Long-term symptoms associated with the 2019 coronavirus illness (COVID-19) in nonhospitalized pediatric populations in the United States are little characterized. The purpose of this study was to compare children with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody status for the existence of chronic COVID symptoms. The Texas Coronavirus Antibody REsponse Survey is a statewide prospective population-based survey that collected data between October 2020 and May 2022 from people aged 5 to 90. The Roche Elecsys Anti-SARS-CoV-2 Immunoassay was utilized to evaluate serological status by detecting antibodies to the SARS-CoV-2 nucleocapsid protein. Concurrent data collection included self-reported antigen/polymerase chain reaction COVID-19 test results and the presence/absence and duration of persisting COVID symptoms. Age, antibody status, symptom presence/severity, variant, body mass index, and vaccination status were factored in to determine risk ratios for chronic COVID symptoms compared to adulthood. Among the overall sample size of 1,813, 82 (4.5%) reported ongoing COVID symptoms (8.0% pre-Delta, 3.4% Delta and beyond; n = 27 [1.5%] 4-12 weeks, n = 58 [3.3%] >12 weeks). When compared to adults, children of all ages were at a significantly lower risk of developing long-lasting COVID symptoms. Other risk factors for COVID symptoms lasting more than 12 weeks were having severe symptoms at initial infection, not being vaccinated, and being overweight (BMI >85th percentile for age and sex). These results underline the fact that there may be young people outside of hospital care who also have recurrent COVID symptoms. Compared to adults, children and adolescents are less likely to experience persistent COVID symptoms, but they are more likely to be symptomatic, experience severe symptoms, and have unhealthy weight than children and adolescents without persistent COVID symptoms.
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