Prevalence and Characteristics of Persistent Symptoms in Children During the COVID-19 Pandemic: Evidence From a Household Cohort Study in England and Wales

Miller, Faith; Nguyen, Dr Vincent; Navaratnam, Annalan M D; Shrotri, Madhumita; Kovar, Jana; Hayward, Andrew; Fragaszy, Ellen; Aldridge, Robert W; Hardelid, Pia

doi:10.1097/inf.0000000000003715

Cited by 48 publications

(54 citation statements)

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“…Few studies have reported on measures of association between key characteristics and persistent symptoms lasting ≥3 months in CYP. We show that increasing age and reporting a pre-existing health condition were associated with higher odds of persistent symptoms following COVID-19, consistent with other studies in children 9 14. Persistent symptoms in children aged 12–17 years were higher in those infected during the delta period compared with the original wild-type period earlier in the pandemic.…”

Section: Discussionsupporting

confidence: 90%

“…The most common persistent symptoms post-COVID-19 reported across existing studies in CYP are headaches, fatigue, insomnia and anosmia 8–13. However, estimates of symptom persistence vary substantially ranging from 1% to 51%, arguably due to heterogeneous study designs, follow-up periods and definitions 8–17. A recent meta-analysis of five controlled studies in CYP found that the frequency of the majority of reported persistent symptoms was similar in SARS-CoV-2 positive cases and SARS-CoV-2 negative controls.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11][12][13] However, estimates of symptom persistence vary substantially ranging from 1% to 51%, arguably due to heterogeneous study designs, follow-up periods and definitions. [8][9][10][11][12][13][14][15][16][17] A recent meta-analysis of five controlled studies in CYP found that the frequency of the majority of reported persistent symptoms was similar in SARS-CoV-2 positive cases and SARS-CoV-2 negative controls. Small but significant increases in the pooled risk difference…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and predictors of persistent symptoms post-COVID-19 in children and young people: a large community cross-sectional study in England

et al. 2023

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ObjectiveTo estimate the prevalence of, and associated risk factors for, persistent symptoms post-COVID-19 among children aged 5–17 years in England.DesignSerial cross-sectional study.SettingRounds 10–19 (March 2021 to March 2022) of the REal-time Assessment of Community Transmission-1 study (monthly cross-sectional surveys of random samples of the population in England).Study populationChildren aged 5–17 years in the community.PredictorsAge, sex, ethnicity, presence of a pre-existing health condition, index of multiple deprivation, COVID-19 vaccination status and dominant UK circulating SARS-CoV-2 variant at time of symptom onset.Main outcome measuresPrevalence of persistent symptoms, reported as those lasting ≥3 months post-COVID-19.ResultsOverall, 4.4% (95% CI 3.7 to 5.1) of 3173 5–11 year-olds and 13.3% (95% CI 12.5 to 14.1) of 6886 12–17 year-olds with prior symptomatic infection reported at least one symptom lasting ≥3 months post-COVID-19, of whom 13.5% (95% CI 8.4 to 20.9) and 10.9% (95% CI 9.0 to 13.2), respectively, reported their ability to carry out day-to-day activities was reduced ‘a lot’ due to their symptoms. The most common symptoms among participants with persistent symptoms were persistent coughing (27.4%) and headaches (25.4%) in children aged 5–11 years and loss or change of sense of smell (52.2%) and taste (40.7%) in participants aged 12–17 years. Higher age and having a pre-existing health condition were associated with higher odds of reporting persistent symptoms.ConclusionsOne in 23 5–11 year-olds and one in eight 12–17 year-olds post-COVID-19 report persistent symptoms lasting ≥3 months, of which one in nine report a large impact on performing day-to-day activities.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characteristics and predictors of persistent symptoms post-COVID-19 in children and young people: a large community cross-sectional study in England

et al. 2023

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“…Of those that were not case reports, most were cohort studies (26) 23,24,33,36,41,43,47,48,51,52,55,57,[60][61][62][64][65][66][67][68][69][70]72,78,80,[85][86][87]89,92,[98][99][100][101]107,108,110,112 . Most studies recruited from hospital or secondary care settings, eight recruited solely from community settings 38,81,82,90,91,94,107,114 .…”

