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Postacute COVID Less Common in US Youth Than Reported Earlier
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IDWeek 2022, October 19-23, 2022, Washington, DC
Mark Mascolini
Postacute sequelae of SARS-CoV-2 (PASC) appeared to affect children and adolescents less in a large 8-hospital US analysis than in previous reviews: Incidence of one or more PASC features proved only 3.7% more frequent in young people who tested PCR- or antigen-positive for the coronavirus than in those who tested negative [1]. Factors linked to higher risk of PASC were intensive care unit (ICU) care during acute COVID illness, age under 5 years, and having complex chronic conditions.
This retrospective study analyzed electronic medical records from 8 US children's hospitals for children and youth under 21 years old who had PCR or antigen testing for SARS-CoV-2 from March 2020 through October 2021 then up to 6 months of follow-up. All participants had at least one medical encounter in the 3 years before their COVID test.
Researchers tabulated 151 PASC-associated symptoms, conditions, or medications that occurred in these children in the 28 to 179 days after COVID testing. Then they used Cox proportional hazards models to determine which of these features occurred more frequently in PCR- or antigen-positive youth than in negative youth. Models adjusted for site, age, sex, testing location, race/ethnicity, medical complexity, and time period when entering the cohort. To focus only on incident (not prevalent) conditions, they excluded young people who had evidence of a PASC condition 18 months before entering the cohort.
The analysis involved 660,368 children and youth, 58,891 (9%) of whom had a positive PCR or antigen test for SARS-CoV-2. PCR-positive and -negative groups differed moderately in age (average 9.4 years with COVID and 7.9 without, standardized difference 0.26). The COVID group had a slightly higher proportion of females (48.7% vs 47.0%, standardized difference 0.03). A small majority overall (52%) was non-Hispanic white, and the COVID group had a moderately higher proportion of blacks (20.2% vs 15.4%) and Hispanics (18.8% vs 15.3%). Follow-up averaged 4.7 months overall, with little difference between PCR-positive and -negative participants.
Cox proportional hazard ratios determined that PASC symptoms most often associated with testing positive versus negative for COVID were changes in smell/taste (adjusted hazard ratio [aHR] 1.96, 95% confidence interval [95% CI] 1.16 to 3.32), loss of smell (aHR 1.85, 95% CI 1.20 to 2.86), hair loss (aHR 1.58, 95% CI 1.24 to 2.01), chest pain (aHR 1.52, 95% CI 1.38 to 1.68), and abnormal liver enzymes (aHR 1.50, 95% CI 1.27 to 1.77). Other PASC symptoms related to a positive PCR were generalized pain, anxiety, skin rash, fatigue/malaise, fever/chills, cardiorespiratory signs/symptoms, diarrhea, respiratory failure, allergies, skin signs/symptoms, genitourinary signs/symptoms, and nausea and vomiting.
PASC conditions most often associated with a positive COVID test were myocarditis (aHR 3.10, 95% CI 1.94 to 4.96), acute respiratory distress syndrome (aHR 2.96, 95% CI 1.54 to 5.67), myositis (aHR 2.59, 95% CI 1.37 to 4.89), and mental health treatment (aHR 1.62, 95% CI 1.46 to 1.80). Other PASC conditions tied to a positive COVID test were disorders of teeth/gingiva, other/ill-defined heart disease, fluid/electrolyte disturbances, thrombophlebitis and thromboembolism, acute kidney injury, tonsilitis, bronchiolitis, pneumonia, inflammatory skin conditions, obesity, communication/motor disorders, and gastroenteritis.
Incidence of at least one PASC feature-symptoms, conditions, or medications-was only slightly higher in PCR- or antigen-positive youth (41.9%) than negative youth (38.2%) for an incidence proportion difference of 3.7% (95% CI 3.2 to 4.2). The researchers identified a higher risk of PASC in youngsters who received ICU care during their acute COVID (aHR 2.15, 95% CI 1.95 to 2.36), children younger than 5 years old (aHR 1.87, 95% CI 1.84 to 1.89), and youth with complex chronic conditions (aHR 3.43, 95% CI 3.40 to 3.48).
Reference
1. Rao S, Lee G, Lorman V, et al. Clinical features and burden of post-acute sequelae of SARS-CoV-2 infection in children and adolescents. IDWeek 2022, October 19-23, 2022, Washington, DC. Abstract 76.
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