Long-term Symptoms After SARS-CoV-2 Infection in Children and Adolescents

Abstract

Children can experience SARS-CoV-2 postviral syndromes, but it is unclear to what extent these individuals are affected by long COVID. Evidence is predominantly limited to select populations without control groups, 1-4 which does not allow estimating the overall prevalence and burden in a general pediatric population. We compared symptoms compatible with long COVID in children and adolescents (hereafter "children") reported within 6 months after SARS-CoV-2 serologic testing.Methods | Ciao Corona is a longitudinal cohort study investigating SARS-CoV-2 seroprevalence in 55 randomly selected schools in the canton of Zurich in Switzerland, 5,6 which has a linguistically and ethnically diverse population of 1.5 million residents in urban and rural settings. Schools were selected randomly from the 12 cantonal districts, with number of schools proportional to population size. In Switzerland, children attended schools in person (with protective measures) in 2020-2021, except during a 6-week nationwide lockdown (March 16 to May 10, 2020).Within participating schools, we invited all children of randomly selected classes to participate. Between June 2020 and April 2021, 3 testing phases included collection of venous blood for serologic analysis and online questionnaires for symptoms. For serologic analysis, we used the ABCORA 2.0 test (eMethods in the Supplement). 5 We compared children who tested positive for SARS-CoV-2 antibodies in October or November 2020 with those who tested negative. We excluded children who were seronegative in October or November 2020 and seroconverted or were not retested by March or April 2021. In March to May 2021, parents reported symptoms of their children occurring since October 2020 and lasting for at least 4 weeks, as well as whether the symptoms persisted for more than 12 weeks. The questionnaire contained a list of predefined symptoms and a free-text field.Descriptive analysis was performed with R version 4.0.3 (R Foundation). The Ethics Committee of the Canton of Zurich, Switzerland, approved the study and parents provided written informed consent.

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

“…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].…”

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

“…Many of the reported long-COVID symptoms are non-specific, thus making it difficult to distinguish long COVID from pandemic-associated symptoms caused by lockdown measures (i.e., restricted socializing, school closures), which have been shown to have negative effects on the well-being and mental health of children and adolescents (16,32,39). In order to prove the correlation between SARS-CoV-2 infection and symptom persistence in children, it is crucial to carry out research with matched control groups and validated research tools, including objective functional testing and imaging, since self-reported symptoms may be difficult to validate (14,16,29).…”

“…The precise prevalence of long COVID remains unknown, and the data is heterogeneous, ranging from 10 to 87% in adults to 4 to 66% in children (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). This wide range could be explained by lack of systematic, long-term follow-ups, with high variability in terms of age, severity of infection, prevalence of pre-existing clinical conditions, and characteristics of the clinical evaluation (since most pediatric studies are based on self-or parent-reported symptom persistence using questionnaires or online surveys) (7,14,16,17).…”

Pathogenesis, Symptomatology, and Transmission of SARS-CoV-2 through Analysis of Viral Genomics and Structure

“…However, not all cases of severe COVID-19 in children are characterizable as MIS-C. A recent study ( 132 ) described demographic and clinical variables associated with MIS-C in comparison with non-MIS-C severe acute COVID-19 in young people in the United States. Efforts to characterize long-term sequelae of SARS-CoV-2 infection in children face the same challenges as in adults, but long-term effects remain a concern in pediatric patients ( 105 , 133 , 134 ), although some early studies have suggested that they may be less of a concern than in adults ( 135 – 137 ). Research is ongoing into the differences between the pediatric and adult immune responses to SARS-CoV-2, and future research may shed light on the factors that lead to MIS-C; it is also unknown whether the relative advantages of children against severe COVID-19 will remain in the face of current and future variants ( 138 ).…”