Robustness of reported postacute health outcomes in children with SARS-CoV-2 infection: a systematic review

Hirt, Julian; Janiaud, Perrine; Gloy, Viktoria; Schandelmaier, Stefan; Pereira, Tiago; Contopoulos‐Ioannidis, Despina G.; Goodman, Steven N.; Ioannidis, John P. A.; Munkholm, Klaus; Hemkens, Lars G

doi:10.1136/archdischild-2022-324455

Cited by 11 publications

(13 citation statements)

References 45 publications

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“… 38 Fourth, we have not captured information on potential long-term consequences of COVID-19, although claims for frequent pediatric post–COVID-19 condition may be unfounded. 39 Fifth, children and adolescents in the studied population were mostly unvaccinated, and our analyses were underpowered to address the impact of vaccination. However, outcomes were already excellent for pediatric infections and even more so for reinfections.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk, and Severity of SARS-CoV-2 Reinfections in Children and Adolescents Between March 2020 and July 2022 in Serbia

et al. 2023

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ImportanceDuring the COVID-19 pandemic, children and adolescents were massively infected worldwide. In 2022, reinfections became a main feature of the endemic phase of SARS-CoV-2, so it is important to understand the epidemiology and clinical impact of reinfections.ObjectiveTo assess the incidence, risk, and severity of pediatric SARS-CoV-2 reinfection.Design, Setting, and ParticipantsThis retrospective cohort study used epidemiologic data of documented SARS-CoV-2 infections from the surveillance database of the Institute for Public Health of Vojvodina. A total of 32 524 children and adolescents from Vojvodina, Serbia, with laboratory-confirmed SARS-CoV-2 infection between March 6, 2020, and April 30, 2022, were followed up for reinfection until July 31, 2022.Main Outcomes and MeasuresIncidence rates of documented SARS-CoV-2 reinfection per 1000 person-months, estimated risk of documented reinfection 90 days or more after laboratory confirmation of primary infection, reinfection severity, hospitalizations, and deaths.ResultsThe study cohort included 32 524 children and adolescents with COVID-19 (mean [SD] age, 11.2 [4.9] years; 15 953 [49.1%] male), including 964 children (3.0%) who experienced documented reinfection. The incidence rate of documented reinfections was 3.2 (95% CI, 3.0-3.4) cases per 1000 person-months and was highest in adolescents aged 12 to 17 years (3.4; 95% CI, 3.2-3.7). Most reinfections (905 [93.9%]) were recorded in 2022. The cumulative reinfection risk was 1.3% at 6 months, 1.9% at 9 months, 4.0% at 12 months, 6.7% at 15 months, 7.2% at 18 months, and 7.9% after 21 months. Pediatric COVID-19 cases were generally mild. The proportion of severe clinical forms decreased from 14 (1.4%) in initial episodes to 3 (0.3%) in reinfections. Reinfected children were approximately 5 times less likely to have severe disease during reinfection compared with initial infection (McNemar odds ratio, 0.2; 95% CI, 0.0-0.8). Pediatric reinfections rarely led to hospitalization (0.5% vs 1.3% during primary infections), and none resulted in death.Conclusions and RelevanceThis cohort study found that the SARS-CoV-2 reinfection risk remained substantially lower for children and adolescents compared with adults as of July 2022. Pediatric infections were mild, and reinfections were even milder than primary infections.

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Section: Discussionmentioning

confidence: 99%

Incidence, Risk, and Severity of SARS-CoV-2 Reinfections in Children and Adolescents Between March 2020 and July 2022 in Serbia

et al. 2023

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“…These authors did not stratify analyses by study design and pointed out the considerable risk of bias in particular because of the lack of standardised definitions of symptoms and a high level of heterogeneity [ 16 ]. Two recent systematic reviews including studies up to early 2022 reported rates of post-COVID syndrome in children ranging from 0% to 70% [ 52 , 53 ]. One of these reviews highlighted the critical risk of bias across studies, mostly due to confounding [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two recent systematic reviews including studies up to early 2022 reported rates of post-COVID syndrome in children ranging from 0% to 70% [ 52 , 53 ]. One of these reviews highlighted the critical risk of bias across studies, mostly due to confounding [ 52 ]. Regarding healthcare resources use, Magnusson et al conducted a before and after study to explore if the use of healthcare services is mildly increased among children and adolescents after COVID-19, mostly in primary care settings due to respiratory and general unspecified conditions during the first months, with limited impact on healthcare services, especially in children under 5 years of age [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Short and Long-Term Wellbeing of Children following SARS-CoV-2 Infection: A Systematic Review

