Trends in Pediatric ICU Admissions for Vaccine-Preventable Diseases From 2001-2022

Introduction: Vaccine-preventable disease (VPD) remains a critical public health concern, particularly for vulnerable pediatric populations. It is unknown how many children are hospitalized with VPD and how many require intensive care unit (ICU) care. This study aimed to characterize national trends in pediatric ICU admissions for VPD from 2001-2022, hypothesizing that hospitalizations and illness severity have increased over time.


Methods: We used the Healthcare Cost and Utilization Project’s State Inpatient Databases from 20 U.S. states in 2001, 2004, 2010, 2016, 2019, and 2022. We used ICD 9/10-CM codes to identify admissions for VPD in children < 18 years and used generalized linear regression to assess differences and temporal trends in patient and clinical characteristics.


Results: Of 2,630,769 pediatric admissions from 2001-2022, 2.0% (n=52,494) were for VPD. Hospitalizations for VPD decreased from 2.0% in 2001 to 0.9% in 2010 before increasing steadily to 3.1% in 2022. Children with VPD were less likely to be non-Hispanic white (RR 0.91, 95% CI 0.90-0.92) and more likely to have public insurance (RR 1.11, 95% CI 1.10-1.12) than children without VPD. Influenza was the most prevalent VPD, followed by rotavirus, pertussis, and varicella. Cases of rotavirus, pertussis, varicella, and meningococcus decreased across the study period, while influenza increased from 0.33% to 2.82% of admissions (RR 8.44, 95% CI 7.98-8.93). ICU admission prevalence for children with VPDs increased from 7.1% to 26.4% (RR 3.74, 95% CI 3.44-4.07), with the highest 2022 ICU admission prevalence for Hemophilus influenza B (65.4%), pertussis (35.8%), influenza (26.3%), and varicella (20.9%). ICU patients with VPD had a higher prevalence of organ failure (70.2% vs 49.6%) than patients without VPD, and the prevalence of organ failure in the VPD ICU population increased from 45.3% in 2001 to 80.0% in 2019. Patients with VPD had longer length of stay (p < 0.001) but similar mortality (1.90%) than patients without VPD.


Conclusions: The prevalence of VPD in hospitalized children increased from 2001-2022, with patients more likely to require ICU care. These findings underscore the need for enhanced vaccine education and targeted public health outreach to better protect the pediatric population from vaccine-preventable critical illness.