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1.
Lancet Child Adolesc Health ; 6(9): 614-623, 2022 09.
Article in English | MEDLINE | ID: covidwho-1915210

ABSTRACT

BACKGROUND: After the acute phase of SARS-CoV-2 infection, children can develop long COVID symptoms. We aimed to investigate the prevalence of long-lasting symptoms, the duration and intensity of symptoms, quality of life, number of sick days and absences from daycare or school, and psychological and social outcomes in children aged 0-14 years who had been infected with SARS-CoV-2 relative to controls with no history of SARS-CoV-2 infection. METHODS: A nationwide cross-sectional study was conducted including children with a confirmed SARS-CoV-2-positive PCR test (cases) and matched controls from Danish national registers. A survey was sent to mothers (proxy reporting) of children aged 0-14 years who had had a positive SARS-CoV-2 test between Jan 1, 2020, and July 12, 2021, and a control group matched (1:4) by age and sex. The survey included the Pediatric Quality of Life Inventory (PedsQL) and the Children's Somatic Symptoms Inventory-24 (CSSI-24) to capture current overall health and wellbeing, and ancillary questions about the 23 most common long COVID symptoms. Descriptive statistics and logistic regression analysis were used. Clinically relevant differences were defined as those with a Hedges'g score greater than 0·2. This study is registered at ClinicalTrials.gov (NCT04786353). FINDINGS: Responses to the survey were received from 10 997 (28·8%) of 38 152 cases and 33 016 (22·4%) of 147 212 controls between July 20, 2021, and Sept 15, 2021. Median age was 10·2 years (IQR 6·6-12·8) in cases and 10·6 years (6·9-12·9) in controls. 5267 (48·2%) cases and 15 777 (48·3%) controls were female, and 5658 (51·8%) cases and 16 870 (51·7%) controls were male. Cases had higher odds of reporting at least one symptom lasting more than 2 months than did controls in the 0-3 years age group (478 [40·0%] of 1194 vs 1049 [27·2%] of 3855; OR 1·78 [95% CI 1·55-2·04], p<0·0001), 4-11 years age group (1912 [38·1%] of 5023 vs 6189 [33·7%] of 18 372; 1·23 [1·15-1·31], p<0·0001), and 12-14 years age group (1313 [46·0%] of 2857 vs 4454 [41·3%] of 10 789; 1·21 [1·11-1·32], p<0·0001). Differences in CSSI-24 symptom scores between cases and controls were statistically significant but not clinically relevant. Small clinically relevant differences in PedsQL quality-of-life scores related to emotional functioning were found in favour of cases in the children aged 4-11 years (median score 80·0 [IQR 65·0-95·0]) in cases vs 75·0 [60·0-85·0] in controls; p<0·0001) and 12-14 years (90·0 [70·0-100·0] vs (85·0 [65·0-95·0], p<0·0001). PedsQL social functioning scores were also higher in cases (100·0 [90·0-100·0] than controls (95·0 [80·0-100·0]) in the 12-14 years age group (p<0·0001; Hedges g>0·2). INTERPRETATION: Compared with controls, children aged 0-14 years who had a SARS-CoV-2 infection had more prevalent long-lasting symptoms. There was a tendency towards better quality-of-life scores related to emotional and social functioning in cases than in controls in older children. The burden of symptoms among children in the control group requires attention. Long COVID must be recognised and multi-disciplinary long COVID clinics for children might be beneficial. FUNDING: A P Møller and Chastine Mc-Kinney Møller Foundation.


Subject(s)
COVID-19 , Adolescent , COVID-19/complications , COVID-19/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Denmark/epidemiology , Female , Humans , Infant , Infant, Newborn , Male , Quality of Life , SARS-CoV-2
3.
Lancet Reg Health Eur ; 16: 100354, 2022 May.
Article in English | MEDLINE | ID: covidwho-1882324

