other COVID-19 prevention behaviors," Havers and team said. "Vaccination of adolescents is expected to reduce the risk for COVID-19 in these settings."

The study utilized data from COVID-NET (COVID-19-Associated Hospitalization Surveillance Network), a population-based surveillance system of laboratory-confirmed COVID-19-associated hospitalizations in 99 counties across 14 states (about 10% of the U.S. population).

The study looked specifically at the 204 adolescents ages 12 to 17 in that dataset who appeared to have been admitted primarily due to COVID-19 from March 1, 2020 through April 24, 2021.

Among these patients, 52.5% were girls, 31.4% were Hispanic or Latinx, and 35.8% were non-Hispanic Black. Most had an underlying medical condition (70.6%), most commonly obesity (35.8%), asthma or other chronic lung disease (30.9%), and neurologic disorders (14.2%). In adults, 92% of those hospitalized for COVID-19 have had an underlying medical condition.

For the entire study period, the 12- to 17-year-olds had a much lower COVID-19 hospitalization rate than adults -- a 12.5-fold difference -- but a higher rate compared with children ages 5 to 11.

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