Magdeburg University Hospital researchers study Long COVID in children, Magdeburg, Germany; Identified subgroups, tailored treatment may be possible

Magdeburg University Hospital researchers study Long COVID in children, Magdeburg, Germany; Identified subgroups, tailored treatment may be possible

Medical Faculty/University Hospital Magdeburg - Long COVID in Children: Study Shows Varied Disease Progression

Long COVID in Children: Study Shows Varied Disease Progression

International research team identifies biological subgroups and provides insights for more targeted therapies.

Most children and adolescents recover quickly from a coronavirus infection. However, about 1 to 3 percent developpediatric Long COVID—symptoms that persist for weeks or months after the initial infection. A new study published in the prestigious journal Nature Communications now shows:Long COVID in young people is not a uniform condition.The international research team, including researchers from Magdeburg University Hospital, was able to identify different biological subgroups that differ significantly from one another. A one-size-fits-all treatment for all affected individuals may therefore fall short.

Long-term observation provides new insights

For the study, the researchers followed 74 children and adolescents with Long COVID as well as 27 healthy control subjects over a period of up to 3.2 years. In addition torecording symptoms, the study examined, among other things,heart and lung function, blood values, metabolic processes, and immune responses. Based on current knowledge, the study is among themost comprehensive European studiesto have monitored children and adolescents with Long COVID in such detail over several years.

The result: Only about 1 to 3 percent of pediatric SARS-CoV-2 cases develop Long COVID, but the burden can be significant:The clinical picture encompasses more than 200 possible symptoms.Of the children who developed Long COVID, about 20 percent reported symptoms that persisted for more than a year. The majority recovered within the first year. At the same time, there were no clear indications of severe damage to the heart or lungs. Typical autoimmune reactions, in which the immune system turns against the body’s own tissues, also did not occur at a higher rate.

Photo: Portrait of Prof. Dr. Monika Brunner-Weinzierl, Photographer: Jana Dünnhaupt

Different biological patterns in the body

“Our analysis showed that pediatric Long COVID is not a uniform clinical picture. Instead, we found different biological subgroups and disease courses.These differ, among other things, in immune system activity and metabolism,” explains Prof. Dr. Monika Brunner-Weinzierl, Head of theDepartment of Experimental Pediatrics and Neonatology at Otto von Guericke University Magdeburg.

The Epstein-Barr virus (EBV), which many people contract at some point in their lives, plays an important role here. Children and adolescents with prior EBV exposure were more likely to exhibit persistent inflammatory responses. Parts of the immune system that normally subside after an infection remained active for longer in these individuals.

In children without this exposure, the researchers found different correlations: specific blood values, vitamin B1, and immune signaling molecules were linked to physical resilience. For instance, higher levels of certain immune substances or specific blood cells were associated with fewer limitations in daily life.

Additionally, a subgroup with specific antibodies was identified that was associated with fewer abnormalities in blood clotting.

Brunner-Weinzierl emphasizes:“Immunologically speaking, children are not just small adults. Their immune system is more geared toward controlling infections while simultaneously protecting tissue and enabling repair processes.”This is precisely why pediatric Long COVID offers a unique opportunity: In children, it is relatively easy to investigate which immune system reactions following an infection contribute to the disease—and which may contribute to recovery.

Starting points for future treatments

The study makes it clear that in treating Long COVID in children, it is not enough to broadly suppress all immune responses—for example, with drugs that dampen the immune system. This is because some of the observed immune patterns could perform protective functions.

“Our results show that children’s immune systems react very differently to Long COVID. Some of these reactions could help the body stabilize and recover,” says the immunologist.“That is why it is important in the future to distinguish more precisely which processes should be treated and which could instead be supported.”

For medical practice, this means that one-size-fits-all treatment approaches may fall short. Instead, individually tailored therapies could be beneficial. At the same time, the study points out that broadly suppressing the immune system can carry risks if potentially helpful processes are impaired in the process.

Further research is needed to confirm the identified biological patterns and develop targeted treatments. The question of whether certain blood or metabolic values can be used in the future as indicators of disease progression also remains open. Such so-calledbiomarkerscould help treat affected children more quickly and effectively.

Department of Experimental Pediatrics and Neonatology at Otto von Guericke University Magdeburg

The work was funded by the Federal Ministry of Education and Research as well as the State of Saxony-Anhalt.

Vilser D., Han I., Vogel K., Jakobs P. et al.; Immune-metabolic trajectories delineate subgroups in pediatric long COVID; Nature Communications 17, 4023, 2026; DOI:https:

Prof. Dr. Monika Brunner-Weinzierl, Head of Experimental Pediatrics and Neonatology at Otto von Guericke University Magdeburg, Phone: +49-391-67-24003,monika.brunner-weinzierl@med.ovgu.de