ABSTRACT

Background: The purpose of this study was to investigate prevalence of self-reported symptom burden during the acute phase of SARS-CoV-2 infection and associated factors including sex differences. Methods: All Danish adolescents aged 15-18 years with laboratory confirmed SARS-CoV-2 infection between January 2020 and July 2021 were invited to participate. A survey covered the initial four weeks of SARS-CoV-2 infection and included questions regarding 17 symptoms associated with acute COVID-19, symptom burden and medical history. Statistical analyses included descriptive statistics and logistic regression. Findings: A total of 24,315 adolescents with SARS-CoV-2 infection were invited and 6630 (27.3%) completed the questionnaire. The median age was 17.6 years, and 58.4% (n = 3873) were female. No symptoms were reported by 33.8% (n = 2241), mild perceived symptom burden by 57.2%(n = 3775), and severe symptom burden by 9.0 % (n = 594). Two thirds (n = 2999) of the symptomatic participants reported a symptom duration of 1-10 days. The most prevalent symptoms included headaches 39.2% (n = 2597), a reduced sense of smell 36.2% (n = 2398), cough 31.6% (n = 2093), sore throat 31.1% (n = 2063), and a reduced sense of taste 31.1% (n = 2062). Adolescents at the age of 18 years had higher odds of reporting ≥6 symptoms OR1.47 (95%CI, 1.23-1.76), p < 0.0001 and adolescents 18+ years old had higher odds of reporting a severe symptom burden OR1.98 (95%CI, 1.43-2.73) compared to the 15years old adolescents. A history of OCD/anxiety/depression was associated with reporting ≥6 symptoms OR 1.67 (95%CI, 1.34-2.09), p < 0.0001 and a history of allergy and OCD/anxiety/depression reporting severe symptom burden OR 1.64 (95%CI, 1.35-1.99), p < 0.0001 and OR 1.75 (95%CI, 1.28-2.36), p = 0.0004. Females reported more symptoms than males; median of three (IQR 0-6) vs. a median of two (IQR 0-4) symptoms, p < 0.0001. Interpretation: Two in three experienced symptoms and the majority reported mild symptom burden. Headache, a reduced sense of smell and taste, cough and sore throat were most common. Female sex, asthma and previous Epstein-Barr virus were associated with more symptoms and higher symptom burden. Funding: The study was funded by the AP Møller Foundation. The research was investigator initiated. The study funder played no role in the study.

5.
Lancet Child Adolesc Health ; 6(7): 459-465, 2022 07.
Article in English | MEDLINE | ID: covidwho-1821558

ABSTRACT

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) occurs after infection with SARS-CoV-2 and its incidence is likely to depend on multiple factors, including the variant of the preceding SARS-CoV-2 infection and vaccine effectiveness. We aimed to estimate the incidence of MIS-C, and describe the clinical phenotype, following the delta variant of SARS-CoV-2 (B.1.617.2 and sublineages) according to vaccination status. We aimed to compare the incidence and clinical phenotype of MIS-C from our cohort during the pre-delta era. METHODS: This prospective, population-based cohort study included patients aged 0-17 years hospitalised with MIS-C in Denmark, according to the US Centers for Disease Control and Prevention case definition, from Aug 1, 2021, to Feb 1, 2022, a period dominated by the delta variant. We identified MIS-C cases via a nationwide research collaboration involving real-time data collection from all 18 paediatric departments. Aggregated number of SARS-CoV-2 infections by vaccination status was obtained from the Danish COVID-19 surveillance registries. The incidence of MIS-C was calculated using the estimated number of infected individuals by vaccination status. We calculated the incidence of MIS-C per 1 000 000 vaccinated and unvaccinated person-years, and estimated vaccine effectiveness as 1-incidence rate ratio using Poisson regression. Incidence and phenotype of MIS-C were compared with MIS-C cases from the first year of the pandemic. This study is registered at ClinicalTrials.gov, NCT05186597. FINDINGS: We identified 51 MIS-C cases among unvaccinated individuals and one in a fully vaccinated adolescent. The incidence of MIS-C was one in 3400 unvaccinated individuals (95% CI 2600-4600) with the delta variant and one in 9900 vaccinated individuals (95% CI 1800-390 000) with breakthrough infection. The estimated vaccine effectiveness against MIS-C after the delta variant was 94% (95% CI 55-99; p=0·0061) in individuals aged 5-17 years. The clinical phenotype during the delta wave was comparable to the pre-delta era. INTERPRETATION: We found the incidence and phenotype of MIS-C in unvaccinated children during the delta wave to be similar to the incidence during the first year of the pandemic. We found vaccine effectiveness to be high against MIS-C, which we suggest was due to protection from infection and, possibly, a decreased incidence of MIS-C after breakthrough infection. Knowledge of the incidence of MIS-C after different SARS-CoV-2 variants and the effect of vaccination might contribute to the elucidation of the extent to which MIS-C is a vaccine-preventable disease. FUNDING: National Ministry of Higher Education and Science and Innovation Fund Denmark.


Subject(s)
COVID-19 , SARS-CoV-2 , Systemic Inflammatory Response Syndrome , Adolescent , COVID-19/complications , COVID-19/epidemiology , Child , Child, Preschool , Cohort Studies , Denmark/epidemiology , Humans , Incidence , Infant , Infant, Newborn , Phenotype , Prospective Studies , SARS-CoV-2/genetics , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/virology , Vaccination
6.
Pediatr Infect Dis J ; 41(4): e142-e145, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1752202

ABSTRACT

We reviewed all cases of Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) bacteremia in Danish children between 2016 and 2021. We found 2 fatal cases with preceding viral prodrome due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the usual benign course of SARS-CoV-2 infection in children, awareness of possible superinfection with PVL-SA in a child with rapid deterioration is crucial to ensure adequate treatment, including antimicrobial drugs with antitoxin effect.


