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How does post COVID differ from other post-viral conditions in childhood and adolescence (0-20 years old)? A
Chiara Minotti1,2, Carla McKenzie3, Isabelle Dewandel3
1Department of Women's and Children's Health, University of Padua, Italy.
Insights
Post Coronavirus disease (COVID) and other post-viral conditions share symptoms like fatigue in children. Further research is needed to understand post-COVID as a distinct syndrome and its healthcare impact.
Area of Science:
- Pediatric infectious diseases
- Post-viral syndromes
- Public health
Background:
- Post-viral syndromes, including post Coronavirus disease (COVID), share overlapping pathogenesis and symptoms.
- Understanding the distinct features of post-COVID in children compared to other post-viral conditions is crucial.
Purpose of the Study:
- To systematically review and describe studies on post-viral conditions in children (0-20 years).
- To compare the characteristics of post-COVID in children with other post-viral conditions.
Main Methods:
- Systematic literature search across Embase, MEDLINE, Cochrane Library, and Google Scholar (1946-2023).
- Adherence to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
- Focus on condition duration, symptom type, and chronic symptom development.
Main Results:
- 35 studies involving 42,934 children were analyzed, with 28 focusing on post-COVID.
- Post-COVID symptoms in older children include fatigue, neurological, cardiorespiratory, musculoskeletal, mental health, and gastrointestinal issues, lasting up to 18 months.
- Chronic symptoms affect 36.8% of patients; post-EBV shows similar fatigue, while post-RSV/Rhinovirus involves recurrent wheezing in younger children.
Conclusions:
- Post-viral fatigue is a common feature in post-COVID and post-Epstein-Barr Virus (EBV) conditions.
- Post-COVID requires further understanding as a unique entity within post-viral syndromes.
- Standardized definitions and outcome measures are essential for evaluating the burden of various viral infections and developing management plans.
Background:
Post Coronavirus disease (COVID) and other post-viral infection syndromes present an overlap of pathogenesis, onset, progression, and symptom profile. We aimed to systematically describe studies on post-viral conditions and determine the entity of post COVID compared to other post-viral conditions in children.
Methods:
We conducted a systematic search of the Embase, MEDLINE, Cochrane Library, and GoogleScholar databases (January 1946-3 November 2023), according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The main outcomes were differences in condition duration, symptom type, and development of chronic symptoms. This systematic review was registered on PROSPERO (CRD42023401789).
Findings:
35/5051 studies were included, with 42,934 children, adolescents and young adults (0-20 years old) overall. Twenty-eight studies focused on post COVID symptoms, followed by five papers on Respiratory Syncytial Virus (RSV) and Rhinovirus, one study on Epstein-Barr Virus (EBV), and one on gastrointestinal viruses. Studies on post COVID mainly reported data on older children/adolescents, describing long-lasting symptoms, including fatigue, neurologic, cardiorespiratory, musculoskeletal, mental health, and gastrointestinal symptoms. The maximum described symptoms duration was eighteen months, with an average follow-up of seven months. The development of chronic symptoms was reported by 30 studies (93.8%) for 10,473/28,474 patients (36.8%). Recovery was achieved in 18,001/28,474 cases (63.2%). The study on EBV reported persistent fatigue in adolescents for a similar duration (6 months, 46% chronic). Studies on RSV and Rhinovirus were mainly done in children under three years, with development of recurrent wheezing (up to 3 years).
Interpretation:
Post-viral fatigue was a shared feature between post COVID and post EBV conditions. A better understanding of post COVID as a unique condition, sharing features with other post-viral syndromes, is needed. The healthcare burden and socio-economic consequences for children and their families warrant further investigation and development of appropriate healthcare management plans. The foremost requirement is the establishment of consistent and shareable definitions, as well as a consensus on outcomes, to effectively evaluate follow-up and quantify the burden of different viral infections.
Funding:
EU Horizon, EDCTP, NIH.
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