Minotti Chiara, McKenzie Carla, Dewandel Isabelle, Bekker Carien, Sturniolo Giulia, Doni Denis, Giaquinto Carlo, Van Der Zalm Marieke M, Donà Daniele
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.
EClinicalMedicine. 2024 Feb 2;68:102436. doi: 10.1016/j.eclinm.2024.102436. eCollection 2024 Feb.
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.
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).
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).
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.
EU Horizon, EDCTP, NIH.
冠状病毒病（COVID）后综合征及其他病毒感染后综合征在发病机制、起病、进展和症状表现方面存在重叠。我们旨在系统描述有关病毒感染后状况的研究，并确定儿童COVID后综合征与其他病毒感染后综合征相比的特征。
我们根据系统评价和Meta分析的首选报告项目（PRISMA）指南，对Embase、MEDLINE、Cochrane图书馆和谷歌学术数据库（1946年1月至2023年11月3日）进行了系统检索。主要结局为疾病持续时间、症状类型和慢性症状的发生情况。该系统评价已在PROSPERO（CRD42023401789）上注册。
纳入了35项/5051项研究，共涉及42,934名儿童、青少年和青年（0至20岁）。28项研究聚焦于COVID后症状，其次是5篇关于呼吸道合胞病毒（RSV）和鼻病毒的论文，1项关于EB病毒（EBV）的研究，以及1项关于胃肠道病毒的研究。关于COVID后综合征的研究主要报告了大龄儿童/青少年的数据，描述了持续存在的症状，包括疲劳、神经、心肺、肌肉骨骼、心理健康和胃肠道症状。所描述的最长症状持续时间为18个月，平均随访时间为7个月。30项研究（93.8%）报告了10,473/28,474例患者（36.8%）出现慢性症状。18,001/28,474例（63.2%）实现了康复。关于EBV的研究报告青少年持续疲劳的持续时间相似（6个月，46%为慢性）。关于RSV和鼻病毒的研究主要在3岁以下儿童中进行，出现反复喘息（最长3年）。
病毒感染后疲劳是COVID后综合征和EBV感染后状况的共同特征。需要更好地将COVID后综合征理解为一种独特的状况，它与其他病毒感染后综合征有共同特征。儿童及其家庭的医疗负担和社会经济后果值得进一步调查，并制定适当的医疗管理计划。首要要求是建立一致且可共享的定义，以及对结局达成共识，以有效评估随访情况并量化不同病毒感染的负担。
欧盟地平线计划、欧洲发展中国家临床试验合作计划、美国国立卫生研究院。