Section: Resultsmentioning

confidence: 99%

Long-term outcomes of COVID-19 infection in children and young people: a systematic review and meta-analysis

Twohig

Bajpai

Corp

et al. 2023

Preprint

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Background Children and young people (CYP) may experience prolonged symptoms following COVID-19, commonly termed "Long-COVID". The nature of this in CYP is unclear, as are the sequalae of acute COVID-19. We aimed to systematically synthesise evidence of the long-term outcomes of COVID-19 in CYP. Methods 13 databases were searched until January 2022. Inclusion criteria: Observational studies reporting outcomes occurring four-weeks or more after COVID-19 in children <18 years old. Exclusion criteria: Outcomes of Paediatric Inflammatory Multisystem Syndrome. Title, abstract and full text screening were conducted independently by two reviewers. Data extraction and risk of bias assessment was by one reviewer with independent verification. Critical appraisal tools appropriate for study type were employed. Results were narratively synthesised with meta-analysis to generate summary estimates of risk of prolonged symptoms in CYP. Findings 94 studies were included. 66 recruited from hospital settings, 8 recruited solely from community settings. >100 symptoms were reported, the most common being fatigue, headache and cognitive symptoms. Summary estimates of risk of prolonged symptoms were higher for hospital samples (31.2%, 95% CI 20.3% to 43.2%) than for community samples (4.6%, 95% CI 3.4% to 5.8). Sequalae including stroke, type-1 diabetes, Guillan-Barre syndrome, and persistent radiological or blood test abnormalities have been reported in CYP following COVID-19. Most studies reporting these are case reports / case series and quality of evidence is low. Interpretation Prolonged symptoms following COVID-19 in children are variable and multi-system. Rates in community samples are lower than hospital. There is limited data on other sequalae in CYP. Heterogeneity in diagnosis of COVID-19, symptom classification, assessment method and duration of follow-up made synthesis less secure. Funding HT, CB and GS have National Institute for Health and Care Research fellowships. RB, CM and VW are supported by the NIHR West Midlands Applied Research Collaboration. CM Is supported by the NIHR School for Primary Care Research Research in context panel Evidence before this study At the time of writing and to the best of our knowledge, the protocol for this systematic review was a novel endeavour to summarise the longer-term effects of COVID-19 in children and young people (CYP). At least three systematic reviews have since been published, summarising the symptom profile and prevalence of Long-COVID in CYP, but prevalence estimates vary widely and the evidence base remains uncertain. In addition, there is very limited information on other sequalae of COVID-19 in this population group. We searched thirteen electronic databases (MEDLINE, EMBASE, AMED, HMIC, CINAHLPlus, PsycINFO, Web of Science (Science Citation and Social Science Citation indicies), ASSIA, WHO COVID-19: Global literature on coronavirus disease, Cochrane COVID-19 study register, ProQuest Coronavirus research database, NDLTD and OpenGrey) up to January 2022 for any empirical study including search terms pertaining to longer term symptoms of COVID-19 in CYP (<18 years old). The quality of the studies was mixed. Results were analysed narratively for each objective, and random effects meta-analyses conducted to estimate risk of prolonged symptoms in CYP who have had COVID-19. Added value of this study This review adds to the evidence of the heterogeneity of prolonged symptoms following COVID-19 in CYP but importantly, stratifies risk of this by recruitment setting. We also synthesise evidence on broader sequalae of the acute infection in this CYP and longer-term effects in CYP with pre-existing conditions, which have not been considered in previous reviews. We purposefully included case studies and case series, to capture emerging patterns of outcomes, which may well be important in a novel condition with a rapidly increasing volume of publications. To our knowledge, this systematic review and meta-analysis is the most comprehensive to date. Implications of all the available evidence This review adds to the evidence that a substantial proportion of CYP do experience effects of COVID-19 that last longer than four-weeks, with the most frequently reported prolonged symptoms being fatigue, headache and cognitive symptoms. The proportion of CYP developing prolonged symptoms in children recruited from community setting was low, although this may translate to a large number of affected CYP at population level. There is a paucity of controlled studies and this limits confidence that prolonged symptoms are attributable to COVID-19. Sequalae including stroke, type-1 diabetes, Guillan-Barre syndrome, and persistent radiological or blood test abnormalities have been reported in CYP following COVID-19 but most studies reporting these are case reports / case series and quality of evidence is low. To develop treatment plans and interventions for affected CYP, further studies are needed to better characterise this condition and understand its impact on the lives of CYP and their families and communities. These should ideally recruit from community settings, include population-based control groups and consider using standardised definitions and outcome measures where possible.

