Children’s risk of long COVID rare beyond 12 weeks

By Melissa Coade

Friday September 17, 2021

Children and adolescents ‘rarely’ experience persistent symptoms of ‘long COVID’ after 12 weeks, even in the case of the more virulent Delta variant.
Children and adolescents ‘rarely’ experience persistent symptoms of ‘long COVID’ after 12 weeks, even in the case of the more virulent Delta variant.

A systematic review of young COVID-19 patients has found that children and adolescents ‘rarely’ experience persistent symptoms of so-called ‘long COVID’ after 12 weeks, even in the case of the more virulent Delta variant.

The findings on long COVID impact on children contrasts with the risk and impact of the more virulent COVID Delta variant on adults, the authors noted.

To date, no children aged under 10 have died in Australia with COVID-19 and there has been one adolescent who has died — NSW teen Osama Subuh, who passed away in August at the Sydney Children’s Hospital, where he was also being treated for pneumococcal meningitis.

The review findings from the Murdoch Children’s Institute (MCRI) were published in the Paediatric Infectious Disease Journal on Friday. It analysed the findings of 14 different international studies that 19,426 children and adolescents that reported persistent symptoms following COVID-19.

MCRI Professor and lead author Nigel Curtis is also a paediatric infectious disease expert at the University of Melbourne and head of infectious diseases at The Royal Children’s Hospital. He said it was reassuring that the review found ‘little evidence’ that COVID symptoms lasted long in children, suggesting that it may be of less of a concern for people in much younger age groups.

“The low risk posed by acute disease means that one of the key benefits of COVID vaccination of children and adolescents might be to protect them from long COVID,” Curtis said. 

However the researchers also advised that more studies examining the risk and impact of long COVID in young people were needed to help guide vaccine policy decisions for certain age groups. 

Curtis underscored that while COVID positive children were usually asymptomatic or experienced mild disease with low rates of hospitalisation, the risk and features of long COVID were still poorly understood.

“Current studies lack a clear case definition and age-related data, have variable follow-up times, and rely on self- or parent-reported symptoms without lab confirmation,” he said. 

“Another significant problem is that many studies have low response rates meaning they might overestimate the risk of long COVID.”

Professor Curtis added that one of the major limitations for all current studies concerning long COVID in children and adolescents, was that some failed to show the difference between patients with SARS-CoV-2 and their experience of symptoms against those who were not infected with the virus.

“An accurate determination of the risk of long COVID in this age group is therefore crucial in the debate about the risks and benefits of vaccination,” he said. 

Review co-author Dr Petra Zimmermann said it was difficult to distinguish long COVID symptoms from other negative effects that could be caused by indirect effects of the pandemic, such as school closures, being unable to spend time with friends or participate in sports and hobbies.

“This highlights why it’s critical that future studies involve more rigorous control groups, including children with other infections and those admitted to hospital or intensive care for other reasons,” Zimmermann said.

According to MCRI’s Professor Andrew Steer, co-chair of the institute’s governance group, two main reasons were driving the need for more data on the impact of COVID on young people: the emergence of the more virulent Delta strain transmitting in the community, and due to the fact adults have been prioritised to receive vaccines.

A total of 22% of all COVID cases were in those aged 19 and under as of September 5, 2021. Globally there have been over 226.9 million cases of COVID-19 recorded by health authorities and more than 4.6 million recorded deaths.

“As restrictions ease and other respiratory viruses increase in circulation, we also need to understand whether co-infection with other respiratory viruses, such as RSV or influenza, increases disease severity in young people,” Steer added.

A research brief also recently released by the MCRI outlined that some overseas child deaths were caused by a condition known as multisystem inflammatory syndrome in children (MIS-C). Most of these deaths occurred in the early stages of the pandemic, the brief said, and early diagnosis and better treatments since that time had improved outcomes.

The brief noted that a total of four (MIS-C) cases have been recorded in Australian children and no deaths. 

The MCRI brief also revealed that although the Delta strain had not caused more serious disease in children, those with pre-existing health conditions such as obesity, kidney and heart problems and other immune disorders faced a risk of catching severe COVID 25 times higher than those without.

A recent systematic review reported severe COVID-19 occurred in 5.1% of children and adolescents with pre-existing conditions and in 0.2% without,” the brief found. 

On Friday, prime minister Scott Morrison confirmed that over 45.3% of Australians aged over 16 were fully vaccinated against COVID-19. Over 64.5% of adults aged over 50 had received two vaccine doses by 17 September. 

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