514 - Persistence of Long COVID in Children in the RECOVER-Pediatrics Longitudinal Cohort Study

Publication Number: 3495.514

Kelan Tantisira, Rady Children's Hospital San Diego, San Diego, CA, United States; Melissa Stockwell, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Tanayott Thaweethai, Massachusetts General Hospital Biostatistics, Somerville, MA, United States; Rachel S. Gross, New York University Grossman School of Medicine, New York, NY, United States; Katherine Irby, Arkansas Children's Research Institute/ UAMS, Little Rock, AR, United States; Lawrence C. Kleinman, Rutgers RWJMS, New Brunswick, NJ, United States; Kyung E.. Rhee, UC San Diego School of Medicine, LA JOLLA, CA, United States; Patricia Kinser, Virginia Commonwealth University School of Nursing, Richmond, VA, United States; Thomas J. Connors, Columbia University Medical Center, New York, NY, United States; Megan Carmilani, Long Covid Families, Charlotte, NC, United States; Valerie Flaherman, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Richard Gallagher, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; John Wood, Childrens Hospital Los Angeles, Los Angeles, CA, United States; Sindhu Mohandas, Children's Hospital Los Angeles, Los Angeles, CA, United States; John Bolecek, NIH RECOVER, Richmond, VA, United States; Laura Covington, RECOVER Representative, Fredericksburg, VA, United States; Teia A. Pearson, NIH Recover, Lebanon, OR, United States; Deepti Pant, Massachusetts General Hospital, Boston, MA, United States; Shreya Ahirwar, Massachusetts General Hospital, Somerville, MA, United States; Andrea S. Foulkes, Harvard Medical School and Massachusetts General Hospital, Somerville, MA, MA, United States

Background: An estimated 2-10% of children will develop Long COVID (LC) symptoms following SARS-CoV-2 infection. The natural history of those symptomatic children, and the factors determining persistent symptoms, remains poorly characterized.

Objective: Prospectively assess: 1) trajectories of LC symptoms over time and 2) factors influencing persistent symptoms.

Design/Methods: The multicenter, observational pediatric cohort, Researching COVID to Enhance Recovery (RECOVER) enrolled children and young adults ages 0-25 years with and without history of SARS-CoV-2 infection. Using a case-cohort design, participants with a greater number of (or more severe) LC-associated symptoms were followed at 6, 12, and 24 months after enrollment. Participants were categorized as having LC using age-specific LC Research Indices, which classify LC status based on presence of LC-associated symptoms persisting for at least 4 weeks since initial SARS-CoV-2 infection and ongoing during the symptom survey. Sampling and inverse-probability weights were used to account for the case-cohort design and study attrition when estimating the proportion of participants with baseline LC with LC symptoms at 6, 12, or 24 months, overall and stratified by age and time since initial infection.

Results: RECOVER included 4,272 participants with a history of SARS-CoV-2 infection, with 2,001 participants in the longitudinal cohort (Table 1); 60% were female, 7% were 0-2, 9% 3-5, 21% 6-11, 28% 12-17, and 35% 18-25 years old. The cohort was 14% Black, 30% Hispanic and 58% White. 1,851 participants completed 12 months and 742 completed 24 months of follow-up. Among 559 participants with LC at enrollment, 59% (95% CI: 54-64%) still had LC at 6 months, 52% (95% CI: 47-57%) at 12 months, and 40% (95% CI: 33-49%) at 24 months (Table 2). LC persistence differed by age at enrollment, with 18-24% of children < 5 years. 47% of school age, and >55% of adolescents and young adults with enduring LC at one year. LC also persisted among participants with greater elapsed time between initial SARS-CoV-2 infection and enrollment, but risk was similar for initial SARS-CoV-2 infection variant (before vs. during the Omicron era).

Conclusion(s): At least 50% of children with LC continue to have LC after 1 year, with a minimal decline to 40% at 2 years follow-up, underscoring the chronic nature of LC. This runs counter to any misperception that children with LC recover quickly. The highest proportion of ongoing LC symptoms impacts adolescents and young adults, but up to a quarter of young children remain chronically affected.

Table 1
Table 1.pdf

Table 2
Table 2.pdf