Coughtrey Anna, Pereira Snehal M Pinto, Ladhani Shamez, Shafran Roz, Stephenson Terence
UCL GOS Institute of Child Health.
University College London Division of Surgery & Interventional Science.
Curr Opin Infect Dis. 2025 Oct 1;38(5):487-492. doi: 10.1097/QCO.0000000000001136. Epub 2025 Aug 13.
On 11 March 2020, the WHO characterized COVID-19 as a pandemic. A clinical case definition for post-COVID-19 condition in children and adolescents by expert consensus was agreed by the WHO in 2023. It is now 5 years since the WHO declared a pandemic, and this review aims to summarize key advances in our understanding of long COVID over those 5 years.
That symptoms could persist in adults and CYP for months after initial infection was first reported in Autumn 2020. Long COVID in adults is frequently characterized by symptoms of fatigue and breathlessness but brain-fog, joint and muscle pain have been reported much more commonly in adult follow-up than CYP. The most common persisting symptoms experienced by CYP after COVID-19 infection in initial studies, often with less than a year of follow-up, were fatigue, headache, shortness of breath and persisting loss of smell and taste. With longer follow-up, up to 2 years, the commonest symptoms still include not only fatigue, headache and shortness of breath but also sleep difficulties, whereas loss of smell and taste persisted only in a minority. However, many symptoms were almost as common in test-negative controls, raising questions about the causal role of SARS-CoV-2 virus. Predictors of long COVID, as defined, were female sex, history of asthma, allergy problems, learning difficulties at school and family history of ongoing COVID-19 problems.
The implications of the findings for clinical practice and research are that long COVID is not the same in CYP as adults; both their physical and mental health should be studied; and intervention trials are needed.
2020年3月11日，世界卫生组织（WHO）将新型冠状病毒肺炎（COVID-19）列为大流行病。2023年，WHO通过专家共识确定了儿童和青少年COVID-19后状况的临床病例定义。自WHO宣布大流行至今已有5年，本综述旨在总结这5年来我们对长期新冠（long COVID）认识的关键进展。
2020年秋季首次报道成人和儿童及青少年在初次感染数月后症状仍会持续。成人长期新冠常表现为疲劳和呼吸急促症状，但在成人随访中，脑雾、关节和肌肉疼痛的报告比儿童及青少年更常见。在最初研究中，儿童及青少年在感染COVID-19后最初经历的最常见持续症状，通常随访时间不到一年，包括疲劳、头痛、呼吸急促以及持续的嗅觉和味觉丧失。随着长达2年的更长随访，最常见症状不仅仍包括疲劳、头痛和呼吸急促，还包括睡眠困难，而嗅觉和味觉丧失仅在少数人中持续存在。然而，许多症状在检测阴性对照中几乎同样常见，这引发了关于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒因果作用的疑问。已确定的长期新冠预测因素为女性、哮喘病史、过敏问题、在学校的学习困难以及持续存在COVID-19问题的家族史。
这些发现对临床实践和研究的启示是，儿童及青少年的长期新冠与成人不同；应同时研究他们的身心健康；并且需要进行干预试验。
