26 Ago Long COVID symptoms in SARS-CoV-2-positive children aged 0–14 years and matched controls in Denmark (LongCOVIDKidsDK): a national, cross-sectional study
Lancet Child Adolesc Health
2022; 6: 614–23
June 22, 2022
See Comment page 595
Department of Cardiology
(Prof S Kikkenborg Berg PhD,
P Palm PhD, Prof H Bundgaard DMSc,
A Vinggaard Christensen PhD), Department of Paediatrics and Adolescents Medicine
(U Nygaard PhD), and Department of Infectious
Disease (Prof S Dam Nielsen DMSc), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen,
(Prof S Kikkenborg Berg, U Nygaard, Prof H Bundgaard, Prof S Dam Nielsen); The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (M N S Petersen MSc,
S Rosenkilde MSc, A B Thorsted MSc, Prof A K Ersbøll PhD,
Prof L C Thygesen PhD)
Correspondence to: Prof Selina Kikkenborg Berg, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital,
2100 Copenhagen, Denmark
Selina Kikkenborg Berg, Pernille Palm, Ulrikka Nygaard, Henning Bundgaard, Maria Nivi Schmidt Petersen, Siri Rosenkilde, Anne Bonde Thorsted, Annette Kjær Ersbøll, Lau Casper Thygesen, Susanne Dam Nielsen, Anne Vinggaard Christensen.
Background After the acute phase of SARS-CoV-2 infection, children can develop long COVID symptoms. We aimed to investigate the prevalence of long-lasting symptoms, the duration and intensity of symptoms, quality of life, number of sick days and absences from daycare or school, and psychological and social outcomes in children aged 0–14 years who had been infected with SARS-CoV-2 relative to controls with no history of SARS-CoV-2infection.
Methods A nationwide cross-sectional study was conducted including children with a confirmed SARS-CoV-2-positive PCR test (cases) and matched controls from Danish national registers. A survey was sent to mothers (proxy reporting) of children aged 0–14 years who had had a positive SARS-CoV-2 test between Jan 1, 2020, and July 12, 2021, and a control group matched (1:4) by age and sex. The survey included the Pediatric Quality of Life Inventory (PedsQL) and the Children’s Somatic Symptoms Inventory-24 (CSSI-24) to capture current overall health and wellbeing, and ancillary questions about the 23 most common long COVID symptoms. Descriptive statistics and logistic regression analysis were used. Clinically relevant differences were defined as those with a Hedges’ g score greater than 0·2. This study is registered at ClinicalTrials.gov (NCT04786353).
Findings Responses to the survey were received from 10 997 (28·8%) of 38 152 cases and 33 016 (22·4%) of 147 212 controls between July 20, 2021, and Sept 15, 2021. Median age was 10·2 years (IQR 6·6–12·8) in cases and 10·6 years (6·9–12·9) in controls. 5267 (48·2%) cases and 15 777 (48·3%) controls were female, and 5658 (51·8%) cases and 16 870 (51·7%) controls were male. Cases had higher odds of reporting at least one symptom lasting more than 2 months than did controls in the 0–3 years age group (478 [40·0%] of 1194 vs 1049 [27·2%] of 3855; OR 1·78 [95% CI 1·55–2·04], p<0·0001), 4–11 years age group (1912 [38·1%] of 5023 vs 6189 [33·7%] of 18 372; 1·23 [1·15–1·31], p<0·0001), and 12–14 years age group (1313 [46·0%] of 2857 vs 4454 [41·3%] of 10 789; 1·21 [1·11–1·32], p<0·0001). Differences in CSSI-24 symptom scores between cases and controls were statistically significant but not clinically relevant. Small clinically relevant differences in PedsQL quality-of-life scores related to emotional functioning were found in favour of cases in the children aged 4–11 years (median score 80·0 [IQR 65·0–95·0]) in cases vs 75·0 [60·0–85·0] in controls; p<0·0001) and 12–14 years (90·0 [70·0–100·0] vs (85·0 [65·0–95·0], p<0·0001). PedsQL social functioning scores were also higher in cases (100·0 [90·0–100·0] than controls (95·0 [80·0–100·0]) in the 12–14 years age group (p<0·0001; Hedges g>0·2).
Interpretation Compared with controls, children aged 0–14 years who had a SARS-CoV-2 infection had more prevalent long-lasting symptoms. There was a tendency towards better quality-of-life scores related to emotional and social functioning in cases than in controls in older children. The burden of symptoms among children in the control group requires attention. Long COVID must be recognised and multi-disciplinary long COVID clinics for children might be beneficial.
Funding A P Møller and Chastine Mc-Kinney Møller Foundation.
Copyright © 2022 Elsevier Ltd. All rights reserved.
Children worldwide are at risk of SARS-CoV-2 infection1 because of a lack of approved vaccines for children aged 0–4 years, few countries recommending vaccination for children aged 5–11 years, low vaccine uptake among children overall, difficulties practising physical distancing and, in particular, low vaccine effectiveness against the
omicron variant of SARS-CoV-2.2 Thus, a considerable number of children have been infected with SARS-CoV-2,3 including in Denmark, where 58% of all children have
had laboratory-confirmed infection during the period from Dec 15, 2021, to Feb 15, 2022.4 This situation leaves a considerable number of children at risk of long-term sequelae following SARS-CoV-2 infection (generally referred to as long COVID, post-COVID-19 condition, or post-COVID-19 syndrome). Different definitions of this condition exist, but WHO has defined post-COVID-19 condition among adults as persistent or fluctuating symp- toms with an influence on daily functioning following SARS-CoV-2 infection for at least 2 months that cannot be
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