A systematic review today in Pediatrics of 31 studies published through December 2022 reveals that persistent symptoms 3 months after confirmed COVID-19 infections, or "long COVID," affect 16% of children and adolescents.

The 31 studies included 15,000 children, and researchers recorded more than 20 persistent symptoms. For the first months of the pandemic, there was a dearth of research and understanding on how and if children could suffer from long COVID.

"It was thought at first that the pediatric population was relatively spared from the long-term effects of COVID-19 after infection," the authors said. "But this changed rapidly with increasing reports and studies of pediatric patients not fully recovering from acute COVID-19."

Sore throat, fever, sleep disturbance most common

Among the studies included in the present analysis, 16.2% (95% confidence interval [CI], 8.5% to 28.6%) of the pediatric participants experienced 1 or more persistent symptoms at least 3 months post COVID-19. Symptoms included fatigue, depression, sleep disturbance, cough, throat pain, and gastrointestinal symptoms.

The three most common persistent symptoms seen in the studies were sore throat with a pooled estimate of 14.8% (95% CI, 4.8% to 37.5%); persistent fever, with an estimate of 10.9 (95% CI, 2.4% to 38.2%); and sleep disturbance, with an estimate of 10.3% (95% CI, 4.9% to 20.4%).

Long COVID in children and adolescents has been reported with a very wide symptom spectrum and with great heterogeneity among studies.

"Long COVID in children and adolescents has been reported with a very wide symptom spectrum and with great heterogeneity among studies included in this review," the authors concluded. "There is the need for high quality, prospective, and well controlled studies to address these issues."

A series of reports published yesterday by the Africa Centres for Disease Control and Prevention on antimicrobial resistance (AMR) in 14 countries highlights a lack of capacity for bacteriologic testing and limited access to antibiotics.

The project, by the Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP), reviewed 819,584 AMR records collected from 205 laboratories and data from 327 hospital and community pharmacies and 16 national-level antimicrobial consumption data sets covering 2016 through 2019. The countries involved in the project were Burkina Faso, Cameroon, Eswatini, Gabon, Ghana, Kenya, Malawi, Nigeria, Senegal, Sierra Leone, Tanzania, Uganda, Zambia, and Zimbabwe. Africa has the highest mortality rate from AMR infections in the world, but most available AMR data from these countries to date have been based on statistical modeling.

While the project produced 14 individual reports for each country, among the key findings overall were that only 1.3% of the biology laboratories across the 14 countries perform bacteriologic testing, 80% perform fewer than 1,000 antimicrobial susceptibility tests a year, and testing was consistently conducted for only 5 of the World Health Organization's 15 antibiotic-resistant priority pathogens. In 8 of the 14 countries, more than half of the population is out of reach of a bacteriology laboratory.

The study also found that, of 187,000 clinical samples tested for AMR, 88% had no information on patients' clinical profiles, including the diagnosis and origin of infection, which makes it difficult to understand what's driving AMR.

Analysis of antimicrobial consumption data indicated that only four antibiotics accounted for more than 67% of antibiotic used in healthcare settings in the 14 countries, and that access to broader-spectrum antibiotics for resistant infections was limited. Up to 34 uncategorized antibiotics were found to be in circulation.

The project is supported by a grant from the Fleming Fund.

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• The European Medicines Agency today recommended Pfizer's respiratory syncytial virus (RSV) vaccine (Abrysvo) for use in pregnant women as a way to protect babies from birth to 6 months from the disease. The agency also recommended the vaccine for use in adults ages 60 and older. The bivalent (two-strain) vaccine against RSV A and B was evaluated on an accelerated basis.