A recent study published in Pediatrics by a large team of scientists from the United States (USA) aimed to understand the long-term impact of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infections in the pediatric population, including factors such as prevalence, clinical features, risk factors, and underlying mechanisms associated with post-acute sequelae of Coronavirus Disease 2019 (COVID-19) (PASC).
The global impact of the COVID-19 pandemic has affected various aspects of life, with studies showing disproportionate effects on certain racial and socioeconomic groups. Additionally, a significant portion of the population continues to struggle with persistent and debilitating post-COVID-19 symptoms, now referred to as PASC or long COVID.
It is estimated that about 20% of pediatric cases of COVID-19 in the US may develop into PASC, affecting approximately 5.8 million children in the country. This study summarizes the current understanding of the epidemiology, prevalence, underlying mechanisms, clinical features, and outcomes of PASC in the pediatric population.
The review revealed a lack of consensus on the prevalence of PASC in children, with studies reporting prevalence ranging from 4% to 62%. Differences in study design, follow-up duration, diagnosis criteria, and study population contribute to the wide range of prevalence estimates. Furthermore, the broad range of symptoms affecting multiple organ systems and overlapping with existing comorbidities complicates the diagnosis of PASC.
There are also few studies examining the course of PASC in the pediatric population, with very limited research on the disease progression beyond a year. Studies found that only 15% of asymptomatic SARS-CoV-2 infections in children progressed to PASC, while 45% of symptomatic infections led to lasting consequences.
Furthermore, it was found that infections with variants predated the onset of Omicron increase the PASC risk. Risk factors for PASC development include increasing age, infection severity, higher body weight, chronic comorbidities, and the organ systems affected during acute SARS-CoV-2 infection.
While the influence of environmental and psychosocial factors on PASC development and manifestation has not been sufficiently studied, scientists believe that increasing food and housing insecurity, disruptions to education and healthcare resources, and lower family income may have exacerbated the condition, leading to mental and physical health problems in children, weakening immunity, and worsening existing diseases.
PASC bei Kindern
Based on the available information, the team formulated a conceptual model for PASC in the pediatric population, defining it as a heterogeneous group of symptoms that occur after a SARS-CoV-2 infection. These symptoms include persistent COVID-19 symptoms such as cough, breathlessness, fatigue, headaches, anosmia, ageusia, and chronic pain. It is also believed that worsening existing conditions, such as increased cough in children with asthma, worsening neurological and mental health conditions, and diabetic ketoacidosis in pediatric diabetes cases, are part of PASC.
The review emphasizes the need to pay special attention to the understanding of PASC development in children with higher risk of SARS-CoV-2 infections due to existing comorbidities. Researchers also discussed the possible development of de novo post-acute conditions and the occurrence of autoimmune diseases. Studies have already reported that multisystem inflammatory syndrome in children (MIS-C) is one of the most common complications of COVID-19 in children.
The review provided a comprehensive summary of the diverse manifestations and symptoms of PASC, including constitutional symptoms such as persistent fatigue, post-exertional malaise, brain fog or difficulty concentrating, depressive symptoms, and sleepiness. The researchers extensively discussed the respiratory, cardiac, neurological, olfactory, gastrointestinal, mental, musculoskeletal, dermatological, and inflammatory or hematological manifestations of PASC.
Additionally, the study also examined the role of PASC in exacerbating underlying conditions in children such as asthma, fibromyalgia, and connective tissue diseases, as well as post-infectious conditions like MIS-C and de novo conditions such as diabetes, autoimmune diseases, and neurological problems that may arise during PASC.
In summary, the review analyzed studies investigating the long-term consequences of SARS-CoV-2 infections in children and presented a comprehensive understanding of PASC in children. The results indicate that while the severity and prevalence of COVID-19 in the pediatric population may not be as high as in adults, PASC carries serious and long-lasting consequences, including the development of new autoimmune diseases and diabetes. These findings underscore the need to establish initiatives aimed at better understanding the susceptibility of children with underlying conditions to SARS-CoV-2 infections.
- Rao, S., Gross, RS, Mohandas, S., Stein, CR, Case, A., Dreyer, B., Pajor, NM, Timothy, BH, Warburton, D., Berg, E., Overdevest, JB, Gorelik, M., Milner, J., Saxena, S., Jhaveri, R., Wood, JC, Rhee, KE, Letts, R., Maughan, C. & Guthe, N. (2024). Postakute Folgen von SARS-CoV-2 bei Kindern. Pädiatrie, e2023062570. DOI: 10.1542/peds.2023062570, https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2023-062570/196606/Postacute-Sequelae-of-SARS-CoV-2-in-Children? autologincheck=umgeleitet