Long/post-COVID in children and adolescents: symptom onset and recovery after one year based on healthcare records in Germany

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Abstract

Purpose

Evidence on the incidence and persistence of post-acute sequelae of COVID-19 (PASC) among children and adolescents is still limited.

Methods

In this retrospective cohort study, 59,339 children and adolescents with laboratory-confirmed COVID-19 in 2020 and 170,940 matched controls were followed until 2021-09-30 using German routine healthcare data. Incidence rate differences (ΔIR) and ratios (IRR) of 96 potential PASC were estimated using Poisson regression. Analyses were stratified according to age (0–11, 12–17 years), and sex. At the individual level, persistence of diagnoses in patients with onset symptoms was tracked starting from the first quarter post-infection.

Results

At 0–3 month follow-up, children and adolescents with a previous SARS-CoV-2 infection showed a 34% increased risk of adverse health outcome, and approximately 6% suffered from PASC in association with COVID-19. The attributable risk was higher among adolescents (≥ 12 years) than among children. For most common symptoms, IRRs largely persisted at 9–12 month follow-up. IRR were highest for rare conditions strongly associated with COVID-19, particularly inflammatory conditions among children 0–11 years, and chronic fatigue and respiratory insufficiency among adolescents. Tracking of diagnoses at the individual level revealed similar rates in the decline of symptoms among COVID-19 and control cohorts, generally leaving less than 10% of the patients with persistent diagnoses after 12 months.

Conclusion

Although very few patients presented symptoms for longer than 12 months, excess morbidity among children and, particularly, adolescents with a history of COVID-19 means a relevant burden for pediatric care.

Supplementary Information

The online version contains supplementary material available at 10.1007/s15010-024-02394-8.

Related collections

Most cited references 30

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Post-acute COVID-19 syndrome

Ani Nalbandian, Kartik Sehgal, Aakriti Gupta … (2021)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.

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Is Open Access

The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement

Eric Benchimol, Liam Smeeth, Astrid Guttmann … (2015)

Routinely collected health data, obtained for administrative and clinical purposes without specific a priori research goals, are increasingly used for research. The rapid evolution and availability of these data have revealed issues not addressed by existing reporting guidelines, such as Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement was created to fill these gaps. RECORD was created as an extension to the STROBE statement to address reporting items specific to observational studies using routinely collected health data. RECORD consists of a checklist of 13 items related to the title, abstract, introduction, methods, results, and discussion section of articles, and other information required for inclusion in such research reports. This document contains the checklist and explanatory and elaboration information to enhance the use of the checklist. Examples of good reporting for each RECORD checklist item are also included herein. This document, as well as the accompanying website and message board (http://www.record-statement.org), will enhance the implementation and understanding of RECORD. Through implementation of RECORD, authors, journals editors, and peer reviewers can encourage transparency of research reporting.

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Global Prevalence of Post COVID-19 Condition or Long COVID: A Meta-Analysis and Systematic Review

Chen Chen, Spencer Haupert, Lauren Zimmermann … (2022)

Abstract Introduction This study aims to examine the worldwide prevalence of post COVID-19 condition, through a systematic review and meta-analysis. Methods PubMed, Embase, and iSearch were searched on July 5, 2021 with verification extending to March 13, 2022. Using a random effects framework with DerSimonian-Laird estimator, we meta-analyzed post COVID-19 condition prevalence at 28+ days from infection. Results 50 studies were included, and 41 were meta-analyzed. Global estimated pooled prevalence of post COVID-19 condition was 0.43 (95% CI: 0.39,0.46). Hospitalized and non-hospitalized patients have estimates of 0.54 (95% CI: 0.44,0.63) and 0.34 (95% CI: 0.25,0.46), respectively. Regional prevalence estimates were Asia— 0.51 (95% CI: 0.37,0.65), Europe— 0.44 (95% CI: 0.32,0.56), and North America— 0.31 (95% CI: 0.21,0.43). Global prevalence for 30, 60, 90, and 120 days after infection were estimated to be 0.37 (95% CI: 0.26,0.49), 0.25 (95% CI: 0.15,0.38), 0.32 (95% CI: 0.14,0.57) and 0.49 (95% CI: 0.40,0.59), respectively. Fatigue was the most common symptom reported with a prevalence of 0.23 (95% CI: 0.17,0.30), followed by memory problems (0.14 [95% CI: 0.10,0.19]). Discussion This study finds post COVID-19 condition prevalence is substantial; the health effects of COVID-19 appear to be prolonged and can exert stress on the healthcare system.

