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Harvey BJ, McElvaney NG. Sex differences in airway disease: estrogen and airway surface liquid dynamics. Biol Sex Differ 2024; 15:56. [PMID: 39026347 PMCID: PMC11264786 DOI: 10.1186/s13293-024-00633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024] Open
Abstract
Biological sex differences exist for many airway diseases in which females have either worse or better health outcomes. Inflammatory airway diseases such as cystic fibrosis (CF) and asthma display a clear male advantage in post-puberty while a female benefit is observed in asthma during the pre-puberty years. The influence of menstrual cycle stage and pregnancy on the frequency and severity of pulmonary exacerbations in CF and asthma point to a role for sex steroid hormones, particularly estrogen, in underpinning biological sex differences in these diseases. There are many ways by which estrogen may aggravate asthma and CF involving disturbances in airway surface liquid (ASL) dynamics, inappropriate hyper-immune and allergenic responses, as well as exacerbation of pathogen virulence. The deleterious effect of estrogen on pulmonary function in CF and asthma contrasts with the female advantage observed in airway diseases characterised by pulmonary edema such as pneumonia, acute respiratory distress syndrome (ARDS) and COVID-19. Airway surface liquid hypersecretion and alveolar flooding are hallmarks of ARDS and COVID-19, and contribute to the morbidity and mortality of severe forms of these diseases. ASL dynamics encompasses the intrinsic features of the thin lining of fluid covering the airway epithelium which regulate mucociliary clearance (ciliary beat, ASL height, volume, pH, viscosity, mucins, and channel activating proteases) in addition to innate defence mechanisms (pathogen virulence, cytokines, defensins, specialised pro-resolution lipid mediators, and metabolism). Estrogen regulation of ASL dynamics contributing to biological sex differences in CF, asthma and COVID-19 is a major focus of this review.
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Affiliation(s)
- Brian J Harvey
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, 126 St Stephens Green, Dublin 2, Ireland.
- Department of Medicine, RCSI ERC, Beaumont Hospital, Dublin 2, Ireland.
| | - Noel G McElvaney
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, 126 St Stephens Green, Dublin 2, Ireland
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2
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Baba A, Aregbesola A, Caldwell PHY, Elliott SA, Elsman EBM, Fernandes RM, Hartling L, Heath A, Kelly LE, Preston J, Sammy A, Webbe J, Williams K, Woolfall K, Klassen TP, Offringa M. Developments in the Design, Conduct, and Reporting of Child Health Trials. Pediatrics 2024; 154:e2024065799. [PMID: 38832441 DOI: 10.1542/peds.2024-065799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 06/05/2024] Open
Abstract
To identify priority areas to improve the design, conduct, and reporting of pediatric clinical trials, the international expert network, Standards for Research (StaR) in Child Health, was assembled and published the first 6 Standards in Pediatrics in 2012. After a recent review summarizing the 247 publications by StaR Child Health authors that highlight research practices that add value and reduce research "waste," the current review assesses the progress in key child health trial methods areas: consent and recruitment, containing risk of bias, roles of data monitoring committees, appropriate sample size calculations, outcome selection and measurement, and age groups for pediatric trials. Although meaningful change has occurred within the child health research ecosystem, measurable progress is still disappointingly slow. In this context, we identify and review emerging trends that will advance the agenda of increased clinical usefulness of pediatric trials, including patient and public engagement, Bayesian statistical approaches, adaptive designs, and platform trials. We explore how implementation science approaches could be applied to effect measurable improvements in the design, conducted, and reporting of child health research.
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Affiliation(s)
- Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Alex Aregbesola
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Patrina H Y Caldwell
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Sarah A Elliott
- Cochrane Child Health
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ellen B M Elsman
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Ricardo M Fernandes
- Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Lisa Hartling
- Cochrane Child Health
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Heath
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Statistical Science, University College London, London, United Kingdom
| | - Lauren E Kelly
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pharmacology and Therapeutics, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jennifer Preston
- National Institute for Health and Care Research (NIHR) Alder Hey Clinical Research Facility, Liverpool, United Kingdom
| | - Adrian Sammy
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - James Webbe
- Section of Neonatal Medicine, Imperial College London, London, United Kingdom
| | - Katrina Williams
- Department of Paediatrics, Monash University and Developmental Paediatrics, Monash Children's Hospital, Melbourne, Australia
| | - Kerry Woolfall
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Vu TT, Nguyen KC, Nguyen HT, Hoang A, Ngu ND, Tran DN, Phan HB, Nguyen HTT, Pham TQ, Vogt F. Prevalence and Symptom Profile of Long COVID among Schoolchildren in Vietnam. Viruses 2024; 16:1021. [PMID: 39066184 PMCID: PMC11281543 DOI: 10.3390/v16071021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Long COVID is a recognized condition that can follow SARS-CoV-2 infection. It has been primarily observed and studied in adults. Evidence on long COVID among children is scarce. We aimed to estimate its prevalence and symptom profile among schoolchildren, and its effects on studying, daily activities, and quality of life. METHODS We conducted a cross-sectional online survey among caregivers of 2226 schoolchildren aged 12-17 in Thai Nguyen, Vietnam, from 11 April to 16 May 2023 using WHO definitions and a validated quality of life questionnaire. RESULTS Among 1507 children with confirmed SARS-CoV-2 infection ≥ 5 months prior, 85 (5.6%) had long COVID. Memory loss (85.9%), poor concentration capacity (58.8%), and fatigue (57.6%) were their most common symptoms. They reported more frequent interference with their studies, observed differences in school absence rates, reduced daily activities, worsened overall health status, and relatively higher utilization of health services compared with children who only suffered from acute COVID-19 symptoms after infection. CONCLUSIONS Given the near-ubiquitous exposure to SARS-CoV-2 among children at this stage of the pandemic, our findings contribute invaluable evidence of an emerging public health burden among the pediatric population in Vietnam and globally. Concerted public health measures are needed to reduce long-term impacts on health, education, and wellbeing.
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Affiliation(s)
- Trang Thu Vu
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia;
- Department of Communicable Disease Control, National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam; (K.C.N.); (N.D.N.); (D.N.T.); (T.Q.P.)
| | - Khanh Cong Nguyen
- Department of Communicable Disease Control, National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam; (K.C.N.); (N.D.N.); (D.N.T.); (T.Q.P.)
- Field Epidemiology Training Program, National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam
| | - Hieu Thi Nguyen
- Thai Nguyen Centers for Disease Control and Prevention, Thai Nguyen 250000, Vietnam; (H.T.N.); (A.H.); (H.T.T.N.)
| | - Anh Hoang
- Thai Nguyen Centers for Disease Control and Prevention, Thai Nguyen 250000, Vietnam; (H.T.N.); (A.H.); (H.T.T.N.)
| | - Nghia Duy Ngu
- Department of Communicable Disease Control, National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam; (K.C.N.); (N.D.N.); (D.N.T.); (T.Q.P.)
| | - Duong Nhu Tran
- Department of Communicable Disease Control, National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam; (K.C.N.); (N.D.N.); (D.N.T.); (T.Q.P.)
| | - Hoa Bich Phan
- Thai Nguyen District Health Center, Thai Nguyen 250000, Vietnam;
| | - Ha Thi Thu Nguyen
- Thai Nguyen Centers for Disease Control and Prevention, Thai Nguyen 250000, Vietnam; (H.T.N.); (A.H.); (H.T.T.N.)
| | - Thai Quang Pham
- Department of Communicable Disease Control, National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam; (K.C.N.); (N.D.N.); (D.N.T.); (T.Q.P.)
- Research Methodology and Biostatistics Department, SPMPH, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Florian Vogt
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia;
- The Kirby Institute, University of New South Wales, Sydney, NSW 2000, Australia
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Heidar Alizadeh A, Nurchis MC, Garlasco J, Mara A, Pascucci D, Damiani G, Gianino MM. Pediatric post COVID-19 condition: an umbrella review of the most common symptoms and associated factors. Eur J Public Health 2024; 34:517-523. [PMID: 38411398 PMCID: PMC11161168 DOI: 10.1093/eurpub/ckae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Although the long-term consequences of the Coronavirus Disease-2019 (COVID-19) pandemic are yet to be fully comprehended, a syndrome symptomatically akin to the COVID-19 disease has been defined, for children and adolescents, in February 2023 by the World Health Organization (WHO) as 'post COVID-19 condition' (PCC). Potential consequences of COVID-19 that affect developmental milestones in children and adolescents should be comprehended in their magnitude and duration. The aim is to investigate the most common symptoms and predictors or risk factors for pediatric PCC. METHODS In this umbrella review, the population of interest was defined as children and adolescents from 0 to 19 years old presenting PCC symptoms as defined by the WHO in the International Classification of Diseases. The intervention considered was general follow-up activity to monitor the patients' recovery status. No comparator was chosen, and the outcomes were symptoms of PCC and predictors or risk factors of developing PCC. Methodological quality, risk of bias and the level of overlap between studies were assessed. A random-effects meta-analytic synthesis of respective estimates with inverse variance study weighting was carried out, for the primary studies included by the reviews retrieved, regarding predictors or risk factors reported. RESULTS We identified six eligible systematic reviews, five with meta-analyses, from three databases. The most common symptoms reported were fatigue and respiratory difficulties; female sex and older age were the most reported factors associated with the development of pediatric PCC. CONCLUSIONS A deeper understanding of pediatric PCC requires well-designed and clearly defined prospective studies, symptom differentiation, and adequate follow-up.
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Affiliation(s)
- Aurora Heidar Alizadeh
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Mario Cesare Nurchis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Jacopo Garlasco
- Department of Public Health and Paediatrics, Università di Torino, Torino, Italy
| | - Alessandro Mara
- Department of Public Health and Paediatrics, Università di Torino, Torino, Italy
| | - Domenico Pascucci
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Roma, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Gianfranco Damiani
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Roma, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Han M, Chang T, Chun HR, Jo S, Jo Y, Yu DH, Yoo S, Cho SI. Symptoms and Conditions in Children and Adults up to 90 Days after SARS-CoV-2 Infection: A Retrospective Observational Study Utilizing the Common Data Model. J Clin Med 2024; 13:2911. [PMID: 38792452 PMCID: PMC11122571 DOI: 10.3390/jcm13102911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/28/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: There have been widespread reports of persistent symptoms in both children and adults after SARS-CoV-2 infection, giving rise to debates on whether it should be regarded as a separate clinical entity from other postviral syndromes. This study aimed to characterize the clinical presentation of post-acute symptoms and conditions in the Korean pediatric and adult populations. Methods: A retrospective analysis was performed using a national, population-based database, which was encoded using the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). We compared individuals diagnosed with SARS-CoV-2 to those diagnosed with influenza, focusing on the risk of developing prespecified symptoms and conditions commonly associated with the post-acute sequelae of COVID-19. Results: Propensity score matching yielded 1,656 adult and 343 pediatric SARS-CoV-2 and influenza pairs. Ninety days after diagnosis, no symptoms were found to have elevated risk in either adults or children when compared with influenza controls. Conversely, at 1 day after diagnosis, adults with SARS-CoV-2 exhibited a significantly higher risk of developing abnormal liver function tests, cardiorespiratory symptoms, constipation, cough, thrombophlebitis/thromboembolism, and pneumonia. In contrast, children diagnosed with SARS-CoV-2 did not show an increased risk for any symptoms during either acute or post-acute phases. Conclusions: In the acute phase after infection, SARS-CoV-2 is associated with an elevated risk of certain symptoms in adults. The risk of developing post-acute COVID-19 sequelae is not significantly different from that of having postviral symptoms in children in both the acute and post-acute phases, and in adults in the post-acute phase. These observations warrant further validation through studies, including the severity of initial illness, vaccination status, and variant types.
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Affiliation(s)
- Minjung Han
- Graduate School of Public Health, Seoul National University, Seoul 08826, Republic of Korea; (M.H.); (T.C.); (H.-r.C.)
- Chaum Life Center, CHA University School of Medicine, Seoul 06062, Republic of Korea
| | - Taehee Chang
- Graduate School of Public Health, Seoul National University, Seoul 08826, Republic of Korea; (M.H.); (T.C.); (H.-r.C.)
| | - Hae-ryoung Chun
- Graduate School of Public Health, Seoul National University, Seoul 08826, Republic of Korea; (M.H.); (T.C.); (H.-r.C.)
| | - Suyoung Jo
- Institute of Health and Environment, Seoul National University, Seoul 08826, Republic of Korea;
| | - Yeongchang Jo
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
| | - Dong Han Yu
- Big Data Department, Health Insurance Review and Assessment Service, Wonju 26465, Republic of Korea;
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea;
| | - Sung-il Cho
- Graduate School of Public Health, Seoul National University, Seoul 08826, Republic of Korea; (M.H.); (T.C.); (H.-r.C.)
- Institute of Health and Environment, Seoul National University, Seoul 08826, Republic of Korea;
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6
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Zhao X, Wang D, Chen Y, Zhang N, Li T, Fan R, Yang L, Yang C, Yang J. Factors influencing cardiovascular system-related post-COVID-19 sequelae: A single-center cohort study. Open Med (Wars) 2024; 19:20240950. [PMID: 38737442 PMCID: PMC11087739 DOI: 10.1515/med-2024-0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/29/2024] [Accepted: 03/21/2024] [Indexed: 05/14/2024] Open
Abstract
Background COVID-19 sequelae are long-term symptoms of COVID-19. Cardiovascular disease is not only a risk factor for the occurrence of COVID-19 sequelae but also a potential result directly or indirectly caused by COVID-19 infection. Objectives The aim of this study is to investigate the cardiovascular system-related symptoms of outpatients and inpatients of the Cardiovascular Department of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine after recovery from novel coronavirus infection, analyze the influencing factors, and symptom characteristics of related symptoms, and thereby provide a basis for further formulating a reasonable diagnosis and treatment plan. Materials and methods From January 15, 2023 to February 15, 2023, 452 recovered patients with novel coronavirus infection who were admitted to the Cardiovascular Department of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine due to symptoms of the cardiovascular system (complaints of chest pain and palpitations) were involved in this study. A unified questionnaire was used to record the general information, past medical history, characteristics of chest pain or palpitations, and other COVID-19-related sequelae of the selected patients. All data were statistically analyzed by SPSS 26.0 statistical software. Results A total of 226 patients with cardiovascular symptoms and 226 patients without cardiovascular symptoms were included in this study. After univariate and multivariate logistic regression analysis, women (OR 2.081, 95% CI = 1.358-3.189) and young people (OR 2.557, 95% CI = 1.44-4.54) had a higher risk of cardiovascular symptoms; prehypertension (OR 1.905, 95% CI = 1.091-3.329) and hypertension (OR 2.287, 95% CI = 1.433-3.649) increased the risk of cardiovascular symptoms; patients with history of previous cardiovascular disease (OR 1.862, 95% CI = 1.16-2.988) and history of diabetes (OR 2.138, 95% CI = 1.058-4.319) had a higher risk of developing cardiovascular symptoms. The main symptoms related to COVID-19 sequelae reported by all 452 patients were fatigue (76.8%), shortness of breath (54.2%), dry mouth and bitter mouth (46.0%), gastrointestinal symptoms (42.7%), sleep disturbances (37.4%), sweating (31.9%), chills (29%), dizziness (25.7%), confusion of brain fog (25.2%), and tinnitus (14.6%). Compared with patients without cardiovascular symptoms, patients with cardiovascular symptoms were more likely to have shortness of breath (OR 3.521, 95% CI = 2.226-5.472), gastrointestinal symptoms (OR 2.039, 95% CI = 1.226-3.393), and dry mouth and bitter mouth (OR 1.918, 95% CI = 1.229-2.992). The differences were statistically significant (P < 0.05). Conclusion In this new coronavirus infection, women, young people, the elderly, people with prehypertension, hypertension, and patients with a history of cardiovascular disease and diabetes have a higher risk of developing cardiovascular symptoms, and patients with cardiovascular symptoms are more likely to develop other COVID-19 sequelae.
