Intended for healthcare professionals

Letters Long covid in children

Vaccinating children to prevent long covid? More caution is needed in interpreting current epidemiological data

BMJ 2021; 372 doi: (Published 24 February 2021) Cite this as: BMJ 2021;372:n520
  1. Sunil S Bhopal, academic clinical lecturer in population health paediatrics1,
  2. Michael Absoud, consultant and senior clinical lecturer in paediatric neurodisability2
  1. 1Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
  2. 2Evelina London Children's Hospital and Department of Women and Children's Health, King's College London, London, UK
  1. sunil.bhopal{at}

We are used to supporting children with chronic illness and have followed closely concerns raised by Simpson and Lokugamage regarding long covid in children.12 Media reports following the All Party Parliamentary Group on Coronavirus meeting on schools34 stated that “scientists called for reconsideration of covid-19 vaccinations for children” because of fears regarding the prevalence of the condition.5 The Office for National Statistics (ONS) prevalence of 12.9% (primary school age) and 15% (secondary school age) of long covid are widely quoted. So how much should parents and their children worry, and does this worry warrant vaccination?

The ONS figures6 need context. Our understanding is that they represent the proportion of children who—within five weeks of a positive covid-19 test—have one of the following symptoms: fatigue, cough, headache, loss of taste or smell, myalgia, sore throat, fever, shortness of breath, nausea or vomiting, diarrhoea, or abdominal pain. For some of these symptoms the ONS reported prevalence is as follows: fatigue 3.5%; cough 4%; headache 5.3%; loss of taste or smell 2%; myalgia 1.7%. These seem in line with or lower than the population prevalence—for example, cough reported in an unselected cohort of 7670 children aged 1-18,7 or headache and fatigue in children from a representative Finnish cohort.8 Given current high levels of family and community stress we would expect the prevalence of some of these symptoms to be higher.

The prevalence estimates being discussed need a comparator group, and to be interpreted with much more caution, especially given the lack of a dedicated case definition for children.9 Specifically, we need to know how many survey participants (by age) without covid-19 had similar symptoms. In the meantime—especially while there are no safety data in children—we endorse the Royal College of Paediatrics and Child Health’s sensible position on covid-19 vaccination.10


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