A 24-month National Cohort Study Examining Long-term Effects of COVID-19 in Children and Young People

Overview

Journal Commun Med (Lond)

Publisher Nature Portfolio

Specialty General Medicine

Date 2024 Dec 5

PMID 39633013

Authors

Terence Stephenson

Snehal M Pinto Pereira

Manjula D Nugawela

Emma Dalrymple

Anthony Harnden

Elizabeth Whittaker

Isobel Heyman

Tamsin Ford

Terry Segal

Trudie Chalder

Shamez N Ladhani

Kelsey McOwat

Ruth Simmons

Laila Xu

Lana Fox-Smith

Roz Shafran

Affiliations

Soon will be listed here.

Abstract

Background: Some children and young people (CYP) infected with SARS-COV-2 experience impairing symptoms post-infection, known as post-COVID-19 condition (PCC). Using data from the National Long COVID in Children and Young People (CloCk) study, we report symptoms and their impact up to 24-months post-infection.

Methods: CloCk is a cohort of CYP in England aged 11-to-17-years when they had a SARS-CoV-2 PCR-test (between September 2020 and March 2021). Of 31,012 eligible CYP 24-months post-PCR test, 12,632 participated (response = 40.7%). CYP were grouped by infection status: 'initial test-negatives; no subsequent positive-test' (NN); 'initial test-negatives; subsequent positive-test' (NP); 'initial test-positives; no reported re-infection' (PN); and 'initial test-positives; reported re-infection' (PP). The Delphi research definition of PCC in CYP was operationalised; symptom severity/impact and validated scales (e.g., Chalder Fatigue Scale) were recorded. We examine symptom profiles 24-month post-index-test by infection status.

Results: 7.2% of CYP consistently fulfil the PCC definition at 3-, 6-, 12- and 24-months. These CYPs have a median of 5-to-6 symptoms at each time-point. Between 20% and 25% of all infection status groups report 3+ symptoms 24-months post-testing; 10-25% experience 5+ symptoms. The reinfected group has more symptoms than the other positive groups; the NN group has the lowest symptom burden (p < 0.001). PCC is more common in older CYPs and in the most deprived. Symptom severity/impact is higher in those fulfilling the PCC definition.

Conclusions: The discrepancy in the proportion of CYP fulfilling the Delphi PCC definition at 24-months and those consistently fulfilling the definition across time, highlights the importance of longitudinal studies and the need to consider clinical impairment and range of symptoms.

References

Wang E, Mao T, Klein J, Dai Y, Huck J, Jaycox J . Diverse functional autoantibodies in patients with COVID-19. Nature. 2021; 595(7866):283-288. DOI: 10.1038/s41586-021-03631-y. View

Zheng Y, Zeng N, Yuan K, Tian S, Yang Y, Gao N . Prevalence and risk factor for long COVID in children and adolescents: A meta-analysis and systematic review. J Infect Public Health. 2023; 16(5):660-672. PMC: 9990879. DOI: 10.1016/j.jiph.2023.03.005. View

Borch L, Holm M, Knudsen M, Ellermann-Eriksen S, Hagstroem S . Long COVID symptoms and duration in SARS-CoV-2 positive children - a nationwide cohort study. Eur J Pediatr. 2022; 181(4):1597-1607. PMC: 8742700. DOI: 10.1007/s00431-021-04345-z. View

Meltzer H, Gatward R, Goodman R, Ford T . Mental health of children and adolescents in Great Britain. Int Rev Psychiatry. 2003; 15(1-2):185-7. DOI: 10.1080/0954026021000046155. View

Stephenson T, Allin B, Nugawela M, Rojas N, Dalrymple E, Pereira S . Long COVID (post-COVID-19 condition) in children: a modified Delphi process. Arch Dis Child. 2022; 107(7):674-680. PMC: 8983414. DOI: 10.1136/archdischild-2021-323624. View

Pinto Pereira S, Shafran R, Nugawela M, Panagi L, Hargreaves D, Ladhani S . Natural course of health and well-being in non-hospitalised children and young people after testing for SARS-CoV-2: a prospective follow-up study over 12 months. Lancet Reg Health Eur. 2022; 25:100554. PMC: 9719829. DOI: 10.1016/j.lanepe.2022.100554. View

