Long-COVID in immunocompromised children

Abstract

Coronavirus disease 2019 (COVID-19) can lead to an illness characterized by persistent symptoms which affect various organs and systems, known as long-COVID. This study aimed to assess the prevalence and clinical characteristics of long-COVID in children with immunodeficiency, in comparison to those without. A self-constructed questionnaire was created, which included questions regarding the child’s general health, the course of their COVID-19, their symptoms of long-COVID and its impact on their daily functioning, the diagnosis of multisystem inflammatory syndrome (MIS-C), and vaccination status. The questionnaire was completed by parents of 147 children — 70 children with a diagnosis of immunodeficiency (47.6%) and 77 who were immunocompetent (52.4%). Immunocompetent children were more significantly affected by long-COVID than those immunocompromised. Its prevalence in the first 12-week post-infection was 60.0% and 35.7% in these groups, respectively. Beyond this period, these percentages had dropped to 34.6% and 11.43%, respectively. Children who were immunocompetent reported more often symptoms of fatigue, reduced exercise tolerance, and difficulty concentrating. Meanwhile, there was a slight increase in complaints of gastrointestinal symptoms in immunocompromised patients. The risk of developing long-COVID increased with age and COVID-19 severity in both groups. Furthermore, the daily activities of immunocompetent children were limited more frequently (41.8%) than for those who were immunocompromised (25%). Conclusions: Although immunocompromised children experienced long-COVID, its prevalence and impact on daily functioning were significantly lower than among immunocompetent children. However, as the pathomechanisms of long-COVID are not yet fully understood, it is not currently possible to fully explain these findings. What is Known: • Long COVID is characterized by persistent symptoms following COVID-19, which can affect various tissues and organs, as well as mental health. • Due to the similar course of COVID-19 — mainly mild or asymptomatic — among children with and without immunodeficiency, the question arises, over whether the prevalence and severity of long-COVID is also similar in both groups. What is New: • Immunocompromised children also suffer from long-COVID, but the prevalence is significantly lower than in the immunocompetent group of children. • The potential causes of less frequent and milder long-COVID in this group may be the milder course of COVID-19 and the state of reduced immunity protecting against neuroinflammation.

Post-COVID Syndrome in Adults—An Overview

“…Conversely to the above indicated increased risk, immunocompromised individuals may also exhibit less detrimental inflammatory responses than previously healthy subjects upon SARS-CoV-2 infection. Remarkably, immunocompetent children appear to be significantly more affected by post-COVID syndrome than those with immunocompromised conditions [ 73 ]. A potential explanation for this finding of less frequent and milder post-COVID syndrome among immunocompromised children may be their less serious course of COVID-19.…”

Vaccine Effectiveness Against Long COVID in Children: A Report from the RECOVER EHR Cohort

“…Main analysis. We matched vaccinated and unvaccinated patients on age group at cohort entry (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) and time period (six-month cohort entry period). We limited long COVID observations to 12 months following cohort entry to account for waning of vaccine effectiveness (VE) over time.…”

“…Further, children may experience long-term health burdens after infection, collectively referred to as post-acute sequelae of SARS-CoV-2 (PASC) or “long COVID” 4 5,6 . These may represent effects of host response to the original infection in addition to or instead of direct pathogen effects 7–9 . Long COVID is heterogeneous and likely underdiagnosed, but symptoms such as brain fog, dyspnea, gastrointestinal dysfunction, generalized pain, and fatigue can cause significant burden for children, even after mild COVID-19 4,5,10,11 .…”

Vaccines and therapeutics for immunocompromised patients with COVID-19

“… 9 While immunocompromised patients are generally at increased risk for severe presentations, hospitalizations, development of persistent infection and deaths one study found that they may be partially protected from acquiring long COVID, except possibly those with underlying HIV infection. 11 , 12 , 13 …”