DuBray, Kara

Phan, Katherine

Anglemyer, Andrew

Burell, Rebecca

Blyth, Christopher C

Carr, Jeremy

Clark, Julia E

Crawford, Nigel W

Francis, Joshua

Marshall, Helen

McMullan, Brendan J

Waak, Michaela

Dale, Russell C

Jones, Cheryl A

Carey, Emma

Macartney, Kristine

Wood, Nicholas

Britton, Philip N

2025-04-10

We aimed to describe the clinical spectrum and burden of COVID-19-associated neurologic disease in Australian children.We extracted Australian national sentinel site surveillance data on COVID-19-associated neurologic disease in children hospitalized in the Paediatric Active Enhanced Disease Surveillance network, 2020-2023. Neurologic complications included encephalitis, encephalopathy, Guillain-Barre syndrome, seizures and cerebrovascular accident among others. We calculated the proportion of hospitalized pediatric COVID-19 cases associated with neurologic disease and described the spectrum of presentations including clinical features and severity. We calculated incidence rates of neurologic disease within COVID-19 variant eras among hospitalized patients.We identified 311 cases of SARS-CoV-2 infection with neurologic disease among 4616 hospitalized pediatric cases of COVID-19 reported through the surveillance network, representing 5.3 cases per 100 pediatric COVID-19 admissions. The most common COVID-19-associated neurologic presentations were seizures (n = 215), including febrile seizures. Nonspecific encephalopathy (n = 62), encephalitis, Guillain-Barre Syndrome, acute cerebellar syndromes, acute demyelinating encephalomyelitis and cerebrovascular accident were also reported. Almost 60% of children were ≤4 years, approximately 30% had pre-existing neurologic conditions and almost half had other medical comorbidities. COVID-19-associated neurologic complications infrequently led to death, although 25% (n = 2/8) of children with COVID-19 encephalitis died. The incidence rate of COVID-19-associated neurologic disease was lowest during the late Omicron era.Neurologic complications among COVID-19 hospitalized children are relatively frequent. While most neurologic complications are transient, including seizures, encephalitis remains a cause of significant morbidity. Children with pre-existing neurologic disease and other comorbidities are at higher risk.

From the Department of Paediatrics, Dunedin Hospital, Dunedin, New Zealand.

Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney.

Centre of Paediatric and Perinatal Infection Research, The Children's Hospital at Westmead, Westmead, Australia.

Health Intelligence and Surveillance Team, Institute of Environmental Science and Research, Wellington.

Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.

Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney.

Centre of Paediatric and Perinatal Infection Research, The Children's Hospital at Westmead, Westmead, Australia.

Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia.

Department of Infectious Diseases, Perth Children's Hospital.

Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre (QEIIMC), Perth, Western Australia.

Infection & Immunity, Monash Children's Hospital.

Monash University, Melbourne, Victoria, Australia.

Department of Paediatrics, University of Oxford, Oxford, United Kingdom.

Infection Management and Prevention Service, Queensland Children's Hospital.

UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland.

Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne.

Immunisation Services, The Royal Children's Hospital.

SAEFVIC, Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Victoria.

Royal Darwin Hospital.

Menzies School of Health Research, Charles Darwin University, Northern Territory.

Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network.

Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide.

Department of Infectious Diseases, Sydney Children's Hospital, Randwick.

Discipline of Paediatrics, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales.

Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane.

Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney.

Clinical Neuroimmunology Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney.

Department of Neurology and Neurosurgery, Children's Hospital, Westmead.

Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney.

Infectious Diseases Department and Microbiology Department, Children's Hospital at Westmead, Sydney.

Faculty of Medicine and Health, UNSW, Kensington; and.

National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia.

Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney.

National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia.

Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney.

National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia.

Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney.

Centre of Paediatric and Perinatal Infection Research, The Children's Hospital at Westmead, Westmead, Australia.

Infectious Diseases Department and Microbiology Department, Children's Hospital at Westmead, Sydney.

Pediatr Infect Dis J . 2025 Apr 10. doi: 10.1097/INF.0000000000004830. Online ahead of print.

1532-0987

https://pubmed.ncbi.nlm.nih.gov/40233341/?otool=iaurydwlib

https://hdl.handle.net/10137/14251

COVID-19

cohort study

encephalitis

neurologic disease

The Spectrum and Burden of COVID-19-Associated Neurologic Disease in Australian Children 2020-2023.

Journal Article

Publication