What do we know so far?

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A student returns to campus for the first day of class at Tustin Ranch Elementary School in Tustin, Calif., August 11, 2021. Paul Bersebach / MediaNews Group / Orange County Register via Getty Images
  • A recent review included 14 international studies of long-term COVID in children and adolescents involving nearly 20,000 participants.
  • Some studies have shown no difference in symptoms reported by those who have had COVID-19 and those who have not.
  • The review found little evidence to suggest that symptoms of long COVID typically last more than 12 weeks in children and adolescents.

The Centers for Disease Control and Prevention (CDC) say that for most people who develop COVID-19, symptoms go away within weeks of onset.

Still, some people experience ongoing health issues, such as fatigue, cardiorespiratory and neurological symptoms, weeks after the initial onset of their illness – a phenomenon commonly referred to as long COVID.

While the CDC reports that post-COVID symptoms appear to be less common in children and adolescents than in adults, children have reported long-term health problems following SARS-CoV infection. 2.

A study, conducted by the Murdoch Children’s Research Institute (MCRI) in Australia, recently appeared in the Journal of Pediatric Infectious Diseases.

The review included 14 studies involving 19,426 children and adolescents.

In these participants, for those who reported persistent symptoms after developing COVID-19, the most common symptoms reported 4 to 12 weeks after acute infection were headache, fatigue, sleep disturbance, difficulty concentration and abdominal pain.

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From the start of the pandemic to early September this year, nearly 5.3 million children have tested positive for SARS-CoV-2 in the United States, according to the American Academy of Pediatrics (AAP) .

The new review authors point out that even though only a small number of these people experience a lengthy COVID, the overall impact can be significant.

However, they found that almost all of the existing studies had significant limitations, which prompted the authors to point out in the review that new studies are urgently needed to examine the long-term risk of COVID in this population.

The co-author of the journal, Dr Petra Zimmermann, lecturer at the University of Friborg in Switzerland and honorary member of MCRI, spoke with Medical News Today.

She explained that health researchers need to have a clear understanding of the impact of long-term COVID in children and adolescents to help guide authorities in making vaccine policy decisions.

“Since children are often asymptomatic or have mild symptoms when they [contracting infection] with SARS-CoV-2, one of the reasons for [vaccinate] is to protect them from the long-term consequences of SARS-CoV-2, such as [multisystem inflammatory syndrome in children] and long COVID, ”wrote Dr. Zimmermann.

“Therefore, we need to accurately determine the long-term risk of COVID in this age group. Often, only one study is cited to give a prevalence of persistent symptoms. We wanted to summarize them to get a better overview.

In the review, Dr Zimmermann and co-authors Dr Laure Pittet and Dr Nigel Curtis found that some studies indicate no difference in symptoms reported by those who developed COVID-19 and those who did not. .

According to the authors, this highlights the length of time that COVID symptoms are difficult to distinguish from symptoms associated with the pandemic.

“Only a few studies have a control group of children and adolescents who do not have [acquired the infection]», Underlined Dr Zimmermann to MNT.

“Of the five studies that had a control group, two did not find a difference between children who had [contracted the infection] and those who had not. This means that the symptoms attributed to the long COVID are very difficult to differentiate from the symptoms that [arise for other reasons related to the pandemic] – like school closures, closures, inability to see friends or play sports and hobbies, see friends and family suffer or even die from COVID-19, be afraid to transmit the virus to others, and many more.

Another important finding from the review: Studies have indicated that symptoms of long-lasting COVID rarely last more than 12 weeks in children and adolescents.

The review authors highlight several major limitations of the studies. They say one problem is that there is currently no clear definition of long COVID, and researchers also disagree on the typical duration of the phenomenon.

The review points out that more than 200 symptoms have long-term links to COVID – many of which are also prevalent in the general population, including fatigue and joint pain.

“It’s a new virus, so it’s more difficult to study than something clinicians and researchers are familiar with,” Dr Zimmermann said. MNT. “Every day we learn new things and need to adapt our clinical management and research.”

Additionally, the review authors explain that some of the studies relied on participants saying they tested positive for SARS-CoV-2 rather than using laboratory confirmation. Most studies have also relied on self-reported symptoms without a physical exam.

Another limitation pointed out by Dr. Zimmermann is that many studies have had a low response rate. In the 2021 clock study, for example, researchers invited more than 50,000 children and youth who had taken COVID-19 tests to complete a questionnaire about their symptoms. Only about 13% responded.

“It is likely that people with persistent symptoms are more likely to respond than those who feel healthy, which can lead to selection bias and an overestimation of the rate of persistent symptoms,” said Dr Zimmermann.

Other studies, she added, recruited participants in support groups for parents of children with long-term COVID. “This will also lead to an overestimation of the prevalence,” wrote Dr Zimmermann.

Additionally, the studies included participants from a wide range of ages. The review’s authors suspect that the prevalence and symptoms of long-term COVID vary between young children and adolescents.

The researchers also point out that all of the studies took place before the Delta variant became widespread. Children and adolescents who contract this variant may face a different risk of suffering a lengthy COVID, they write – another factor researchers should consider in future studies.

MNT also spoke with Dr. Tina Tan, professor of pediatrics at Northwestern University’s Feinberg School of Medicine and pediatric infectious diseases at Ann & Robert H. Lurie Children’s Hospital, both in Chicago.

She said the review illustrates the urgent need for more research into how long COVID has an impact on children and adolescents.

“This study is very good in pointing out that we just need more specific and precise information to determine: a, what the symptoms are, although the symptoms in most children are probably going to be very similar to what we are. let’s see in adults, and then what might be the consequences of children with these symptoms for prolonged periods of time, ”commented Dr. Tan.

Earlier in the pandemic, Dr Tan explained that the general consensus was that children were less likely to develop COVID-19 and were more likely to be asymptomatic when they did.

With the Delta variant, she added, more children test positive for SARS-CoV-2, and more are hospitalized. Dr. Tan explained that she believes this will lead to more research on the impact of long-term COVID in children and adolescents.

“I think what’s also very important about this study is that it shows that children get COVID-19 and they get sick with COVID-19. They can have long symptoms of COVID, and this is one of the main reasons children eligible for vaccination need to be vaccinated. “

– Dr Tan

The review authors recommend that future studies investigate the severity of an individual’s initial illness and examine its impact on the likelihood of developing a long-term COVID.

They also hope to see studies that include “rigorous control groups,” which would include children admitted to hospital for reasons other than COVID-19.

“In addition, the underlying mechanisms need to be identified and whether the lengthy COVID can be prevented by vaccination,” said Dr Zimmermann MNT.

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