Nugawela M, Pinto Pereira S, Rojas N, McOwat K, Simmons R, Dalrymple E . Data Resource Profile: the Children and Young People with Long COVID (CLoCk) Study. Int J Epidemiol. 2023; 53(1). PMC: 10859131. DOI: 10.1093/ije/dyad158. View

Goodman R . Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001; 40(11):1337-45. DOI: 10.1097/00004583-200111000-00015. View

Shen Q, Joyce E, Ebrahimi O, Didriksen M, Lovik A, Saevarsdottir K . COVID-19 illness severity and 2-year prevalence of physical symptoms: an observational study in Iceland, Sweden, Norway and Denmark. Lancet Reg Health Eur. 2023; 35:100756. PMC: 10730314. DOI: 10.1016/j.lanepe.2023.100756. View

10.

Molteni E, Sudre C, Canas L, Bhopal S, Hughes R, Antonelli M . Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. Lancet Child Adolesc Health. 2021; 5(10):708-718. PMC: 8443448. DOI: 10.1016/S2352-4642(21)00198-X. View

11.

Chang S, Feng A, Meng W, Apostolidis S, Mack E, Artandi M . New-onset IgG autoantibodies in hospitalized patients with COVID-19. Nat Commun. 2021; 12(1):5417. PMC: 8440763. DOI: 10.1038/s41467-021-25509-3. View

12.

Radtke T, Ulyte A, Puhan M, Kriemler S . Long-term Symptoms After SARS-CoV-2 Infection in Children and Adolescents. JAMA. 2021; . PMC: 8283661. DOI: 10.1001/jama.2021.11880. View

13.

Morello R, Martino L, Buonsenso D . Diagnosis and management of post-COVID (Long COVID) in children: a moving target. Curr Opin Pediatr. 2023; 35(2):184-192. PMC: 9994801. DOI: 10.1097/MOP.0000000000001221. View

14.

Zavala M, Ireland G, Amin-Chowdhury Z, Ramsay M, Ladhani S . Acute and Persistent Symptoms in Children With Polymerase Chain Reaction (PCR)-Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection Compared With Test-Negative Children in England: Active, Prospective, National.... Clin Infect Dis. 2021; 75(1):e191-e200. PMC: 8767867. DOI: 10.1093/cid/ciab991. View

15.

Selvakumar J, Havdal L, Drevvatne M, Brodwall E, Berven L, Stiansen-Sonerud T . Prevalence and Characteristics Associated With Post-COVID-19 Condition Among Nonhospitalized Adolescents and Young Adults. JAMA Netw Open. 2023; 6(3):e235763. PMC: 10064252. DOI: 10.1001/jamanetworkopen.2023.5763. View

16.

Joffe A, Elliott A . Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response. SAGE Open Med. 2023; 11:20503121231194400. PMC: 10467233. DOI: 10.1177/20503121231194400. View

17.

Soriano J, Murthy S, Marshall J, Relan P, Diaz J . A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2021; 22(4):e102-e107. PMC: 8691845. DOI: 10.1016/S1473-3099(21)00703-9. View

18.

Newlands F, Goddings A, Juste M, Boyd H, Nugawela M, Pinto Pereira S . Children and Young People with Long COVID-Comparing Those Seen in Post-COVID Services with a Non-Hospitalised National Cohort: A Descriptive Study. Children (Basel). 2023; 10(11). PMC: 10670307. DOI: 10.3390/children10111750. View

19.

Atchison C, Whitaker M, Donnelly C, Chadeau-Hyam M, Riley S, Darzi A . Characteristics and predictors of persistent symptoms post-COVID-19 in children and young people: a large community cross-sectional study in England. Arch Dis Child. 2023; 108(7):e12. PMC: 10313975. DOI: 10.1136/archdischild-2022-325152. View

20.

Pan D, Pareek M . Toward a Universal Definition of Post-COVID-19 Condition-How Do We Proceed?. JAMA Netw Open. 2023; 6(4):e235779. DOI: 10.1001/jamanetworkopen.2023.5779. View