Subject(s)
Bacteremia , Bacterial Toxins/biosynthesis , COVID-19/complications , Exotoxins/biosynthesis , Leukocidins/biosynthesis , SARS-CoV-2 , Staphylococcal Infections/etiology , Staphylococcal Infections/mortality , Staphylococcus aureus/genetics , Adolescent , COVID-19/virology , Child , Child, Preschool , Coinfection , Comorbidity , Denmark/epidemiology , Female , Humans , Infant , Male , Methicillin-Resistant Staphylococcus aureus/genetics , Methicillin-Resistant Staphylococcus aureus/metabolism , Public Health Surveillance , Severity of Illness Index , Staphylococcal Infections/diagnosis , Staphylococcal Infections/therapy , Staphylococcus aureus/drug effects , Staphylococcus aureus/metabolism
7.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-330028

ABSTRACT

Background: Multisystem inflammatory syndrome in children (MIS-C) occurs after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C hospitalizations depends on the risk of MIS-C following specific SARS-CoV-2 variants and vaccine effectiveness. Methods: This prospective nationwide multicentre cohort study included patients aged 0-17 years in Denmark with MIS-C following the SARS-CoV-2 variant Delta in the period August 1, 2021 to February 1, 2022. The risk of MIS-C was calculated using estimated number of infected individuals by vaccination status. We calculated the incidence rate of MIS-C per 1,000,000 vaccinated and unvaccinated person-years and estimated vaccine effectiveness as 1-IRR (incidence rate ratio) using Poisson regression. Phenotype and risk of MIS-C were compared with MIS-C cases from the first year of the pandemic. Findings: We identified fifty-one MIS-C cases among unvaccinated individuals and one in a fully vaccinated adolescent. The risk of MIS-C was one in 4,000 [95% CI 3,100-5,400] unvaccinated individuals with SARS-CoV-2 variant Delta and one in 15,800 [95% CI 2,800-500,000] vaccinated adolescents with break-through infections. The estimated vaccine effectiveness against MIS-C following the Delta variant was 94% [95% CI;55%-99%];p=0·005) in persons aged 5-17 years. The clinical phenotype during the Delta wave was comparable to the pre-Delta era, e.g. hypotension in 57% vs. 50%, respectively. Interpretation: We found the phenotype and the risk of MIS-C following infection with the Delta variant similar to previous variants. Further, we found a high vaccine effectiveness against MIS-C, which we suggest was due to protection from infection and, possibly, a decreased risk of MIS-C following break-through infection. Knowledge of the risk of MIS-C following different SARS-CoV-2 variants, and the effect of vaccination, is important for estimating MIS-C hospitalizations with new variants, such as Omicron, and in the debate of COVID-19 vaccination of children.

9.
Lancet Child Adolesc Health ; 6(4): 240-248, 2022 04.
Article in English | MEDLINE | ID: covidwho-1671373

ABSTRACT

BACKGROUND: Many adolescents have been affected by the COVID-19 pandemic either directly by being infected with the virus or indirectly by lockdowns and restrictions influencing normal living. We aimed to investigate health, including symptoms of long COVID, in adolescents (aged 15-18 years) who tested positive for SARS-CoV-2 compared with a control group. METHODS: LongCOVIDKidsDK was a national, cross-sectional study carried out in Denmark, which included SARS-CoV-2-positive adolescents and matched controls. All Danish adolescents aged 15-18 years with a positive SARS-CoV-2 test during the period Jan 1, 2020, to July 12, 2021, and a control group matched (1:4) by age and sex were sent a survey from July 20, 2021. Participants had until Sept 15, 2021, to respond. Symptoms associated with COVID-19, school attendance, and health-related quality of life were investigated using ancillary questions and validated questionnaires (Paediatric Quality of Life Inventory [PedsQL] and Children's Somatic Symptoms Inventory-24 [CSSI-24]). Statistical analyses included descriptive statistics and logistic regression. This study is registered at ClinicalTrials.gov, NCT04786353. FINDINGS: 24 315 adolescents with a positive SARS-CoV-2 test (case group) and 97 257 matched controls were invited to participate. 3013 matched controls were excluded because of suspected SARS-CoV-2 infection. 6630 (27·3%) responded in the case group and 21 640 (22·3%) responded and were eligible to participate in the control group. Across both groups, median age was 17·6 years (IQR 16·4-18·5), 16 277 (57·6%) of 28 270 responders were female, and 11 993 (42·4%) were male. Participants in the case group had greater odds of having at least one long COVID symptom lasting at least 2 months compared with the control group (3159 [61·9%] vs 12 340 [57·0%], odds ratio 1·22 [95% CI 1·15-1·30]; p<0·0001). Participants in the case group reported significantly lower symptom scores (ie, less somatic distress) on the CSSI-24 than in the control group: mean 10·7 (SD 11·4, median 7·0 [IQR 2·0-15·0]) versus 11·9 (10·6, 9·0 [4·0-17·0]; p<0·0001). Participants in the case group had better quality of life scores on the PedsQL than in the control group: physical functioning mean score 88·7 (SD 13·9, median 93·8 [IQR 84·4-100·0]) versus 86·5 (14·3, 90·6 [81·3-96·9]; p<0·0001); emotional functioning 77·1 (20·3, 80·0 [65·0-95·0]) versus 71·7 (21·4, 75·0 [60·0-90·0]; p<0·0001); social functioning 93·1 (12·5, 100·0 [90·0-100·0]) versus 88·4 (16·2, 95·0 [80·0-100·0]; p<0·0001); and school functioning 66·9 (22·5, 65·0 [60·0-85·0]) versus 62·9 (22·1, 65·0 [50·0-80·0]; p<0·0001). More participants in the case group than in the control group reported 16 or more sick days (1205 [18·2%] vs 2518 [11·6%]; p<0·0001) and 16 or more days of school absence (695 [10·5%] vs 1777 [8·2%]; p<0·0001). INTERPRETATION: Participants with SARS-CoV-2-positive tests had more long-lasting symptoms and sick leave, whereas participants in the control group had more short-lasting symptoms and worse quality of life. Knowledge of long COVID in adolescents is important to guide clinical recognition and management of this condition. FUNDING: AP Møller and Chastine McKinney Møller Foundation.


