[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Wang  CJ, Ng  CY, Brook  RH.  Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing.   JAMA. 2020. doi:10.1001/jama.2020.3151 PubMedGoogle Scholar
Wu  C, Chen  X, Cai  Y,  et al.  Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China.   JAMA Intern Med. 2020;180(7):1-11. doi:10.1001/jamainternmed.2020.0994 PubMedGoogle ScholarCrossref
Eliezer  M, Hautefort  C, Hamel  AL,  et al.  Sudden and complete olfactory loss function as a possible symptom of COVID-19.   JAMA Otolaryngol Head Neck Surg. Published online April 8, 2020. doi:10.1001/jamaoto.2020.0832PubMedGoogle Scholar
Whitcroft  KL, Hummel  T.  Olfactory dysfunction in COVID-19: diagnosis and management.   JAMA. 2020;323(24):2512-2514. doi:10.1001/jama.2020.8391 PubMedGoogle Scholar
Wang  X, Li  Y, O’Brien  KL,  et al; Respiratory Virus Global Epidemiology Network.  Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study.   Lancet Glob Health. 2020;8(4):e497-e510. doi:10.1016/S2214-109X(19)30545-5 PubMedGoogle ScholarCrossref
Committee on Infectious Diseases.  Recommendations for prevention and control of influenza in children, 2019-2020.   Pediatrics. 2019;144(4):e20192478. doi:10.1542/peds.2019-2478 PubMedGoogle Scholar
CDC COVID-19 Response Team.  Coronavirus disease 2019 in children–United States, February 12-April 2, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(14):422-426. doi:10.15585/mmwr.mm6914e4 PubMedGoogle ScholarCrossref
 Children may be less affected than adults by novel coronavirus (COVID-19).   J Paediatr Child Health. 2020;56(4):657. doi:10.1111/jpc.14876 PubMedGoogle Scholar
Panahi  L, Amiri  M, Pouy  S.  Clinical characteristics of COVID-19 infection in newborns and pediatrics: a systematic review.   Arch Acad Emerg Med. 2020;8(1):e50.PubMedGoogle Scholar
Cheung  EW, Zachariah  P, Gorelik  M,  et al.  Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City.   JAMA. 2020;324(3):294-296. doi:10.1001/jama.2020.10374 PubMedGoogle Scholar
DeBiasi  RL, Song  X, Delaney  M,  et al.  Severe COVID-19 in children and young adults in the Washington, DC metropolitan region.   J Pediatr. 2020;223:199–203.e1.Google Scholar
Government of the District of Columbia. Stay Home DC. Accessed June 5, 2020. https://coronavirus.dc.gov/stayhome
Maryland.gov. As COVID-19 crisis escalates in capital region, Governor Hogan issues stay at home order effective tonight. Published March 30, 2020. Accessed June 5, 2020. https://governor.maryland.gov/2020/03/30/as-covid-19-crisis-escalates-in-capital-region-governor-hogan-issues-stay-at-home-order-effective-tonight/
World Health Organization. Coronavirus disease (COVID-19): situation report—124 2020. Accessed May 23, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200523-covid-19-sitrep-124.pdf?sfvrsn=9626d639_2
Centers for Disease Control and Prevention. Cases in the US. Accessed May 23, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
Faust  JS, Del Rio  C.  Assessment of deaths from COVID-19 and from seasonal Influenza.   JAMA Intern Med. 2020;180(8):1045-1046. doi:10.1001/jamainternmed.2020.2306 PubMedGoogle Scholar
Wu  Z, McGoogan  JM.  Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.   JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648 PubMedGoogle Scholar
Garazzino  S, Montagnani  C, Donà  D,  et al; Italian SITIP-SIP Pediatric Infection Study Group; Italian SITIP-SIP SARS-CoV-2 Paediatric Infection Study Group.  Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020.   Euro Surveill. 2020;25(18). doi:10.2807/1560-7917.ES.2020.25.18.2000600 PubMedGoogle Scholar
Khaddour  K, Sikora  A, Tahir  N, Nepomuceno  D, Huang  T.  Case report: the importance of novel coronavirus disease (COVID-19) and coinfection with other respiratory pathogens in the current pandemic.   Am J Trop Med Hyg. 2020;102(6):1208-1209. doi:10.4269/ajtmh.20-0266 PubMedGoogle ScholarCrossref
Nowak  MD, Sordillo  EM, Gitman  MR, Paniz Mondolfi  AE.  Co-infection in SARS-CoV-2 infected patients: where are influenza virus and rhinovirus/enterovirus?   J Med Virol. Published online April 30, 2020. doi:10.1002/jmv.25953 PubMedGoogle Scholar
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    2 Comments for this article
    Age range of study sample
    Eugenie Coakley, MA, MPH, PStat |
    This very good article is on an important and timely topic. I wonder about the definition of children, however. The overall median age was 8.4 years, but the maximum age was 35.6 years (40.4 years for the influenza group). Could some long-term patients of the Children's National Hospital have been included in the sample? Clarification of the inclusion criterion regarding age would be helpful.
    Re: age range in study sample
    Xiaoyan Song, PhD, MBBS | Children's National Hospital, Washington, D.C
    As a pediatric hospital, we provide care to patients with congenital issues regardless of age at the time of diagnosis. We also provide care to patients with diseases (e.g. cystic fibrosis) that were used to be associated with a short life span. With advances of modern medicine, these patients now can survive much longer and live in their adult life. Although these patients are often transitioned into adult care, some choose to stay with their pediatric specialist. These patient populations constitute the study patients of older age.
    Views 35,686
    Citations 0
    Original Investigation
    Infectious Diseases
    September 8, 2020

