Omicron reinfection doubled long Covid risk for children: Lancet study
A study found that children reinfected with Covid-19 during the Omicron wave are over twice as likely to develop long Covid compared to initial infections.
Children who were infected with Covid-19 for the second time during the Omicron wave had more than double the risk of developing long Covid, according to a new study published in The Lancet Infectious Diseases.
Conducted by researchers under the US National Institutes of Health (NIH)-funded Recover Initiative, this is the largest study to date examining the long-term effects of Covid-19 reinfection in young people, said the authors.
The NIH’s Recover (Researching Covid to Enhance Recovery) Initiative is dedicated to understanding long Covid, developing better treatments, and guiding strategies to protect people of all ages from the prolonged effects of Covid-19.
The study titled ‘Long Covid associated with Sars-CoV-2 reinfection among children and adolescents in the omicron era (Recover-EHR): a retrospective cohort study’ involved at least 460,000 children and adolescents across 40 paediatric hospitals in the USA.
“Post-acute sequelae of SARS-CoV-2 infection (Pasc) remain a major public health challenge. Although previous studies have focused on characterising PASC in children and adolescents after an initial infection, the risks of PASC after reinfection with the omicron variant remain unclear. We aimed to assess the risk of Pasc diagnosis and symptoms and conditions potentially related to Pasc in children and adolescents after a Sars-CoV-2 reinfection during the omicron period,” said authors in the study.
The study analysed electronic health records from January 2022 through October 2023, a period dominated by the highly transmissible Omicron variant. Researchers compared health outcomes following children’s first and second documented Covid-19 infections to isolate the risks associated with reinfection.
They found that after a first Covid-19 infection, about 904 children per million developed long Covid within six months. Following a second infection (reinfection), this number more than doubled to approximately 1,884 children per million. The higher risk was observed across many different groups in the study, regardless of whether they were vaccinated, how serious their first illness was, their age, gender, race or ethnicity, or if they were living with overweight or obesity.
“We identified 407 300 (87·5%) of 465717 eligible children and adolescents with a first infection episode and 58 417 (12·5%) with a second infection episode from Jan 1, 2022, to Oct 13, 2023, in the RECOVER database. 233 842 (50·2%) patients were male and 231 875 (49·8%) were female. The mean age was 8·17 years (SD 6·58). The incident rate of PASC diagnosis (U09.9) per million people per 6 months was 903·7 in the first infection group and 1883·7 in the second infection group,” read the study.
“Reinfection was associated with a significantly increased risk of an overall PASC diagnosis… and a range of symptoms and conditions potentially related to PASC…, including myocarditis, changes in taste and smell, thrombophlebitis and thromboembolism, heart disease, acute kidney injury, fluid and electrolyte disturbance, generalised pain, arrhythmias, abnormal liver enzymes, chest pain, fatigue and malaise, headache, musculoskeletal pain, abdominal pain, mental ill health, POTS or dysautonomia, cognitive impairment, skin conditions, fever and chills, respiratory signs and symptoms, and cardiovascular signs and symptoms.”
The authors said this increased risk of long Covid following reinfections highlights the continued importance of preventing Covid-19 infections through vaccination and other protective measures such as masking and social distancing.
They also observed that reinfection was linked to a wide range of rare but persistent and sometimes serious conditions potentially associated with long Covid in children, including heart inflammation (myocarditis), blood clots, kidney injury, cognitive difficulties, fatigue, and respiratory problems.
The authors emphasised that while vaccines and other prevention measures may not completely eliminate the risk of contracting Covid-19, they remain the most effective way to prevent both initial infections and reinfections, thereby reducing the risk of long-lasting symptoms in children. They added that the study’s findings reinforce the need to strengthen public health efforts to increase Covid-19 vaccination coverage among children and adolescents.
“Children and adolescents face a significantly higher risk of various PASC outcomes after reinfection with SARS-CoV-2. These findings add to previous evidence linking paediatric long COVID to multisystem effects and highlight the need to promote vaccination in younger populations and support ongoing research to better understand PASC, identify high-risk subgroups, and improve prevention and care strategies,” they said.
