For babies, the Covid pandemic is as bad as it ever was

Our new peer-reviewed paper highlights how the pandemic hasn't got better for infants in England

The pandemic is as bad as it ever was for babies - in the year to August 2023, 6,300 babies under 1 were admitted to hospital wholly or partly because of Covid.

They are the only age group where admissions have not gone down over time.

Our study, published yesterday in the Journal of Pediatrics and led by Prof Kate Brown, looked at all hospitalisations in England in children with a Covid diagnosis or positive test from August 2020-August 2023.

We then excluded all admissions where a Covid diagnosis was incidental (ie not why they were in hospital), using a rigorous classification method that we developed and published in a previous BMJ paper.

Infants (babies under 1) are generally at higher risk from respiratory infections, plus they are the age group that, if infected, are overwhelmingly (>99%) meeting the virus for the first time. They are also not vaccinated.

Over the whole period of our study, Covid admissions in infants accounted for 43% of all admissions in children under 18 (19,700/45,900).

As children over one year old gained some immunity from infection or were vaccinated (vaccination mostly in teens), their risk of needing hospital fell.

But this doesn't help infants in their first encounter with the virus. In the most recent 12 months of our data to August 2023, infants accounted for 64% of all covid child admissions.

We also checked for evidence of underlying health conditions considered high risk by JCVI. We found that by the most recent 12 months of data, 52% of Covid admissions in children over 1 had an underlying condition. But only 10% of infants did.

While most infants were in hospital for only a short time - about 2 days, a significant minority did need intensive care. For instance, in last 12 months about 5% needed intensive care and 8 babies died.

We also found that children of ethnic minority background or in deprived areas were more at risk of Covid admission to hospital.

So what are the implications? There is a safe and effective covid vaccine for 6 month-4 yr olds. It's part of routine childhood immunisation in some countries like the US and Ireland. It's approved in UK, but JCVI has not recommended its use in otherwise healthy babies.

However, while personally I am in favour including the Covid vaccine in the standard childhood immunisation programme, it's not quite that simple.

Firstly, newborn babies are by far the most vulnerable and there is no available vaccine (anywhere) before 6 months old. US analysis has shown that Covid hospitalisations in babies under 6 months old are higher than any other age group apart from over 75s! Similar to adults aged 65-74! Almost 1 in 5 babies under 6 months in the US needed intensive care.

The most effective thing to protect newborns is for their mothers to be vaccinated during pregnancy (ideally in 3rd trimester). It's not perfect but far better than nothing and, most importantly, Covid vaccines in pregnancy are recommended in the UK.

Dr Viki Male curates a comprehensive google document answering all your questions on the covid vaccine in pregnancy! Please do check it out.

In fact, pregnant women can protect their newborns against all sorts of nasty respiratory viruses by being vaccinated in pregnancy. As well as Covid, there's flu, whooping cough, and - now - RSV!

The problem is that uptake of vaccines in pregnancy is quite low. About 40% for the Covid vaccine and 42% for flu vax in pregnancy. Uptake of whooping cough vaccine was only 60% last winter - 15% points lower than in 2017. This year has seen more babies died of whooping cough.

We also know that uptake of routine childhood vaccinations in childhood is declining in England, and we've seen not just whooping cough outbreaks this year, but several measles ones as well.

Given increasing vaccine hesitancy, perhaps the most important immediate effort is to tackle that across all existing childhood vaccines and uptake in pregnant women- esp whooping cough & RSV, two of the nastiest things for babies (worse than Covid). For instance, while average stay in hospital for babies with Covid is 2 days., it’s more than a week for babies with RSV.

We need to be vaccine champions! Decline in vaccine uptake, particularly in pregnant women, is risking babies’ lives.

Then, in the medium term, I believe we should offer infants and young children the covid vaccination, as part of routine immunisation. This is so that those not already infected can meet their first infection (e.g. on starting nursery) with good protection against severe disease.

In summary, our new paper shows clearly that for babies, the pandemic is as bad as it ever was. There are things we can do to protect them, and we should.