Study: Incidence of PASC in Pediatric Individuals Is Rare

Analysis shows that myocarditis was the most commonly diagnosed condition associated with pediatric post-acute sequelae of SARS-CoV-2.

Pediatric post-acute sequelae of severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection (PASC) appeared to be rare in children, according to the results of a study published in JAMA Pediatrics.

Investigators found that myocarditis was the most commonly diagnosed PASC-associated condition, with acute illness severity, comorbid complex chronic disease, and a young age, increasing the risk of PASC.

They found that the features that were described in adult populations, which include changes in cardiorespiratory signs or symptoms, chest pain, fatigue, fever, smell, and taste were present in among children.

However, there were also rarer features in children, such as abnormal liver enzymes, diarrhea, hair loss, and skin rashes, which investigators found were most commonly present in children in the 1 to 6 months following SARS-CoV-2 infections.

Investigators included 659,286 children in the study sample, 52.8% of whom were male. The mean age was aged 8.1 years. A total of 59,893 tested positive for SARS-CoV-2.

Investigators found that the most common symptoms, conditions, and medication features were cold and cough preparations, myocarditis, and cold and cough preparations, respectively.

In addition to myocarditis, investigators found that encounters for mental health treatment, myositis, and respiratory infections, which included bronchitis and tonsillitis pneumonia, were also associated with COVID-19.

Approximately 41.9% of children who tested positive for COVID-19 had at least 1 medication, syndromic, or systemic feature of PASC, while 3.7% of those who tested negative experienced PASC.

Investigators found that there was a larger associated for PASC for children who were in the intensive care unit during the acute illness phase, children who were younger than aged 5 years, and those with complex chronic conditions.

Investigators used electronic health records from 9 children’s hospitals in the United States between March 1, 2020, and October 2021, including individuals younger than aged 21 years who had antigen or reverse transcriptase-polymerase chain reaction (RT-PCR) testing for SARS-CoV-2.

All individuals had at least 1 encounter in the 3 years prior to testing, the study results showed.

Investigators measured for symptoms, conditions, and medication PASC features in the 28 to 179 days following the initial test date. They also collected adjusted hazard ratios for 151 clinically predicted PASC features.

Investigators contrasted viral test-positive groups with viral test-negative groups using proportional hazards models, as well as adjusting for age, ethnicity, race, sex, site, testing location, and time period of cohort entrance. They also estimated the incidence proportions for symptoms, conditions, and medication PASC features in the 2 groups to find a burden of PASC estimate.

Further, the investigators noted some limitations of the study, which included that because of the use of EHR-based data, it is possible that some could have been missed in other sources, such as laboratory, procedural, radiological, and other unstructured data.

Investigators also limited the cohort to at least 1 visit in the prior 3 years to identify individuals who were active in the health system, which they said could underestimated the burden of PASC by excluding previous healthy children without any prior health encounters.

Reference

Rao S, Lee GM, Razzaghi H, et al. Clinical features and burden of postacute sequelae of SARS-CoV-2 infection in children and adolescents. JAMA Pediatr. 2022. doi:10.1001/jamapediatrics.2022.2800