. 2023 Mar 1;6(3):e235763.

doi: 10.1001/jamanetworkopen.2023.5763.

Prevalence and Characteristics Associated With Post-COVID-19 Condition Among Nonhospitalized Adolescents and Young Adults

Joel Selvakumar^{1

2}, Lise Beier Havdal¹, Martin Drevvatne^{1

2}, Elias Myrstad Brodwall¹, Lise Lund Berven¹, Tonje Stiansen-Sonerud^{1

3}, Gunnar Einvik^{2

4}, Truls Michael Leegaard^{2

5}, Trygve Tjade⁶, Annika E Michelsen^{2

7}, Tom Eirik Mollnes^{8

9

10}, Fridtjof Lund-Johansen⁸, Trygve Holmøy^{2

11}, Henrik Zetterberg^{12

13

14

15

16}, Kaj Blennow^{12

13}, Carolina X Sandler^{17

18}, Erin Cvejic¹⁹, Andrew R Lloyd¹⁸, Vegard Bruun Bratholm Wyller^{1

2}

Affiliations

¹ Department of Paediatrics and Adolescent Health, Akershus University Hospital, Lørenskog, Norway.
² Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
³ Department of Clinical Molecular Biology (EpiGen), University of Oslo and Akershus University Hospital, Lørenskog, Norway.
⁴ Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway.
⁵ Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway.
⁶ Fürst Medical Laboratory, Oslo, Norway.
⁷ Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.
⁸ Department of Immunology, University of Oslo and Oslo University Hospital, Oslo, Norway.
⁹ Research Laboratory, Nordland Hospital, Bodø, Norway.
¹⁰ Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway.
¹¹ Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
¹² Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
¹³ Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
¹⁴ UCL Institute of Neurology, Department of Neurodegenerative Disease, London, United Kingdom.
¹⁵ UK Dementia Research Institute, Gower Street, London, United Kingdom.
¹⁶ Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China.
¹⁷ School of Health Sciences, Western Sydney University, Penrith, Australia.
¹⁸ The Kirby Institute, University of New South Wales, Sydney, Australia.
¹⁹ School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney Australia.

PMID: 36995712
PMCID: PMC10064252
DOI: 10.1001/jamanetworkopen.2023.5763

Prevalence and Characteristics Associated With Post-COVID-19 Condition Among Nonhospitalized Adolescents and Young Adults

Joel Selvakumar et al. JAMA Netw Open. 2023.

. 2023 Mar 1;6(3):e235763.

doi: 10.1001/jamanetworkopen.2023.5763.

Authors

Affiliations

¹ Department of Paediatrics and Adolescent Health, Akershus University Hospital, Lørenskog, Norway.
² Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
³ Department of Clinical Molecular Biology (EpiGen), University of Oslo and Akershus University Hospital, Lørenskog, Norway.
⁴ Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway.
⁵ Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway.
⁶ Fürst Medical Laboratory, Oslo, Norway.
⁷ Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.
⁸ Department of Immunology, University of Oslo and Oslo University Hospital, Oslo, Norway.
⁹ Research Laboratory, Nordland Hospital, Bodø, Norway.
¹⁰ Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway.
¹¹ Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
¹² Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
¹³ Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
¹⁴ UCL Institute of Neurology, Department of Neurodegenerative Disease, London, United Kingdom.
¹⁵ UK Dementia Research Institute, Gower Street, London, United Kingdom.
¹⁶ Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China.
¹⁷ School of Health Sciences, Western Sydney University, Penrith, Australia.
¹⁸ The Kirby Institute, University of New South Wales, Sydney, Australia.
¹⁹ School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney Australia.

PMID: 36995712
PMCID: PMC10064252
DOI: 10.1001/jamanetworkopen.2023.5763

Abstract

Importance: The prevalence and baseline risk factors of post-COVID-19 condition (PCC) remain unresolved among the large number of young people who experienced mild COVID-19.

Objectives: To determine the point prevalence of PCC 6 months after the acute infection, to determine the risk of development of PCC adjusted for possible confounders, and to explore a broad range of potential risk factors.

