Prevalence of persistent symptoms in children during the COVID-19 pandemic: evidence from a household cohort study in England and Wales

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

doi:10.1101/2021.05.28.21257602

Cited by 64 publications

(110 citation statements)

References 8 publications

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“…Up to now, only five in pediatric population-based studies with included control groups have been published (13-15, 40, 41). The long-COVID prevalence rates are quite different, since only three of these studies found persistent symptoms to be more common in children with confirmed SARS-CoV-2 infection (13,15,40). The spectrum of the most commonly reported persistent symptoms was compatible with our study, since fatigue, headaches and prolonged respiratory symptoms were the most commonly reported complains.…”

Section: Discussionsupporting

confidence: 83%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 83%

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

et al. 2021

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“…Our study therefore extends previous research as it is the first that suggests relevant post COVID-19 healthcare utilization and new-onset morbidity patterns documented by physicians in children and adolescents following COVID-19 disease in a large sample of patients with confirmed COVID-19 compared to a matched control group. Previous studies among children and adolescents, which did not observe significant group differences between children and adolescents with COVID-19 and controls were limited by restrictions to hospitalized patients [10], high drop-out rates and/or high risk of selection bias [10,23], self-reported outcome assessment [5,10,19,24,25], lack of a control group [10], insufficiently long follow-up time to assess post COVID-19 outcomes [23,26], and low sample size resulting in low statistical power [26,27].…”

Section: Discussionmentioning

confidence: 99%

Post COVID-19 in children, adolescents, and adults: results of a matched cohort study including more than 150,000 individuals with COVID-19

Roessler

Tesch

Batram

et al. 2021

Preprint

110

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BackgroundLong-term health sequelae of the coronavirus disease 2019 (COVID-19) are a major public health concern. However, evidence on post-acute COVID-19 syndrome (post COVID-19) is still limited, particularly for children and adolescents. Utilizing comprehensive healthcare data on more than 45 percent of the German population from January 2019 through December 2020, we investigated post COVID-19 in children/adolescents and adults.MethodsFrom a total of 38 million individuals, we identified all patients with laboratory confirmed diagnosis of COVID-19 through June 30, 2020. A control cohort was assigned using 1:5 exact matching on age, sex, and propensity score matching on prevalent medical conditions. COVID-19 and control cohorts were followed for incident morbidity outcomes documented at least three months after the date of COVID-19 diagnosis, which was used as the index date for both groups. Overall, 96 pre-defined outcomes were aggregated into 13 diagnosis/symptom complexes and three domains (physical health, mental health, physical/mental overlap domain). We used Poisson regression to estimate incidence rate ratios (IRRs) with 95%-confidence intervals (95%-CI).ResultsThe study population included 157,134 individuals (11,950 children/adolescents and 145,184 adults) with confirmed COVID-19. COVID-19 and control cohort were well-balanced regarding covariates. For all health outcomes combined, incidence rates (IRs) in the COVID-19 cohort were significantly higher than those in the control cohort in both children/adolescents (IRR=1.30, 95%-CI=[1.25-1.35], IR COVID-19=436.91, IR Control=335.98) and adults (IRR=1.33, 95%-CI=[1.31-1.34], IR COVID-19=615.82, IR Control=464.15). The relative magnitude of increased documented morbidity was similar for the physical, mental, and physical/mental overlap domain. In the COVID-19 cohort, incidence rates were significantly higher in all 13 diagnosis/symptom complexes in adults and in ten diagnosis/symptom complexes in children/adolescents. IRR estimates were similar for the age groups 0-11 and 12-17. Incidence rates in children/adolescents were consistently lower than those in adults. Among the specific outcomes with the highest IRR and an incidence rate of at least 1/100 person-years in the COVID-19 cohort in children and adolescents were malaise/fatigue/exhaustion (IRR=2.28, 95%-CI=[1.71-3.06], IR COVID-19=12.58, IR Control=5.51), cough (IRR=1.74, 95%-CI=[1.48-2.04], IR COVID-19=36.56, IR Control=21.06), and throat/chest pain (IRR=1.72, 95%-CI=[1.39-2.12], IR COVID-19=20.01, IR Control=11.66). In adults, these included dysgeusia (IRR=6.69, 95%-CI=[5.88-7.60], IR COVID-19=12.42, IR Control=1.86), fever (IRR=3.33, 95%-CI=[3.01-3.68], IR COVID-19=11.53, IR Control=3.46), and dyspnea (IRR=2.88, 95%-CI=[2.74-3.02], IR COVID-19=43.91, IR Control=15.27).ConclusionsThis large, matched cohort study indicates substantial new-onset post COVID-19 morbidity in pediatric and adult populations based on routine health care documentation. Further investigation is required to assess the persistence and long-term health impact of post COVID-19 conditions, especially in children and adolescents.

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“…The three that did find a difference had significant limitations, including potential selection bias due to a high non-responder rate, that could lead to an overestimate of the risk of long COVID-19. 55 69 70 and as a consequence, transmission from vaccinated individual to household contacts is significantly lower 71 (by 50% in one study 69 ). However, more recent studies done since the Delta variant became dominant show similar viral loads in vaccinated and unvaccinated individuals.…”

Section: Protection Against Long Covid-19mentioning

confidence: 93%

“…21 Studies to date report a prevalence ranging from 1.2% to 66%. [54][55][56][57][58][59][60][61][62][63][64] However, most of these studies have substantial limitations, including a lack of a clear case definition, the absence of a control group without infection, inclusion of children without laboratory-confirmed SARS-CoV-2 infection, follow-up at arbitrary time points and high non-responder bias. 54-63 65-68 Of the five studies to date that have included controls, 55 59 61 65 two did not find a difference in the prevalence of persistent symptoms between infected and uninfected children.…”

Section: Protection Against Long Covid-19mentioning

confidence: 99%

Should children be vaccinated against COVID-19?

et al. 2021

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Whether all children under 12 years of age should be vaccinated against COVID-19 remains an ongoing debate. The relatively low risk posed by acute COVID-19 in children, and uncertainty about the relative harms from vaccination and disease mean that the balance of risk and benefit of vaccination in this age group is more complex. One of the key arguments for vaccinating healthy children is to protect them from long-term consequences. Other considerations include population-level factors, such as reducing community transmission, vaccine supply, cost, and the avoidance of quarantine, school closures and other lockdown measures. The emergence of new variants of concern necessitates continual re-evaluation of the risks and benefits. In this review, we do not argue for or against vaccinating children against COVID-19 but rather outline the points to consider and highlight the complexity of policy decisions on COVID-19 vaccination in this age group.

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Prevalence of persistent symptoms in children during the COVID-19 pandemic: evidence from a household cohort study in England and Wales

Cited by 64 publications

References 8 publications

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

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

Post COVID-19 in children, adolescents, and adults: results of a matched cohort study including more than 150,000 individuals with COVID-19

Should children be vaccinated against COVID-19?

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