Franco

Garegnani²,

Oltra³

et al. 2022

IJERPH

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Post-COVID conditions in children and adolescents were mostly investigated as the incidence of individual or clusters of symptoms. We aimed to describe the findings of studies assessing key outcomes related to global wellbeing and recovery in children and adolescents from a public health perspective. We searched the Cochrane COVID-19 Study Register and WHO COVID-19 Global literature on coronavirus disease database on 5 November 2021 and tracked ongoing studies published after this date. We included observational studies on children and adolescents with a follow-up greater than 12 weeks and focused on the outcomes of quality of life, recovery/duration of symptoms, school attendance and resource use/rehabilitation. We assessed their methodological quality, and we prepared a narrative synthesis of the results. We included 21 longitudinal and 4 cross-sectional studies (6 with a control group) with over 68 thousand unvaccinated children and adolescents with mostly asymptomatic or mild disease. Study limitations included convenience sampling, a poor description of their study population and heterogeneous definitions of outcomes. Quality of life was not largely affected in adolescents following COVID-19, but there might be greater impairment in young children and in those with more severe forms of the disease (4 studies). There might also be an impairment in daily activities and increased school absenteeism following COVID-19, but the findings were heterogeneous (5 studies). A total of 22 studies provided highly variable estimates based on heterogeneous definitions of overall persistence of symptoms (recovery), ranging from 0 to 67% at 8–12 weeks and 8 to 51% at 6–12 months. We found limited data on resource use and the need for rehabilitation. One controlled study indicated that the quality of life of infected children and adolescents might not substantially differ from controls. All controlled studies found a higher burden of persistent symptoms in COVID-19 cases compared with test-negative controls or cases of influenza. There is limited evidence on the short and long-term well-being of children following SARS-CoV-2 infection. High-quality longitudinal studies with control groups are needed to describe the outcomes in this population, especially in vaccinated children and those affected by new variants of the virus.

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“…Third, we have not captured information on potential long-term consequences of COVID-19 infection in children and adolescents, although claims for frequent pediatric long-COVID-19 may be unfounded. 30 Fourth, children and adolescents in the studied population were mostly unvaccinated and our analyses were underpowered to address the impact of vaccination. However, outcomes were already excellent for pediatric COVID-19 infections and even more so for reinfections.…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk and severity of SARS-CoV-2 reinfections in children and adolescents: a population-level study between March 2020 and July 2022

Medić

Anastassopoulou

Lozanov-Crvenković

et al. 2022

Preprint

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IMPORTANCE During the COVID-19 pandemic children and adolescents were massively infected worldwide. In 2022 reinfections became increasingly common and they may continue to be a main feature of the endemic phase of SARS-CoV-2. It is important to understand the epidemiology and clinical impact of reinfections. OBJECTIVE To assess the incidence, risk, and severity of SARS-CoV-2 reinfection in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS A population-level observational study was performed using surveillance data from the Autonomous Province of Vojvodina, Serbia between March 6, 2020 and April 30, 2022 with follow-up until July 31, 2022. The population-based sample consisted of 32 524 residents of Vojvodina <18 years of age with laboratory confirmed SARS-CoV-2 infection. EXPOSURES The surveillance database of the Institute for Public Health of Vojvodina was harnessed for epidemiological data of laboratory-confirmed SARS-CoV-2 infections. MAIN OUTCOMES AND MEASURES Incidence rates of documented SARS-CoV-2 reinfection per 1000 person-months. Estimated risk of documented reinfection ≥90 days after laboratory confirmation of primary infection. Reinfection severity and associated hospitalizations and deaths. RESULTS A total of 964 children (3.0%) experienced documented reinfection. The incidence rate of SARS-CoV-2 documented reinfections was 3.2 (CI 3.0-3.4) cases per 1000 person- months and was highest in adolescents aged 12-17 years (3.4; CI 3.2-3.7). Most reinfections (905, 93.9%) were recorded in 2022. The reinfection risk was 1.3% at six months, 1.9% at nine months, 4.0% at 12 months, 6.7% at 15 months, 7.2% at 18 months and 7.9% after 21 months. 3 Pediatric COVID-19 cases were generally mild. The proportion of severe clinical forms decreased from 14 (1.4%) in initial episodes to 3 (0.3%) in reinfections. Reinfected children were 4.7 times more likely to suffer from severe disease during initial infection compared to reinfection (McNemar OR=4.7; 95%CI 1.3-16.2, p=0.015). Pediatric reinfections rarely led to hospitalization (0.5% vs. 1.3% during primary infections) and none resulted in death. CONCLUSION AND RELEVANCE Reinfections are becoming more frequent as the pandemic progresses, yet the risk remains substantially lower for children and adolescents compared to adults. Pediatric infections rarely had clinical consequences and reinfections were even milder than primary infections.

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Robustness of reported postacute health outcomes in children with SARS-CoV-2 infection: a systematic review

Cited by 11 publications

References 45 publications

Incidence, Risk, and Severity of SARS-CoV-2 Reinfections in Children and Adolescents Between March 2020 and July 2022 in Serbia

Incidence, Risk, and Severity of SARS-CoV-2 Reinfections in Children and Adolescents Between March 2020 and July 2022 in Serbia

Short and Long-Term Wellbeing of Children following SARS-CoV-2 Infection: A Systematic Review

Incidence, risk and severity of SARS-CoV-2 reinfections in children and adolescents: a population-level study between March 2020 and July 2022

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