Comparison of Persistent Symptoms After COVID-19 and Other Non-SARS-CoV-2 Infections in Children

Abstract

Introduction: The data on long COVID in children is scarce since children and adolescents are typically less severely affected by acute COVID-19. This study aimed to identify the long-term consequences of SARS-CoV-2 infection in children, and to compare the persistent symptom spectrum between COVID-19 and community-acquired infections of other etiologies.Methods: This was an ambidirectional cohort study conducted at the Children's Clinical University Hospital in Latvia. The study population of pediatric COVID-19 patients and children with other non-SARS-CoV-2-community-acquired infections were invited to participate between July 1, 2020, and April 30, 2021.Results: In total, 236 pediatric COVID-19 patients were enrolled in the study. Additionally, 142 comparison group patients were also enrolled. Median follow-up time from acute symptom onset was 73.5 days (IQR; 43–110 days) in the COVID-19 patient group and 69 days (IQR, 58–84 days) in the comparison group. Most pediatric COVID-19 survivors (70%, N = 152) reported at least one persistent symptom, but more than half of the patients (53%, N = 117) noted two or more long-lasting symptoms. The most commonly reported complaints among COVID-19 patients included persistent fatigue (25.2%), cognitive sequelae, such as irritability (24.3%), and mood changes (23.3%), as well as headaches (16.9%), rhinorrhea (16.1%), coughing (14.4%), and anosmia/dysgeusia (12.3%). In addition, 105 (44.5%) COVID patients had persistent symptoms after the 12-week cut-off point, with irritability (27.6%, N = 29), mood changes (26.7%, N = 28), and fatigue (19.2%, N = 20) being the most commonly reported ones. Differences in symptom spectrum among the various age groups were seen. Logistic regression analysis showed that long-term persistent symptoms as fever, fatigue, rhinorrhea, loss of taste and/or smell, headaches, cognitive sequelae, and nocturnal sweating were significantly associated with the COVID-19 experience when compared with the controls.Conclusions: We found that at the time of interview almost three-quarters of children reported at least one persistent symptom, but the majority of patients (53%) had two or more concurrent symptoms. The comparison group's inclusion in the study allowed us to identify that symptom persistence is more apparent with COVID-19 than any other non-SARS-CoV-2 infection. More research is needed to distinguish the symptoms of long COVID from pandemic-associated complaints. Each persistent symptom is important in terms of child well-being during COVID-19 recovery.

Long COVID in Children and Adolescents

“…The prevalence of long COVID-19 in children varies remarkably depending on the studies, ranging from 4% to 66% (Table 1) [18][19][20][21][22][23][24]. Studies are very heterogeneous, differing in sample size, the median age of the included population, duration and modalities of follow-up.…”

“…This cohort study enrolled 236 pediatric COVID-19 patients and 142 comparison group patients to identify the long-term consequences of SARS-CoV-2 infection 1-6 months after acute infection. After a median follow-up time of 73.5 days, almost 70% of participants had at least one persisting symptom and more than the 50% had two or more [18].…”

“…As in adults [42], the most common symptom described in children was fatigue, reported in up to 87% of patients [9][10][11][12]15,18,20]. Some authors [20] highlighted that fatigue could be determined by the limitations in daily activities due to school unattendance.…”

“…To date, six studies compared children infected with COVID-19 and a control group [14,16,18,19,21,23] and four [14,16,18,23] reported a higher prevalence of symptoms in children affected by COVID, suggesting long COVID syndrome.…”

“…The persistence of at least one symptom [fatigue (25.2%), irritability (24.3%), mood changes (23.3%), headaches (16.9%), rhinorrhea (16.1%), coughing (14.4%), anosmia/dysgeusia (12.3%)] was more frequent in patients with COVID-19 infection (70% vs. 24.8%, p-value < 0.001). Interestingly, school-age children and adolescents were mostly affected by cognitive and neurological disorders while infants and preschoolers by respiratory problems [18].…”