Early research has shown that children are not susceptible to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of the coronavirus disease 2019 (COVID-19) pandemic. ; however, if infected, they remain asymptomatic or suffer mild symptoms.
After the start of vaccination against COVID-19 in adults and adolescents, children under the age of five became the main victims of COVID-19, along with those who were not vaccinated.
More severe Covid-19 symptoms in children have been reported and the rate of hospitalization in children infected with SARS-CoV-2 has increased slightly. Additionally, two significant complications associated with COVID-19, namely, Multisystem inflammatory syndrome in children (MIS-C) and Long COVID, have been reported. MIS-C only occurs in children and adolescents, while Long COVID is known to affect all age groups.
Some of the characteristic persistent symptoms of Long COVID are dyspnea, fatigue cough, chest pain, trouble sleeping, and headache. Other more complicated symptoms of Long COVID include cardiovascular, sensory, respiratory, and neurological complications.
Scientists have pointed to a research gap regarding the outcome of COVID-19 symptoms in immunocompromised children. The main question is whether the vulnerable group of children are similarly affected by COVID-19 infection, i.e. showing mostly asymptomatic or mild symptoms, compared to the group of children in good health.
A new study
A new study currently published on the Research Square* pre-release server while it is planned to be published to the BMC One Health Insights The journal focused on assessing the prevalence of symptoms characteristic of Long COVID in immunocompromised and immunocompetent children.
The researchers constructed a questionnaire for this study that included questions about general health status, COVID-19 vaccination status, diagnosis of MIS-C, and the presence of long-lasting COVID symptoms and their impact on their daily activities. The parents of 147 children completed the questionnaire. All children in this study were admitted at least three months prior to the establishment of the COVID-19 subunit at the Children’s Memorial Health Institute in Warsaw, Poland, between November 1, 2020 and January 31, 2022.
The participants in this study were divided into two groups, namely, one group consisting of immunocompromised children and the other group consisting of non-immunocompromised children. In this study, 47.6% of the participants were immunocompromised while 52.4% of the study cohort belonged to the control group, i.e. those who were not immunocompromised.
A previous study reported that children with Long COVID suffered from several persistent symptoms, such as fatigue, difficulty concentrating, chest pain, palpitations, headaches and muscle weakness. Another study showed that some of the symptoms persisted for up to five months after COVID-19 infection. The symptoms of Long COVID in children, as described in previous studies, were found to be consistent with the results of the current study.
In this study cohort, the prevalence of Long COVID in the control group was relatively high and increased with age. The researchers found no association between Long COVID and allergic diseases. The current study reported that the prevalence of Long COVID in immunocompromised children is less. However, the reason for such a result is unclear. In the future, the mechanism underlying this observation should be investigated.
Scientists have offered several plausible theories as to why the frequency of Long COVID in immunocompromised children is less. One of the possible reasons suggested by the scientists is the high occurrence of asymptomatic COVID-19 infection in this group. Although several studies have postulated that severe COVID-19 infection and long COVID are not correlated, organ damage due to severe infection has a long-term consequence. For example, inflammation, fibrosis, and scarring in severely infected patients can lead to prolonged chronic cough, pneumonia, and difficulty breathing.
In this study, the authors stated that a reduced immune response may act as a protective factor against the development of inflammatory reactions, and this could be the reason why immunocompromised children are less prone to developing Long COVID. Previous studies have suggested another possible reason for Long COVID, namely the persistence of SARS-CoV-2 reservoirs in specific tissues. In this study, researchers observed that in several immunocompromised patients, symptoms persisted for up to three months.
The authors of this study reported that although immunocompromised children suffer from persistent symptoms of COVID-19, their frequency is significantly low compared to the group of immunocompetent children. Some of the common symptoms of long COVID found in children are chronic cough, gastrointestinal symptoms, and fatigue.
The researchers observed that most symptoms resolved within three months and did not greatly affect the daily activities of immunocompromised children. The scientists also revealed that the risk of developing long COVID increases with age and severe COVID-19 symptoms. Going forward, the pathomechanism of long COVID in children needs to be explored further.
Research Square publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behaviors, or treated as established information.
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