Children at Low Risk of Developing Long COVID

The risk of developing post-COVID-19 condition (PCC) was low for children who tested positive for SARS-CoV-2, although it was greater compared with children who tested negative, according to research published in JAMA Network Open.¹

Although PCC, also referred to as long COVID, is a clinically acknowledged entity, it has not been substantially assessed across differing populations, designs, data collection methods, and definitions. To mitigate some of these limitations, the WHO established a consensus definition that described PCC as including symptoms that have an onset within 3 months of the infection, persist for a minimum of 2 months, and limit everyday function and ascertainment of developmental milestones.

Using this definition, investigators sought to measure the prevalence of PCC at 6 and 12 months after acute SARS-CoV-2 infection and to characterize symptoms of PCC among children with SARS-CoV-2 in pediatric emergency departments (EDs) across Canada. By doing so, they hoped to gain a better understanding of how PCC manifests in pediatric populations.

Participants in the prospective cohort study included children younger than 18 years who underwent SARS-CoV-2 testing on behalf of present symptoms or epidemiologic risk factors. Participants were recruited between August 4, 2020, and February 22, 2022, across 14 Pediatric Emergency Research Canada tertiary-care pediatric EDs. The primary outcome was the proportion of SARS-CoV-2-positive participants with PCC at 6- and 12-months following testing.

Investigators operationalized their own definition of PCC by aligning their database with the WHO definition and requiring the 3 following criteria: caregivers reported the presence of a chronic sign, symptom, or diagnosis within the preceding 3 months that manifested within 2 months of a 90-day follow-up survey; overall health status (0- to 100-point scale) reported on a 12-month survey was lower than before the index ED visit; and for children aged 2 years or older, everyday functioning was assessed on a quality of life (QoL) score.

Among those included in the 12-month follow-up cohort, 1192 of 1454 potentially eligible participants had SARS-CoV-2 positive tests (82%) and 4371 of 5809 participants had negative tests (75.3%), constituting the comparison group. The median age of study participants was 2 (0.9-5.0) years.

At the 12-month follow up, 0.67% of participants with positive tests and 0.16% of participants with negative tests satisfied the WHO pediatric PCC definition, which included having symptoms that reduce daily functioning. This observed increase in prevalence of PCCs among children with positive tests was supported by worse-scoring reports of overall health made by caregivers of children with positive tests (17% and 24% at 6 and 12 months, respectively) compared to those made on behalf of children with negative tests (15% at both time points).

Other notable study findings revealed that the most common symptoms reported by children who tested positive for SARS-CoV-2 at 12 months were respiratory (eg, recurrent infections and congestions) and further that QoL did not differ across negative and positive test status.

Study authors noted that their results may be less generalizable to older children, as children 8 years or younger accounted for all PCC cases with SARS-CoV-2 positive tests. Other study limitations included that participants who completed follow-up were more likely to be infected by the Omicron strain, which has a reduced association with PCC, and that caregiver reports had the potential to underreport or overreport symptoms.

Although the study provided insight into the long-term outcomes associated with infection by SARS-CoV-2 among children, investigators said that based on the present limitations, they are unable to conclude that SARS-Cov-2 test status is independently associated with PCC.

Reference

1. Dun-Dery F, Xie J, Winston K, et al. Post-COVID-19 condition in children 6 and 12 months after infection. JAMA Netw Open. 2023;6(12):e2349613. doi:10.1001/jamanetworkopen.2023.49613