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“…Although children tend to experience mild or no symptoms during the acute phase of COVID-19, several studies have reported persistent symptoms such as fatigue, cough, dyspnea, and decreased functional capacity in children and adolescents up to 12 weeks post-infection [ 11 , 12 , 13 , 14 ]. Evidence suggests that long COVID symptoms can resolve in most children within months of the initial infection, [ 11 ], however, there is limited information about the impact of long COVID in this group of patients beyond the 3 months.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Effect of COVID-19 on Lung Imaging and Function, Cardiorespiratory Symptoms, Fatigue, Exercise Capacity, and Functional Capacity in Children and Adolescents: A Systematic Review and Meta-Analysis

et al. 2022

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Background: The long-term sequela of COVID-19 on young people is still unknown. This systematic review explored the effect of COVID-19 on lung imaging and function, cardiorespiratory symptoms, fatigue, exercise capacity and functional capacity in children and adolescents ≥ 3 months after infection. Methods: A systemic search was completed in the electronic databases of PubMed, Web of Science and Ovid MEDLINE on 27 May 2022. Data on the proportion of participants who had long-term effects were collected, and one-group meta-analysis were used to estimate the pooled prevalence of the outcomes studied. Results: 17 articles met the inclusion criteria, presented data on 124,568 children and adolescents. The pooled prevalence of abnormalities in lung imaging was 10% (95% CI 1–19, I2 = 73%), abnormal pulmonary function was 24% (95% CI 4–43, I2 = 90%), chest pain/tightness was 6% (95% CI 3–8, I2 = 100%), heart rhythm disturbances/palpitations was 6% (95% CI 4–7, I2 = 98%), dyspnea/breathing problems was 16% (95% CI 14–19, I2 = 99%), and fatigue was 24% (95% CI 20–27, I2 = 100%). Decreased exercise capacity and functional limitations were found in 20% (95% CI 4–37, I2 = 88%) and 48% (95% CI 25–70, I2 = 91%) of the participants studied, respectively. Conclusion: Children and adolescents may have persistent abnormalities in lung imaging and function, cardiorespiratory symptoms, fatigue, and decreased functional capacity between 3 to 12 months after infection. More research is needed to understand the long-term effect of COVID-19 on young people, and to clarify its causes and effective management.

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Prevalence and Characteristics of Persistent Symptoms in Children During the COVID-19 Pandemic: Evidence From a Household Cohort Study in England and Wales

Cited by 48 publications

References 27 publications

Characteristics and predictors of persistent symptoms post-COVID-19 in children and young people: a large community cross-sectional study in England

Characteristics and predictors of persistent symptoms post-COVID-19 in children and young people: a large community cross-sectional study in England

Long-term outcomes of COVID-19 infection in children and young people: a systematic review and meta-analysis

Long-Term Effect of COVID-19 on Lung Imaging and Function, Cardiorespiratory Symptoms, Fatigue, Exercise Capacity, and Functional Capacity in Children and Adolescents: A Systematic Review and Meta-Analysis

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