Acute and persistent symptoms in children with PCR-confirmed SARS-CoV-2 infection compared to test-negative children in England: active, prospective, national surveillance

Abstract

Background

Most children recover quickly after COVID-19, but some may have on-going symptoms. Follow-up studies have been limited by small sample sizes and lack of appropriate controls

Methods

We used national testing data to identify children aged 2-16 years with a SARS-CoV-2 PCR test during 01-07 January 2021 and randomly selected1,500 PCR-positive cases and 1,500 matched PCR-negative controls. Parents were asked to complete a questionnaire about the acute illness and pre-specified neurological, dermatological, sensory, respiratory, cardiovascular, gastrointestinal, mental health (including emotional and behavioural well-being) and other symptoms experienced at least five times at one month after the PCR test.

Results

Overall, 35.0% (859/2456) completed the questionnaire, including 38.0% (472/1242) cases and 32% (387/1214) controls. of whom 68% (320/472) and 40% (154/387) were symptomatic, respectively. The most prevalent acute symptoms were cough (249 /859, 29.0%), fever (236/859, 27.5%), headache (236/859, 27.4%) and fatigue (231/859, 26.9%). One month later, 21/320 (6.7%) of symptomatic cases and 6/154 (4.2%) of symptomatic controls (p=0.24) experienced on-going symptoms. Of the 65 on-going symptoms solicited, three clusters were significantly (p<0.05) more common, albeit at low prevalence, among symptomatic cases (3-7%) than symptomatic controls (0-3: neurological, sensory and emotional and behavioural wellbeing. Mental health symptoms were reported by all groups but more frequently among symptomatic cases than symptomatic controls or asymptomatic children.

Conclusions

Children with symptomatic COVID-19 had a slightly higher prevalence of on-going symptoms than symptomatic controls, and not as high as previously reported. Healthcare resources should be prioritised to support the mental health of children.