Long COVID symptoms in SARS-CoV-2-positive children aged 0–14 years and matched controls in Denmark (LongCOVIDKidsDK): a national, cross-sectional study

Berg, Selina Kikkenborg; Palm, Pernille; Nygaard, Ulrikka; Bundgaard, Henning; Petersen, Maria Nivi Schmidt; Rosenkilde, Siri; Thorsted, Anne; Ersbøll, Annette Kjær; Thygesen, Lau Caspar; Nielsen, Susanne Dam; Christensen, Anne Vinggaard

doi:10.1016/s2352-4642(22)00154-7

Cited by 94 publications

(100 citation statements)

References 25 publications

(31 reference statements)

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“…Similar to our findings, cross-sectional national studies based on Danish national register data demonstrated that a large number of predefined health symptoms lasting more than 2 or 3 months were significantly more frequent among children and adolescents with a history of a positive SARS-CoV-2 test until July 2021 compared with age- and sex-matched controls [ 20 , 36 ]. Symptoms most frequently associated with prior SARS-CoV-2 infection in these previous analyses included a wide variety of health conditions, e.g., mood swings, cough, and stomach aches among young children 0 to 3 years of age, fatigue, and mood swings among older children [ 36 ], and sore throat, chest pain, and palpitations among adolescents [ 20 ]. This is in line with our observations, although the limited number of children and adolescents in our study precluded further stratification according to age groups and hence age-specific comparisons.…”

Section: Discussionsupporting

confidence: 90%

“…Several large national studies from the UK, Norway, Denmark, and the US have recently contributed further evidence on the health and social impact of long COVID among children and adolescents with conflicting results [ 20 , 21 , 23 , 35 , 36 , 46 ]. At 3 months of follow-up, the British national matched cohort study of post-COVID-19 condition among children and adolescents 11 to 17 years of age observed small differences between individuals with positive PCR test results compared with controls with regard to individual health symptoms [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…As symptoms associated with post-COVID-19 condition appear to decline over time, controlled studies based on routine medical data may help to identify long-term health conditions following SARS-CoV-2 infection, provided access to healthcare is equally available to individuals with and without SARS-CoV-2 infection. Few such studies have been conducted to this point and almost none of these studies has included both adults and children [ 5 , 6 , 17 – 36 ].…”

Section: Introductionmentioning

confidence: 99%

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Post-COVID-19-associated morbidity in children, adolescents, and adults: A matched cohort study including more than 157,000 individuals with COVID-19 in Germany

et al. 2022

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Background Long-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 approximately 46% of the German population, we investigated post-COVID-19-associated morbidity in children/adolescents and adults. Methods and findings We used routine data from German statutory health insurance organizations covering the period between January 1, 2019 and December 31, 2020. The base population included all individuals insured for at least 1 day in 2020. Based on documented diagnoses, we identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through June 30, 2020. A control cohort was assigned using 1:5 exact matching on age and sex, and propensity score matching on preexisting medical conditions. The date of COVID-19 diagnosis was used as index date for both cohorts, which were followed for incident morbidity outcomes documented in the second quarter after index date or later.Overall, 96 prespecified outcomes were aggregated into 13 diagnosis/symptom complexes and 3 domains (physical health, mental health, and physical/mental overlap domain). We used Poisson regression to estimate incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs). The study population included 11,950 children/adolescents (48.1% female, 67.2% aged between 0 and 11 years) and 145,184 adults (60.2% female, 51.1% aged between 18 and 49 years). The mean follow-up time was 236 days (standard deviation (SD) = 44 days, range = 121 to 339 days) in children/adolescents and 254 days (SD = 36 days, range = 93 to 340 days) in adults. COVID-19 and control cohort were well balanced regarding covariates. The specific outcomes with the highest IRR and an incidence rate (IR) 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 to 3.06, p < 0.01, IR COVID-19: 12.58, IR Control: 5.51), cough (IRR: 1.74, 95% CI: 1.48 to 2.04, p < 0.01, IR COVID-19: 36.56, IR Control: 21.06), and throat/chest pain (IRR: 1.72, 95% CI: 1.39 to 2.12, p < 0.01, IR COVID-19: 20.01, IR Control: 11.66). In adults, these included disturbances of smell and taste (IRR: 6.69, 95% CI: 5.88 to 7.60, p < 0.01, IR COVID-19: 12.42, IR Control: 1.86), fever (IRR: 3.33, 95% CI: 3.01 to 3.68, p < 0.01, IR COVID-19: 11.53, IR Control: 3.46), and dyspnea (IRR: 2.88, 95% CI: 2.74 to 3.02, p < 0.01, IR COVID-19: 43.91, IR Control: 15.27). For all health outcomes combined, IRs per 1,000 person-years 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 to 1.35, p < 0.01, IR COVID-19: 436.91, IR Control: 335.98) and adults (IRR: 1.33, 95% CI: 1.31 to 1.34, p < 0.01, 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, IRs were significantly higher in all 13 diagnosis/symptom complexes in adults and in 10 diagnosis/symptom complexes in children/adolescents. IRR estimates were similar for age groups 0 to 11 and 12 to 17. IRs in children/adolescents were consistently lower than those in adults. Limitations of our study include potentially unmeasured confounding and detection bias. Conclusions In this retrospective matched cohort study, we observed significant new onset morbidity in children, adolescents, and adults across 13 prespecified diagnosis/symptom complexes, following COVID-19 infection. These findings expand the existing available evidence on post-COVID-19 conditions in younger age groups and confirm previous findings in adults. Trial registration ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT05074953.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post-COVID-19-associated morbidity in children, adolescents, and adults: A matched cohort study including more than 157,000 individuals with COVID-19 in Germany

