Study Shows That Children Who Contracted Only Mild COVID-19 Can Still Develop Long COVID Symptoms After ‘Recovery’
Pediatric Long COVID
: A new study by researchers from The University of Texas (UT) Health Science Center at Houston-USA has found that children who contracted mild COVID-19 can still develop Long COVID symptoms after ‘recovery’.
The Pediatric Long COVID
study findings serve as warnings to parents, teachers and also physicians that children who had contracted COVID-19 irrespective of whether they were mild, moderate or severe, should be carefully monitored for any developing health issues after so called ‘recovery’.
The prevalence of long-term symptoms of coronavirus disease 2019 (COVID-19) in non-hospitalized pediatric populations in the United States is not well described. The objective of this analysis was to examine the presence of persistent COVID symptoms in children by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody status.
Data were collected between October 2020 and May 2022 from the Texas Coronavirus Antibody REsponse Survey, a statewide prospective population-based survey among 5-90 years old. Serostatus was assessed by the Roche Elecsys Anti-SARS-CoV-2 Immunoassay for detection of antibodies to the SARS-CoV-2 nucleocapsid protein. Self-reported antigen/polymerase chain reaction COVID-19 test results and persistent COVID symptom status/type/duration were collected simultaneously. Risk ratios for persistent COVID symptoms were calculated versus adults and by age group, antibody status, symptom presence/severity, variant, body mass index and vaccine status.
A total of 82 (4.5% of the total sample [n = 1813], 8.0% pre-Delta, 3.4% Delta and beyond) participants reported persistent COVID symptoms (n = 27 [1.5%] 4–12 weeks, n = 58 [3.3%] >12 weeks).
When compared with adults, all pediatric age groups had a lower risk for persistent COVID symptoms regardless of length of symptoms reported.
Additional increased risk for persistent COVID symptoms >12 weeks included severe symptoms with initial infection, not being vaccinated and having unhealthy weight (body mass index ≥85th percentile for age and sex).
Among those reporting symptoms lasting 4–12 weeks, the most commonly reported symptoms among those who were both seropositive and reported persistent COVID symptoms were new loss of taste and smell (6.7%), fatigue (60.0%), fever or chills (46.7%) and headache (40.0%).
Among those reporting symptoms lasting >12 weeks, the most commonly reported symptoms among those who were both seropositive and reported persistent COVID symptoms were headache and fatigue (53.8% each, respectively), congestion or runny nose (41.0%), cough (35.9%) and fever or chills (30.8%).
Compared with the Texas CARES adult sample who reported persistent COVID symptoms for 4–12 weeks (n = 2171), all pediatric age groups were significantly less at risk for persistent COVID symptoms. Specifically, in univariate modeling 5–19 years old had 93% less risk (RR: 0.07, 95% CI: 0.02–0.27), 10–14 years old had 78% less risk (RR: 0.22, 95% CI: 0.13–0.37) and 15–19 years old had 77% less risk (RR: 0.23, 95% CI: 0.13–0.40) versus adults. Five to 9 years and 10–14 years old were less at risk for reporting persistent COVID sympto
ms that lasted 4–12 months versus 15–19 years old. Those who did not report vaccination information were almost 6 times more likely to report persistent symptoms lasting 4–12 months (RR: 5.76, 95% CI: 1.18–28.06) than those who were vaccinated. Two other findings that were not statistically significant but of note included those who reported severe symptoms were more than 3 times at risk (RR: 3.59, 95% CI: 0.51–25.44) and those reporting at least 1 symptom with initial infection were 28% more at risk (RR: 1.28, 95% CI: 0.46–3.70) for reporting persistent COVID symptoms lasting 4–12 weeks versus those who reported mild-moderate symptoms, and those who reported no initial symptoms, respectively.
The study findings highlight the existence of non-hospitalized youth who may also experience persistent COVID symptoms. Children and adolescents are less likely to experience persistent COVID symptoms than adults and more likely to be symptomatic, experience severe symptoms and have unhealthy weight compared with children/adolescents without persistent COVID symptoms.
The study findings were published in the peer reviewed The Pediatric Infectious Disease Journal. https://journals.lww.com/pidj/Fulltext/9900/Comparison_of_Persistent_Symptoms_Following.151.aspx
Although research has revealed that children and adults hospitalized with COVID-19 are more susceptible to developing long COVID symptoms, this is the first study to show that children infected with COVID-19, but not hospitalized, still experienced long COVID symptoms up to three months past infection.
The study team examined data from volunteers across the state of Texas between the ages of 5 and 18 who were enrolled in the Texas CARES survey, which began in October of 2020 with the goal of assessing COVID-19 antibody status over time among a population of adults and children in Texas.
All data for this study was collected before and after the vaccine rollout and during the waves of the Delta and Omicron variants.
First author, Dr Sarah Messiah, Ph.D., MPH, professor of epidemiology, human genetics, and environmental sciences and director of the Center for Pediatric Population Health at UTHealth School of Public Health told Thailand Medical News
, "We were interested in understanding if children impacted with an acute or severe infection of COVID-19 would go on to have persisting symptoms, or what we call long COVID.”
She added, “This particular study is unique as the first population-based study in literature to report on prevalence of long COVID in children who have not been hospitalized with COVID-19."
In all, a total of 82 pediatric volunteers (4.8% of the total 1,813) reported having long COVID symptoms.
About 1.5% showed symptoms that lasted between four and 12 weeks, including loss of taste and smell, fatigue, and cough. An additional 3.3% reported that symptoms such as loss of taste and smell, cough, and difficulty breathing persisted for longer than 12 weeks.
Professor Messiah further added, "From this information we wanted to know, 'What would put a child more at risk for long COVID and who is more susceptible to this?' When we looked at risk factors of those who reported symptoms past 12 weeks, we found that children who were unvaccinated and who had obesity had a higher chance of developing long COVID. These findings are consistent with other literature that found children and adults who have comorbid health conditions and are unvaccinated are at a higher risk of being hospitalized for the virus.”
The study team additionally found that children infected with COVID-19 before the emergence of the Delta variant were more at risk of developing long COVID.
Professor Messiah commented, "If you had COVID-19 earlier in the pandemic, you were more at risk for longer symptoms. With Delta and Omicron, we did see a lot of children who ended up hospitalized, but their symptoms were less severe, and our results show they were also less likely to report persistent symptoms too.”
The findings of the Texas CARES study, Professor Messiah said, is important because it highlights the presence of non-hospitalized youth who may also experience persistent long COVID symptoms after infection.
She said, "There may be a perception that one needs to be hospitalized to have long COVID, and that is not what we found. I encourage parents to still take caution and get their child vaccinated against COVID-19, because we now know that it will decrease the risk of infection and long COVID.”
In the meanwhile, the study team suggested that proper follow-ups and health screenings should be conducted on all children who have been exposed to the SARS-CoV-2 virus.
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