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Affiliation(s)
- Xiaoyu Zhao
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, 250014, China
| | - Dongli Wang
- Department of Gastroenterology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, 250014, China
| | - Yongzhi Chen
- Department of Cardiovascular, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, 250014, China
| | - Na Zhang
- Department of Critical Care Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, 250014, China
| | - Tianshu Li
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, 250014, China
| | - Ruixia Fan
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, 250014, China
| | - Lei Yang
- First School of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, 250014, China
| | - Chuanhua Yang
- Department of Cardiovascular, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, 250014, China
| | - Jie Yang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Collins E, Galipeau Y, Arnold C, Bhéreur A, Booth R, Buchan AC, Cooper C, Crawley AM, McCluskie PS, McGuinty M, Pelchat M, Rocheleau L, Saginur R, Gravel C, Hawken S, Langlois MA, Little J. Clinical and serological predictors of post COVID-19 condition-findings from a Canadian prospective cohort study. Front Public Health 2024; 12:1276391. [PMID: 38784593 PMCID: PMC11111987 DOI: 10.3389/fpubh.2024.1276391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction More than 3 years into the pandemic, there is persisting uncertainty as to the etiology, biomarkers, and risk factors of Post COVID-19 Condition (PCC). Serological research data remain a largely untapped resource. Few studies have investigated the potential relationships between post-acute serology and PCC, while accounting for clinical covariates. Methods We compared clinical and serological predictors among COVID-19 survivors with (n = 102 cases) and without (n = 122 controls) persistent symptoms ≥12 weeks post-infection. We selected four primary serological predictors (anti-nucleocapsid (N), anti-Spike, and anti-receptor binding domain (RBD) IgG titres, and neutralization efficiency), and specified clinical covariates a priori. Results Similar proportions of PCC-cases (66.7%, n = 68) and infected-controls (71.3%, n = 87) tested positive for anti-N IgG. More cases tested positive for anti-Spike (94.1%, n = 96) and anti-RBD (95.1%, n = 97) IgG, as compared with controls (anti-Spike: 89.3%, n = 109; anti-RBD: 84.4%, n = 103). Similar trends were observed among unvaccinated participants. Effects of IgG titres on PCC status were non-significant in univariate and multivariate analyses. Adjusting for age and sex, PCC-cases were more likely to be efficient neutralizers (OR 2.2, 95% CI 1.11-4.49), and odds was further increased among cases to report deterioration in quality of life (OR 3.4, 95% CI 1.64-7.31). Clinical covariates found to be significantly related to PCC included obesity (OR 2.3, p = 0.02), number of months post COVID-19 (OR 1.1, p < 0.01), allergies (OR 1.8, p = 0.04), and need for medical support (OR 4.1, p < 0.01). Conclusion Despite past COVID-19 infection, approximately one third of PCC-cases and infected-controls were seronegative for anti-N IgG. Findings suggest higher neutralization efficiency among cases as compared with controls, and that this relationship is stronger among cases with more severe PCC. Cases also required more medical support for COVID-19 symptoms, and described complex, ongoing health sequelae. More data from larger cohorts are needed to substantiate results, permit subgroup analyses of IgG titres, and explore for differences between clusters of PCC symptoms. Future assessment of IgG subtypes may also elucidate new findings.
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Affiliation(s)
- Erin Collins
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Yannick Galipeau
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Corey Arnold
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Anne Bhéreur
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Ronald Booth
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Arianne C. Buchan
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Curtis Cooper
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Coronavirus Variants Rapid Response Network (CoVaRR-Net), Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Centre for Infection, Immunity and Inflammation (CI3), University of Ottawa, Ottawa, ON, Canada
| | - Angela M. Crawley
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
- Coronavirus Variants Rapid Response Network (CoVaRR-Net), Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Centre for Infection, Immunity and Inflammation (CI3), University of Ottawa, Ottawa, ON, Canada
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Pauline S. McCluskie
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Michaeline McGuinty
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Martin Pelchat
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Lynda Rocheleau
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Raphael Saginur
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Ottawa Health Science Network Research Ethics Board (OHSN-REB), Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Chris Gravel
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, ON, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Steven Hawken
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marc-André Langlois
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
- Coronavirus Variants Rapid Response Network (CoVaRR-Net), Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Centre for Infection, Immunity and Inflammation (CI3), University of Ottawa, Ottawa, ON, Canada
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Coronavirus Variants Rapid Response Network (CoVaRR-Net), Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Knowledge Synthesis and Application Unit (KSAU), University of Ottawa, Ottawa, ON, Canada
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8
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Calcaterra V, Zanelli S, Foppiani A, Verduci E, Benatti B, Bollina R, Bombaci F, Brucato A, Cammarata S, Calabrò E, Cirnigliaro G, Della Torre S, Dell’osso B, Moltrasio C, Marzano AV, Nostro C, Romagnuolo M, Trotta L, Savasi V, Smiroldo V, Zuccotti G. Long COVID in Children, Adults, and Vulnerable Populations: A Comprehensive Overview for an Integrated Approach. Diseases 2024; 12:95. [PMID: 38785750 PMCID: PMC11120262 DOI: 10.3390/diseases12050095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/27/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Long COVID affects both children and adults, including subjects who experienced severe, mild, or even asymptomatic SARS-CoV-2 infection. We have provided a comprehensive overview of the incidence, clinical characteristics, risk factors, and outcomes of persistent COVID-19 symptoms in both children and adults, encompassing vulnerable populations, such as pregnant women and oncological patients. Our objective is to emphasize the critical significance of adopting an integrated approach for the early detection and appropriate management of long COVID. The incidence and severity of long COVID symptoms can have a significant impact on the quality of life of patients and the course of disease in the case of pre-existing pathologies. Particularly, in fragile and vulnerable patients, the presence of PASC is related to significantly worse survival, independent from pre-existing vulnerabilities and treatment. It is important try to achieve an early recognition and management. Various mechanisms are implicated, resulting in a wide range of clinical presentations. Understanding the specific mechanisms and risk factors involved in long COVID is crucial for tailoring effective interventions and support strategies. Management approaches involve comprehensive biopsychosocial assessments and treatment of symptoms and comorbidities, such as autonomic dysfunction, as well as multidisciplinary rehabilitation. The overall course of long COVID is one of gradual improvement, with recovery observed in the majority, though not all, of patients. As the research on long-COVID continues to evolve, ongoing studies are likely to shed more light on the intricate relationship between chronic diseases, such as oncological status, cardiovascular diseases, psychiatric disorders, and the persistent effects of SARS-CoV-2 infection. This information could guide healthcare providers, researchers, and policymakers in developing targeted interventions.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, Università degli Sudi di Pavia, 27100 Pavia, Italy;
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (S.Z.); (E.V.)
| | - Sara Zanelli
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (S.Z.); (E.V.)
| | - Andrea Foppiani
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20157 Milano, Italy;
- IRCCS Istituto Auxologico Italiano, Department of Endocrine and Metabolic Medicine, Clinical Nutrition Unit, 20145 Milano, Italy
| | - Elvira Verduci
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (S.Z.); (E.V.)
- Department of Health Sciences, Università degli Studi di Milano, 20157 Milano, Italy
| | - Beatrice Benatti
- “Aldo Ravelli” Center for Nanotechnology and Neurostimulation, Università degli Studi di Milano, 20157 Milano, Italy; (B.B.); (B.D.)
- Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milano, 20154 Milano, Italy; (G.C.); (C.N.)
| | - Roberto Bollina
- Department of Medical Oncology, ASST Rhodense, 20024 Milano, Italy; (R.B.); (S.D.T.); (V.S.)
| | - Francesco Bombaci
- Department of Radiology, ASST Fatebenefratelli Sacco, 20154 Milano, Italy;
| | - Antonio Brucato
- Department of Internal Medicine, ASST Fatebenefratelli-Sacco, 20154 Milano, Italy; (A.B.); (E.C.); (L.T.)
| | - Selene Cammarata
- Department of Woman, Mother and Neonate, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, 20154 Milano, Italy; (S.C.); (V.S.)
| | - Elisa Calabrò
- Department of Internal Medicine, ASST Fatebenefratelli-Sacco, 20154 Milano, Italy; (A.B.); (E.C.); (L.T.)
| | - Giovanna Cirnigliaro
- Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milano, 20154 Milano, Italy; (G.C.); (C.N.)
| | - Silvia Della Torre
- Department of Medical Oncology, ASST Rhodense, 20024 Milano, Italy; (R.B.); (S.D.T.); (V.S.)
| | - Bernardo Dell’osso
- “Aldo Ravelli” Center for Nanotechnology and Neurostimulation, Università degli Studi di Milano, 20157 Milano, Italy; (B.B.); (B.D.)
- Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milano, 20154 Milano, Italy; (G.C.); (C.N.)
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
- Centro per lo Studio dei Meccanismi Molecolari alla Base delle Patologie Neuro-Psico-Geriatriche, Università degli Studi di Milano, 20157 Milano, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (C.M.); (A.V.M.); (M.R.)
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (C.M.); (A.V.M.); (M.R.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milano, Italy
| | - Chiara Nostro
- Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milano, 20154 Milano, Italy; (G.C.); (C.N.)
| | - Maurizio Romagnuolo
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (C.M.); (A.V.M.); (M.R.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milano, Italy
| | - Lucia Trotta
- Department of Internal Medicine, ASST Fatebenefratelli-Sacco, 20154 Milano, Italy; (A.B.); (E.C.); (L.T.)
| | - Valeria Savasi
- Department of Woman, Mother and Neonate, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, 20154 Milano, Italy; (S.C.); (V.S.)
- Department of Biomedical and Clinical Science, Università degli Studi di Milano, 20157 Milano, Italy
| | - Valeria Smiroldo
- Department of Medical Oncology, ASST Rhodense, 20024 Milano, Italy; (R.B.); (S.D.T.); (V.S.)
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (S.Z.); (E.V.)
- Department of Biomedical and Clinical Science, Università degli Studi di Milano, 20157 Milano, Italy
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9
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Luedke JC, Vargas G, Jashar DT, Morrow A, Malone LA, Ng R. [Formula: see text] Cognitive disengagement syndrome in pediatric patients with long COVID: associations with mood, anxiety, and functional impairment. Child Neuropsychol 2024; 30:652-672. [PMID: 37667487 DOI: 10.1080/09297049.2023.2252967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
Children with long COVID often report symptoms that overlap with cognitive disengagement syndrome (CDS, previously sluggish cognitive tempo (SCT)), a set of behaviors distinct from attention-deficit/hyperactivity disorder (ADHD) including excessive daydreaming, mental fogginess, and slowed behavior and thinking. Those with long COVID also frequently report low mood and anxiety, which are linked to CDS. The relationships between cognitive difficulties, mood, and functional impairment have yet to be explored in pediatric long COVID. Specifically, it is unclear how much cognitive difficulties (CDS, inattention) contribute to functional impairment, when accounting for mood/anxiety symptoms in this population. Retrospective parent-reported data was collected from 34 patients with long COVID (22 females, Mage = 14.06 years, SD = 2.85, range 7-19) referred for neuropsychological consultation through a multidisciplinary Post-COVID-19 clinic. Compared to community and clinically referred samples, on average, long COVID patients showed elevated CDS symptoms, including Sluggish/sleepy (e.g., fatigue) and Low Initiation subscales (e.g., difficulty performing goal directed behaviors). Low Initiation, mood, anxiety, and inattention were associated with functional impairment. In multiple hierarchical regression models, after controlling for mood and anxiety, Low Initiation and inattention were no longer predictive of functional impairment. Instead, anxiety remained the sole predictor of functional impairment. Our results demonstrate that children with long COVID have high levels of CDS symptoms. The association between cognitive difficulties and functional impairment dissipated with the inclusion of mood and anxiety, suggesting behavioral health interventions targeting anxiety may help improve daily functioning and quality of life in pediatric long COVID patients.
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Affiliation(s)
- Jessica C Luedke
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Gray Vargas
- Kennedy Krieger Institute, Baltimore, MD, USA
| | | | - Amanda Morrow
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura A Malone
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rowena Ng
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Wongwathanavikrom NB, Tovichien P, Udomittipong K, Palamit A, Tiamduangtawan P, Mahoran K, Charoensittisup P. Incidence and risk factors for long COVID in children with COVID-19 pneumonia. Pediatr Pulmonol 2024; 59:1330-1338. [PMID: 38353350 DOI: 10.1002/ppul.26910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/06/2024] [Accepted: 01/31/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND AND OBJECTIVE There are only a few reports of long COVID including pulmonary function in children after COVID-19 pneumonia. We determined the incidence of long COVID and abnormal pulmonary function in those children and identify risk factors. METHODS This cohort study enrolled children admitted with COVID-19 pneumonia during 2021-2022. We gathered clinical characteristics during admission and at follow-up 3 months after. RESULTS We determined the incidence of long COVID at 39.7% (95% confidence interval [CI]: 30.7%-49.1%). All severe pneumonia cases consistently reported persistent symptoms. Exercise intolerance, cough, and fatigue were the three most common persistent symptoms in 26 (22.4%), 21 (18.1%), and 18 (15.5%) of the patients, respectively. At the follow-up, 21 cases (18.1%) demonstrated persistent abnormal chest radiographs. Three cases (6.9%) demonstrated restrictive ventilatory defects. Among those, one case (2.3%) demonstrated concomitant diffusion defect. Three cases (6.0%) demonstrated exercise-induced hypoxemia after the 6-minute walk test. Comparing spirometry variables between children with long COVID and without revealed significant difference of FEF25-75 (z score) between two groups. Age [adjusted OR (95% CI): 1.13 (1.05-1.22), p value 0.002], allergic diseases [adjusted OR (95% CI): 4.05 (1.36-12.06), p value 0.012], and living in polluted areas [adjusted OR (95% CI): 2.73 (1.18-6.33), p value 0.019] were significantly associated with long COVID. CONCLUSION A significant percentage of children developed long COVID after COVID-19 pneumonia. We should give additional attention to those who have exercise intolerance, chronic cough, or fatigue, especially older children, severe cases, children with allergic diseases, and those living in polluted areas.
