Characteristics and predictors of Long Covid in children: a 3-year prospective cohort study, 2024, Anna Camporesi et al

[Mij]

Summary
Background
Children can develop Long Covid, however long term outcomes and their predictors are poorly described in these patients. The primary aim is to describe characteristics and predictors of Long Covid in children assessed in-clinics up to 36 months post-SARS-CoV-2 infection, as well as investigate the role of vaccines in preventing Long Covid, risk of reinfections and development of autoimmune diseases.

Methods
Children aged 0–18 years old with confirmed SARS-CoV-2 infection were invited for a prospective follow-up assessment at a peadiatric post-covid clinic in Rome, Italy, at serial intervals (3-, 6-, 12-, 18-, 24- and 36-months post-infection onset, between 01/02/2020 and 28/02/2024). Long Covid was defined as persistence of otherwise unexplained symptoms for at least three months after initial infection.

Findings
1319 patients were initially included, 1296 reached the 3 months follow-up or more. Of the patients who underwent multiple follow-ups, 23.2% (301), 169 (13.2%), 89 (7.9%), 67 (6.1%), 47 (7.1%) were diagnosed with Long Covid at 3-6-12-18-24 months, respectively For the primary outcome of Long Covid at three months, age >12 years (P < 0.001, OR 11.33, 95% CI 4.2; 15.15), comorbidities (P = 0.008, OR 1.83, 95% CI 1.06; 2.44), being infected with original variants (P < 0.001, OR 4.77, 95% CI 2.46; 14.47), female sex (P < 0.001, OR 1.62, 95% CI 1.02; 1.89) were statistically significant risk factors. Age >12 years (P = 0.002, OR 9.37, 95% CI 1.58; 8.64), and infection with original (P = 0.012, OR 3.52, 95% CI 1.32; 8.64) and alfa (P < 0.001, OR 4.09, 95% CI 2.01; 8.3) SARS-CoV-2 variants remained statistically significant risk factors for Long Covid duration for at least 18 months. Vaccination was associated with a lower risk of long covid at 3, 6 and 12 months for older children and a lower risk of reinfections. Being infected with the original SARS-CoV-2 variant was associated with a higher risk of new-onset autoimmune diseases ((P = 0.035, 95% CI 1.12; 2.4). One patient was diagnosed with Long Covid after a re-infection.

Interpretation
This is the longest follow-up study of children with SARS-CoV-2 infection, showing a significant and long-lasting burden of Long Covid in the pediatric population. Our findings highlight the urgent need of investing in pediatric Long Covid in order to find effective diagnostic and therapeutic approaches, as well can inform preventive strategies in case of future pandemics.

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[rvallee]

Predictors that can't be used to predict anything...

Our findings highlight the urgent need of investing in pediatric Long Covid in order to find effective diagnostic and therapeutic approaches, as well can inform preventive strategies in case of future pandemics

Yes, that would have been great 4 years ago when we knew just as much as this. Still a good idea today. Can't wait for it to begin to be in some eventual planning phase for future consideration.

Because until then the quacks who have dominated this issue will continue to dominate this issue and fail everyone.

Long Covid was defined as persistence of otherwise unexplained symptoms for at least three months after initial infection.

So much mystery. So little effort to solve it.

 

[SNT Gatchaman]

In line with our previous study and others, the most commonly persisting symptoms identified were fatigue, post-exertional dyspnea, headache, and gastrointestinal symptoms.

In addition, we found that specific characteristics at time of the initial infection are associated with a higher risk of developing Long Covid lasting three or more months, including headache, fatigue, duration of initial symptoms. These association, which has never been published before in pediatric studies, may have implication as these patients may deserve a stricter follow-up, or may benefit to enter trials for early preventive treatment of Long Covid, if established in future.

The observation of persisting symptoms for up to 36 months in some patients is worryingly[sic]. So far, pediatric Long Covid studies have mostly focused on 6–12 months follow-up, showing that most children recover. While it is true, this does not happen to all, as also extensively reported in adults, 16–21 posing a significant burden not only for the affected patients, but for their families as well.

Of note, in fact, the same children with Long Covid that we followed in this study are the same that have been enrolled in other diagnostic studies were we documented abnormal lung perfusion, brain metabolism, autonomic dysfunction, cardiorespiratory and muscle impairments, circulating activated platelets and pro-inflammatory signatures (paper under review).

On autoimmune disease —

We assessed how many children in our cohort developed autoimmune disorders. […] an increase in new diagnoses of type 1 diabetes since the beginning of the pandemic has been reported, but the direct association with SARS-CoV-2 infection is still debated. Other small case reports or case series have shown new onset autoimmune diseases following SARS-CoV-2 infection in children. Our study, to our knowledge, has been the first that have evaluated new diagnoses of these disorders in a large cohort of children prospectively followed-up after Covid-19.

15 patients (1.1%) developed autoimmune disorders. In particular, two patients developed Hashimoto Thyroiditis, four developed Celiac Disease, one developed Systemic Lupus Erythematosus, three developed Chronic Autoimmune Urticaria, and the other five undifferentiated autoimmune connective tissue disease. Being infected with the original SARS-CoV-2 variant was associated with a higher risk of developing autoimmune disorders (P=0.035, 95% CI 1.12; 2.4).