Kufa, TendesayiJassat, WaasilaCohen, CherylTempia, StefanoMasha, MaureenWolter, NicoleWalaza, SibongileGottburg, AnneGovender, Nelesh P.Hunt, GillianShonhiwa, Andronica MoiponeEbonwu, JoyNtshoe, Genevie M.Maruma, WellingtonBapela, PonchoNdhlovu, NomathamsanqaMathema, HlenganiModise, MotshabiShuping, LiliweManana, Pinky N.Moore, David R.Dangor, ZiyaadVerwey, CharlMadhi, Shabir A.Saloojee, HaroonZar, Heather J.Blumberg, Lucille Hellen2022-06-202022-06-202022-01Kufa, T., Jassat, W., Cohen, C., et al. Epidemiology of SARS-CoV-2 infection and SARS-CoV-2 positive hospital admissions among children in South Africa. Influenza and Other Respiratory Viruses 2022;16(1):34-47. doi: 10.1111/irv.12916.1750-2640 (print)1750-2659 (online)10.1111/irv.12916https://repository.up.ac.za/handle/2263/85861SUPPORTING INFORMATION : TABLE S1: Description of SARS-CoV-2 rRT-PCR positive children <18 years in South Africa, 1 March 2020–19 September 2020 (N = 45 609). TABLE S2: Description of SARS-CoV-2 rRT-PCR positive hospital admissions among children <18 years in South Africa by province, 1 March 2020–19 September 2020 (N = 2007). TABLE S3: Distribution of non-missing variables among children with complete follow up and included in multivariable model (N = 1817). TABLE S4: Factors associated with in-hospital death among SARS-CoV-2 rRT-PCR positive admissions in children <18 years, South Africa, 1 March 2020–19 September 2020. FIGURE S1: Number of SARS-CoV-2 rRT-PCR tests*, percent positive tests and associated- hospital admissions among children <18 years by province and epidemiology week, South Africa, 1 March 2020–19 September 2020.INTRODUCTION : We describe epidemiology and outcomes of confirmed SARS-CoV-2 infection and positive admissions among children <18 years in South Africa, an upper-middle income setting with high inequality. METHODS : Laboratory and hospital COVID-19 surveillance data, 28 January - 19 September 2020 was used. Testing rates were calculated as number of tested for SARS-CoV-2 divided by population at risk; test positivity rates were calculated as positive tests divided by total number of tests. In-hospital case fatality ratio (CFR) was calculated based on hospitalized positive admissions with outcome data who died in-hospital and whose death was judged SARS-CoV-2 related by attending physician. FINDINGS : 315 570 children aged <18 years were tested for SARS-CoV-2; representing 8.9% of all 3 548 738 tests and 1.6% of all children in the country. Of children tested, 46 137 (14.6%) were positive. Children made up 2.9% (n = 2007) of all SARS-CoV-2 positive admissions to sentinel hospitals. Among children, 47 died (2.6% case-fatality). In-hospital deaths were associated with male sex [adjusted odds ratio (aOR) 2.18 (95% confidence intervals [CI] 1.08–4.40)] vs female; age <1 year [aOR 4.11 (95% CI 1.08–15.54)], age 10–14 years [aOR 4.20 (95% CI1.07–16.44)], age 15–17 years [aOR 4.86 (95% 1.28–18.51)] vs age 1–4 years; admission to a public hospital [aOR 5.07(95% 2.01–12.76)] vs private hospital and ≥1 underlying conditions [aOR 12.09 (95% CI 4.19–34.89)] vs none. CONCLUSIONS : Children with underlying conditions were at greater risk of severe SARS-CoV-2 outcomes. Children > 10 years, those in certain provinces and those with underlying conditions should be considered for increased testing and vaccination.en© 2021 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License.AdolescentsChildrenCOVID-19 pandemicCoronavirus disease 2019 (COVID-19)Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)IncidenceMortalityTesting rateArticle