How does post COVID differ from other post-viral conditions in childhood and adolescence (0–20 years old)? A systematic review, 2024, Minotti

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00015-4/fulltext

How does post COVID differ from other post-viral conditions in childhood and adolescence (0–20 years old)? A systematic review

• Chiara Minotti
• Carla McKenzie
• Isabelle Dewandel
• Carien Bekker
• Giulia Sturniolo
• Denis Doni
• et al.

Open Access
Published:February 01, 2024 DOI:https://doi.org/10.1016/j.eclinm.2024.102436


Summary

Background
Post Coronavirus disease (COVID) and other post-viral infection syndromes present an overlap of pathogenesis, onset, progression, and symptom profile. We aimed to systematically describe studies on post-viral conditions and determine the entity of post COVID compared to other post-viral conditions in children.

Methods

We conducted a systematic search of the Embase, MEDLINE, Cochrane Library, and GoogleScholar databases (January 1946–3 November 2023), according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The main outcomes were differences in condition duration, symptom type, and development of chronic symptoms. This systematic review was registered on PROSPERO (CRD42023401789).

Findings
35/5051 studies were included, with 42,934 children, adolescents and young adults (0–20 years old) overall. Twenty-eight studies focused on post COVID symptoms, followed by five papers on Respiratory Syncytial Virus (RSV) and Rhinovirus, one study on Epstein–Barr Virus (EBV), and one on gastrointestinal viruses. Studies on post COVID mainly reported data on older children/adolescents, describing long-lasting symptoms, including fatigue, neurologic, cardiorespiratory, musculoskeletal, mental health, and gastrointestinal symptoms. The maximum described symptoms duration was eighteen months, with an average follow-up of seven months. The development of chronic symptoms was reported by 30 studies (93.8%) for 10,473/28,474 patients (36.8%). Recovery was achieved in 18,001/28,474 cases (63.2%). The study on EBV reported persistent fatigue in adolescents for a similar duration (6 months, 46% chronic). Studies on RSV and Rhinovirus were mainly done in children under three years, with development of recurrent wheezing (up to 3 years).

Interpretation
Post-viral fatigue was a shared feature between post COVID and post EBV conditions. A better understanding of post COVID as a unique condition, sharing features with other post-viral syndromes, is needed. The healthcare burden and socio-economic consequences for children and their families warrant further investigation and development of appropriate healthcare management plans. The foremost requirement is the establishment of consistent and shareable definitions, as well as a consensus on outcomes, to effectively evaluate follow-up and quantify the burden of different viral infections.
Funding
EU Horizon, EDCTP, NIH.
Keywords

• Post-viral condition
• Long COVID
• Children
• Adolescents
• EBV
• Chronic symptoms

Research in context

Evidence before this study

The overlap between the clinical presentation and course of post Coronavirus disease (COVID) and other post-viral conditions highlights the need to review the clinical characteristics, duration of symptoms, and possible healthcare burden in the pediatric population of both entities. We conducted a systematic search of the Embase, MEDLINE, Cochrane Library databases and GoogleScholar, including citations from January 1946 to 3 November 2023, obtained combining Medical Subject Heading (MeSH) e and free-text terms for “post-viral” AND “condition” AND “children”, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were considered eligible if they included data on post-viral conditions in children up to 18 years and adolescents until 20 years of age. Randomized controlled trials (RCTs), observational, cohort, cross-sectional, and case–control studies were considered for inclusion.

Added value of this study

The results of the present systematic review confirm an overlap between post-viral infection symptoms following acute COVID and other viral infections, with some shared clinical features, duration of symptoms, and affected age subgroups. Potential risk factors for post COVID development, such as gender prevalence, socio-economic status, or comorbidities, did not emerge, or were not identified with certainty. Symptom duration was similar for post COVID and post Epstein–Barr Virus (EBV)/post gastrointestinal virus syndromes. However, recovery was achieved in more than half of the children with post COVID and post EBV condition, with a smaller proportion of children developing chronic symptoms. The timing for symptoms resolution for post COVID was similar to what has been reported so far by previously published studies.

Implications of all the available evidence

A better understanding of Long/post COVID as a unique condition, sharing features with other post-viral syndromes, is needed and implicates a multidisciplinary approach and international awareness in children and adolescents. The experience of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, with the surge of post COVID-19 conditions also in pediatric patients, should be adopted as a model for preparedness for future pandemics and to better comprehend the true post-acute burden of other viral infections. The foremost requirement is the establishment of consistent and shareable definitions, as well as a consensus on outcomes, to effectively evaluate patient follow-up and quantify the burden.