Subject(s)
COVID-19/complications , Adolescent , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/psychology , COVID-19 Testing , Case-Control Studies , Cross-Sectional Studies , Denmark/epidemiology , Female , Humans , Male , Quality of Life , SARS-CoV-2 , Schools , Sick Leave/statistics & numerical data , Surveys and Questionnaires
10.
Cardiol Young ; 32(1): 138-141, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1655373

ABSTRACT

A 17-year-old adolescent with severe multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease-2019 developed reduced left ventricular function and left ventricular thrombus. With treatment, his condition improved and the thrombus was dissolved. This case illustrates the risk of severe intra-cardiac thrombotic complications in patients with MIS-C.


Subject(s)
COVID-19 , Thrombosis , Adolescent , COVID-19/complications , Child , Humans , SARS-CoV-2 , Systemic Inflammatory Response Syndrome , Thrombosis/diagnosis , Thrombosis/etiology
11.
Pediatr Infect Dis J ; 41(1): e25-e28, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1566087

ABSTRACT

In this prospective nationwide multicenter study from Denmark, myopericarditis after Pfizer-BioNTech mRNA COVID-19 vaccination was identified in 13 males and 2 females between May 15 and September 15, 2021, among 133,477 vaccinated males and 127,857 vaccinated females 12-17 years of age, equaling 97 males and 16 females per million. In conclusion, the incidence of myopericarditis after COVID-19 vaccination among males appears higher than reports from the United States.


Subject(s)
/adverse effects , Myocarditis/chemically induced , Myocarditis/epidemiology , Pericarditis/chemically induced , Pericarditis/epidemiology , Adolescent , Child , Denmark/epidemiology , Female , Humans , Incidence , Male , Prospective Studies
14.
Acta Paediatrica ; n/a(n/a), 2021.
Article in English | Wiley | ID: covidwho-1408244

ABSTRACT

Abstract We thank Chu and Hale for their important comments on the findings of our study investigating the use of saliva for detecting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children.1 Our study followed 20 children and found that in week one and two after diagnosis SARS-CoV-2 was detected in 29% and 11% of saliva samples, 86% and 50% of nasal swabs and 58% and 40% of throat swabs, respectively.2 Chu and Hale got the impression that all saliva samples were taken by a parent, except for the first sample

18.
Pediatr Infect Dis J ; 40(4): e157-e159, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1132630

ABSTRACT

In Denmark, severe acute respiratory syndrome coronavirus 2 antibodies were assessed in a cross-sectional study among 1033 children visiting pediatric departments and 750 blood donors in June 2020, using a point-of-care test. Antibodies were detected in 17 children (1.6%) and 15 blood donors (2.0%) (P = 0.58). In conclusion, children and adults were infected to a similar low degree.


Subject(s)
Antibodies, Viral/immunology , COVID-19/epidemiology , SARS-CoV-2/immunology , Adolescent , Adult , Age Factors , Antibodies, Viral/blood , COVID-19/blood , COVID-19/immunology , Child , Child, Preschool , Denmark/epidemiology , Female , Humans , Infant , Infant, Newborn , Male , Prevalence , Public Health Surveillance , Seroepidemiologic Studies
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