Design, setting, and participants: This cohort study included nonhospitalized individuals from 2 counties in Norway between ages 12 and 25 years who underwent reverse transcription-polymerase chain reaction (RT-PCR) testing. At the early convalescent stage and at 6-month follow-up, participants underwent a clinical examination; pulmonary, cardiac, and cognitive functional testing; immunological and organ injury biomarker analyses; and completion of a questionnaire. Participants were classified according to the World Health Organization case definition of PCC at follow-up. Association analyses of 78 potential risk factors were performed.

Exposures: SARS-CoV-2 infection.

Main outcomes and measures: The point prevalence of PCC 6 months after RT-PCR testing in the SARS-CoV-2-positive and SARS-CoV-2-negative groups, and the risk difference with corresponding 95% CIs.

Results: A total of 404 individuals testing positive for SARS-CoV-2 and 105 individuals testing negative were enrolled (194 male [38.1%]; 102 non-European [20.0%] ethnicity). A total of 22 of the SARS-CoV-2-positive and 4 of the SARS-CoV-2-negative individuals were lost to follow-up, and 16 SARS-CoV-2-negative individuals were excluded due to SARS-CoV-2 infection in the observational period. Hence, 382 SARS-CoV-2-positive participants (mean [SD] age, 18.0 [3.7] years; 152 male [39.8%]) and 85 SARS-CoV-2-negative participants (mean [SD] age, 17.7 [3.2] years; 31 male [36.5%]) could be evaluated. The point prevalence of PCC at 6 months was 48.5% in the SARS-CoV-2-positive group and 47.1% in the control group (risk difference, 1.5%; 95% CI, -10.2% to 13.1%). SARS-CoV-2 positivity was not associated with the development of PCC (relative risk [RR], 1.06; 95% CI, 0.83 to 1.37; final multivariable model utilizing modified Poisson regression). The main risk factor for PCC was symptom severity at baseline (RR, 1.41; 95% CI, 1.27-1.56). Low physical activity (RR, 0.96; 95% CI, 0.92-1.00) and loneliness (RR, 1.01; 95% CI, 1.00-1.02) were also associated, while biological markers were not. Symptom severity correlated with personality traits.

Conclusions and relevance: The persistent symptoms and disability that characterize PCC are associated with factors other than SARS-CoV-2 infection, including psychosocial factors. This finding raises questions about the utility of the World Health Organization case definition and has implications for the planning of health care services as well as for further research on PCC.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Einvik reported grants from Boehringer Ingelheim and AstraZeneca outside the submitted work. Dr Michelsen reported holding shares from Pfizer outside the submitted work. Dr Zetterberg reported personal fees from service on advisory boards for Abbvie, Alector, ALZPath, Annexon, Apellis, Artery Therapeutics, AZTherapies, CogRx, Denali, Eisai, Nervgen, Novo Nordisk, Pinteon Therapeutics, Red Abbey Labs, reMYND, Passage Bio, Roche, Samumed, Siemens Healthineers, Triplet Therapeutics, and Wave Scientific and for sponsored lectures from Cellectricon, Fujirebio, Alzecure, Biogen, and Roche outside the submitted work; he reported that he is a cofounder of Brain Biomarker Solutions, which is a part of the GU Ventures Incubator Program. Dr Blennow reported having served as a consultant and on advisory boards for Acumen, ALZPath, BioArctic, Biogen, Eisai, Julius Clinical, Lilly, Novartis, Ono Pharma, Prothena, Roche Diagnostics, and Siemens Healthineers; he has served at data monitoring committees for Julius Clinical and Novartis; he reported giving lectures, producing educational materials, and participating in educational programs for Biogen, Eisai and Roche Diagnostics; and he reported cofounding Brain Biomarker Solutions, which is a part of the GU Ventures Incubator Program, outside the submitted work. No other disclosures were reported.

Figures

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Comment in

Post-COVID syndrome, the real matter of debate.
Tirelli U, Franzini M, Chirumbolo S. Tirelli U, et al. J Med Virol. 2023 May;95(5):e28785. doi: 10.1002/jmv.28785. J Med Virol. 2023. PMID: 37212308 No abstract available.

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Prevalence and Characteristics Associated With Post-COVID-19 Condition Among Nonhospitalized Adolescents and Young Adults

Affiliations

Prevalence and Characteristics Associated With Post-COVID-19 Condition Among Nonhospitalized Adolescents and Young Adults

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding