Post–COVID-19 Conditions Among Children 90 Days After SARS-CoV-2 Infection
Anna Funk, Nathan Kuppermann, Todd A. Florin, Daniel J. Tancredi, Jianling Xie, Kelly Kim, Yaron Finkelstein, Mark I. Neuman, Marina I. Salvadori, Adriana Yock‐Corrales, Kristen Breslin, Lilliam Ambroggio, Pradip P. Chaudhari, Kelly R. Bergmann, Michael Gardiner, Jasmine R. Nebhrajani, Carmen Campos, Fahd A. Ahmad, Laura F. Sartori, Nidhya Navanandan, Nirupama Kannikeswaran, Kerry Caperell, Claudia R. Morris, Santiago Mintegi, Iker Gangoiti, Vikram Sabhaney, Amy C. Plint, Terry P. Klassen, Usha Avva, Nipam Shah, Andrew Dixon, Maren M. Lunoe, Sarah M. Becker, Alexander J. Rogers, Viviana Pavlicich, Stuart R. Dalziel, Daniel C. Payne, Richard Malley, Meredith L Borland, Andrea K. Morrison, Maala Bhatt, Pedro Rino, Isabel Beneyto Ferré, Michelle Eckerle, April Kam, Shu‐Ling Chong, Laura Palumbo, Maria Y. Kwok, Jonathan C. Cherry, Naveen Poonai, Muhammad Waseem, Norma-Jean Simon, Stephen B. Freedman, Jessica Gómez‐Vargas, Bethany Lerman, James Chamberlain, Adebola Owolabi, Camilla Schanche-Perret Gentil, Sofie Ringold, Jocy Perez, Heidi Vander Velden, Tyrus Crawford, Steven Schultz, Kimberly Ross, Kathy Monroe, Karly Stillwell, Jillian Benedetti, Sharon O’Brien, Kyle Pimenta, Amia Andrade, Adam Isacoff, Kendra Sikes, Nina Gold, Kathleen Reichard, Maureen Nemetski, Pavani Avva, Rakesh D. Mistry, Shanon Young, Marlena Cook, V. Gómez Barrena, Sandra Castejón-Ramírez, María T García Castellanos, Emma Patterson, A Tisherman Samuel, Redjana Carciurmaru, Eleanor Fitzpatrick, Megan Bonisch, Bruce Wright, Mithra Sivakumar, Patricia Candelaria, Vincent Cervantes, Shaminy Manoranjithan, Nabeel Khan, Toni Harbour, Usha Sethuraman, Priya Spencer, Neha Gupta, Amira S. Kamboj, Gael Muanamputu, Guillermo Kohn Loncarica
Abstract
Importance: Little is known about the risk factors for, and the risk of, developing post-COVID-19 conditions (PCCs) among children. Objectives: To estimate the proportion of SARS-CoV-2-positive children with PCCs 90 days after a positive test result, to compare this proportion with SARS-CoV-2-negative children, and to assess factors associated with PCCs. Design, Setting, and Participants: This prospective cohort study, conducted in 36 emergency departments (EDs) in 8 countries between March 7, 2020, and January 20, 2021, included 1884 SARS-CoV-2-positive children who completed 90-day follow-up; 1686 of these children were frequency matched by hospitalization status, country, and recruitment date with 1701 SARS-CoV-2-negative controls. Exposure: SARS-CoV-2 detected via nucleic acid testing. Main Outcomes and Measures: Post-COVID-19 conditions, defined as any persistent, new, or recurrent health problems reported in the 90-day follow-up survey. Results: Of 8642 enrolled children, 2368 (27.4%) were SARS-CoV-2 positive, among whom 2365 (99.9%) had index ED visit disposition data available; among the 1884 children (79.7%) who completed follow-up, the median age was 3 years (IQR, 0-10 years) and 994 (52.8%) were boys. A total of 110 SARS-CoV-2-positive children (5.8%; 95% CI, 4.8%-7.0%) reported PCCs, including 44 of 447 children (9.8%; 95% CI, 7.4%-13.0%) hospitalized during the acute illness and 66 of 1437 children (4.6%; 95% CI, 3.6%-5.8%) not hospitalized during the acute illness (difference, 5.3%; 95% CI, 2.5%-8.5%). Among SARS-CoV-2-positive children, the most common symptom was fatigue or weakness (21 [1.1%]). Characteristics associated with reporting at least 1 PCC at 90 days included being hospitalized 48 hours or more compared with no hospitalization (adjusted odds ratio [aOR], 2.67 [95% CI, 1.63-4.38]); having 4 or more symptoms reported at the index ED visit compared with 1 to 3 symptoms (4-6 symptoms: aOR, 2.35 [95% CI, 1.28-4.31]; ≥7 symptoms: aOR, 4.59 [95% CI, 2.50-8.44]); and being 14 years of age or older compared with younger than 1 year (aOR, 2.67 [95% CI, 1.43-4.99]). SARS-CoV-2-positive children were more likely to report PCCs at 90 days compared with those who tested negative, both among those who were not hospitalized (55 of 1295 [4.2%; 95% CI, 3.2%-5.5%] vs 35 of 1321 [2.7%; 95% CI, 1.9%-3.7%]; difference, 1.6% [95% CI, 0.2%-3.0%]) and those who were hospitalized (40 of 391 [10.2%; 95% CI, 7.4%-13.7%] vs 19 of 380 [5.0%; 95% CI, 3.0%-7.7%]; difference, 5.2% [95% CI, 1.5%-9.1%]). In addition, SARS-CoV-2 positivity was associated with reporting PCCs 90 days after the index ED visit (aOR, 1.63 [95% CI, 1.14-2.35]), specifically systemic health problems (eg, fatigue, weakness, fever; aOR, 2.44 [95% CI, 1.19-5.00]). Conclusions and Relevance: In this cohort study, SARS-CoV-2 infection was associated with reporting PCCs at 90 days in children. Guidance and follow-up are particularly necessary for hospitalized children who have numerous acute symptoms and are older.