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Characteristics of pediatric SARS-CoV-2 healthcare-associated infection outbreaks in Germany, 2020-2023: a

L E Schneider^1,2,3, M Brandl⁴, A Ullrich⁴

¹Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. schneiderl@rki.de.

European Journal of Pediatrics

|December 17, 2025

Insights

Healthcare-associated infections (HAI) from SARS-CoV-2 transmission in pediatric care are limited. Pediatric outbreaks primarily affected healthcare workers (HCW), emphasizing the need for HCW protection to reduce HAI transmission.

Area of Science:

Infectious Diseases
Epidemiology
Public Health

Background:

Children and adolescents generally experience less severe illness from SARS-CoV-2.
Pediatric healthcare settings present distinct challenges for infection prevention and control.

Purpose of the Study:

To assess the characteristics of pediatric SARS-CoV-2 healthcare-associated infection (HAI) outbreaks.
To understand HAI transmission dynamics within pediatric care settings.
To compare pediatric SARS-CoV-2 HAI outbreaks with those in non-pediatric populations.

Main Methods:

Analysis of PCR-confirmed SARS-CoV-2 outbreak cases notified through statutory surveillance in Germany (February 2020–December 2023).
Inclusion criteria for pediatric outbreaks: any outbreak in pediatric care or with >50% of cases in patients <18 years old.
Calculation of age-disaggregated median monthly incidences of SARS-CoV-2 HAI outbreak cases per 100,000 hospitalizations using reimbursement data.

Main Results:

Identified 25 pediatric outbreaks with 241 cases among 36,371 total SARS-CoV-2 HAI outbreak cases.
In pediatric outbreaks, 83% of cases were healthcare workers (HCW) and 17% were patients <18 years old.
Pediatric outbreaks had significantly lower incidences (0.3/100,000 hospitalizations) compared to the 18-59 age group (14.8/100,000 hospitalizations).

Conclusions:

SARS-CoV-2 HAI transmission in pediatric care appears limited.
The high proportion of HCW cases in pediatric outbreaks highlights the critical need for HCW protection to curb HAI.
Outbreak surveillance is valuable for monitoring HAI transmission in vulnerable groups like pediatric patients.

Read full analysis

Abstract:

Limiting healthcare-associated infections (HAI) SARS-CoV-2 transmission has been a global challenge. We assessed characteristics of pediatric SARS-CoV-2 HAI outbreaks to better understand HAI transmission in pediatric care. We analyzed PCR-confirmed SARS-CoV-2 outbreak cases notified through statutory surveillance, at case level and at outbreak level, in Germany between 24 February 2020 and 31 December 2023 to describe SARS-CoV-2 HAI outbreaks in pediatric care and compare them with non-pediatric outbreaks. Pediatric outbreaks included any outbreak in pediatric care or with > 50% of cases among patients aged < 18 years. We calculated age-disaggregated median monthly incidences of SARS-CoV-2 HAI outbreak cases per 100,000 hospitalizations using reimbursement data. Among 36,371 SARS-CoV-2 HAI hospital outbreak cases from 3191 outbreaks, we identified 25 pediatric outbreaks with 241 cases. Of 218 cases with case status information, 181 (83%) were healthcare workers (HCW) and 37 (17%) were patients < 18 years old. Among all 241 cases, five (2%) were severe including one death case whereas 2580 (7%) of non-pediatric HAI cases were severe and 2736 (8%) deaths. Age-disaggregated median monthly outbreak case incidence < 18 years (0.3/100,000 hospitalizations; range 0.1-7.6) was markedly lower than among the non-pediatric age group of 18-59-year olds (14.8/100,000 hospitalizations; range 0.1-215.7).

Conclusion:

Our results suggest limited SARS-CoV-2 HAI transmission in pediatric care. The high proportion of cases among HCW in pediatric outbreaks underlines the need to protect HCW from infections to further limit HAI transmission. Our findings highlight the value of outbreak surveillance for monitoring HAI transmission patterns in vulnerable sub-groups such as pediatric patients.

What Is Known:

• Children and adolescents experience less severe SARS-CoV-2 illness. • Pediatric care poses unique infection prevention and control challenges.

What Is New:

• Pediatric outbreaks were very rare with few severe cases suggesting that pediatric care was less affected by SARS-CoV-2 outbreaks. • Most cases in pediatric outbreaks occurred among healthcare workers pointing to the need to protect HCW from infections and a limited role of pediatric patients and caregivers.

Keywords:

COVID-19 Disease outbreaks Health personnel Healthcare-associated infections Hospitals Pediatrics SARS-CoV-2

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