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

Abstract

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.

The Burden of COVID-19 in Children and Its Prevention by Vaccination: A Joint Statement of the Israeli Pediatric Association and the Israeli Society for Pediatric Infectious Diseases

“…As our understanding of the long-term consequences of COVID-19 advances, reliable data on long COVID or the post-COVID-19 condition in children and adolescents accumulate. The incidence of this syndrome varies, reaching up to 30%, depending on the population assessed, methods of data collection and the time elapsed from the acute illness [19][20][21][22][23][24][25][26][27][28]. Nevertheless, the clustering of symptoms and the results of a large-scale controlled study provide evidence of the long-term physical and mental illness in some children recovering from COVID-19 [19].…”

“…Three months post testing, SARS-CoV-2-positive children exhibited higher incidences of more than three (symptoms 30% vs. 16% in the control group) [21]. A large-scale study in Germany compared 96 health outcomes aggregated into 13 symptom complexes between 11,950 SARS-CoV-2-positive children and a control group [19]. Among the SARS-CoV-2 positive children, incidences of physical and mental illness were increased three months after the acute illness, including fatigue (incidence rate ratio (IRR) = 2.28, 95% CI = [1.71-3.06]), cough (IRR = 1.74, 95% CI = [1.48-2.04]) and chest pain (IRR = 1.72, 95% CI = [1.39-2.12]).…”

“…Among the SARS-CoV-2 positive children, incidences of physical and mental illness were increased three months after the acute illness, including fatigue (incidence rate ratio (IRR) = 2.28, 95% CI = [1.71-3.06]), cough (IRR = 1.74, 95% CI = [1.48-2.04]) and chest pain (IRR = 1.72, 95% CI = [1.39-2.12]). Reported risk factors for long COVID in children included older age, female gender, atopic background, acute symptomatic disease and co-morbidities [19,24,25,27].…”

Long-term symptoms after SARS-CoV-2 infection in a cohort of hospital employees: duration and predictive factors

“…Compared to large register studies like Roessler et al where disease diagnoses were recorded, 17 in the present study we were able to capture symptoms that were not necessarily linked to a physician’s disease diagnosis. These symptoms may nevertheless be essential to understand the burden of post-COVID conditions.…”

Considerations for the Safe Operation of Schools During the Coronavirus Pandemic

“…Another study estimated that 10% of children may still experience symptoms 3 months post infection ( 56 ). In a large, matched cohort study, the incidence rate of health problems was ~30% higher in the COVID-19 cohort than in matched controls at least 3 months after infection ( 57 ). Symptoms including fatigue, cough, throat or chest pain, headache, fever, and abdominal pain occurred 1.45 to 2.28 times more frequently in the COVID-19 than in the control cohort.…”