Study: Long-COVID in immunocompromised children. Image Credit: L Julia/Shutterstock

Long-term COVID study in immunodeficient children

Initial research found that children are not susceptible to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of the 2019 coronavirus disease (COVID-19) pandemic; however, in case of infection, they remain asymptomatic or show mild symptoms.

After the initiation of COVID-19 vaccination in adults and adolescents, children under the age of five became the primary victims of COVID-19, along with those who had not been vaccinated.

Study: Long-COVID in immunocompromised children† Image credit: L Julia/Shutterstock


Worse Covid-19 symptoms in children were reported and the number of hospitalizations in children with SARS-CoV-2 infection increased marginally. In addition, there are two significant complications associated with COVID-19, namely: Multisystem Inflammatory Syndrome in Children (MIS-C) and Lung COVID, were reported. MIS-C only occurs in children and adolescents, while Lung COVID is known to affect all age groups.

Some of the hallmark persistent symptoms of Lung COVID are shortness of breath, fatigue cough, chest pain, sleep disturbances and headaches. Other more complicated symptoms of Lung COVID include cardiovascular, sensory, respiratory and neurological complications.

Scientists have pointed to a gap in research on the outcome of COVID-19 symptoms in immunocompromised children. The main question is whether the vulnerable group of children is affected in the same way by COVID-19 infection, that is, usually has asymptomatic or mild symptoms, compared to the healthy group of children.

A new study

A new study currently posted on the Research Square preprint server pending publication on the BMC One Health Outlook journal has focused on evaluating the prevalence of hallmark symptoms of Lung COVID in immunodeficient and immunocompetent children.

Researchers prepared a questionnaire for this study asking about general health status, vaccination status against COVID-19, diagnosis of MIS-C and the presence of long-term COVID symptoms and how they affected their daily activities. Parents of 147 children completed the questionnaire. All children in this study were admitted to the Children’s Memorial Health Institute in Warsaw, Poland, between November 1, 2020, and January 31, 2022 at least three months prior to the establishment of the COVID-19 subunit.

The participants in this study were divided into two groups, ie one group consisted of immunocompromised children and the other group consisted of non-immunocompromised children. In this study, 47.6% of the participants were immunodeficient, while 52.4% of the study cohort were in the control group, ie those who were not immunocompromised.

Key findings

A previous study reported that children with Lung COVID had several persistent symptoms, such as fatigue, difficulty concentrating, chest pain, palpitations, headaches and muscle weakness. Another study found that some of the symptoms persisted for up to five months after being infected with COVID-19. The symptoms of lung COVID in children, as described in previous studies, were found to be consistent with the findings of the current study.

In this study cohort, the prevalence of Lung COVID in the control group was relatively high and increased with age. The researchers found no association between Lung COVID and allergic disease. The current study reported that the prevalence of Lung COVID in immunocompromised children is less. However, the reason behind such a result is not clear. In the future, the underlying mechanism behind this observation should be studied.

Scientists have suggested several plausible theories to explain why the frequency of Lung COVID is less in immunocompromised children. One of the possible reasons suggested by the scientists is the high incidence of asymptomatic COVID-19 infection in this group. While several studies have postulated that severe COVID-19 infection and Lung COVID are not correlated, organ damage from severe infection has long-term consequences. For example, inflammation, fibrosis and scarring in severely infected patients can lead to prolonged chronic cough, pneumonia and breathing difficulties.

In this study, the authors suggested that a diminished immune response may act as a protective factor against developing inflammatory responses, and this could be why immunocompromised children are less likely to develop lung COVID. Previous studies have suggested another possible reason for Lung COVID, which is the persistence of SARS-CoV-2 reservoirs in specific tissues. In this study, researchers noted that in several immunocompromised patients, symptoms lasted for up to three months.


The authors of this study reported that although immunocompromised children have persistent COVID-19 symptoms, their frequency is significantly low compared to the immunocompetent group of children. Some of the common Lung COVID symptoms found in children include chronic cough, gastrointestinal symptoms, and fatigue.

Researchers noted that most symptoms cleared up within three months and didn’t affect the daily activities of immunocompromised children much. Scientists have also revealed that the risk of developing Lung COVID increased with age and severe COVID-19 symptoms. In the future, the pathomechanism of long-COVID in children should be further investigated.

*Important announcement

Research Square publishes preliminary scientific reports that have not been peer-reviewed and therefore should not be considered conclusive, should guide clinical practice/health-related behavior or be treated as established information.

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