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Affiliation(s)
- Na-Bhadhra Wongwathanavikrom
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prakarn Tovichien
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokporn Udomittipong
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apinya Palamit
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pinyapach Tiamduangtawan
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Khunphon Mahoran
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pawinee Charoensittisup
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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11
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Schoeffl I, Raming R, Tratzky JP, Regensburger AP, Kraus C, Waellisch W, Trollmann R, Woelfle J, Dittrich S, Heiss R, Knieling F, Weigelt A. Cardiopulmonary function in paediatric post-COVID-19: a controlled clinical trial. Eur J Pediatr 2024; 183:1645-1655. [PMID: 38193996 PMCID: PMC11001705 DOI: 10.1007/s00431-024-05421-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024]
Abstract
Recently, the importance of post-COVID-19 in children has been recognized in surveys and retrospective chart analysis. However, objective data in the form of cardiopulmonary exercise test as performed in adults suffering from this condition are still lacking. This study aimed to investigate the cardiopulmonary effects of post-COVID-19 on children and adolescents. In this cross-sectional study (the FASCINATE study), children fulfilling the criteria of post-COVID-19 and an age- and sex-matched control group underwent cardiopulmonary exercise testing on a treadmill and completed a questionnaire with regard to physical activity before, during and after the infection with SARS-CoV-2. We were able to recruit 20 children suffering from post-COVID-19 (mean age 12.8 ± 2.4 years, 60% females) and 28 control children (mean age 11.7 ± 3.5 years, 50% females). All participants completed a maximal treadmill test with a significantly lowerV ˙ O 2 peak in the post-COVID-19 group (37.4 ± 8.8 ml/kg/min vs. 43.0 ± 6.7 ml/kg/min. p = 0.019). This significance did not persist when comparing the achieved percentage of predictedV ˙ O 2 peak . There were no significant differences for oxygen pulse, heart rate, minute ventilation or breathing frequency. Conclusion: This is the first study to investigate post-COVID-19 in children using the cardiopulmonary exercise test. Although there was a significantly reducedV ˙ O 2 peak in the post-COVID-19 group, this was not true for the percent of predicted values. No pathological findings with respect to cardiac or pulmonary functions could be discerned. Deconditioning was the most plausible cause for the experienced symptoms. Trial registration: clinicaltrials.gov, NCT054445531, Low-field Magnetic Resonance Imaging in Pediatric Post Covid-19-Full Text View-ClinicalTrials.gov. What is Known: • The persistence of symptoms after an infection with SARS-CoV 2, so-called post-COVID-19 exists also in children. • So far little research has been conducted to analyze this entity in the pediatric population. What is New: • This is the first study proving a significantly lower cardiopulmonary function in pediatric patients suffering from post-COVID-19 symptoms. • The cardiac and pulmonary function appear similar between children suffering from post-COVID-19 and those who don't, but the peripheral muscles seem affected.
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Affiliation(s)
- Isabelle Schoeffl
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany.
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, LS13HE, UK.
| | - Roman Raming
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Jan-Philipp Tratzky
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Adrian P Regensburger
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Calvin Kraus
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Wolfgang Waellisch
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Rafael Heiss
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Annika Weigelt
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany.
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12
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Faux-Nightingale A, Saunders B, Burton C, Chew-Graham CA, Somayajula G, Twohig H, Welsh V. Experiences and care needs of children with long COVID: a qualitative study. BJGP Open 2024; 8:BJGPO.2023.0143. [PMID: 37914226 PMCID: PMC11169971 DOI: 10.3399/bjgpo.2023.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/10/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Long COVID, the patient-preferred term, describes symptoms persisting after an acute episode of COVID-19 infection. Symptoms in children and young people (CYP) can affect daily routine, with broader impacts on education, health-related quality of life, and social activities, which may have long-term effects on health and wellbeing. AIM To explore the lived experiences and care needs of CYP with long COVID from the perspectives of CYP with long COVID, their parents, and professionals associated with the care of children and families living with the condition. DESIGN & SETTING CYP and their parent or carer were invited for interview following participation in a cohort study, which recruited the sample from a primary care setting. METHOD Interviews were carried out with four CYP with long COVID (all female, aged 10-17 years); three interviews included a parent. Two focus groups were conducted, which included seven professionals involved with care of CYP or long COVID, from a range of disciplines. Interviews and focus groups were transcribed verbatim, and data analysed thematically using constant comparison techniques. RESULTS The three main themes presented are as follows: living with long COVID; uncertainty surrounding long COVID; and seeking help for symptoms. CONCLUSION Long COVID can severely impact the lives of CYP and their families. CYP and their families need to be listened to by professionals and have any uncertainties acknowledged. It is imperative that agencies working with them understand the condition and its impact, and are able to offer support where needed.
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Affiliation(s)
| | | | - Claire Burton
- School of Medicine, Keele University, Staffordshire, UK
| | | | | | - Helen Twohig
- School of Medicine, Keele University, Staffordshire, UK
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13
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Makhluf H, Madany H, Kim K. Long COVID: Long-Term Impact of SARS-CoV2. Diagnostics (Basel) 2024; 14:711. [PMID: 38611624 PMCID: PMC11011397 DOI: 10.3390/diagnostics14070711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Four years post-pandemic, SARS-CoV-2 continues to affect many lives across the globe. An estimated 65 million people suffer from long COVID, a term used to encapsulate the post-acute sequelae of SARS-CoV-2 infections that affect multiple organ systems. Known symptoms include chronic fatigue syndrome, brain fog, cardiovascular issues, autoimmunity, dysautonomia, and clotting due to inflammation. Herein, we review long COVID symptoms, the proposed theories behind the pathology, diagnostics, treatments, and the clinical trials underway to explore treatments for viral persistence, autonomic and cognitive dysfunctions, sleep disturbances, fatigue, and exercise intolerance.
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Affiliation(s)
- Huda Makhluf
- Department of Mathematics and Natural Sciences, National University, San Diego, CA 92123, USA
- Center for Infectious Disease, La Jolla Institute, La Jolla, CA 92037, USA; (H.M.); (K.K.)
| | - Henry Madany
- Center for Infectious Disease, La Jolla Institute, La Jolla, CA 92037, USA; (H.M.); (K.K.)
- Public Health Sciences, University of California, Irvine, CA 92697, USA
| | - Kenneth Kim
- Center for Infectious Disease, La Jolla Institute, La Jolla, CA 92037, USA; (H.M.); (K.K.)
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14
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Ruiyin W, Qi J, Tingting W, Yuqin Y, Yan J, Kun P. Long COVID outcomes following omicron wave in non-hospital population. Front Public Health 2024; 12:1377866. [PMID: 38560433 PMCID: PMC10978792 DOI: 10.3389/fpubh.2024.1377866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Background The persistence of symptoms or the development of new symptoms following a diagnosis of SARS-CoV-2 has given rise to a multifaceted clinical condition referred to as "long COVID" (LC). The understanding of LC among China's non-hospitalized population continues to be insufficient. This investigation was designed to evaluate the protracted consequences amongst this demographic, as well as to identify the associated risk factors. Methods This research constitutes a prospective cohort study focusing on non-hospitalized individuals, aged between 18 and 59, who have been positively diagnosed with COVID-19. Each participant was subjected to a sequence of questionnaire-based surveys, designed to evaluate symptoms as well as the status of depression and anxiety. A logistic regression model, adjusted for multiple variables, was employed to scrutinize the correlation between demographic elements, lifestyle attributes, and health-related risk factors in relation to conditions and symptoms post COVID-19 infection. Results A total of 706 individuals participated in the 3 months follow-up, with 620 continuing on to the 6 months follow-up. The median age was 35 (28, 43) years, and 597 (85%) are female. Upon follow-up, Compared with patients without LC, patients with LC have a higher proportion of females (420 (87%) vs. 177 (79%); p = 0.010), were older (35 (29, 44) years vs. 33 (27, 41) years; p = 0.010) and have more comorbidities. Out of all participants, 483 (68.4%) reported experiencing at least one symptom at the 3 months mark, while 49.7% reported symptoms persisting at the 6 months mark. At the 3 months follow-up, the most prevalent persistent symptoms were cough (46%), fatigue (38%), and shortness of breath (34%). By the 6 months follow-up, fatigue (25%), shortness of breath (22%), and sleep disorders (16%) were the most commonly reported symptoms. Anxiety and depression were consistently reported as prevalent symptoms throughout the follow-up period. Most patient symptoms fade over time, with the quickest decreases observed in cough (from 46 to 9%), expectoration (from 26 to 6.3%), smell disorder (from 16 to 3.9%), and taste disorder (from 18 to 3.5%). Male and those possessing advanced educational qualifications exhibit a decreased susceptibility to the sustained incidence of coughing. Conversely, older age and the presence of comorbidities were identified as risk factors for persistent fatigue and shortness of breath. Conclusion In the after of COVID-19, it has been observed that the majority of patient symptoms tend to decrease over time. The primary residual symptoms noticed after a 6 month follow-up were fatigue, dyspnea, and sleep disturbances. However, it's noteworthy that the risk factors associated with these symptoms exhibit subtle variations. Furthermore, psychological sequelae, namely depression and anxiety, are frequently reported among COVID-19 survivors.
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Affiliation(s)
- Wang Ruiyin
- Department of Respiratory, Beijing Longfu Hospital, Beijing, China
| | - Jia Qi
- Department of Respiratory, Beijing Longfu Hospital, Beijing, China
| | - Wang Tingting
- Department of Respiratory, Beijing Longfu Hospital, Beijing, China
| | - Yan Yuqin
- Department of Respiratory, Beijing Longfu Hospital, Beijing, China
| | - Jia Yan
- Department of Respiratory, Beijing Longfu Hospital, Beijing, China
| | - Peng Kun
- Department of Office of the Hospital, Beijing Longfu Hospital, Beijing, China
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15
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Kulkarni D, Ismail NF, Zhu F, Wang X, del Carmen Morales G, Srivastava A, Allen KE, Spinardi J, Rahman AE, Kyaw MH, Nair H. Epidemiology and clinical features of SARS-CoV-2 infection in children and adolescents in the pre-Omicron era: A global systematic review and meta-analysis. J Glob Health 2024; 14:05003. [PMID: 38419461 PMCID: PMC10902805 DOI: 10.7189/jogh.14.05003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Methods We searched MEDLINE, Embase, Global Health, CINAHL, China National Knowledge Infrastructure, Wanfang, CQvip, and the World Health Organization (WHO) COVID-19 global literature databases for primary studies recruiting children aged ≤18 years with a diagnosis of SARS-CoV-2 infection confirmed either by molecular or antigen tests. We used the Joanna Briggs Institute critical appraisal tools to appraise the study quality and conducted meta-analyses using the random effects model for all outcomes except for race/ethnicity as risk factors of SARS-CoV-2 infection. Results We included 237 studies, each reporting at least one of the study outcomes. Based on data from 117 studies, the pooled SARS-CoV-2 positivity rate was 9.30% (95% confidence interval (CI) = 7.15-11.73). Having a comorbidity was identified as a risk factor for SARS-CoV-2 infection (risk ratio (RR) = 1.33; 95% CI = 1.04-1.71) based on data from 49 studies. Most cases in this review presented with mild disease (n = 50; 52.47% (95% CI = 44.03-60.84)). However, 20.70% of paediatric SARS-CoV-2 infections were hospitalised (67 studies), 7.19% required oxygen support (57 studies), 4.26% required intensive care (93 studies), and 2.92% required assisted ventilation (63 studies). The case fatality ratio (n = 119) was 0.87% (95% CI = 0.54-1.28), which included in-hospital and out-of-hospital deaths. Conclusions Our data showed that children were at risk for SARS-CoV-2 infections and severe outcomes in the pre-Omicron era. These findings underscore the need for effective vaccination strategies for the paediatric population to protect against the acute and long-term sequelae of COVID-19. Registration PROSPERO: CRD42022327680.
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Affiliation(s)
- Durga Kulkarni
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Nabihah Farhana Ismail
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
- Communicable Disease Control Unit, Public Health Department, Johor State, Malaysia
| | - Fuyu Zhu
- Schol of Public Health, Nanjing Medical University, China
| | - Xin Wang
- Schol of Public Health, Nanjing Medical University, China
| | | | | | | | | | - Ahmed Ehsanur Rahman
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
- International Centre for Diarrhoeal Diseases Research, Bangladesh
| | | | - Harish Nair
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
- Schol of Public Health, Nanjing Medical University, China
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Gatell A, López N, Balaguer-Martínez J, González X, Martín R, Quezada G, Lobato Z, Ruiz M, Vilà M, Burgaya S, Sánchez A, Giribet M, Biosca M, Canadell D, Alcover E, Soriano-Arandes A. Prevalence, Clinical Characteristics and Risk Factors of Post-COVID-19 Condition in a Multicenter Pediatric Primary and Hospital Care Cohort. Pediatr Infect Dis J 2024; 43:e81-e83. [PMID: 38381955 DOI: 10.1097/inf.0000000000004188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
The prevalence of post-COVID-19 condition is not well defined. We describe a cohort of 244 children diagnosed with COVID-19 and followed up for 6 months, in which 4.9% of patients had persistent symptoms at 12 weeks. Anosmia was the most frequent symptom. Being female and having more than 3 symptoms in acute infection were associated with an increased risk of post-COVID.
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Affiliation(s)
| | - Núria López
- Department of Pediatrics, Hospital del Mar, Universitat Pompeu Fabra
| | | | - Xoan González
- Department of Pediatrics, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
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17
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Rao S, Gross RS, Mohandas S, Stein CR, Case A, Dreyer B, Pajor NM, Bunnell HT, Warburton D, Berg E, Overdevest JB, Gorelik M, Milner J, Saxena S, Jhaveri R, Wood JC, Rhee KE, Letts R, Maughan C, Guthe N, Castro-Baucom L, Stockwell MS. Postacute Sequelae of SARS-CoV-2 in Children. Pediatrics 2024; 153:e2023062570. [PMID: 38321938 PMCID: PMC10904902 DOI: 10.1542/peds.2023-062570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 02/08/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused significant medical, social, and economic impacts globally, both in the short and long term. Although most individuals recover within a few days or weeks from an acute infection, some experience longer lasting effects. Data regarding the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) in children, or long COVID, are only just emerging in the literature. These symptoms and conditions may reflect persistent symptoms from acute infection (eg, cough, headaches, fatigue, and loss of taste and smell), new symptoms like dizziness, or exacerbation of underlying conditions. Children may develop conditions de novo, including postural orthostatic tachycardia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, autoimmune conditions and multisystem inflammatory syndrome in children. This state-of-the-art narrative review provides a summary of our current knowledge about PASC in children, including prevalence, epidemiology, risk factors, clinical characteristics, underlying mechanisms, and functional outcomes, as well as a conceptual framework for PASC based on the current National Institutes of Health definition. We highlight the pediatric components of the National Institutes of Health-funded Researching COVID to Enhance Recovery Initiative, which seeks to characterize the natural history, mechanisms, and long-term health effects of PASC in children and young adults to inform future treatment and prevention efforts. These initiatives include electronic health record cohorts, which offer rapid assessments at scale with geographical and demographic diversity, as well as longitudinal prospective observational cohorts, to estimate disease burden, illness trajectory, pathobiology, and clinical manifestations and outcomes.
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Affiliation(s)
- Suchitra Rao
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Rachel S. Gross
- Departments of Pediatrics
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Sindhu Mohandas
- Division of Infectious Diseases
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Cheryl R. Stein
- Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Abigail Case
- Department of Pediatrics and Rehabilitation Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benard Dreyer
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nathan M. Pajor
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - H. Timothy Bunnell
- Biomedical Research Informatics Center, Nemours Children’s Health, Nemours Children’s Hospital, Delaware, Wilmington, Delaware
| | - David Warburton
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elizabeth Berg
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jonathan B. Overdevest
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Mark Gorelik
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Joshua Milner
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Sejal Saxena
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kyung E. Rhee
- Department of Pediatrics, University of California, San Diego, School of Medicine, San Diego, California
| | - Rebecca Letts
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Christine Maughan
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Nick Guthe
- Population Health, NYU Grossman School of Medicine, New York, New York
| | | | - Melissa S. Stockwell
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
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18
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Daniels D, Conners GP. Treatment of Acute COVID-19 and COVID-19 Exposures in Children and Adolescents. Pediatr Emerg Care 2024; 40:223-230. [PMID: 38416652 DOI: 10.1097/pec.0000000000003143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
ABSTRACT The landscape of acute COVID-19 therapeutics has dramatically evolved since the onset of the pandemic. The treatment of acute COVID-19 in children and adolescents requires knowledge of risk factors and clinical features to appropriately select antiviral and immunomodulatory therapies. This review article provides updated guidance for emergency physicians in the treatment of acute COVID-19 in children and adolescents.
