September 26, 2023
3 min read
Source/Disclosures
Disclosures:
Please see the study for all relevant financial disclosures.
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Key takeaways:
- CDC survey data indicate that 1.3% of U.S. children have had long COVID.
- A Canadian study found that children with more frequently reported symptoms prior to COVID-19 were more likely to have long COVID.
As of last year, around one in 10 children in the United States had ever had long COVID, according to survey findings reported by the CDC’s National Center for Health Statistics.
The finding is based on 7,464 interviews conducted for the 2022 National Health Interview Survey Sample – Child, mostly by telephone.
Data derived from Hahn LM, et al. JAMA Pediatr. 2023;doi: 10.1001/jamapediatrics.2023.3239.
‘Remains rare’
According to the results, in 2022, 1.3% of children in the U.S. reported ever having long COVID, defined as symptoms lasting 3 months or longer that were not present prior to having COVID-19.
Among the respondents, 0.5% of children had long COVID at the time of the interview. Additionally, girls (1.6%) were more likely than boys (0.9%) to have had long COVID.
The survey also found that children aged 12 to 17 years were more likely than those aged 0 to 5 and 6 to 11 years to ever have long COVID, and Hispanic children were more likely than Asian non-Hispanic and Black non-Hispanic children to have long COVID.
“While more than 90% of children ages 0 to 17 years have been exposed to COVID-19, long COVID remains rare, especially in children younger than 12 years,” the authors wrote.
Findings from a review published in Pediatrics last year included a much higher rate of long COVID in children: 16%.
Most symptoms resolve quickly
A separate study published in JAMA Pediatrics found that children who frequently reported symptoms before SARS-CoV-2 infection were more likely to develop long COVID, and that most symptoms resolved within 2 weeks of onset of a COVID-19.
“Understanding of [long COVID] in children remains limited, as studies vary in defining [long COVID] and including limited prospective data before SARS-CoV-2 infection,” Lyndsey M. Hahn, PhD, from the University of Alberta and the Women and Children’s Health Research Institute in Edmonton, and colleagues wrote.
“Recent data suggest that [long COVID] prevalence in children ranges from 1% to 70% in different study samples. We examined the incidence of [long COVID] among school-aged children using a population-based sample that was recruited before SARS-CoV-2 infection.”
For their cohort study, the authors recruited 1,026 children aged 8 to 13 years and their parents in Alberta between Aug. 14, 2020, and March 12, 2021. The parents reported their child’s symptoms every 2 weeks for the 76-week length of the study.
Children were considered to have long COVID if their parents reported a PCR test result for a SARS-CoV-2 infection, any new symptoms that started within 3 months following a positive PCR result for COVID-19, and if these symptoms persisted for a minimum of 8 weeks, or 4 reporting periods. Researchers considered the symptoms resolved if children went through 4 weeks, or two reporting periods, without any symptoms at all.
“Multiple variable analysis also examined the implications of current or past health conditions reported at baseline for time to symptoms resolution,” they wrote. “Children with COVID-19 before study recruitment were excluded from the survival analysis.”
The researchers reported that the most common long COVID symptoms included rhinitis (62%), sore throat (68%), headache (52%), cough (42%), fever (41%) and fatigue (35%). Frequent presence of rhinitis, sore throat, headache, cough, fever and fatigue before a COVID-19 infection was associated with delayed resolution of each symptom of long COVID.
Additionally, children were 77% less likely to experience a resolution of symptoms after COVID-19 if they reported symptoms every 2 weeks before infection.
The authors also found that after exclusions, only one child met the WHO definition of long COVID, although their symptoms had resolved in the last 2 weeks of follow-up in the study.
“The incidence of [long COVID] in this study was strikingly low [at] 0.4%,” they wrote. “Most children experienced a resolution of symptoms within 2 weeks of infection. Pre–COVID-19 symptoms were factors in post–COVID-19 symptoms.”
The authors added that additional research would be required into “the neurobehavioral sequelae of SARS-CoV-2 infection in school-aged children.”
References:
CDC. Long COVID in children: United States, 2022. https://www.cdc.gov/nchs/products/databriefs/db479.htm. Last reviewed Sept 26, 2023. Accessed Sept. 26, 2023
Hahn LM, et al. JAMA Pediatr. 2023;doi: 10.1001/jamapediatrics.2023.3239.
Perspective
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Ziyad Al-Aly, MD
[The Alberta study] is not how you design a study to estimate the prevalence of long Covid in kids.
First and perhaps most important, these are self-reports from a questionnaire — ie, not a medical assessment by a physician. This is not how we find long COVID in kids. Kids do not come to their mom and self-report problems by saying, “Mom, I have brain fog.” These problems show up in falling school performance and poor grades months later.
Second, there is a lot of self-selection in this study, which may have biased the conclusions significantly.
Third, there is a lot of attrition for various reasons, which also may impact the results.
Fourth, the study duration was too short for long COVID in kids, which may have led to significant underestimation of the prevalence.
Fifth, the study included only kids aged 8 to 13 years. It did not include the age group that is most vulnerable — kids in their teens, or 12 to 18 years of age.
Ziyad Al-Aly, MD
Chief of research and development
VA St. Louis Health Care System
Clinical epidemiologist
Washington University in St. Louis
Disclosures: Al-Aly reports no relevant financial disclosures.
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