et al. 2022

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“…Importantly, we observed the greatest impact of masking requirements in weeks with highest background community rates of COVID-19, underscoring the importance of early implementation and sustaining of school masking policies prior to and throughout surges. In addition, given the evolving understanding of the impact of long-COVID on children, 10–13 our results suggest that masking requirements may be an important tool for school administrators and elected officials to consider as they plan for the upcoming school year.…”

Section: Discussionmentioning

confidence: 91%

Impact of Lifting School Masking Requirements on Incidence of COVID-19 among Staff and Students in Greater-Boston Area School Districts: A Difference-in-Differences Analysis

Cowger

Clarke

Murray

et al. 2022

Preprint

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Background. In February 2022, following the rescinding of a Massachusetts statewide school masking mandate, only two cities (Boston and neighboring Chelsea) out of 79 school districts in the greater-Boston area, maintained masking requirements in K-12 schools. This provided an opportunity to examine the impact of removing masking on COVID-19 case rates among students and staff in the public-school setting. Methods. We used difference-in-differences for staggered policy adoption to compare incidence of COVID-19 cases among students and staff in greater-Boston area school districts that lifted masking requirements to those that had not yet lifted masking requirements during the 2021-2022 school year. Results. Before the statewide school masking policy was lifted, there was no statistically significant difference in case rate trajectories between school districts. However, weekly and cumulative case rates were significantly higher in students and staff in school districts that removed masking requirements, compared to districts that had not yet lifted requirements. We estimate that lifting of school masking requirements was associated with an additional 44.9 (95% CI: 32.6, 57.1) COVID-19 cases per 1,000 students and staff over the 15 weeks since the lifting of the statewide school masking requirement, representing nearly 30% of all cases observed in schools during that time. School districts that sustained masking requirements for longer periods tended to have older school buildings in poorer condition, more crowded classrooms, higher proportion of low income and English learning students and students with disabilities, and a higher proportion of Black and Latinx students and staff. Conclusions. Masking is a relatively low-cost but effective intervention that can protect students and staff from substantial illness and loss of in-person days in school. Despite compelling evidence that masking significantly reduces the spread of SARS-CoV-2, political will and public adherence to masking has waned. Our study confirms that universal masking requirements can benefit all students and staff, and therefore represents an important strategy to mitigate the impacts of structural racism, ensure health equity, and to avoid potential deepening of educational inequities.

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“…Other studies have reported varying ranges of persistent symptoms after COVID. A Danish study reported higher rates of symptoms at 2 months post-infection in children aged 0-14 compared to controls in a cross-sectional case-control study 105 , while an international study of ∼1800 children demonstrated very low prevalence of symptoms at day 90 106 .…”

Section: Epidemiologymentioning

confidence: 95%

SARS-CoV-2 Infection and COVID-19 in Children

Waghmare

Hijano

2023

Clinics in Chest Medicine

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Long COVID symptoms in SARS-CoV-2-positive children aged 0–14 years and matched controls in Denmark (LongCOVIDKidsDK): a national, cross-sectional study

Cited by 94 publications

References 25 publications

Post-COVID-19-associated morbidity in children, adolescents, and adults: A matched cohort study including more than 157,000 individuals with COVID-19 in Germany

Post-COVID-19-associated morbidity in children, adolescents, and adults: A matched cohort study including more than 157,000 individuals with COVID-19 in Germany

Impact of Lifting School Masking Requirements on Incidence of COVID-19 among Staff and Students in Greater-Boston Area School Districts: A Difference-in-Differences Analysis

SARS-CoV-2 Infection and COVID-19 in Children

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