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Affiliation(s)
- Danielle Daniels
- From the Assistant Professor of Pediatrics, Division of Pediatric Infectious Diseases
| | - Gregory P Conners
- Stanley A. August Professor and Chair of Pediatrics, Executive Director, Upstate Golisano Children's Hospital, SUNY Upstate Medical University, Syracuse, NY
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19
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Zhang J, Kuang T, Liu X. Advances in researches on long coronavirus disease in children: a narrative review. Transl Pediatr 2024; 13:318-328. [PMID: 38455739 PMCID: PMC10915432 DOI: 10.21037/tp-23-472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/31/2023] [Indexed: 03/09/2024] Open
Abstract
Background and Objective In the context of the global pandemic of coronavirus disease 2019 (COVID-19), more than 700 million infections and millions of deaths have occurred in countries around the world. Currently, two main sequelae of this disease are considered to occur in children, namely, multi-system inflammatory syndrome in children and long COVID. Among these two, the incidence of long COVID is higher and its impact on the population is more extensive, which is the focus of us. However, due to the lack of relevant studies and the limitations of most studies, the studies on sequelae of COVID-19 infection lag behind those of adults, but they have begun to attract the attention of some clinicians and researchers. We aim to summarize the current knowledge of long COVID in children, helping pediatricians and researchers to better understand this disease and providing guidance on research and clinical treatment of it. Methods We reviewed all the studies on "long COVID", pediatric, children, adolescent, post-COVID syndrome in PubMed published after 2019. Key Content and Findings This review summarizes the latest researches on epidemiology, pathogenesis, clinical manifestations, prevention and treatment of long COVID in children. Based on the existing research data, we summarized and analyzed the characteristics of long COVID in children, discovering the means to decipher the diagnosis of COVID-19 in children and some potential therapeutic treatments. Conclusions We aim to summarize existing research on long COVID in children and help pediatricians and government agencies quickly understand the disease so that it can be used for clinical diagnosis, treatment and prevention in the population. In addition, providing a research basis for further researches on the cellular and even molecular level to explain the occurrence and development of diseases, and has a guiding role for future research direction.
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Li L, Zhang J, Sun R, Liu H, Cheng G, Fan F, Wang C, Li A, Liang H, Yu Z, Wang G, Ren Z. Immune Dysregulation in SARS-CoV-2 patients coinfected with Mycobacterium tuberculosis (Mtb) or HIV in China. BMC Public Health 2024; 24:556. [PMID: 38388348 PMCID: PMC10882883 DOI: 10.1186/s12889-024-17905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND SARS-CoV-2 infections usually cause immune dysregulation in the human body. Studies of immunological changes resulting from coinfections with Mycobacterium tuberculosis (Mtb) or HIV are limited. METHODS We conducted a retrospective study focusing on patients with COVID-19. A total of 550 patients infected with SARS-CoV-2 were enrolled in our study and categorized into four groups based on the presence of coinfections; 166 Delta-infected patients, among whom 103 patients had no coinfections, 52 who were coinfected with Mtb, 11 who were coinfected with HIV, and 384 Omicron-infected patients. By collecting data on epidemiologic information, laboratory findings, treatments, and clinical outcomes, we analyzed and compared clinical and immunological characteristics. RESULTS Compared with those in the Delta group, the median white blood cell, CD4 + T-cell and B-cell counts were lower in the Mtb group and the HIV group. Except for those in the Omicron group, more than half of the patients in the three groups had abnormal chest CT findings. Among the three groups, there were no significant differences in any of the cytokines. Compared with those in the Delta group, the disease duration and LOS were longer in the Mtb group and the HIV group. For unvaccinated Delta-infected patients, in the Mtb and HIV groups, the number of B cells and CD4 + T cells was lower than that in the Delta group, with no significant difference in the LOS or disease duration. In the Mtb group, three (6%) patients presented with a disease duration greater than four months and had decreased lymphocyte and IL17A counts, possibly due to double infections in the lungs caused by SARS-CoV-2 and M. tuberculosis. CONCLUSIONS We found that SARS-CoV-2 patients coinfected with Mtb or HIV exhibited a longer disease duration and longer LOS, with a decrease in B cells and CD4 + T cells, suggesting that these cells are related to immune function. Changes in cytokine levels suggest that coinfection with Mtb or HIV does not result in dysregulation of the immune response. Importantly, we discovered a chronic course of coinfection involving more than four months of Mtb and SARS-CoV-2 infection.
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Affiliation(s)
- Lei Li
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, #1 Jianshe East Road, 450052, Zhengzhou, China
- State Key Laboratory of Antiviral Drugs, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Precision Medicine Center, Gene Hospital of Henan Province, the First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Jianxiang Zhang
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, #1 Jianshe East Road, 450052, Zhengzhou, China
- State Key Laboratory of Antiviral Drugs, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Precision Medicine Center, Gene Hospital of Henan Province, the First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Ranran Sun
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, #1 Jianshe East Road, 450052, Zhengzhou, China
- State Key Laboratory of Antiviral Drugs, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Precision Medicine Center, Gene Hospital of Henan Province, the First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Hong Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Genyang Cheng
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Feifei Fan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Chong Wang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Ang Li
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, #1 Jianshe East Road, 450052, Zhengzhou, China
- State Key Laboratory of Antiviral Drugs, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Precision Medicine Center, Gene Hospital of Henan Province, the First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Hongxia Liang
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, #1 Jianshe East Road, 450052, Zhengzhou, China
- State Key Laboratory of Antiviral Drugs, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Precision Medicine Center, Gene Hospital of Henan Province, the First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Zujiang Yu
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, #1 Jianshe East Road, 450052, Zhengzhou, China.
- State Key Laboratory of Antiviral Drugs, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China.
- Precision Medicine Center, Gene Hospital of Henan Province, the First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China.
| | - Guiqiang Wang
- Department of Infectious Diseases and the Center for Liver Diseases, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034, Beijing, China.
| | - Zhigang Ren
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, #1 Jianshe East Road, 450052, Zhengzhou, China.
- State Key Laboratory of Antiviral Drugs, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China.
- Precision Medicine Center, Gene Hospital of Henan Province, the First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China.
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21
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Schiavo M, Di Filippo P, Porreca A, Prezioso G, Orlandi G, Rossi N, Chiarelli F, Attanasi M. Potential Predictors of Long COVID in Italian Children: A Cross-Sectional Survey. CHILDREN (BASEL, SWITZERLAND) 2024; 11:221. [PMID: 38397333 PMCID: PMC10887525 DOI: 10.3390/children11020221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Identifying predictive factors of long COVID syndrome (LCS) is essential to preventing and managing this condition. We investigated the prevalence, symptoms, and risk factors of LCS in a cohort of Italian children and adolescents. METHODS We carried out a cross-sectional survey on demographic characteristics and clinical data related to COVID-19 phase and LCS in a cohort of children and adolescents, sending a questionnaire by using the PEDIATOTEM platform. RESULTS The prevalence of LCS was 25% (99/396). The most frequent symptoms of LCS included nasal congestion, diarrhea, headache, and fatigue. We found no association between demographic data (gender, age, and ethnicity) and LCS. Additionally, we showed that patients with concurrent allergic rhinitis, atopic dermatitis, respiratory disease, gastrointestinal disease, and rheumatologic disease had a higher risk of LCS than patients without those comorbidities. Patients experiencing fatigue, muscle, and abdominal pain in COVID-19 showed a higher risk of LCS than patients complaining of other symptoms. We found no association between vaccination and LCS. CONCLUSIONS Specific comorbidities or symptoms during acute illness were identified as being risk factors for LCS. Understanding which are the risk factors for LCS could yield a clearer picture of its pathogenesis.
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Affiliation(s)
- Marco Schiavo
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (M.S.); (P.D.F.); (G.P.); (G.O.); (N.R.); (F.C.)
| | - Paola Di Filippo
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (M.S.); (P.D.F.); (G.P.); (G.O.); (N.R.); (F.C.)
| | - Annamaria Porreca
- Department of Economic Studies, University of Chieti, 66100 Chieti, Italy;
| | - Giovanni Prezioso
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (M.S.); (P.D.F.); (G.P.); (G.O.); (N.R.); (F.C.)
| | - Greta Orlandi
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (M.S.); (P.D.F.); (G.P.); (G.O.); (N.R.); (F.C.)
| | - Nadia Rossi
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (M.S.); (P.D.F.); (G.P.); (G.O.); (N.R.); (F.C.)
| | - Francesco Chiarelli
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (M.S.); (P.D.F.); (G.P.); (G.O.); (N.R.); (F.C.)
| | - Marina Attanasi
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (M.S.); (P.D.F.); (G.P.); (G.O.); (N.R.); (F.C.)
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22
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Cho SM, Premraj L, Battaglini D, Fanning JP, Suen J, Bassi GL, Fraser J, Robba C, Griffee M, Solomon T, Semple MG, Baillie K, Sigfrid L, Scott JT, Citarella BW, Merson L, Arora RC, Whitman G, Thomson D, White N. Sex differences in post-acute neurological sequelae of SARS-CoV-2 and symptom resolution in adults after coronavirus disease 2019 hospitalization: an international multi-centre prospective observational study. Brain Commun 2024; 6:fcae036. [PMID: 38444907 PMCID: PMC10914448 DOI: 10.1093/braincomms/fcae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/11/2023] [Accepted: 02/06/2024] [Indexed: 03/07/2024] Open
Abstract
Although it is known that coronavirus disease 2019 can present with a range of neurological manifestations and in-hospital complications, sparse data exist on whether these initial neurological symptoms of coronavirus disease 2019 are closely associated with post-acute neurological sequelae of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; PANSC) and whether female versus male sex impacts symptom resolution. In this international, multi-centre, prospective, observational study across 407 sites from 15 countries (30 January 2020 to 30 April 2022), we report the prevalence and risk factors of PANSC among hospitalized adults and investigate the differences between males and females on neurological symptom resolution over time. PANSC symptoms included altered consciousness/confusion, fatigue/malaise, anosmia, dysgeusia and muscle ache/joint pain, on which information was collected at index hospitalization and during follow-up assessments. The analysis considered a time to the resolution of individual and all neurological symptoms. The resulting times were modelled by Weibull regression, assuming mixed-case interval censoring, with sex and age included as covariates. The model results were summarized as cumulative probability functions and age-adjusted and sex-adjusted median times to resolution. We included 6862 hospitalized adults with coronavirus disease 2019, who had follow-up assessments. The median age of the participants was 57 years (39.2% females). Males and females had similar baseline characteristics, except that more males (versus females) were admitted to the intensive care unit (30.5 versus 20.3%) and received mechanical ventilation (17.2 versus 11.8%). Approximately 70% of patients had multiple neurological symptoms at the first follow-up (median = 102 days). Fatigue (49.9%) and myalgia/arthralgia (45.2%) were the most prevalent symptoms of PANSC at the initial follow-up. The reported prevalence in females was generally higher (versus males) for all symptoms. At 12 months, anosmia and dysgeusia were resolved in most patients, although fatigue, altered consciousness and myalgia remained unresolved in >10% of the cohort. Females had a longer time to the resolution (5.2 versus 3.4 months) of neurological symptoms at follow-up for those with more than one neurological symptom. In the multivariable analysis, males were associated with a shorter time to the resolution of symptoms (hazard ratio = 1.53; 95% confidence interval = 1.39-1.69). Intensive care unit admission was associated with a longer time to the resolution of symptoms (hazard ratio = 0.68; 95% confidence interval = 0.60-0.77). Post-discharge stroke was uncommon (0.3% in females and 0.5% in males). Despite the methodological challenges involved in the collection of survey data, this international multi-centre prospective cohort study demonstrated that PANSC following index hospitalization was high. Symptom prevalence was higher and took longer to resolve in females than in males. This supported the fact that while males were sicker during acute illness, females were disproportionately affected by PANSC.
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Affiliation(s)
- Sung-Min Cho
- Neuroscience Critical Care Division, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21278, USA
- Neuroscience Critical Care Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21278, USA
- Neuroscience Critical Care Division, Department of Anaesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21278, USA
| | - Lavienraj Premraj
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
- Griffith University School of Medicine, Gold Coast 4215, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
| | - Denise Battaglini
- Department of Surgical Science and Integrated Diagnostic, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of Genoa, Genoa 16132, Italy
- Department of Medicine, University of Barcelona, Barcelona 08036, Spain
| | - Jonathon Paul Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Gianluigi Li Bassi
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
- Institut d’Investigacions Biomediques August Pi I Sunyer, Barcelona 08036, Spain
| | - John Fraser
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
- St Andrew’s War Memorial Hospital, UnitingCare, Spring Hill 4000, Australia
| | - Chiara Robba
- Department of Surgical Science and Integrated Diagnostic, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of Genoa, Genoa 16132, Italy
| | - Matthew Griffee
- Department of Anesthesiology, University of Utah, Salt Lake City, UT 84132, USA
| | - Tom Solomon
- Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, Liverpool, L3 5TR, UK
- Department of Neuroscience, University of Liverpool, Liverpool, L3 5TR, UK
- Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Malcolm G Semple
- Child Health and Outbreak Medicine, University of Liverpool, Liverpool, L3 5TR, UK
| | - Kenneth Baillie
- Experimental Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Louise Sigfrid
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7LG, UK
| | - Janet T Scott
- Infectious Disease, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Barbara Wanjiru Citarella
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, OX1 2JD, UK
| | - Laura Merson
- Institut d’Investigacions Biomediques August Pi I Sunyer, Barcelona 08036, Spain
| | - Rakesh C Arora
- Department of Surgery, University Hospitals/Case Western Reserve University, Cleveland, OH 44106, USA
| | - Glenn Whitman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21278, USA
| | - David Thomson
- Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town 7700, South Africa
- Division of Critical Care, Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Nicole White
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
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23
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Sansone F, Di Filippo P, Russo D, Sgrazzutti L, Di Pillo S, Chiarelli F, Attanasi M. Lung function assessment in children with Long-Covid syndrome. Pediatr Pulmonol 2024; 59:472-481. [PMID: 38088231 DOI: 10.1002/ppul.26779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 10/31/2023] [Accepted: 11/19/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION A significant percentage of patients who survived the Coronavirus Infection Disease 2019 (COVID-19) showed persistent general and respiratory symptoms even months after recovery. This condition, called Post-Acute Sequelae of COVID-19 or Long-Covid syndrome (LCS), has been described also in children with positive history for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Little is known about the pathophysiologic mechanisms underlying this syndrome. The aim of this study was to investigate any difference between children with LCS and asymptomatic peers with previous COVID-19 in terms of lung function and lung ultrasound (LUS) patterns. Secondly, we tested associations between lung function abnormalities and LUS findings with Long-Covid. METHODS We carried out a prospective, descriptive, observational study including 58 children aged 5-17 years: 28 with LCS compared to 30 asymptomatic children with previous COVID-19. We collected demographic data, history of asthma, allergy or smoke exposure, and acute COVID-19 symptoms. After a median period of 4.5 months (1%-95% range 2-21) since the infection, lung function was assessed by spirometry, body plethysmography, diffusion lung capacity for carbon monoxide (DLCO). Airways inflammation was investigated by fractional exhaled nitric oxide (FeNO). LUS was performed independently by two experienced clinicians. RESULTS We found that children with LCS were older than controls (mean (SD) 12 (4.1) vs. 9.7 (2.6); p = .04). Children with LCS complained more frequently fatigue (46.4%), cough (17.9%), exercise intolerance (14.3%) and dyspnea (14.3%). Lung function was normal and similar between the two groups. The frequency of LUS abnormalities was similar between the two groups (43.3% children with LCS vs. 56.7% controls; p = .436). Children with LCS showed lower FeNO values (log difference -0.30 (CI 95% -0.50, -0.10)), but no association of LCS with a lower lung function and abnormal LUS findings was found. CONCLUSIONS LCS seems to be more frequent in older age children. Lung functional and structural abnormalities were not different between children with LCS and asymptomatic subjects with previous COVID-19. In addition, children with LCS showed lower FeNO values than controls, suggesting its potential role as a marker in LCS. However, further and larger studies are needed to confirm our findings.
