Background: There have been no population-based studies of SARS-CoV-2 testing, PCR-confirmed infections and COVID-19-related hospital admissions across the full paediatric age range. We examine the epidemiology of SARS-CoV-2 in children and young people (CYP) aged <23 years.

Methods: We used a birth cohort of all children born in Scotland since 1997, constructed via linkage between vital statistics, hospital records and SARS-CoV-2 surveillance data. We calculated risks of tests and PCR-confirmed infections per 1000 CYP-years between August and December 2020, and COVID-19-related hospital admissions per 100,000 CYP-years between February and December 2020. We used Poisson and Cox proportional hazards regression models to determine risk factors.

Results: Among the 1226855 CYP in the cohort, there were 378,402 tests (a rate of 770.8/1000 CYP years (95% confidence interval [768.4-773.3]), 19,005 PCR confirmed infections (179.4/1000 CYP years [176.9-182.0]) and 346 admissions (29.4/100,000CYP years [26.3-32.8]). Infants had the highest COVID-19-related admission rates. Chronic conditions, particularly multiple types of conditions, was strongly associated with COVID-19-related admissions across all ages. Overall, 49% of admitted CYP had at least one chronic condition recorded.

Conclusions: Infants, and CYP with chronic conditions are at highest risk of admission with COVID-19. Half of admitted CYP had chronic conditions. Studies examining COVID vaccine effectiveness among children with chronic conditions, and whether maternal vaccine during pregnancy prevents COVID-19 admissions in infants are urgently needed.


This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

Cite as

Hardelid, P., Favarato, G., Wijlaars, L., Fenton, L., McMenamin, J., Clemens, T., Dibben, C., Milojevic, A., MacFarlane, A., Taylor, Jonathon, Cunningham, S. & Wood, R. 2022, 'SARS-CoV-2 tests, confirmed infections and COVID-19 related hospital admissions in children and young people: birth cohort study', BMJ Paediatrics Open, 6(1), article no: e001545. https://doi.org/10.1136/bmjpo-2022-001545

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Last updated: 21 September 2022
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