Characterizing Long COVID in Children and Adolescents

Rachel S. Gross, Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York.
Tanayott Thaweethai, Department of Biostatistics, Massachusetts General Hospital, Boston.
Lawrence C. Kleinman, Division of Population Health, Quality, and Implementation Sciences (PopQuIS), Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Jessica N. Snowden, Division of Infectious Diseases, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock.
Erika B. Rosenzweig, Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Joshua D. Milner, Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Kelan G. Tantisira, Division of Respiratory Medicine, Department of Pediatrics, UC San Diego School of Medicine, Rady Children's Hospital, San Diego, California.
Kyung E. Rhee, Division of Child and Community Health, Department of Pediatrics, UC San Diego School of Medicine, Rady Children's Hospital, San Diego, California.
Terry L. Jernigan, Departments of Cognitive Science, Psychiatry, and Radiology, UC San Diego School of Medicine, Rady Children's Hospital, San Diego, California.
Patricia A. Kinser, School of Nursing, Virginia Commonwealth University, Richmond.
Amy L. Salisbury, School of Nursing, Virginia Commonwealth University, Richmond.
David Warburton, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles.
Sindhu Mohandas, Division of Infectious Diseases, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles.
John C. Wood, Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles.
Jane W. Newburger, Department of Cardiology, Harvard Medical School, Boston, Massachusetts.
Dongngan T. Truong, Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City.
Valerie J. Flaherman, Division of General Pediatrics, Department of Pediatrics, University of California, San Francisco.
Torri D. Metz, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City.
Elizabeth W. Karlson, Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Massachusetts General Hospital, Boston.
Lori B. Chibnik, Division of Neurology, Department of Neurology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Deepti B. Pant, Department of Biostatistics, Massachusetts General Hospital, Boston.
Aparna Krishnamoorthy, Department of Biostatistics, Massachusetts General Hospital, Boston.
Richard Gallagher, Division of Child Study Center, Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York.
Michelle F. Lamendola-Essel, Department of Medicine, NYU Grossman School of Medicine, New York.
Denise C. Hasson, Division of Pediatric Critical Care Medicine, Department of Pediatrics, NYU Grossman School of Medicine, New York.
Stuart D. Katz, Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York.
Shonna Yin, Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York.
Benard P. Dreyer, Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York.
Megan Carmilani, RECOVER Patient, Caregiver, or Community Advocate Representative, New York, New York.
K Coombs, RECOVER Patient, Caregiver, or Community Advocate Representative, New York, New York.
Megan L. Fitzgerald, RECOVER Patient, Caregiver, or Community Advocate Representative, New York, New York.
Nick Güthe, RECOVER Patient, Caregiver, or Community Advocate Representative, New York, New York.

Document Type

Journal Article

Publication Date

8-21-2024

Journal

JAMA

DOI

10.1001/jama.2024.12747

Abstract

IMPORTANCE: Most research to understand postacute sequelae of SARS-CoV-2 infection (PASC), or long COVID, has focused on adults, with less known about this complex condition in children. Research is needed to characterize pediatric PASC to enable studies of underlying mechanisms that will guide future treatment. OBJECTIVE: To identify the most common prolonged symptoms experienced by children (aged 6 to 17 years) after SARS-CoV-2 infection, how these symptoms differ by age (school-age [6-11 years] vs adolescents [12-17 years]), how they cluster into distinct phenotypes, and what symptoms in combination could be used as an empirically derived index to assist researchers to study the likely presence of PASC. DESIGN, SETTING, AND PARTICIPANTS: Multicenter longitudinal observational cohort study with participants recruited from more than 60 US health care and community settings between March 2022 and December 2023, including school-age children and adolescents with and without SARS-CoV-2 infection history. EXPOSURE: SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES: PASC and 89 prolonged symptoms across 9 symptom domains. RESULTS: A total of 898 school-age children (751 with previous SARS-CoV-2 infection [referred to as infected] and 147 without [referred to as uninfected]; mean age, 8.6 years; 49% female; 11% were Black or African American, 34% were Hispanic, Latino, or Spanish, and 60% were White) and 4469 adolescents (3109 infected and 1360 uninfected; mean age, 14.8 years; 48% female; 13% were Black or African American, 21% were Hispanic, Latino, or Spanish, and 73% were White) were included. Median time between first infection and symptom survey was 506 days for school-age children and 556 days for adolescents. In models adjusted for sex and race and ethnicity, 14 symptoms in both school-age children and adolescents were more common in those with SARS-CoV-2 infection history compared with those without infection history, with 4 additional symptoms in school-age children only and 3 in adolescents only. These symptoms affected almost every organ system. Combinations of symptoms most associated with infection history were identified to form a PASC research index for each age group; these indices correlated with poorer overall health and quality of life. The index emphasizes neurocognitive, pain, and gastrointestinal symptoms in school-age children but change or loss in smell or taste, pain, and fatigue/malaise-related symptoms in adolescents. Clustering analyses identified 4 PASC symptom phenotypes in school-age children and 3 in adolescents. CONCLUSIONS AND RELEVANCE: This study developed research indices for characterizing PASC in children and adolescents. Symptom patterns were similar but distinguishable between the 2 groups, highlighting the importance of characterizing PASC separately for these age ranges.

Department

Pediatrics

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