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Affiliation(s)
- Francesco Sansone
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Paola Di Filippo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Daniele Russo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Laura Sgrazzutti
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Sabrina Di Pillo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Marina Attanasi
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
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24
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Rayner DG, Wang E, Su C, Patel OD, Aleluya S, Giglia A, Zhu E, Siddique M. Risk factors for long COVID in children and adolescents: a systematic review and meta-analysis. World J Pediatr 2024; 20:133-142. [PMID: 38055113 DOI: 10.1007/s12519-023-00765-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/26/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The long-term sequelae of COVID-19 in children and adolescents remain poorly understood and characterized. This systematic review and meta-analysis sought to summarize the risk factors for long COVID in the pediatric population. METHODS We searched six databases from January 2020 to May 2023 for observational studies reporting on risk factors for long COVID or persistent symptoms those were present 12 or more weeks post-infection using multivariable regression analyses. Trial registries, reference lists of included studies, and preprint servers were hand-searched for relevant studies. Random-effects meta-analyses were conducted to pool odds ratios for each risk factor. Individual study risk of bias was rated using QUIPS, and the GRADE framework was used to assess the certainty of evidence for each unique factor. RESULTS Sixteen observational studies (N = 46,262) were included, and 19 risk factors were amenable to meta-analysis. With moderate certainty in the evidence, age (per 2-year increase), allergic rhinitis, obesity, previous respiratory diseases, hospitalization, severe acute COVID-19, and symptomatic acute COVID-19 are probably associated with an increased risk of long COVID. Female sex, asthma, comorbidity, and heart diseases may be associated with an increased risk of long COVID, and Asian and Black races may be associated with a decreased risk of long COVID. We did not observe any credible subgroup effects for any risk factor. CONCLUSIONS The current body of literature presents several compelling risk factors for the development of long COVID in the pediatric population. Further research is necessary to elucidate the pathophysiology of long COVID.
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Affiliation(s)
- Daniel G Rayner
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
| | - Elaine Wang
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Cloris Su
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Om D Patel
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Stephanie Aleluya
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Alessandra Giglia
- Faculty of Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Evelyn Zhu
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Maha Siddique
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
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25
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Pazukhina E, Rumyantsev M, Baimukhambetova D, Bondarenko E, Markina N, El-Taravi Y, Petrova P, Ezhova A, Andreeva M, Iakovleva E, Bobkova P, Pikuza M, Trefilova A, Abdeeva E, Galiautdinova A, Filippova Y, Bairashevskaia A, Zolotarev A, Bulanov N, DunnGalvin A, Chernyavskaya A, Kondrikova E, Kolotilina A, Gadetskaya S, Ivanova YV, Turina I, Eremeeva A, Fedorova LA, Comberiati P, Peroni DG, Nekliudov N, Genuneit J, Reyes LF, Brackel CLH, Mazankova L, Miroshina A, Samitova E, Borzakova S, Carson G, Sigfrid L, Scott JT, McFarland S, Greenhawt M, Buonsenso D, Semple MG, Warner JO, Olliaro P, Osmanov IM, Korsunskiy AA, Munblit D. Event rates and incidence of post-COVID-19 condition in hospitalised SARS-CoV-2 positive children and young people and controls across different pandemic waves: exposure-stratified prospective cohort study in Moscow (StopCOVID). BMC Med 2024; 22:48. [PMID: 38302974 PMCID: PMC10835884 DOI: 10.1186/s12916-023-03221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/07/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Long-term health outcomes in children and young people (CYP) after COVID-19 infection are not well understood and studies with control groups exposed to other infections are lacking. This study aimed to investigate the incidence of post-COVID-19 condition (PCC) and incomplete recovery in CYP after hospital discharge and compare outcomes between different SARS-CoV-2 variants and non-SARS-CoV-2 infections. METHODS A prospective exposure-stratified cohort study of individuals under 18 years old in Moscow, Russia. Exposed cohorts were paediatric patients admitted with laboratory-confirmed COVID-19 infection between April 2 and December 11, 2020 (Wuhan variant cohort) and between January 12 and February 19, 2022 (Omicron variant cohort). CYP admitted with respiratory and intestinal infections, but negative lateral flow rapid diagnostic test and PCR-test results for SARS-CoV-2, between January 12 and February 19, 2022, served as unexposed reference cohort. Comparison between the 'exposed cohorts' and 'reference cohort' was conducted using 1:1 matching by age and sex. Follow-up data were collected via telephone interviews with parents, utilising the long COVID paediatric protocol and survey developed by the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). The WHO case definition was used to categorise PCC. RESULTS Of 2595 CYP with confirmed COVID-19, 1707 (65.7%) participated in follow-up interviews, with 1183/1707 (69%) included in the final 'matched' analysis. The median follow-up time post-discharge was 6.7 months. The incidence of PCC was significantly higher in the Wuhan variant cohort (89.7 cases per 1000 person-months, 95% CI 64.3-120.3) compared to post-infection sequalae in the reference cohort (12.2 cases per 1000 person-months, 95% CI 4.9-21.9), whereas the difference with the Omicron variant cohort and reference cohort was not significant. The Wuhan cohort had higher incidence rates of dermatological, fatigue, gastrointestinal, sensory, and sleep manifestations, as well as behavioural and emotional problems than the reference cohort. The only significant difference between Omicron variant cohort and reference cohort was decreased school attendance. When comparing the Wuhan and Omicron variant cohorts, higher incidence of PCC and event rates of fatigue, decreased physical activity, and deterioration of relationships was observed. The rate of incomplete recovery was also significantly higher in the Wuhan variant cohort than in both the reference and the Omicron variant cohorts. CONCLUSIONS Wuhan variant exhibited a propensity for inducing a broad spectrum of physical symptoms and emotional behavioural changes, suggesting a pronounced impact on long-term health outcomes. Conversely, the Omicron variant resulted in fewer post-infection effects no different from common seasonal viral illnesses. This may mean that the Omicron variant and subsequent variants might not lead to the same level of long-term health consequences as earlier variants.
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Affiliation(s)
- Ekaterina Pazukhina
- Laboratory of Health Economics, Institute of Applied Economic Studies, The Russian Presidential Academy of National Economy and Public Administration, Moscow, Russia
- Center for Advanced Financial Planning, Macroeconomic Analysis and Financial Statistics, Financial Research Institute of the Ministry of Finance of the Russian Federation, Moscow, Russia
| | - Mikhail Rumyantsev
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Dina Baimukhambetova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Elena Bondarenko
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nadezhda Markina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yasmin El-Taravi
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Polina Petrova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anastasia Ezhova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Margarita Andreeva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ekaterina Iakovleva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Polina Bobkova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Maria Pikuza
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anastasia Trefilova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Elina Abdeeva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Aysylu Galiautdinova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yulia Filippova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anastasiia Bairashevskaia
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Aleksandr Zolotarev
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nikolay Bulanov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Audrey DunnGalvin
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- School of Applied Psychology, University College Cork, Cork City, Ireland
| | - Anastasia Chernyavskaya
- Department of Paediatrics and Paediatric Rheumatology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Elena Kondrikova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anastasia Kolotilina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Svetlana Gadetskaya
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yulia V Ivanova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Irina Turina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alina Eremeeva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ludmila A Fedorova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Diego G Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Nikita Nekliudov
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jon Genuneit
- Department of PediatricsPediatric Epidemiology, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Luis Felipe Reyes
- Universidad de La Sabana, School of Medicine, Chía, Colombia
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Caroline L H Brackel
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Department of Pediatrics, Tergooi MC, Hilversum, the Netherlands
| | - Lyudmila Mazankova
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Elmira Samitova
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia
| | - Svetlana Borzakova
- Department of Pediatrics, Russian Medical Academy of Continuing Professional Education of the Ministry of Health, Moscow, Russia
- Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, Moscow, Russia
| | - Gail Carson
- ISARIC Global Support Centre, Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Louise Sigfrid
- ISARIC Global Support Centre, Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Janet T Scott
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | | | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, USA
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Malcolm G Semple
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - John O Warner
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Piero Olliaro
- ISARIC Global Support Centre, Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ismail M Osmanov
- Department of Pediatrics, Russian Medical Academy of Continuing Professional Education of the Ministry of Health, Moscow, Russia
- ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia
| | - Anatoliy A Korsunskiy
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
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Minotti C, McKenzie C, Dewandel I, Bekker C, Sturniolo G, Doni D, Giaquinto C, Van Der Zalm MM, Donà D. How does post COVID differ from other post-viral conditions in childhood and adolescence (0-20 years old)? A systematic review. EClinicalMedicine 2024; 68:102436. [PMID: 38333536 PMCID: PMC10850405 DOI: 10.1016/j.eclinm.2024.102436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
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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Affiliation(s)
- Chiara Minotti
- Department of Women's and Children's Health, University of Padua, Italy
- PhD Program in Clinical Research, University Children's Hospital Basel, University of Basel, Switzerland
| | - Carla McKenzie
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Isabelle Dewandel
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carien Bekker
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Giulia Sturniolo
- Department of Women's and Children's Health, University of Padua, Italy
| | - Denis Doni
- Department of Women's and Children's Health, University of Padua, Italy
| | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padua, Italy
| | - Marieke M. Van Der Zalm
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Daniele Donà
- Department of Women's and Children's Health, University of Padua, Italy
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27
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Assia-Robles SI, Hernández-Morales MDR, Mancilla-Hernández E, López-Méndez DP, Nazarala-Sanchez S, González-Hidalgo SA. [Post-COVID-19 condition in children and adolescents from a cohort: prevalence and risk factors]. REVISTA ALERGIA MÉXICO 2024; 71:23-28. [PMID: 38683065 DOI: 10.29262/ram.v71i1.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/14/2023] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE To determine the prevalence and risk factors of the post-COVID-19 condition of children and adolescents from a cohort. METHODS Observational and analytical cohort study. Statistical analysis: percentages, frequencies; averages; Odds ratio, χ2 test, and multiple binary logistic regression. Statistical Package, for the Social Sciences 23. RESULTS Prevalence of the post-COVID-19 condition was: 14.8% of 175 patients who fulfilled the inclusion criteria, 26 developed post-COVID-19 condition, mean age 5.9 years (SD: 5.05), sex: 27% men, 73% women, frequent symptoms: fatigue, runny nose, muscle pain, dyspnea. Symptoms associated with post-COVID-19 condition: muscle pain (OR: 27; p = 0.000; IC95%5.2-139), dysgeusia (OR: 19; p = 0.012; IC95%: 1.9-19), and fatigue (OR: 5; p = 0.001; IC95%: 1.9-13.5). Associated risk factors: female (OR: 3.58; p = 0.023; CI95%: 1.19-10.71), comorbidities (OR: 24.5; p = 0.000; CI95%: 7.52-79), allergic rhinitis (OR: 8.7; p = 0.000; CI95%: 2.66-28.87), atopic dermatitis (OR: 9. 58; p = 0.016 CI95%: 1.51-60.5). CONCLUSIONS Although the majority of children infected with SARS-CoV-2 recover completely, some of them will develop a post-COVID-19 condition, knowing the most frequent symptoms and associated factors, will allow a better evaluation, for its opportune detection and effective treatment.
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28
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Indolfi C, Klain A, Dinardo G, D’Addio E, Ferrara S, Decimo F, Ciprandi G, Tosca MA, Miraglia del Giudice M. COVID-19 Pediatric Follow-Up: Respiratory Long COVID-Associated Comorbidities and Lung Ultrasound Alterations in a Cohort of Italian Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:166. [PMID: 38397278 PMCID: PMC10887372 DOI: 10.3390/children11020166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
In children, the factors that influence COVID-19 disease and its medium- and long-term effects are little known. Our investigation sought to evaluate the presence of comorbidity factors associated with respiratory long COVID manifestations in children and to study ultrasound abnormalities following SARS-CoV-2 infection. Children, who arrived at the 'Respiratory Diseases of Pediatric Interest Unit' at the Department of Woman, Child, and General and Specialized Surgery of the University of Campania 'Luigi Vanvitelli', were selected during the timeframe from September 2021 to October 2022. The children were diagnosed with a SARS-CoV-2 infection that occurred at least one month before the visit. All patients followed a COVID-19 follow-up protocol, developed by the Italian Society of Pediatric Respiratory Diseases (SIMRI), which included: collection of data regarding SARS-CoV-2 illness and history of known respiratory and allergic diseases; physical examination; BMI assessment; baseline spirometry and after bronchodilation test; six-minute walking test; and lung ultrasound (LUS). In a cohort of 104 participants with respiratory long COVID symptoms (64.7% male, average age 8.92 years), 46.1% had fever with other symptoms, and 1% required hospitalization. BMI analysis showed 58.4% of the cohort was overweight. The LUS was positive in 27.0% of cases. A significant BMI association was observed with COVID-19 symptoms and LUS score (p-value < 0.05). No associations were found with asthma or atopy.
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Affiliation(s)
- Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Giulio Dinardo
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Elisabetta D’Addio
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Serena Ferrara
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Fabio Decimo
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
| | - Giorgio Ciprandi
- Department of Medicine, Allergy Clinic, Casa di Cura Villa Montallegro, 16145 Genoa, Italy;
| | - Maria Angela Tosca
- Pediatric Allergy Center, Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Michele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.I.); (G.D.); (E.D.); (S.F.); (F.D.); (M.M.d.G.)