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Author and article information

Contributors

Franz Ehm:

ORCID: http://orcid.org/0000-0003-3749-4000

franz.ehm@ukdd.de

Journal

Journal ID (nlm-ta): Infection

Journal ID (iso-abbrev): Infection

Title: Infection

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0300-8126

ISSN (Electronic): 1439-0973

Publication date (Electronic): 16 September 2024

Publication date PMC-release: 16 September 2024

Publication date (Print): 2025

Volume: 53

Issue: 1

Pages: 415-426

Affiliations

[1 ]Center for Evidence-Based Healthcare (ZEGV), University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, ( https://ror.org/042aqky30) Fetscherstraße 74, 01307 Dresden, Germany

[2 ]IKK Classic, ( https://ror.org/053x0fn40) Tannenstraße 4 B, 01099 Dresden, Germany

[3 ]Techniker Krankenkasse, ( https://ror.org/000466g76) Bramfelder Straße 140, 22305 Hamburg, Germany

[4 ]InGef - Institute for Applied Health Research Berlin GmbH, ( https://ror.org/028xc6z83) Otto-Ostrowski-Straße 5, 10249 Berlin, Germany

[5 ]BARMER Institut für Gesundheitssystemforschung (Bifg), Axel-Springer-Straße 44, 10969 Berlin, Germany

[6 ]GRID grid.518864.6, Vandage GmbH, ; Detmolder Str. 30, 33604 Bielefeld, Germany

[7 ]AOK PLUS, Sternplatz 7, 01067 Dresden, Germany

[8 ]Robert Koch Institute, ( https://ror.org/01k5qnb77) Nordufer 20, 13353 Berlin, Germany

[9 ]DAK-Gesundheit, ( https://ror.org/05qp89973) Nagelsweg 27 – 31, 20097 Hamburg, Germany

[10 ]Department of Pediatrics, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, ( https://ror.org/042aqky30) Fetscherstraße 74, 01307 Dresden, Germany

Author information

Franz Ehm http://orcid.org/0000-0003-3749-4000

Falko Tesch http://orcid.org/0000-0001-8933-643X

Danny Wende http://orcid.org/0000-0002-0545-0807

Manuel Batram http://orcid.org/0000-0003-4445-965X

Marion Ludwig http://orcid.org/0000-0002-2446-0090

Martin Roessler http://orcid.org/0000-0002-4662-4156

Giselle Sarganas Margolis http://orcid.org/0000-0002-6296-3174

Lukas Reitzle http://orcid.org/0000-0001-7095-6567

Reinhard Berner http://orcid.org/0000-0002-6216-9173

Christa Scheidt-Nave http://orcid.org/0000-0002-1902-7567

Jochen Schmitt http://orcid.org/0000-0003-0264-0960

Nicole Toepfner http://orcid.org/0000-0002-9693-4419

Article

Publisher ID: 2394

DOI: 10.1007/s15010-024-02394-8

PMC ID: 11825604

PubMed ID: 39285063

SO-VID: a6a8d16e-35d4-42d8-b4c3-a278f6623484

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 5 April 2024

Date accepted : 9 September 2024

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003107, Bundesministerium für Gesundheit;

Award ID: 2521NIK705

Award Recipient : Franz Ehm Falko Tesch Annika Vivirito Marion Ludwig Martin Seifert Giselle Sarganas Margolis Lukas Reitzle Christa Scheidt-Nave Jochen Schmitt

Funded by: Technische Universität Dresden (1019)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: covid-19,post-covid,electronic health records,epidemiology,pediatrics

Data availability:

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: covid-19, post-covid, electronic health records, epidemiology, pediatrics

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