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Myocarditis a Common Long COVID Condition in Kids


The burden of post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID, appeared to be low among children, but myocarditis was the most commonly diagnosed PASC-associated condition, according to a large retrospective cohort study.

Among over 650,000 individuals under the age of 21 who underwent antigen or RT-PCR testing, the incidence of at least one systemic, syndromic, or medication feature of PASC was 41.9% for positive children compared with 38.2% for negative children 28 to 179 days after initial testing, reported Suchitra Rao, MBBS, MSCS, of the University of Colorado School of Medicine and Children’s Hospital Colorado in Aurora, and colleagues.

The most common condition linked with PASC was myocarditis (aHR 3.10, 95% CI 1.94-4.96), while loss of taste or smell was the most common symptom (adjusted HR 1.96, 95% CI 1.16-3.32) and cough and cold preparations the most commonly prescribed medication (aHR 1.52, 95% CI 1.18-1.96), they noted in JAMA Pediatrics.

Admission to the intensive care unit during initial infection, age younger than 5 years, and complex chronic conditions were associated with PASC, they added.

“Notably, the frequency of any PASC-related symptoms is high in both viral test-positive and -negative patients … similar to observations in adult studies,” Rao and team wrote. “Nonetheless, the attributable and measurable burden of PASC may still differ in children compared with adults. Potential reasons for these differences may be under-recognition of signs and symptoms associated with PASC because of a dynamic developmental trajectory or age-specific differences in the immune response to infection in PASC related either to ongoing viral replication or an aberrant response.”

They further noted that during the first 6 months following infection, the study found increased rates of pneumonia, tonsillitis, and bronchiolitis, “which may represent persistent pulmonary symptoms as well as the potential for an increased susceptibility to other infections from lung pathology developing after SARS-CoV-2 infection.”

“While the mechanisms for injury in patients with pulmonary manifestations of PASC are providing some insights in adults, further research is required to determine how the lung pathophysiology in children differs from adults both in acute COVID-19 infection (for example, increased susceptibility to infection or asthma) and in the mechanisms driving long-term symptoms,” they continued.

For this study, Rao and colleagues used electronic health record data from nine U.S. children’s hospitals on 659,286 patients who tested positive from March 2020 through October 2021, with at least one prior encounter in the 3 years before testing. Mean age was 8.1 years, and 52.8% were male.

They looked at 151 clinically predicted PASC features, and adjusted for site, age, sex, race and ethnicity, obesity, testing location (emergency department, inpatient, outpatient clinic, or outpatient testing facility), intensive care unit care 7 days before through 13 days after cohort entrance, and medical complexity.

Of the total patients, 9.1% tested positive by viral test, and 90.9% tested negative. Most were tested in outpatient testing facilities (50.3%) or office settings (24.6%).

In addition to the most common PASC features, those with a positive test also had higher rates of acute respiratory distress syndrome (aHR 2.96, 95% CI 1.54-5.67), myositis (aHR 2.59, 95% CI 1.37-4.89), disorders of teeth or gingiva (aHR 1.48, 95% CI 1.36-1.60), other or ill-defined heart disease (aHR 1.47, 95% CI 1.17-1.84), and fluid and electrolyte disturbances (aHR 1.45, 95% CI 1.32-1.58).

They also had higher rates of loss of smell (aHR 1.85, 95% CI 1.20-2.86), mental health treatment (aHR 1.62, 95% CI 1.46-1.80), hair loss (aHR 1.58, 95% CI 1.24-2.01), chest pain (aHR 1.52, 95% CI 1.38-1.68), abnormal liver enzymes (aHR 1.50, 95% CI 1.27-1.77), anxiety symptoms (aHR 1.29, 95% CI 1.08-1.55), skin rashes (aHR 1.26, 95% CI 1.15-1.38), fatigue and malaise (aHR 1.24, 95% CI 1.13-1.35), fever and chills (aHR 1.22, 95% CI 1.16-1.28), cardiorespiratory signs and symptoms (aHR 1.20, 95% CI 1.15-1.26), and diarrhea (aHR 1.18, 95% CI 1.09-1.29).

Gao and team noted that the true burden of PASC may have been underestimated in their study because they excluded previously healthy children who did not have prior health encounters. In addition, they “did not identify specific race or ethnic groups as a risk factor for PASC, despite the fact that SARS-CoV-2 disproportionally affects racial and ethnic minority communities, which may reflect differences in care seeking behavior and access to care,” they wrote.

Disclosures

This study was funded by the National Institutes of Health as part of the Researching COVID to Enhance Recovery (RECOVER) program.

Rao reported receiving grants from the National Institutes of Health during the conduct of the study, as well as grants from BioFire and consulting fees from Seqirus outside the submitted work.

Co-authors reported receiving support from government sources and multiple pharmaceutical companies. One co-author reported being an editor for JAMA Pediatrics, but was not involved in the review or acceptance of the manuscript.



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