    Comparison of Clinical Features of COVID-19 vs Seasonal Influenza A and B in US Children

    Author Affiliations
    • 1Office of Infection Control and Epidemiology, Children’s National Hospital, Washington, DC
    • 2Department of Pediatrics, George Washington University School of Health Science, Washington, DC
    • 3Department of Laboratory Medicine, Children’s National Hospital, Washington, DC
    • 4Division of Quality and Safety, Children’s National Hospital, Washington, DC
    • 5Chief Medical Office, Children’s National Hospital, Washington, DC
    • 6Division of Infectious Disease, Children’s National Hospital, Washington, DC
    JAMA Netw Open. 2020;3(9):e2020495. doi:10.1001/jamanetworkopen.2020.20495
    Key Points español 中文 (chinese)

    Question  What are the similarities and differences in clinical features between coronavirus disease 2019 (COVID-19) and seasonal influenza in US children?

    Findings  In this cohort study of 315 children with COVID-19 and 1402 children with seasonal influenza, there were no statistically significant differences in the rates of hospitalization, admission to the intensive care unit, and mechanical ventilator use between the 2 groups. More patients with COVID-19 than with seasonal influenza reported fever, diarrhea or vomiting, headache, body ache, or chest pain at the time of diagnosis.

    Meaning  The findings suggest that prevention of both COVID-19 and seasonal influenza in US children is prudent and urgent for the well-being of this population.


    Importance  Compared with seasonal influenza, the clinical features and epidemiologic characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus 2019 (COVID-19) in US children remain largely unknown.

    Objective  To describe the similarities and differences in clinical features between COVID-19 and seasonal influenza in US children.

    Design, Setting, and Participants  This retrospective cohort study included children who were diagnosed with laboratory-confirmed COVID-19 between March 25 and May 15, 2020, and children diagnosed with seasonal influenza between October 1, 2019, and June 6, 2020, at Children’s National Hospital in the District of Columbia.

    Exposures  COVID-19 or influenza A or B.

    Main Outcomes and Measures  Rates of hospitalization, admission to the intensive care unit, and mechanical ventilator use and the association between underlying medical conditions, clinical symptoms, and COVID-19 vs seasonal influenza.

    Results  The study included 315 patients diagnosed with COVID-19 (164 [52%] male; median age, 8.3 years [range, 0.03-35.6 years]) and 1402 patients diagnosed with seasonal influenza (743 [53%] male; median age, 3.9 years [range, 0.04-40.4 years]). Patients with COVID-19 and those with seasonal influenza had a similar hospitalization rate (54 [17%] vs 291 [21%], P = .15), intensive care unit admission rate (18 [6%] vs 98 [7%], P = .42), and use of mechanical ventilators (10 [3%] vs 27 [2%], P = .17). More patients hospitalized with COVID-19 than with seasonal influenza reported fever (41 [76%] vs 159 [55%], P = .005), diarrhea or vomiting (14 [26%] vs 36 [12%], P = .01), headache (6 [11%] vs 9 [3%], P = .01), body ache or myalgia (12 [22%] vs 20 [7%], P = .001), and chest pain (6 [11%] vs 9 [3%], P = .01). Differences between patients hospitalized with COVID-19 vs influenza who reported cough (24 [48%] vs 90 [31%], P = .05) and shortness of breath (16 [30%] vs 59 [20%], P = .13) were not statistically significant.

    Conclusions and Relevance  In this cohort study of US children with COVID-19 or seasonal influenza, there was no difference in hospitalization rates, intensive care unit admission rates, and mechanical ventilator use between the 2 groups. More patients hospitalized with COVID-19 than with seasonal influenza reported clinical symptoms at the time of diagnosis.