Heart problems after COVID-19 rare in children and young adults, more research needed – ScienceDaily
Heart complications are rare, but treatable for children and young adults after COVID-19 illness or SARS-CoV-2 infection, according to a new scientific statement from the American Heart Association that details what has been learned about how to treat, manage and even prevent cardiovascular complications from the SARS-CoV-2 virus in young people. The statement published today in the Association’s flagship journal Traffic.
The latest data also indicate that returning to sports and strenuous physical activity after cardiac symptoms resolve is safe, although further screening may be considered for young people with more severe symptoms.
The new statement also calls for more research, including studies of the long-term cardiovascular effects of COVID-19 in children and young adults. The volunteer writing group’s extensive research into the latest data found that children with congenital heart disease (heart disease or defects present at birth) have low rates of infection and complications from SARS-CoV-2, the virus which causes the disease COVID-19. A scientific statement from the American Heart Association is an expert analysis of current research and may inform future guidelines.
“Two years into the pandemic and with large amounts of research being conducted on children with COVID-19, this statement summarizes what we know so far regarding COVID-19 in children,” the president said. of the statement writing group Pei-Ni Jone, MD. , FAHA, Director of 3D Echocardiography, Kawasaki Disease Clinic, and Echocardiography Quality at Children’s Hospital Colorado in Aurora, Colorado. “We focused on the effects of this virus for people with congenital or other heart conditions, as well as the latest data on the potential association of COVID-19 vaccines with heart complications in children and young adults. Although we know a lot, this public health emergency requires continued research to understand the short and long term impacts on children. »
Analysis of the latest research indicates that children usually show mild symptoms of SARS-CoV-2 infection. In the United States, as of February 24, 2022, children accounted for 17.6% of total COVID-19 cases and approximately 0.1% of deaths from the virus. Additionally, young adults, ages 18 to 29, accounted for 21.3% of cases and 0.8% of deaths from COVID-19. Studies suggest that a few factors may help explain why children may be less susceptible to severe COVID-19 infection: 1) children’s body cells have fewer receptors to attach to the SARS-CoV-2 virus and 2) children may have a weaker immune system response due to a different cytokine response than adults and trained immunity to other vaccines and viral infections.
While children with congenital heart disease have had low rates of infection and mortality from SARS-CoV-2 infection, having an underlying genetic syndrome, such as trisomy 21 (also known as Down syndrome), appears to be associated with an increased risk of severe COVID -19.
The statement outlines available treatments for children with COVID-19, although there are no specific COVID-19 antiviral therapies. These include remdesivir and dexamethasone for children in certain age groups. Remdesivir is the only antiviral drug currently approved by the United States Food and Drug Administration (FDA) for the treatment of people ages 12 and older hospitalized with COVID-19 who have risk factors for severe disease and who have need for supplemental oxygen, and it is most effective when given as soon as possible after the onset of symptoms. Dexamethasone, which has been shown to reduce the risk of death in adults with COVID-19, is suggested for children with more severe illness who need respiratory support.
Cardiac complications in children with COVID-19 are rare. Case reports of cardiac complications include:
- cardiogenic shock, where a suddenly weakened heart cannot pump enough blood to meet the body’s needs;
- myocarditis (inflammation of the heart muscle); pericarditis (inflammation of the pericardium, a thin sac-like structure that surrounds the heart); and
- arrhythmias (irregular heart beats and rhythms).
Sudden cardiac death and death following intensive medical treatment and life-sustaining therapy have occurred in children with severe COVID-19 that has affected the heart.
Since the start of the COVID-19 pandemic, a new Multisystem Inflammatory Syndrome in Children (MIS-C) has been identified worldwide, with up to half of cases involving inflammation of the heart muscle or heart arteries . In the first year of the pandemic, one in 3,164 children infected with SARS-CoV-2 developed MIS-C.
For children who develop MIS-C, intravenous immunoglobulin (IVIg) has been given alone or in combination with infliximab or other immunomodulating agents. Most children’s hearts recovered well within 1-4 weeks of being diagnosed with MIS-C. The risk of long-term complications and death from MIS-C is estimated at 1.4-1.9%.
The majority of MIS-C cases involved children identified in medical records as black or Hispanic. More research on MIS-C is needed to know why people from various racial or ethnic groups may be disproportionately affected and to understand the risk factors for this disease.
For children and young adults who have had COVID-19, returning to sports and vigorous physical activity has been an area of focused research and examination. The latest data suggests that those who have had a mild COVID-19 infection or an infection without symptoms can safely return to sport after recovering from all symptoms. For young people with more severe SARS-CoV-2 infection or who develop MIS-C, it is reasonable to consider certain cardiovascular screenings, such as an echocardiogram, blood tests for enzyme levels heart tests and other screening tests for cardiac function, before resuming sport.
COVID-19 vaccines can prevent patients from getting COVID-19 and decrease the risk of MIS-C by 91% in children 12-18 years old. Some have expressed concern about the risk of heart inflammation after COVID-19 mRNA vaccines. The data indicate that the benefits of getting vaccinated outweigh the risk of potentially developing vaccine-associated myocarditis. For example, for every million doses of COVID-19 mRNA vaccines in men aged 12-29 (the group most at risk for vaccine-associated myocarditis), an estimated 11,000 cases of COVID-19, 560 hospitalizations and 6 deaths would be avoided, while 39 to 47 cases of myocarditis would be expected. The FDA has granted emergency use authorization for the mRNA vaccine made by Pfizer-BioNTech for children ages 5 and older, and it has full approval for anyone ages 16 and older.
Viral infection is the most common cause of myocarditis in children. About 1 to 2 in 100,000 children are diagnosed with myocarditis each year in the United States before the COVID-19 pandemic, according to data from the United States Centers for Disease Control and Prevention. Children are also more likely than adults to develop myocarditis following a viral infection such as COVID-19. The CDC continues to closely monitor myocarditis in children and young adults, particularly a possible link to COVID-19 mRNA vaccines.
Further research is needed to better understand the mechanisms and optimal treatment approaches for SARS-CoV-2 infection, vaccine-associated myocarditis, long-term outcomes of COVID-19 and MIS-C, and the impact of these various conditions on the heart in children and young adults. Additionally, the development of new antiviral therapies needs to be tested in clinical trials focused on children.
“While much has been learned about the impact of the virus on the hearts of children and young adults, the best way to treat cardiovascular complications and prevent serious illness and further clinical research trials are needed to better understand the long-term cardiovascular impacts,” Jone said. “It is also important to address health disparities that have become more apparent during the pandemic. We must work to ensure that all children have equal access to immunization and high-quality care.
This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Council on Lifelong Congenital Heart Disease and Heart Health in Young People (Young Hearts); the Hypertension Council; and the Peripheral Vascular Disease Council. Scientific statements from the American Heart Association promote greater awareness of cardiovascular disease and stroke and help facilitate informed healthcare decisions. Scientific statements describe what is currently known about a subject and areas that require further research. Although scientific statements inform the development of guidelines, they do not make treatment recommendations. The American Heart Association guidelines provide the Association’s official clinical practice recommendations.
Co-authors are Vice President Sarah D. de Ferranti, MD, MPH, FAHA; Anitha John, MD, Ph.D.; Matthew E. Oster, MD, MPH, FAHA; Kiona Allen, MD; Adrianna H. Tremoulet, MD, MAS, FAHA; Elizabeth V. Saarel, MD, FAHA; Linda M. Lambert, APRN, FAHA; and Shelley D. Miyamoto, MD, FAHA. The authors’ disclosures are listed in the manuscript.