CDC: More Clots, Kidney Failure in Kids After COVID

A wide range of symptoms and conditions cropped up in children and adolescents in the year after a COVID-19 infection, though they were seemingly spared from mental and breathing issues, a CDC study reported.

Compared with peers not diagnosed with COVID-19, young people ages 0-17 years with laboratory-confirmed illness were significantly more likely to develop the following conditions within 31-365 days of diagnosis:

• Acute pulmonary embolism (adjusted HR 2.01, 95% CI 1.62-2.50)
• Myocarditis and cardiomyopathy (adjusted HR 1.99, 95% CI 1.81-2.19)
• Venous thromboembolic events (adjusted HR 1.87, 95% CI 1.54-2.26)
• Acute and unspecified renal failure (adjusted HR 1.32, 95% CI 1.22-1.43)
• Type 1 diabetes (adjusted HR 1.23, 1.13-1.33)

Also linked to COVID-19 were persistent cardiac arrhythmias, bleeding disorders, smell and taste disturbances, and malaise and fatigue.

Nevertheless, the incidence of these conditions remained uncommon in the post-COVID pediatric population, according to Lyudmyla Kompaniyets, PhD, health economist at the CDC in Atlanta, and colleagues reporting in Morbidity and Mortality Weekly Report.

Study authors said their finding of elevated diabetes and myocarditis among children months after COVID is consistent with previous evidence, whereas the other observed risks appear to be novel in this population.

Notably, the COVID patients had low rates of respiratory, mental health, neurological, muscle disorders, and sleeping disorders compared with the general population in this study.

“Reasons for these observed associations are likely multifactorial, and might be, in part, because patients without COVID-19 were selected from a cohort of patients with a health care encounter possibly related to COVID-19 and were less healthy than were patients with COVID-19 at baseline,” the CDC group suggested.

The definition of post-COVID symptoms and conditions used by the authors was new, recurring, or ongoing health problems that occurred 4 or more weeks after infection with SARS-CoV-2.

The study was conducted using large medical claims databases in order to assess nine potential post-COVID signs and symptoms and 15 potential post-COVID conditions among children and adolescents.

Data were collected on 781,419 U.S. children and adolescents with COVID-19, who were matched 1:3 with peers with a healthcare encounter but no reported COVID-19 from March 2021 to January 2022. Participants were followed for a minimum of 60 days and a maximum of 365 days.

The cohort had a mean age of 12 years, and was evenly split between boys and girls.

Statistical models were adjusted for age, sex, race, U.S. Census Bureau region, payor type, previous medical complexity, and previous hospitalization.

Kompaniyets and colleagues warned that their analysis of post-COVID symptoms and conditions was subject to misclassification bias and did not account for events that started before COVID infection. Whether the reported conditions were transient or chronic was not known.

There is also the possibility that some children may have had undocumented COVID-19, they acknowledged, adding that the 70% rate of patients being on Medicaid managed care limits the study’s generalizability to all children and adolescents.

Finally, vaccination status was not adjusted for in the study because of assumed underreporting in the dataset. Nonetheless, the CDC group maintained the importance of COVID vaccination in children and teenagers.

“COVID-19 prevention strategies, including vaccination for all eligible persons aged ≥6 months, are critical for preventing SARS-CoV-2 infection and subsequent illness and for reducing the public health impact of post-COVID symptoms and conditions,” they wrote.