Camporesi Anna, Morello Rosa, La Rocca Anna, Zampino Giuseppe, Vezzulli Federico, Munblit Daniel, Raffaelli Francesca, Valentini Piero, Buonsenso Danilo
Pediatric Anesthesia and Intensive Care, V. Buzzi Children's Hospital, Milano, Italy.
Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
EClinicalMedicine. 2024 Sep 5;76:102815. doi: 10.1016/j.eclinm.2024.102815. eCollection 2024 Oct.
Children can develop Long Covid, however long term outcomes and their predictors are poorly described in these patients. The primary aim is to describe characteristics and predictors of Long Covid in children assessed in-clinics up to 36 months post-SARS-CoV-2 infection, as well as investigate the role of vaccines in preventing Long Covid, risk of reinfections and development of autoimmune diseases.
Children aged 0-18 years old with confirmed SARS-CoV-2 infection were invited for a prospective follow-up assessment at a peadiatric post-covid clinic in Rome, Italy, at serial intervals (3-, 6-, 12-, 18-, 24- and 36-months post-infection onset, between 01/02/2020 and 28/02/2024). Long Covid was defined as persistence of otherwise unexplained symptoms for at least three months after initial infection.
1319 patients were initially included, 1296 reached the 3 months follow-up or more. Of the patients who underwent multiple follow-ups, 23.2% (301), 169 (13.2%), 89 (7.9%), 67 (6.1%), 47 (7.1%) were diagnosed with Long Covid at 3-6-12-18-24 months, respectively For the primary outcome of Long Covid at three months, age >12 years (P < 0.001, OR 11.33, 95% CI 4.2; 15.15), comorbidities (P = 0.008, OR 1.83, 95% CI 1.06; 2.44), being infected with original variants (P < 0.001, OR 4.77, 95% CI 2.46; 14.47), female sex (P < 0.001, OR 1.62, 95% CI 1.02; 1.89) were statistically significant risk factors. Age >12 years (P = 0.002, OR 9.37, 95% CI 1.58; 8.64), and infection with original (P = 0.012, OR 3.52, 95% CI 1.32; 8.64) and alfa (P < 0.001, OR 4.09, 95% CI 2.01; 8.3) SARS-CoV-2 variants remained statistically significant risk factors for Long Covid duration for at least 18 months. Vaccination was associated with a lower risk of long covid at 3, 6 and 12 months for older children and a lower risk of reinfections. Being infected with the original SARS-CoV-2 variant was associated with a higher risk of new-onset autoimmune diseases ((P = 0.035, 95% CI 1.12; 2.4). One patient was diagnosed with Long Covid after a re-infection.
This is the longest follow-up study of children with SARS-CoV-2 infection, showing a significant and long-lasting burden of Long Covid in the pediatric population. Our findings highlight the urgent need of investing in pediatric Long Covid in order to find effective diagnostic and therapeutic approaches, as well can inform preventive strategies in case of future pandemics.
This study has been funde by Pfizer non-competitive grant, granted to DB (#65925795).
儿童可能会患上“长新冠”，然而这些患者的长期预后及其预测因素却鲜有描述。主要目的是描述在SARS-CoV-2感染后长达36个月在门诊接受评估的儿童“长新冠”的特征和预测因素，同时研究疫苗在预防“长新冠”、再感染风险和自身免疫性疾病发展中的作用。
邀请0至18岁确诊感染SARS-CoV-2的儿童，在意大利罗马的一家儿科新冠后诊所进行前瞻性随访评估，随访时间间隔为感染后3、6、12、18、24和36个月（2020年2月1日至2024年2月28日）。“长新冠”定义为初始感染后持续存在无法解释的症状至少三个月。
最初纳入1319例患者，1296例完成了3个月或更长时间的随访。在接受多次随访的患者中，分别有23.2%（301例）、169例（13.2%）、89例（7.9%）、67例（6.1%）、47例（7.1%）在感染后3、6、12、18和24个月被诊断为“长新冠”。对于三个月时“长新冠”的主要结局，年龄>12岁（P<0.001，OR 11.33，95%CI 4.2；15.15）、合并症（P = 0.008，OR 1.83，95%CI 1.06；2.44）、感染原始毒株（P<0.001，OR 4.77，95%CI 2.46；14.47）、女性（P<0.001，OR 1.62，95%CI 1.02；1.89）是具有统计学意义的危险因素。年龄>12岁（P = 0.002，OR 9.37，95%CI 1.58；8.64），以及感染原始毒株（P = 0.012，OR 3.52，95%CI 1.32；8.64）和阿尔法（P<0.001，OR 4.09，95%CI 2.01；8.3）SARS-CoV-2变异株仍然是“长新冠”持续至少18个月的具有统计学意义的危险因素。接种疫苗与年龄较大儿童在3、6和12个月时患“长新冠”的风险较低以及再感染风险较低相关。感染原始SARS-CoV-2变异株与新发自身免疫性疾病的风险较高相关（（P = 0.035，95%CI 1.12；2.4）。一名患者在再次感染后被诊断为“长新冠”。
这是对感染SARS-CoV-2儿童进行的最长随访研究，显示了儿科人群中“长新冠”的显著且持久的负担。我们的研究结果突出了投资于儿科“长新冠”研究以找到有效诊断和治疗方法的迫切需求，也可为未来大流行情况下的预防策略提供参考。
本研究由辉瑞非竞争性赠款资助，授予DB（#65925795）。
