# Children and adolescents: Respiratory infection and long-term effects longitudinal study (CARE Study): Study protocol

## TL;DR

This study tracks the long-term effects of SARS-CoV-2 and influenza infections in children and adolescents in Australia to better understand post-acute symptoms.

## Contribution

The study introduces a longitudinal protocol to assess post-acute sequelae in children following SARS-CoV-2 and influenza infections in the Omicron era.

## Key findings

- The study will determine the cumulative incidence of post-COVID conditions in Australian children and adolescents.
- It will also identify the cumulative incidence of post-influenza sequelae in the same population.
- The study design allows for comparison between post-COVID and post-influenza symptoms to inform clinical management.

## Abstract

The effects of SARS-Cov-2 infection can extend beyond the acute phase of the illness, often described as Long COVID, post-COVID condition (PCC) or Post-acute sequelae of COVID (PASC). Post-acute sequelae (PAS) are also likely to be a problem for a small proportion of children and adolescents following influenza infection. However, there is no comprehensive ongoing data collection in Australian children and adolescents, and global data on both PCC during the SARS-Cov-2 Omicron variant period and PAS following influenza is limited.

This study aims to determine the cumulative incidence of PCC in Australian children and adolescents five years after the start of the COVID-19 pandemic. Secondary aims include identifying the cumulative incidence of PAS in children and adolescents following influenza infection.

This longitudinal cohort study will recruit children and adolescents aged 0–18 years in South Australia who tested positive for SARS-Cov-2 or influenza in the previous 2 months. Following consent, participants will complete an online baseline survey and then at 3, 6, and 12 months post-infection. The survey has been adapted from the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) Paediatric COVID-19 follow-up survey. The survey includes validated assessment tools such as the Pediatric Quality of Life Inventory (PedsQL), Multidimensional Fatigue Scale, and the Malmö Postural Orthostatic Tachycardia Syndrome (POTS) Score questionnaire. PCC following COVID-19 and PAS following influenza infection will be identified according to an adapted World Health Organization definition of PCC in children and adolescents.

This study addresses gaps in understanding PCC and PAS following influenza in children and adolescents during Omicron circulation. Whilst it is no longer feasible to prospectively compare post-acute sequelae in children and adolescents who have never had COVID-19, this design allows a comparison with another common viral infection, influenza, informing clinical management of children post-infection.