Long COVID Incidence and Symptoms Differ by Age and Gender

Long COVID did not affect children, manifested differently in males vs females, and was worse for those with more symptomatic initial infections.

At 1-year post COVID-19 infection, persistent symptoms are uncommon in children; however, adolescent girls may have greater risk for prolonged symptoms. Moreover, long COVID symptoms generally manifest differently in males vs females and are worse among those who experienced more severe symptoms when initially infected with COVID-19. These are among study findings reported in eBio Medicine.

Researchers sought to evaluate long COVID symptoms in a large cohort of families that included infected and non-infected adults, adolescents, and children approximately 1 year following infection. The investigators also examined persistent symptom clustering within households and the long-term effects of COVID-19 in exposed but non-infected household members.

The investigators conducted an observational, multi-center, prospective study that included 341 households with 1267 family members (723 adults; 140 adolescents 14-18 years of age; 404 children younger than 14 years of age; median household size of 4 persons). All participants lived in Baden-Wurttemberg, Germany, and were recruited at study centers in Freiburg, Tubingen, Ulm, and Heidelberg from May 2020 to August 2020 at 9 to 17 weeks following household exposure/infection (which was confirmed by RT-PCR and serologically proven). All participating family members were stratified into cohorts based on whether they had been infected by SARS-CoV-2 vs exposed to the virus by another family member within their household.  Those who were exposed but not infected served as the control group.

Information on long COVID symptoms were collected via online questionnaires completed upon study enrollment and at 11 to 12 months following infection within the household. Notably, 35.4% of participants completing the initial questionnaire did not complete the 11 to 12-month questionnaire.

Researchers found that moderate or severe persistent long COVID symptom were higher by a statistically significant amount in infected vs exposed men (22.9% [95% CI, 17.9%-28.5%] vs 10.3% [95% CI, 5.8-16.9%]), infected vs exposed women (36.4% [95% CI, 30.7-42.4%] vs 14.2% [95% CI, 8.7-21.5%]), and infected vs exposed adolescent girls (32.1% [95% CI, 17.2-50.5%] vs 8.9% [95% CI, 3.1-19.8%]).

Long COVID symptoms were also found to differ by gender. Infected men showed higher prevalence of moderate or severe dysgeusia/dysosmia than exposed men. Infected women showed higher prevalence of moderate or severe fatigue, reduced physical resilience, sleep problems, and dysgeusia/dysosmia than exposed women. Overall, infected adults showed higher prevalence of moderate or severe breathlessness than exposed adults, with no statistical significance in subgroups by sex.

Prolonged symptoms tended to cluster within families, suggesting family-level interventions for long COVID could prove useful.

Infected adolescent girls showed higher prevalence of moderate or severe reduced physical resilience than exposed adolescent girls. Researchers found adolescent boys and children less than 14 years of age largely showed no moderate or severe persistent symptoms in infected or exposed cohorts. Moreover, persistent moderate or severe symptoms of long COVID were not statistically more prevalent in infected vs exposed adolescent boys or in infected vs exposed children.

Notably, researchers found an association between the number of prolonged symptoms reported by household members and the number of prolonged symptoms reported by individuals (incidence rate ratio=1.11; 95% CI, 1.03-1.20; P =.005).

Significant study limitations include underpowered sample size; lack of generalizability; subjective reporting of data on children by their parents; selection bias; recall bias in questionnaire responses; possible unreported therapeutic interventions between enrollment and the study’s end; and possible non-response bias.

“In this controlled, multi-centre study, infected men, women and adolescent girls were at increased risk of negative outcomes 11-12 months after SARS-CoV-2 infection,” said study authors. “Prolonged symptoms tended to cluster within families, suggesting family-level interventions for long COVID could prove useful,” they added.

This article originally appeared on Pulmonology Advisor


Haddad A, Janda A, Renk H, et al. Long COVID symptoms in exposed and infected children, adolescents and their parents 1 year after SARS-CoV-2 infection: A prospective observational cohort study. EBioMedicine. Published online September 22, 2022. doi:10.1016/j.ebiom.2022.104245