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29
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Glazyrina A, Zholobova E, Iakovleva E, Bobkova P, Krasnaya E, Kovygina K, Romanova O, Blyuss O, Tutelman K, Petrova P, Bairashevskaia A, Rumyantsev M, Korsunskiy AA, Kondrikova E, Nargizyan A, Yusupova V, Korobyants E, Sologub A, Kurbanova S, Suvorov A, Sigfrid L, Buonsenso D, Peroni DG, McArdle AJ, Comberiati P, Munblit D. Short-term and medium-term clinical outcomes of multisystem inflammatory syndrome in children: a prospective observational cohort study. Ital J Pediatr 2024; 50:1. [PMID: 38178192 PMCID: PMC10768316 DOI: 10.1186/s13052-023-01569-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Even though the incidence of Multisystem Inflammatory Syndrome in children (MIS-C) is decreasing cases are still reported across the world. Studying the consequences of MIS-C enhances our understanding of the disease's prognosis. The objective of this study was to assess short- and medium-term clinical outcomes of MIS-C. METHODS Prospective observational cohort study at Municipal Children's Hospital Morozovskaya, Moscow, Russia. All children meeting the Royal College of Paediatrics and Child Health (RCPCH), Centers for Disease Control and Prevention (CDC), or the World Health Organization (WHO) MIS-C case definition admitted to the hospital between 17 May and 26 October 2020 were included in the study. All survivors were invited to attend a clinic at 2 and 6 weeks after hospital discharge. RESULTS 37 children median age 6 years (interquartile range [IQR] 3.3-9.4), 59.5% (22/37) boys were included in the study. 48.6% (18/37) of patients required ICU care. One child died. All children had increased levels of systemic inflammatory markers during the acute event. Echocardiographic investigations identified abnormal findings in 35.1% (13/37) of children. 5.6% (2/36) of children were presenting with any symptoms six weeks after discharge. By six weeks the inflammatory markers were within the reference norms in all children. The echocardiographic evaluation showed persistent coronary dilatation in one child. CONCLUSIONS Despite the severity of their acute MIS-C, the majority of children in our cohort fully recovered with none having elevated laboratory markers of inflammation at 6 weeks, few (< 10%) reporting persistent symptoms at 6 weeks, and only one with persistent echocardiographic abnormalities.
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Affiliation(s)
- Anastasia Glazyrina
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Elena Zholobova
- Department of Children Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Ekaterina Iakovleva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Polina Bobkova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ekaterina Krasnaya
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Karina Kovygina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Olga Romanova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Oleg Blyuss
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Centre for Prevention, Detection and Diagnosis, Queen Mary University of London, London, UK
| | - Konstantin Tutelman
- Veltischev Clinical Pediatric Research Institute of Pirogov Russian National Research Medical University, Moscow, Russia
| | - Polina Petrova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anastasiia Bairashevskaia
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Mikhail Rumyantsev
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anatoliy A Korsunskiy
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Elena Kondrikova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anzhelika Nargizyan
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Valeriya Yusupova
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Evgeniya Korobyants
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Anna Sologub
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Seda Kurbanova
- Morozovskaya Children's Municipal Clinical Hospital of the Moscow City Health Department, Moscow, Russia
| | - Aleksandr Suvorov
- World-Class Research Center "Digital biodesign and personalized healthcare", Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Louise Sigfrid
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diego G Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Andrew James McArdle
- Department of Infectious Disease, Section of Pediatric Infectious Disease, Imperial College London, London, UK
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
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Kostev K, Smith L, Koyanagi A, Konrad M, Jacob L. Post-COVID-19 conditions in children and adolescents diagnosed with COVID-19. Pediatr Res 2024; 95:182-187. [PMID: 35568733 PMCID: PMC9107066 DOI: 10.1038/s41390-022-02111-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to investigate the prevalence of and the factors associated with post-COVID-2019 condition in COVID-19 children and adolescents in Germany. METHODS The present retrospective cohort study used data from the Disease Analyzer database (IQVIA), and included patients aged <18 years who were diagnosed with COVID-19 in one of 524 general and 81 pediatric practices in Germany between October 2020 and August 2021 (index date: first COVID-19 diagnosis). Post-COVID-19 condition was assessed between the index date and November 2021. Covariates included age, sex, type of practice, and chronic conditions documented in at least 1% of the population. RESULTS There were 6568 children and adolescents included in this study (mean [SD] age 10.1 [4.9] years; 49.2% girls). The prevalence of post-COVID-19 condition was 1.7% in the population. Patients aged 13-17 years were more likely to be diagnosed with post-COVID-19 condition compared with those being aged ≤5 years (RR = 3.14). Anxiety disorders (RR = 2.53), somatoform disorders (RR = 2.11), and allergic rhinitis (RR = 2.02) were also significantly associated with post-COVID-19 condition. CONCLUSION Post-COVID-19 condition was rare in COVID-19 children and adolescents in Germany. Data from other settings are warranted to confirm these findings. IMPACT The prevalence of post-COVID-19 condition was 1.7% in this population of children and adolescents. Older children and adolescents were more likely to be diagnosed with post-COVID-19 condition than their younger counterparts. Anxiety disorders, somatoform disorders, and allergic rhinitis were significantly associated with post-COVID-19 condition. More data from other settings and countries are warranted to corroborate or refute these findings.
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Affiliation(s)
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys 23, Barcelona, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
| | - Marcel Konrad
- Health & Social, FOM University of Applied Sciences for Economics and Management, Frankfurt am Main, Germany
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
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31
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Calcaterra G, Bassareo PP, Barilla' F, Mehta JL. Letter on the Recent Paper "Vascular 'Long COVID': A New Vessel Disease?". Angiology 2024; 75:98. [PMID: 36964670 DOI: 10.1177/00033197231167051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Affiliation(s)
| | - Pier Paolo Bassareo
- School of Medicine, Mater Misericordiae University Hospital and Children's Health at Crumlin, University College of Dublin, Dublin, Ireland
| | - Francesco Barilla'
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Javahar L Mehta
- Division of Cardiology, University of Arkansas for Medical Sciences and the VA Medical Center, Little Rock, AR, USA
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32
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Gordon AS, Shambhu S, Xia Y, Bowers PN, Sloop S, Hsu E. Clinical and healthcare utilization outcomes during the 6 months following COVID infection in children. Pediatr Res 2024; 95:342-349. [PMID: 37587368 DOI: 10.1038/s41390-023-02762-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/30/2023] [Accepted: 07/16/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND We aimed to identify the impact of COVID infection in children in the US prior to vaccine availability on clinical and healthcare utilization outcomes within 6 months of infection. METHODS Using claims data from a large national insurer, we identified 223,842 children with a COVID diagnosis in May 2020-March 2021 and matched them to 223,842 children with a COVID test and no diagnosis. We compared the two cohorts' outcomes during the 6 months after infection/test. RESULTS Uncommon acute adverse events occurring in <0.5% of cases, including MIS-C (relative risk (RR) = 45.2), myocarditis (RR = 10.3), acute heart failure (RR = 2.14), sepsis (RR = 2.02), and viral pneumonia (RR = 2.43) were more frequent in the COVID cohort (all p < 0.001). Development of arrhythmias (RR = 1.24, p < 0.001) and atherosclerotic cardiovascular disease (RR = 1.41, p = 0.007) were more common in the COVID group, while behavioral health disorders were less common (RR = 0.94, p < 0.001). Lab testing and imaging were slightly higher in the COVID group (RR ranging 1.05-1.11 depending on the service and timeframe), though medical costs did not increase. CONCLUSION Severe disease and diagnoses of new conditions are rare in children following COVID infection. We observed an increase in cardiac complications, though they may not last long term. IMPACT Few studies have analyzed the association between COVID infection and medium-term outcomes in children. Our study of >447,000 geographically and socioeconomically diverse children in the US found that uncommon acute adverse events, including myocarditis, MIS-C, and acute heart failure, were more frequent in children with COVID than matched controls, and development of arrhythmias and cardiovascular disease were 1.2 and 1.4 times more common, respectively. Six-month healthcare utilization was similar between cohorts. We provide data on the risks of COVID in children, particularly with respect to cardiac complications, that decision makers may find useful when weighing the benefits and harms of preventive measures.
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Affiliation(s)
- Aliza S Gordon
- Public Policy Institute, Elevance Health, Inc., Indianapolis, IN, 46204, USA.
| | - Sonali Shambhu
- Public Policy Institute, Elevance Health, Inc., Indianapolis, IN, 46204, USA
| | - Yaoxuan Xia
- Carelon Research, Wilmington, DE, 19801, USA
| | - Peter N Bowers
- Population Health Management Support, Elevance Health, Inc., Indianapolis, IN, 46204, USA
| | - Sue Sloop
- Health Economics, Elevance Health, Inc., Indianapolis, IN, 46204, USA
| | - Eugene Hsu
- Medicare Clinical Operations, Elevance Health, Inc., Indianapolis, IN, 46204, USA
- Stanford University School of Medicine, Stanford, CA, 94305, USA
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Chuang HJ, Lin CW, Hsiao MY, Wang TG, Liang HW. Long COVID and rehabilitation. J Formos Med Assoc 2024; 123 Suppl 1:S61-S69. [PMID: 37061399 PMCID: PMC10101546 DOI: 10.1016/j.jfma.2023.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/17/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has caused tremendous morbidity and mortality worldwide. The large number of post-COVID survivors has drawn attention to the management of post-COVID condition, known as long COVID. This review examines current knowledge of long COVID, regarding its epidemiology, mechanism, and clinical presentations in both adults and children. We also review the rehabilitation principles, modules, and effects, and share Taiwan's efforts to provide a top-down, nationwide care framework for long COVID patients. Dyspnea, chronic cough, and fatigue are the most commonly reported symptoms in the first 6 months after infection, but cognitive impairment and psychological symptoms may persist beyond this time. Several possible mechanisms behind these symptoms were proposed, but remained unconfirmed. These symptoms negatively impact individuals' function, activities, participation and quality of life. Rehabilitation is a key element of management to achieve functional improvement. Early management should start with comprehensive evaluation and identification of red flags. Exercise-based therapy, an essential part of management of long COVID, can be conducted with different modules, including telerehabilitation. Post-exertional symptom exacerbation and orthostatic hypotension should be carefully monitored during exercise. Randomized control trials with a large sample size are needed to determine the optimal timing, dosage, and modules.
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Affiliation(s)
- Hung-Jui Chuang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Chia-Wei Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC
| | - Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan, ROC.
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Behnood S, Newlands F, O’Mahoney L, Haghighat Ghahfarokhi M, Muhid MZ, Dudley J, Stephenson T, Ladhani SN, Bennett S, Viner RM, Bhopal R, Kolasinska P, Shafran R, Swann OV, Takeda A. Persistent symptoms are associated with long term effects of COVID-19 among children and young people: Results from a systematic review and meta-analysis of controlled studies. PLoS One 2023; 18:e0293600. [PMID: 38153928 PMCID: PMC10754445 DOI: 10.1371/journal.pone.0293600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/16/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Research on the long-term impact on COVID-19 in children and young people (CYP) has been published at pace. We aimed to update and refine an earlier systematic review and meta-analysis to assess the current evidence for Post-COVID-19 Condition in CYP. METHODS Studies from the previous systematic review were combined with studies from a systematic search from July 2021 to November 2022 (registration PROSPERO CRD42021233153). Eligible studies included CYP aged ≤19 years with confirmed or probable SARS-CoV-2 infection and symptoms persisting at least 12 weeks. FINDINGS 55 studies (n = 1,139,299 participants) were included. Over two-hundred symptoms were associated with Post COVID-19 Condition. Gastrointestinal problems, headaches, cough and fever were among the most prevalent symptoms with rates of 50.2%, 35.6%, 34.7% and 25.8% respectively. Twenty-one symptoms from 11 studies were suitable for meta-analysis. There were significantly higher pooled estimates of proportions of symptoms for altered / loss of smell or taste, dyspnoea, fatigue, and myalgia in CYP with confirmed SARS-CoV-2 infection. Heterogeneity was high suggesting substantial variation amongst the included studies. CONCLUSIONS Many CYP continue to experience symptoms after SARS-CoV-2 infection. Efforts to aid early identification and intervention of those most in need is warranted and the consequences of COVID-19 for CYP call for long-term follow-up.
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Affiliation(s)
- Sanaz Behnood
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona Newlands
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Lauren O’Mahoney
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | | | | | - Jake Dudley
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Terence Stephenson
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Shamez N. Ladhani
- Immunisation Department, MRCPCH(UK), UK Health Security Agency, London, United Kingdom
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Russell M. Viner
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Rowan Bhopal
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Paige Kolasinska
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Olivia V. Swann
- Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Andrea Takeda
- Freelance Systematic Reviewer, Winchester, United Kingdom
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Ha EK, Kim JH, Han MY. Long COVID in children and adolescents: prevalence, clinical manifestations, and management strategies. Clin Exp Pediatr 2023; 66:465-474. [PMID: 37350170 PMCID: PMC10626026 DOI: 10.3345/cep.2023.00472] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/09/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023] Open
Abstract
Long coronavirus disease (COVID), also known as postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection, has been defined as signs and symptoms which persist for 4 weeks or even lasting for 6 months after the initial infection. Although the prevalence of long COVID in children is currently unknown, epidemiological investigations have reported cases in pediatric populations. Clinical manifestations of long COVID in children include respiratory symptoms, such as cough and dyspnea, as well as neuropsychiatric and general conditions, including fatigue, headache, and muscle weakness. The pathophysiology of long COVID in children is still being investigated, but potential mechanisms include viral persistence, autoimmunity, and neuroinflammation. Risk factors for long COVID in children are not yet well understood, but studies have suggested that children with a history of severe acute COVID-19 infection or comorbidities may be at increased risk. Evaluation for respiratory symptoms of long COVID in children is essential, including spirometry and imaging studies to assess lung function and any potential damage. Furthermore, long COVID in children has been associated with a higher prevalence of mental health problems than in adults, emphasizing the importance of monitoring and addressing these aspects in pediatric patients. Although our understanding of long COVID in children and adolescents is still evolving, it is clear that the condition can have significant impacts on their health and well-being. The aim of this review is to synthesize the current knowledge on the prevalence, risk factors, and pathophysiology of long COVID in children and adolescents, and to discuss potential management strategies based on existing evidence.
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Affiliation(s)
- Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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36
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Tang SW, Helmeste DM, Leonard BE. COVID-19 as a polymorphic inflammatory spectrum of diseases: a review with focus on the brain. Acta Neuropsychiatr 2023; 35:248-269. [PMID: 36861428 DOI: 10.1017/neu.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
There appear to be huge variations and aberrations in the reported data in COVID-19 2 years now into the pandemic. Conflicting data exist at almost every level and also in the reported epidemiological statistics across different regions. It is becoming clear that COVID-19 is a polymorphic inflammatory spectrum of diseases, and there is a wide range of inflammation-related pathology and symptoms in those infected with the virus. The host's inflammatory response to COVID-19 appears to be determined by genetics, age, immune status, health status and stage of disease. The interplay of these factors may decide the magnitude, duration, types of pathology, symptoms and prognosis in the spectrum of COVID-19 disorders, and whether neuropsychiatric disorders continue to be significant. Early and successful management of inflammation reduces morbidity and mortality in all stages of COVID-19.
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Affiliation(s)
- Siu Wa Tang
- Department of Psychiatry, University of California, Irvine, Irvine, CA, USA
- Institute of Brain Medicine, Hong Kong, China
| | - Daiga Maret Helmeste
- Department of Psychiatry, University of California, Irvine, Irvine, CA, USA
- Institute of Brain Medicine, Hong Kong, China
| | - Brian E Leonard
- Institute of Brain Medicine, Hong Kong, China
- Department of Pharmacology, National University of Ireland, Galway, Ireland
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Su S, Zhao Y, Zeng N, Liu X, Zheng Y, Sun J, Zhong Y, Wu S, Ni S, Gong Y, Zhang Z, Gao N, Yuan K, Yan W, Shi L, Ravindran AV, Kosten T, Shi J, Bao Y, Lu L. Epidemiology, clinical presentation, pathophysiology, and management of long COVID: an update. Mol Psychiatry 2023; 28:4056-4069. [PMID: 37491461 DOI: 10.1038/s41380-023-02171-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/27/2023]
Abstract
The increasing number of coronavirus disease 2019 (COVID-19) infections have highlighted the long-term consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection called long COVID. Although the concept and definition of long COVID are described differently across countries and institutions, there is general agreement that it affects multiple systems, including the immune, respiratory, cardiovascular, gastrointestinal, neuropsychological, musculoskeletal, and other systems. This review aims to provide a synthesis of published epidemiology, symptoms, and risk factors of long COVID. We also summarize potential pathophysiological mechanisms and biomarkers for precise prevention, early diagnosis, and accurate treatment of long COVID. Furthermore, we suggest evidence-based guidelines for the comprehensive evaluation and management of long COVID, involving treatment, health systems, health finance, public attitudes, and international cooperation, which is proposed to improve the treatment strategies, preventive measures, and public health policy making of long COVID.
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Affiliation(s)
- Sizhen Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yimiao Zhao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Scholl of Public Health, Peking University, Beijing, China
| | - Na Zeng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Scholl of Public Health, Peking University, Beijing, China
| | - Xiaoxing Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yongbo Zheng
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Jie Sun
- Pain Medicine Center, Peking University Third Hospital, Beijing, China
| | - Yi Zhong
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Shuilin Wu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Scholl of Public Health, Peking University, Beijing, China
| | - Shuyu Ni
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Scholl of Public Health, Peking University, Beijing, China
| | - Yimiao Gong
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Zhibo Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Nan Gao
- The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Kai Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Wei Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Thomas Kosten
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.
- Scholl of Public Health, Peking University, Beijing, China.
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China.
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Meng QT, Song WQ, Churilov LP, Zhang FM, Wang YF. Psychophysical therapy and underlying neuroendocrine mechanisms for the rehabilitation of long COVID-19. Front Endocrinol (Lausanne) 2023; 14:1120475. [PMID: 37842301 PMCID: PMC10570751 DOI: 10.3389/fendo.2023.1120475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
With the global epidemic and prevention of the COVID-19, long COVID-19 sequelae and its comprehensive prevention have attracted widespread attention. Long COVID-19 sequelae refer to that three months after acute COVID-19, the test of SARS-CoV-2 is negative, but some symptoms still exist, such as cough, prolonged dyspnea and fatigue, shortness of breath, palpitations and insomnia. Its pathological mechanism is related to direct viral damage, immunopathological response, endocrine and metabolism disorders. Although there are more effective methods for treating COVID-19, the treatment options available for patients with long COVID-19 remain quite limited. Psychophysical therapies, such as exercise, oxygen therapy, photobiomodulation, and meditation, have been attempted as treatment modalities for long COVID-19, which have the potential to promote recovery through immune regulation, antioxidant effects, and neuroendocrine regulation. Neuroendocrine regulation plays a significant role in repairing damage after viral infection, regulating immune homeostasis, and improving metabolic activity in patients with long COVID-19. This review uses oxytocin as an example to examine the neuroendocrine mechanisms involved in the psychophysical therapies of long COVID-19 syndrome and proposes a psychophysical strategy for the treatment of long COVID-19.
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Affiliation(s)
- Qing-Tai Meng
- WU Lien-Teh Institute, Department of Microbiology, Harbin Medical University, Harbin, China
| | - Wu-Qi Song
- WU Lien-Teh Institute, Department of Microbiology, Harbin Medical University, Harbin, China
| | - Leonid P. Churilov
- Department of Experimental Tuberculosis, St. Petersburg State Research Institute of Phthisiopulmonology, Saint-Petersburg, Russia
| | - Feng-Min Zhang
- WU Lien-Teh Institute, Department of Microbiology, Harbin Medical University, Harbin, China
| | - Yu-Feng Wang
- Department of Physiology, Harbin Medical University, Harbin, China
- International Translational Neuroscience Research Institute, Zhejiang Chinese Medical University, Hangzhou, China
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Ambalavanan R, Snead RS, Marczika J, Kozinsky K, Aman E. Advancing the Management of Long COVID by Integrating into Health Informatics Domain: Current and Future Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6836. [PMID: 37835106 PMCID: PMC10572294 DOI: 10.3390/ijerph20196836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
The ongoing COVID-19 pandemic has profoundly affected millions of lives globally, with some individuals experiencing persistent symptoms even after recovering. Understanding and managing the long-term sequelae of COVID-19 is crucial for research, prevention, and control. To effectively monitor the health of those affected, maintaining up-to-date health records is essential, and digital health informatics apps for surveillance play a pivotal role. In this review, we overview the existing literature on identifying and characterizing long COVID manifestations through hierarchical classification based on Human Phenotype Ontology (HPO). We outline the aspects of the National COVID Cohort Collaborative (N3C) and Researching COVID to Enhance Recovery (RECOVER) initiative in artificial intelligence (AI) to identify long COVID. Through knowledge exploration, we present a concept map of clinical pathways for long COVID, which offers insights into the data required and explores innovative frameworks for health informatics apps for tackling the long-term effects of COVID-19. This study achieves two main objectives by comprehensively reviewing long COVID identification and characterization techniques, making it the first paper to explore incorporating long COVID as a variable risk factor within a digital health informatics application. By achieving these objectives, it provides valuable insights on long COVID's challenges and impact on public health.
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Affiliation(s)
- Radha Ambalavanan
- The Self Research Institute, Broken Arrow, OK 74011, USA; (R.S.S.); (J.M.); (K.K.); (E.A.)
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Körner RW, Bansemir OY, Franke R, Sturm J, Dafsari HS. Atopy and Elevation of IgE, IgG3, and IgG4 May Be Risk Factors for Post COVID-19 Condition in Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1598. [PMID: 37892261 PMCID: PMC10605545 DOI: 10.3390/children10101598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 10/29/2023]
Abstract
SARS-CoV-2 infection causes transient cardiorespiratory and neurological disorders, and severe acute illness is rare among children. Post COVID-19 condition (PCC) may cause profound, persistent phenotypes with increasing prevalence. Its manifestation and risk factors remain elusive. In this monocentric study, we hypothesized that atopy, the tendency to produce an exaggerated immunoglobulin E (IgE) immune response, is a risk factor for the manifestation of pediatric PCC. We present a patient cohort (n = 28) from an early pandemic period (2021-2022) with comprehensive evaluations of phenotypes, pulmonary function, and molecular investigations. PCC predominantly affected adolescents and presented with fatigue, dyspnea, and post-exertional malaise. Sensitizations to aeroallergens were found in 93% of cases. We observed elevated IgE levels (mean 174.2 kU/L, reference < 100 kU/L) regardless of disease severity. Concurrent Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) was found in 29% of patients that also faced challenges in school attendance. ME/CFS manifestation was significantly associated with elevated immunoglobulin G subclasses IgG3 (p < 0.05) and IgG4 (p < 0.05). A total of 57% of patients showed self-limiting disease courses with mean recovery at 12.7 months (range 5-25 months), 29% at 19.2 months (range 12-30 months), and the rest demonstrated overall improvement. These findings offer additional insights into immune dysregulation as a risk factor for pediatric PCC.
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Affiliation(s)
- Robert Walter Körner
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Ole Yannick Bansemir
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Rosa Franke
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Julius Sturm
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Hormos Salimi Dafsari
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- Center for Rare Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- Max-Planck-Institute for Biology of Ageing, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
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Esposito S, Deolmi M, Ramundo G, Puntoni M, Caminiti C, Principi N. True prevalence of long COVID in children: a narrative review. Front Microbiol 2023; 14:1225952. [PMID: 37789860 PMCID: PMC10543413 DOI: 10.3389/fmicb.2023.1225952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/23/2023] [Indexed: 10/05/2023] Open
Abstract
Contrary to what is true for adults, little is known about pediatric long COVID (LC). Studies enrolling children are relatively few and extremely heterogeneous. This does not allow to draw definitive conclusions on the frequency and pathogenesis of pediatric LC and limits the development of appropriate and effective measures to contain the clinical, social and economic impact of this condition on the pediatric population. Depending on the methods used to collect and analyze data, studies have found that the incidence rate of pediatric LC may vary from about 25% to less than 5%. However, despite true prevalence of pediatric LC cannot be exactly defined, studies comparing children with previous COVID-19 and uninfected controls have shown that most of the clinical manifestations detected in infected children, mainly mood symptoms, mental health disorders and heart abnormalities could be diagnosed with similar frequency and severity in uninfected subjects also. This seems to indicate that SARS-CoV-2 is the cause of pediatric LC only in a part of children and other factors play a relevant role in this regard. Pandemic itself with the persistent disruption of child lives may have caused persistent stress in all the pediatric population causing mood symptoms, mental health disorders or several organ and body system functional alterations, regardless SARS-CoV-2 infection. These suppositions suggest the need for long-term physical control of all the children after COVID-19 especially when they were already suffering from an underlying disease or have had a severe disease. Moreover, attention should be paid to the assessment of change in children's emotional and behavioral functioning in order to assure adequate interventions for the best emotional and behavioral well being. However, whatever its origin, it seems highly likely that the prevalence of the pediatric LC is set to decline in the future. Preliminary observations seem to suggest that recently developed SARS-CoV-2 variants are associated with less severe COVID-19. This suggests that, as already seen in adults, a lower number of pediatric virus-associated LC cases should occur. Furthermore, the use of COVID-19 vaccines, reducing incidence and severity of SARS-CoV-2 infection, may reduce risk of LC development. Finally, elimination of restrictive measures should significantly reduce mood symptoms and mental health disorders.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Michela Deolmi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Greta Ramundo
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Matteo Puntoni
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Caterina Caminiti
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
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Mammas IN, Drysdale SB, Charalampous C, Koletsi P, Papatheodoropoulou A, Koutsaftiki C, Sergentanis T, Merakou K, Kornarou H, Papaioannou G, Kramvis A, Greenough A, Theodoridou M, Spandidos DA. Navigating paediatric virology through the COVID‑19 era (Review). Int J Mol Med 2023; 52:83. [PMID: 37503745 PMCID: PMC10555476 DOI: 10.3892/ijmm.2023.5286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
The present review article presents the key messages of the 8th Workshop on Paediatric Virology organised virtually by the Institute of Paediatric Virology based on the island of Euboea in Greece. The major topics covered during the workshop were the following: i) New advances in antiviral agents and vaccines against cytomegalovirus; ii) hantavirus nephropathy in children; iii) human rhinovirus infections in children requiring paediatric intensive care; iv) complications and management of human adenovirus infections; v) challenges of post‑coronavirus disease 2019 (COVID‑19) syndrome in children and adolescents; and vi) foetal magnetic resonance imaging in viral infections involving the central nervous system. The COVID‑19 era requires a more intensive, strategic, global scientific effort in the clinic and in the laboratory, focusing on the diagnosis, management and prevention of viral infections in neonates and children.
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Affiliation(s)
- Ioannis N. Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion
- First Department of Paediatrics, School of Medicine, University of Athens, 11527 Athens
- Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece
| | - Simon B. Drysdale
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London SW17 0RE
- Department of Paediatrics, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | | | - Patra Koletsi
- Department of Paediatrics, 'Penteli' Children's Hospital, 15236 Palaia Penteli
- Paediatric Intensive Care Unit (PICU), 'Penteli' Children's Hospital, 15236 Palaia Penteli
| | | | - Chryssie Koutsaftiki
- COVID-19 Reference Centre, 'Rafina' Health Care Centre, 19009 Rafina
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Theodoros Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Kyriakoula Merakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Helen Kornarou
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Georgia Papaioannou
- Department of Paediatric Radiology, 'Mitera' Children's Hospital, 15123 Athens, Greece
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, 2193 Johannesburg, South Africa
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, King's College London, London SE5 9RS, UK
| | - Maria Theodoridou
- First Department of Paediatrics, School of Medicine, University of Athens, 11527 Athens
| | - Demetrios A. Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion
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Quan M, Wang X, Gong M, Wang Q, Li Y, Jia J. Post-COVID cognitive dysfunction: current status and research recommendations for high risk population. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100836. [PMID: 37457901 PMCID: PMC10344681 DOI: 10.1016/j.lanwpc.2023.100836] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/13/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
Post-COVID cognitive dysfunction (PCCD) is a condition in which patients with a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, usually three months from the onset, exhibit subsequent cognitive impairment in various cognitive domains, and cannot be explained by an alternative diagnosis. While our knowledge of the risk factors and management strategy of PCCD is still incomplete, it is necessary to integrate current epidemiology, diagnosis and treatment evidence, and form consensus criteria to better understand this disease to improve disease management. Identifying the risk factors and vulnerable population of PCCD and providing reliable strategies for effective prevention and management is urgently needed. In this paper, we reviewed epidemiology, diagnostic markers, risk factors and available treatments on the disease, formed research recommendation framework for vulnerable population, under the background of post-COVID period.
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Affiliation(s)
- Meina Quan
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
- National Medical Center for Neurological Disorders and National Clinical Research Center for Geriatric Diseases, China
| | - Xuechu Wang
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Min Gong
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Qi Wang
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
- National Medical Center for Neurological Disorders and National Clinical Research Center for Geriatric Diseases, China
| | - Yan Li
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Jianping Jia
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, China
- National Medical Center for Neurological Disorders and National Clinical Research Center for Geriatric Diseases, China
- Beijing Key Laboratory of Geriatric Cognitive Disorders, China
- Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, China
- Center of Alzheimer's Disease, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, China
- Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China
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Jiang L, Li X, Nie J, Tang K, Bhutta ZA. A Systematic Review of Persistent Clinical Features After SARS-CoV-2 in the Pediatric Population. Pediatrics 2023; 152:e2022060351. [PMID: 37476923 PMCID: PMC10389775 DOI: 10.1542/peds.2022-060351] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 07/22/2023] Open
Abstract
CONTEXT Long-term health effects after coronavirus disease 2019 (COVID-19) have been increasingly reported but their prevalence and significance in the pediatric population remains uncertain. OBJECTIVE To present the prevalence and characteristics of the long-term clinical features of COVID-19 (long COVID) in the global pediatric population. DATA SOURCES PubMed, Embase, Web of Science, Cochrane Library, WHO COVID-19 database, google scholar, medRxiv, bioRxiv, and multiple national public health databases. STUDY SELECTION Published articles and preprints from December, 2019 to December, 2022 investigating the epidemiology and characteristics of persistent clinical features at least 3 months after COVID-19 in children and adolescents (0-19 years old) were included. DATA EXTRACTION Study characteristics and detailed description of long COVID were extracted into a predefined form. RESULTS Twenty seven cohorts and 4 cross-sectional studies met the inclusion criteria and involved over 15 000 pediatric participants. A total of more than 20 persistent symptoms and clinical features were reported among children and adolescents. 16.2% (95% confidence interval 8.5% to 28.6%) of the pediatric participants experienced 1 or more persistent symptom(s) at least 3 months post COVID-19. Female gender might be associated with developing certain long COVID symptoms. LIMITATIONS Included studies presented with great heterogeneity because of significant variations in the definition of "long COVID," follow up duration, and method. There could be nonresponse and other potential bias. CONCLUSIONS Persistent clinical features beyond 3 months among children and adolescents with proven COVID-19 are common and the symptom spectrum is wide. High-quality, prospective studies with proper controls are necessary in the future.
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Affiliation(s)
- Li Jiang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Xuan Li
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jia Nie
- Institute for Risk Assessment Science (IRAS), Utrecht University, the Netherlands
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
- Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
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Nemyatykh OD, Maistrenko MA, Demchenko DD, Narkevich IA, Okovityi SV, Timchenko VN. Principles of Rational COVID-19 Therapy in Pediatrics. J Clin Med 2023; 12:4731. [PMID: 37510846 PMCID: PMC10380754 DOI: 10.3390/jcm12144731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
The purpose of this review was to conduct a comparative assessment of the concepts of therapy for pediatric patients with COVID-19 in the framework of global clinical practice. A structural analysis of the range of drugs and treatment strategies in the context of etiotropic, pathogenetic, and symptomatic therapy has shown that in the global context and in real clinical practice, the etiotropic-pathogenetic approach based on information about the effectiveness of individual medical technologies prevails today. It has been established that eight international nonproprietary/grouping names are present in international practice as means of etiotropic therapy for pediatric patients with COVID-19, and 18 positions are used for pathogenetic therapy. In terms of frequency of occurrence, the leading positions are occupied by remdesivir and the combination of nirmatrelvir with ritonavir, as well as dexamethasone and tocilizumab. The paper emphasizes the relevance of research in the field of evaluating the effectiveness of individual treatment regimens as well as the analysis of the delayed consequences of pathology suffered in childhood under the conditions of using various approaches to pharmacotherapy.
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Affiliation(s)
- Oksana D. Nemyatykh
- Department of Management and Economics of Pharmacy, Faculty of Pharmacy, Saint-Petersburg State Chemical Pharmaceutical University, Ministry of Health of Russia, Prof. Popova Str., 14 Lit. A, 197376 Saint-Petersburg, Russia
| | - Marina A. Maistrenko
- Department of Management and Economics of Pharmacy, Faculty of Pharmacy, Ryazan State Medical University Named after Academician I.P. Pavlov, Ministry of Health of Russia, Vysokovoltnaya Str., 9, 390026 Ryazan, Russia
| | - Dina D. Demchenko
- Department of Management and Economics of Pharmacy, Faculty of Pharmacy, Saint-Petersburg State Chemical Pharmaceutical University, Ministry of Health of Russia, Prof. Popova Str., 14 Lit. A, 197376 Saint-Petersburg, Russia
| | - Igor A. Narkevich
- Department of Management and Economics of Pharmacy, Faculty of Pharmacy, Saint-Petersburg State Chemical Pharmaceutical University, Ministry of Health of Russia, Prof. Popova Str., 14 Lit. A, 197376 Saint-Petersburg, Russia
| | - Sergey V. Okovityi
- Department of Pharmacology and Clinical Pharmacology, Faculty of Pharmacy, Saint-Petersburg State Chemical Pharmaceutical University, Ministry of Health of Russia, Prof. Popova Str., 14 Lit. A, 197376 Saint-Petersburg, Russia
| | - Vladimir N. Timchenko
- Department of Infectious Diseases in Children Named after Prof. M.G. Danilevich, Faculty of Pediatrics, Saint-Petersburg State Pediatric Medical University, Ministry of Health of Russia, Litovskaya Str., 2, 194100 Saint-Petersburg, Russia
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Miraglia Del Giudice M, Klain A, Dinardo G, D'Addio E, Bencivenga CL, Fontanella C, Decimo F, Umano GR, Siciliano M, Carotenuto M, Indolfi C. Behavioral and Sleep Disorders in Children and Adolescents following COVID-19 Disease: A Case-Control Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1189. [PMID: 37508686 PMCID: PMC10378309 DOI: 10.3390/children10071189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Recent studies show that neuropsychiatric disorders are the most frequent sequelae of COVID-19 in children. PURPOSE Our work aimed to evaluate the impact of SARS-CoV-2 infection on behavior and sleep in children and adolescents. MATERIALS AND METHODS We enrolled 107 patients aged 1.5-18 years who contracted COVID-19 between one year and one month prior to data collection, referred to the University of Campania Luigi Vanvitelli in Italy. We asked their parents to complete two standardized questionnaires for the assessment of behavior (Child Behavior CheckList (CBCL)) and sleep (Sleep Disturbance Scale for Children (SLDS)). We analysed and compared the results with a control group (pre-COVID-19 pandemic). RESULTS In the COVID-19 group, the major results were found for sleep breathing disorders, sleep-wake transition disorders and disorders of initiating and maintaining sleep for the SDSC questionnaire, and internalizing scale, total scale and anxiety/depression for the CBCL questionnaire. The comparison of the CBCL results of the cases with the controls revealed statistically significant differences for the following items: internalizing scale, externalizing scale, somatic complaints, total score, thought problems [(p < 0.01)], anxious/depressed problems and withdrawn [(p < 0.001)]. CONCLUSIONS COVID-19 has impacted children's and adolescents' mental health. Adolescents were the most affected patient group for internalizing problems, including anxiety and depression.
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Affiliation(s)
- Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Giulio Dinardo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Elisabetta D'Addio
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Chiara Lucia Bencivenga
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Cristina Fontanella
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Caserta, Italy
| | - Fabio Decimo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Margherita Siciliano
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Caserta, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Caserta, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
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Howe de la Torre S, Parlatini V, Cortese S. Long-term central nervous system (CNS) consequences of COVID-19 in children. Expert Rev Neurother 2023; 23:703-720. [PMID: 37545414 DOI: 10.1080/14737175.2023.2239500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Neurological/neuropsychiatric symptoms are commonly reported by children/young people with long COVID, especially headache, fatigue, cognitive deficits, anosmia and ageusia, dizziness, mood symptoms, and sleep problems. However, reported prevalence estimates are highly variable due to study heterogeneity and often small sample size; most studies only considered short-term follow-ups; and, apart from mood and sleep problems, neuropsychiatric conditions have received less attention. Considering the potential debilitating effects of neurological/neuropsychiatric conditions, a comprehensive review of the topic is timely, and needed to support clinical recognition as well as to set the direction for future research. AREAS COVERED The authors discuss neurological/neuropsychiatric manifestations of long COVID in pediatric populations, with a focus on prevalence, associated demographic characteristics, and potential pathogenetic mechanisms. EXPERT OPINION Children/young people may develop persistent neurological/neuropsychiatric symptoms following acute SARS-CoV-2 infection, which may affect daily functioning and well-being. Studies in larger samples with longer follow-ups are needed to clarify prevalence and symptom duration; as well as less investigated risk factors, including genetic predisposition, ethnicity, and comorbidities. Controlled studies may help separate infection-related direct effects from pandemic-related psychosocial stressors. Clarifying pathogenetic mechanisms is paramount to develop more targeted and effective treatments; whilst screening programs and psychoeducation may enhance early recognition.
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Affiliation(s)
| | - Valeria Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Samuele Cortese
- School of Psychology, University of Southampton, Southampton, UK
- Horizon Centre, CAMHS West, William Macleod Way, Solent NHS Trust, Southampton, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA
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48
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Martino L, Morello R, De Rose C, Buonsenso D. Persistent respiratory symptoms associated with post-Covid condition (Long Covid) in children: a systematic review and analysis of current gaps and future perspectives. Expert Rev Respir Med 2023; 17:837-852. [PMID: 37844017 DOI: 10.1080/17476348.2023.2271836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION There is increasing evidence that also children can develop Long Covid. However, there are no specific reviews providing a clear description of reported respiratory symptoms and potential diagnostics. AREAS COVERED We performed on PubMed a systematic search of studies conducted on children aged less than 18 years with previous SARS-CoV-2 infection complaining about persistent respiratory symptoms; the aim of our review is to characterize the incidence, pattern and duration of respiratory symptoms after the acute infection in pediatric population. EXPERT OPINION Children can develop persisting respiratory symptoms, as documented by several follow-up studies both including or not control groups of non-infected children. However, the methodological variabilities of the analyzed studies does not allow to provide firm conclusions about the rate, type and best diagnostics for children with persistent respiratory symptoms. Future studies should investigate on larger pediatric cohorts the role of noninvasive diagnostics and new biomarkers as well as investigating therapeutic options both during acute infection or when Long Covid has been diagnosed.
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Affiliation(s)
- Laura Martino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italia
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Sedik RNM. The clinical course and outcomes of SARS-CoV-2 virus infection in children: a 24-week follow-up study in Sulaimaniyah, Iraq. BMC Pediatr 2023; 23:303. [PMID: 37330479 PMCID: PMC10276471 DOI: 10.1186/s12887-023-04111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/03/2023] [Indexed: 06/19/2023] Open
Abstract
Most children infected with the SARS-CoV-2 virus have asymptomatic or mild disease with a short clinical course and excellent outcome; meanwhile, some children experienced persisting symptoms lasting > 12 weeks from the COVID-19 infection diagnosis. This study aimed to define the acute clinical course of SARS-CoV-2 virus infection and outcomes in children after recovery. This prospective cohort study was conducted on 105 children (aged < 16 years) with confirmed COVID-19 infection at Jamal Ahmed Rashid Teaching Hospital, Sulaimaniyah, Iraq, from July to September 2021. The symptomatic and suspicious cases of COVID-19 infection in children were confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) on nasopharyngeal swabs. About 85.6% of children fully recovered at ≤ 4 weeks from initial COVID-19 infection diagnosis, 42% were hospitalized, while 15.2% reported long COVID-19 infection symptoms. The most commonly reported symptoms were fatigue (7.1%), hair fall (4.0%), lack of concentration (3.0%), and abdominal pain (2.0%). Children aged 11-16 showed a greater risk of long-term COVID-19 infection symptoms. We also observed a higher risk of long COVID infection symptoms in those who reported ongoing symptoms at 4-6 weeks of follow-up assessment (p = 0.01). Despite mild disease and complete recovery in most children, many suffered from long COVID infection symptoms.
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Affiliation(s)
- Rozhan Nabaz Mohammed Sedik
- Department of Medical Education, College of Medicine, University of Sulaimani, Sulaimaniyah, Iraq.
- Dr Jamal Ahmed Rashid Pediatric Teaching Hospital, Sulaimaniyah, Iraq.
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Al-Shamrani A, Al-Shamrani K, Al-Otaibi M, Alenazi A, Aldosaimani H, Aldhalaan Z, Alalkami H, Yousef AA, Kobeisy S, Alharbi S. Residual Cough and Asthma-like Symptoms Post-COVID-19 in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1031. [PMID: 37371263 DOI: 10.3390/children10061031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide and is characterized by different presentations ranging from asymptomatic to severe pneumonia. COVID-19 affects all age groups, including pediatric patients. We observed numerous children complaining of a cough post-COVID-19, even if it was trivial. The most reported persistent symptoms after recovery from COVID-19 were insomnia, coughing, fatigue, dyspnea, loss of taste and/or smell, and headache. To date, residual cough post-COVID-19 has been reported in pediatrics and adolescents. METHOD we conducted a retrospective study, with a self-administered questionnaire by the patient or caregiver, 12 months post-COVID-19-infection. RESULT A total of 94.8% of patients were Saudi citizens and were mainly from the southern region of Saudi Arabia (50.0%). Mothers (64.4%) submitted most of the results. The ages were as follows: 6-14 years (51.0%), 3-5 years (32.3%), and younger than 2 years of age (only 16.7%). Females accounted for 41.7% of those studied. Nearly half of the patients (48.5%) had had a previous COVID-19 infection in 2022, with only 2.1% infected in 2019. Only 27/194 (13.9%) patients required hospital admission, and 7 of them (4.2%) required intensive care treatment. A total of 179 (92.2%) patients still reported persistent symptoms 4 weeks post-COVID-19-infection. A cough was reported in 69.8% of patients, followed by cough and wheezing in 12.3%. The cough was described as dry in 78.0% and nocturnal in 54.1%, while 42.5% did not notice any diurnal variation. For those reporting residual cough, 39.3% found that it affected school attendance and daily activities, 31.1% reported associated chest pain, 51.9% associated it with wheezing, and 27.1% associated it with shortness of breath. For 54.4%, the residual cough lasted less than one month, while 31.4% reported a 1-2 month duration. Only 1.0% had a duration of cough of more than 3 months. For cough relief, 28.2% used bronchodilators, 19.9% used cough syrup, 16.6% used a combination of bronchodilators and steroid inhalers, and 1.7% used antibiotics. Surprisingly, 33% attempted herbal remedies for cough relief. Sesame oil was used the most (40.0%), followed by a mixture of olive oil and sesame oil (25.0%), and 21.7% used male frankincense. The majority (78.4%) sought medical advice for their post-infection cough, either from general pediatricians (39.5%) or via specialist pediatric pulmonology consultations (30.9%). A total of 11.0% with a residual cough reported having pets at home, while 27.2% reported secondhand smoke exposure in the household. Before infection with COVID-19, only 32.6% were diagnosed with asthma, while 68.2% reported a diagnosis of atopic skin. CONCLUSIONS There was a high prevalence of residual cough post-COVID-19, extended for a minimum of two months, and the characteristics of the cough were very similar to those of asthmatic patients. There was still a high prevalence of using cough syrup and herbal remedies, especially olive oil, sesame oil, and male frankincense. A residual cough adversely affected school attendance in daily activities, and there was a high prevalence of other siblings in the family being affected. The study showed that a minority of patients were seen by the pulmonologist; luckily, long COVID was rare in our study, and so further studies are highly needed to confirm the association with asthma. More educational programs are highly needed regarding herbal remedies and cough syrup.
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Affiliation(s)
- Abdullah Al-Shamrani
- Department of Pediatrics, Prince Sultan Military Medical City, Al Faisal University, P.O. Box 7897, Riyadh 11159, Saudi Arabia
| | - Khalid Al-Shamrani
- College of Medicine, Al Marifah University, P.O. Box 92882, Riyadh 11663, Saudi Arabia
| | - Maram Al-Otaibi
- Department of Pediatrics, Prince Sultan Military Medical City, P.O. Box 26523, Riyadh 12841, Saudi Arabia
| | - Ayed Alenazi
- Respiratory Division, Department of Pediatrics, Prince Sultan Military Medical City, P.O. Box 7456, Riyadh 13326, Saudi Arabia
| | - Hareth Aldosaimani
- Department of Emergency, Prince Sultan Military Medical City, P.O. Box 282236, Riyadh 11392, Saudi Arabia
| | - Zeyad Aldhalaan
- Department of Infectious Disease, Prince Sultan Military Medical City, P.O. Box 106383, Riyadh 11666, Saudi Arabia
| | - Haleimah Alalkami
- Department of Pediatrics, Abha Maternity & Children Hospital, P.O. Box 62521, Abha 3613, Saudi Arabia
| | - Abdullah A Yousef
- Department of Pediatrics, King Fahd Hospital of the University, P.O. Box 2208, Al-Khobar 31952, Saudi Arabia
- College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 34212, Saudi Arabia
| | - Sumayyah Kobeisy
- Dr. Soliman Fakeeh Hospital, P.O. Box 2537, Jeddah 21461, Saudi Arabia
| | - Saleh Alharbi
- Dr. Soliman Fakeeh Hospital, P.O. Box 2537, Jeddah 21461, Saudi Arabia
- Department of Pediatrics, Umm Al-Qura University, P.O. Box 715, Mecca 24382, Saudi Arabia
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