Health
Long COVID and children: expert panel agrees on definition, study says – CTV News
Scientists and medical experts from around the world have agreed on a research definition for “long COVID” in children, according to a U.K.-based study, the first such consensus for young people.
The peer-reviewed paper, published in BMJ’s Archives of Disease in Childhood journal, defines long COVID, or post-COVID-19 condition, as an illness that “occurs in young people with a history of confirmed SARS CoV-2 infection, with at least one persisting physical symptom for a minimum duration of 12 weeks after initial testing that cannot be explained by an alternative diagnosis. The symptoms have an impact on everyday functioning, may continue or develop after COVID-19 infection, and may fluctuate or relapse over time.”
There are more than 200 symptoms associated with Long COVID in adults, researchers said, but the most common symptoms in both adults and children are similar, especially fatigue and headache. But less is known about long COVID in children. There are also differences including early data that suggested a higher proportion of younger patients were asymptomatic at the time of their initial infection, making a separate definition useful, researchers said.
“It is currently unclear whether long COVID represents one or many different conditions and it has consequently been difficult to derive a universally accepted definition for the condition,” the authors wrote.
“Research into the prevalence and impact of long COVID has consequently been hampered, thereby delaying the implementation of policies and services that could help affected [children and young people].”
The definition was agreed upon by a panel of participants with relevant expertise, knowledge and lived experience. Among those invited to participate, a total of 120 people registered. In addition, children between the ages of 11 and 17 were also included in the final review.
The definition aligns closely with the clinical case definition proposed for adults by the World Health Organization (WHO), and if widely adopted, could help researchers get a more accurate account of the condition and its impact on patients, the study’s authors say.
The WHO defines long COVID in adults as “people with a history of probable or confirmed SARS CoV-2 infection, usually three months from the onset of COVID-19, with symptoms that last for at least two months and cannot be explained by alternative diagnoses.”
With no formal definition for children who have post-COVID-19 condition – the preferred term by the WHO – comparison and evaluation of different studies is challenging. Definitions vary in terms of the number, type and duration of symptoms, resulting in estimates between one per cent and 51 per cent in terms of how common long COVID is in children, researchers said.
In order to reach a consensus, panel participants had to give a score between one and nine on 49 statements related to long COVID. A score of one to three meant the statement was not important, while a score of four to six meant it was important. A score of seven to nine meant it was very important.
The statements were developed based on existing literature, guidelines by the U.K.’s National Institute for Health and Care Excellence (NICE) on managing the effects of long COVID, COVID-19 advice by the U.K.’s National Health Service (NHS), and other sources. They were then pruned down in three phases with 10 final statements discussed in a consensus meeting and finalized down to five. The final statements were also reviewed by a group of eight children aged eleven to 17 to make sure their voices were heard as well.
The final statements included defining the condition as having:
• impacted a patient’s physical, mental, or social wellbeing
• interfered with some aspect of their daily living, such as school, work, home life, or relationships
• lasted for at least 12 weeks after testing positive for COVID-19, even if symptoms “waxed and waned” over that period
The authors noted some limitations and caveats to the study, including the fact that it was conducted in English. The authors noted that having representation from non-English speaking countries and less developed countries would have been preferred since the goal of the study was to provide a definition that would allow comparison between studies from around the world.
Researchers also highlighted the importance of distinguishing between their research definition and a clinical case definition.
“It is understandable that the patient groups representing people with Long COVID are concerned about a definition that could restrict access to services that are needed,” researchers said.
“In our view, the decision whether a child or young person can see a healthcare professional, access any support needed, or be referred, investigated or treated for Long COVID should be a shared decision involving the young person, their [care givers] and clinicians.”
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Grande Prairie RCMP issued a warning Friday after it was revealed fentanyl linked to a deadly overdose was mixed with a chemical that doesn’t respond to naloxone treatment.
The drugs were initially seized on Feb. 28 after a fatal overdose, and this week, Health Canada reported back to Mounties that the fentanyl had been mixed with Bromazolam, which is a benzodiazepine.
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Mounties say this is the first recorded instance of Bromazolam in Alberta. The drug has previously been linked to nine fatal overdoses in New Brunswick in 2022.
The pills seized in Alberta were oval-shaped and stamped with “20” and “SS,” though Mounties say it can come in other forms.
Naloxone treatment, given in many cases of opioid toxicity, is not effective in reversing the effects of Bromazalam, Mounties said, and therefore, any fentanyl mixed with the benzodiazepine “would see a reduced effectiveness of naloxone, requiring the use of additional doses and may still result in a fatality.”
From January to November of last year, there were 1,706 opioid-related deaths in Alberta, and 57 linked to benzodiazepine, up from 1,375 and 43, respectively, in 2022.
Mounties say officers responded to about 1,100 opioid-related calls for service, last year with a third of those proving fatal. RCMP officers also used naloxone 67 times while in the field, a jump of nearly a third over the previous year.
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Health
CFIA continues surveillance for HPAI in cattle, while sticking with original name for disease – RealAgriculture
The Canada Food Inspection Agency will continue to refer to highly pathogenic avian influenza in cattle as HPAI in cattle, and not refer to it as bovine influenza A virus (BIAV), as suggested by the American Association of Bovine Practitioners earlier this month.
Dr. Martin Appelt, senior director for the Canadian Food Inspection Agency, in the interview below, says at this time Canada will stick with “HPAI in cattle” when referencing the disease that’s been confirmed in dairy cattle in multiple states in the U.S.
The CFIA’s naming policy is consistent with the agency’s U.S. counterparts’, as the U.S. Animal and Plant Health Inspection Service has also said it will continue referring to it as HPAI or H5N1.
Appelt explains how the CFIA is learning from the U.S. experience to-date, and how it is working with veterinarians across Canada to stay vigilant for signs of the disease in dairy and beef cattle.
As of April 19, there has not been a confirmed case of HPAI in cattle in Canada. Appelt says it’s too soon to say if an eventual positive case will significantly restrict animal movement, as is the case with positive poultry cases.
This is a major concern for the cattle industry, as beef cattle especially move north and south across the U.S. border by the thousands. Appelt says that CFIA will address an infection in each species differently in conjunction with how the disease is spread and the threat to neighbouring farms or livestock.
Currently, provincial dairy organizations have advised producers to postpone any non-essential tours of dairy barns, as a precaution, in addition to other biosecurity measures to reduce the risk of cattle contracting HPAI.
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Health
Toronto reports 2 more measles cases. Use our tool to check the spread in Canada – Toronto Star
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Canada has seen a concerning rise in measles cases in the first months of 2024.
By the third week of March, the country had already recorded more than three times the number of cases as all of last year. Canada had just 12 cases of measles in 2023, up from three in 2022.
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