COVID-19 in children: Evolving epidemiology, immunology, symptoms, diagnostics, treatment, post covid conditions, prevention strategies, and future directions.

Abstract

The epidemiology of COVID-19 in children has evolved throughout the pandemic, with initially low infection rates rising significantly due to the emergence of the more transmissible Omicron variant. Adolescents, children from ethnic minorities and lower-income households, and those with obesity are at increased risk of contracting SARS-CoV-2 infection. The immune response in children leads to milder symptoms compared to adults, with fever and cough being most frequent; tough symptoms vary by SARS-CoV-2 variant and age. Diagnostic methods to confirm current or past infection include RT-PCR, rapid antigen tests and serology. Treatment is mainly supportive, with antivirals and glucocorticoids reserved for severe cases. While serious conditions like MIS-C and other post-COVID-19 conditions are rare, they require careful management. Vaccination has proven effective in reducing severe disease and protecting against post-COVID-19 conditions. Continued surveillance, including wastewater monitoring and universal or pooled testing, remains crucial for controlling community spread. Key questions remain regarding the duration and quality of immunity following re-infection or vaccination, the impact of co-infections, and optimal treatment protocols for different pediatric populations.