Characterizing Long COVID in Children and Adolescents. 2024, Rachel S. Gross, MD, MS et al

This is in JAMA. It should be open-access. Rapid summary —

• The analytic sample included individuals aged 6 to 17 years enrolled between March 16, 2022, and December 16, 2023, with and without known SARS-CoV-2 infection history (infected and uninfected, respectively). Child age was recorded at symptom survey completion.

• the infected group included participants who completed their survey about prolonged symptoms at least 90 days after their first infection,reportedbytheir caregivers

• SARS-CoV-2 antibodies were not required.

• uninfected group was defined by caregiver report and required confirmation of negative nucleocapsid antibodies at enrollment.

• Those thought to be uninfected but found to be antibody-positive (Ab+) within 30 days of survey completion were analyzed separately to understand asymptomatic infection.

• Throughout, uninfected refers strictly to uninfected participants who were confirmed to be nucleocapsid antibody–negative.

• If a symptom lasted for more than 4 weeks but was absent at survey completion, it was not counted as a prolonged symptom.

• This study included 751 infected and 147 uninfected school-age children and 3109 infected and 1369 uninfected adolescents

• Overall, 45% of infected (338/751) and 33% of uninfected (48/147) school-age children and 39% of infected (1219/3109) and 27% of uninfected (372/1369) adolescents reported having at least 1 prolonged symptom.

• In both age groups, higher PASC research indices were correlated with worse PROMIS scores (Figures 2C and 3C). The number of systems affected among infected PASC-probable participants (eFigure 4 in Supplement 3) indicated substantial multisystem burden.

• The most common prolonged symptom among PASC-probable school-age children that also contributed to the PASC research index (Figures 2B and 4) was headache (57%), followed by trouble with memory/focusing and trouble sleeping (44%) and stomach pain (43%). Among symptoms that did not contribute to the index, body/muscle/joint pain (51%), daytime tiredness/

• sleepiness or low energy (49%), and feeling anxious (47%) were the most common (Figure 4). The distribution of symptoms was similar between PASC-unspecified and uninfected school-age children.

• AmongPASC-probable adolescents, the most common prolonged symptoms contributing to the index (Figures 3B and 4) were daytime tiredness/sleepiness or low energy (80%), body/muscle/joint pain (60%), headaches (55%), and trouble

• with memory/focusing (47%). Among symptoms that did not contribute to the index, trouble sleeping (47%), feeling anxious (47%), and feeling sad/depressed (38%) were the most common (Figure 4).

• Among school-age children, 4 symptom clusters

• Cluster 1 had high rates of many symptoms and the highest symptom burden.

• Cluster 2 was characterized by high rates of headache (95%), body/muscle/joint pain (60%), and daytime tiredness/sleepiness or low energy (52%).

• Cluster 3 was characterized by higher rates of trouble sleeping (64%) and trouble with memory/focusing (62%).

• Cluster 4 was characterized predominantly by stomach pain (100%) and nausea/vomiting (61%).

• Among adolescents, 3 clusters were identified

• Cluster 1 had high rates of many symptoms

• Cluster 2 was characterized by high rates of daytime tiredness/ sleepiness or low energy (89%) and body/muscle/joint pain (87%).

• Cluster 3 was characterized by having change/loss in smell or taste (100%), with relatively low rates of all other symptoms.

• Overall, 64 school-age children and 781 adolescents enrolled as uninfected but were Ab+ (ie, asymptomatically infected)

• In this cohort, 20% of infected school-age children exceeded the PASC symptom threshold, while 14% of adolescents exceeded the threshold.

• Most research to understand PASC symptoms has focused on adults, potentially due to the misperception that children were not severely affected by COVID-19, leaving childhood symptoms less understood.

• The current study had the advantage of comprehensively assessing caregiver-reported symptoms across every organ system, examining them in combination, and comparing them directly to an uninfected seronegative control group. The symptoms identified as being related to PASC were associated with infection, not only symptoms that became more common during the pandemic.

• These findings underscore the need for separate assessments in different age groups. This may be one reason that younger children with PASC are being undercounted in studies and/or undiagnosed clinically, although undercounting may also be due to younger children being less able to recognize and report symptoms.

• The pathophysiology behind these age-related differences warrants future study, given substantial changes in growth, development, immunological factors, and pubertal hormones that occur across the life course.

 

See also RECOVER preprint —

Pediatric Gastrointestinal Outcomes During the Post-Acute Phase of COVID-19: Findings from RECOVER Initiative from 29 Hospitals in the US (June 2024)
Dazheng Zhang; Ronen Stein; Yiwen Lu; Ting Zhou; Yuqing Lei; Lu Li; Jiajie Chen; Jonathan Arnold; Michael J. Becich; Elizabeth A. Chrischilles; Cynthia H. Chuang; Dimitri A Christakis; Daniel Fort; Carol R. Geary; Mady Hornig; Rainu Kaushal; David M. Liebovitz; Abu Saleh Mohammad Mosa; Hiroki Morizono; Parsa Mirhaji; Jennifer L. Dotson; Claudia Pulgarin; Marion R. Sills; Srinivasan Suresh; David A. Williams; Robert N. Baldassano; Christopher B. Forrest; Yong Chen; the RECOVER Initiative

IMPORTANCE
The profile of gastrointestinal (GI) outcomes that may affect children in post-acute and chronic phases of COVID-19 remains unclear.

OBJECTIVES
To investigate the risks of GI symptoms and disorders during the post-acute phase (28 days to 179 days after SARS-CoV-2 infection) and the chronic phase (180 days to 729 days after SARS-CoV-2 infection) in the pediatric population.

DESIGN
We used a retrospective cohort design from March 2020 to Sept 2023.

SETTING
Twenty-nine healthcare institutions.

PARTICIPANTS
A total of 413,455 patients aged not above 18 with SARS-CoV-2 infection and 1,163,478 patients without SARS-CoV-2 infection.

EXPOSURES
Documented SARS-CoV-2 infection, including positive polymerase chain reaction (PCR), serology, or antigen tests for SARS-CoV-2, or diagnoses of COVID-19 and COVID-related conditions.

MAIN OUTCOME(S) AND MEASURE(S)
Prespecified GI symptoms and disorders during two intervals: post-acute phase and chronic phase following the documented SARS-CoV-2 infection. The adjusted risk ratio (aRR) was determined using a stratified Poisson regression model, with strata computed based on the propensity score.

RESULTS
Our cohort comprised 1,576,933 patients, with females representing 48.0% of the sample. The analysis revealed that children with SARS-CoV-2 infection had an increased risk of developing at least one GI symptom or disorder in both the post-acute (8.64% vs. 6.85%; aRR 1.25, 95% CI 1.24-1.27) and chronic phases (12.60% vs. 9.47%; aRR 1.28, 95% CI 1.26-1.30) compared to uninfected peers. Specifically, the risk of abdominal pain was higher in COVID-19 positive patients during the post-acute phase (2.54% vs. 2.06%; aRR 1.14, 95% CI 1.11-1.17) and chronic phase (4.57% vs. 3.40%; aRR 1.24, 95% CI 1.22-1.27).

CONCLUSIONS AND RELEVANCE
In the post-acute phase or chronic phase of COVID-19, the risk of GI symptoms and disorders was increased for COVID-positive patients in the pediatric population.

Link | PDF (Preprint: MedRxiv) [Open Access]

 

Sure it is. It's under the section "Feelings and behavior" - "Refusing to follow rules"