Postacute infection and vaccination syndromes in children and adolescents: Current knowledge, current forms of treatment

Abstract

Postacute infection and vaccination syndromes (PAIVS), including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), also affect children and adolescents. Due to heterogeneous symptoms and a lack of biomarkers and causal therapy, treatment is challenging. This article summarizes the current state of knowledge on PAIVS in children and adolescents and provides practical recommendations for the clinical management. This summary of current knowledge is based on international evidence and the authors’ clinical experience. They are initiators and partners of the new, interdisciplinary and multiprofessional Pediatric Network Project (PEDNET-LC) for the treatment and research of postacute sequelae of coronavirus disease 2019 (COVID-19), similar postacute infection and vaccination syndromes as well as ME/CFS in children and adolescents that establishes and expands the pediatric care and research structures on PAIVS throughout Germany. The PAIVS require interdisciplinary (differential) diagnostic clarification. In particular, screening for postexertional malaise (PEM) as a core symptom of ME/CFS and for orthostatic intolerance is necessary. If PEM is present, it is essential to avoid symptom worsening by adaptation of the patient’s daily routine activities (pacing). In addition to symptomatic treatment options, sociomedical measures to strengthen participation in everyday life and education is of great importance in the treatment. Children and adolescents with PAIVS need individualized, interdisciplinary, multiprofessional and longitudinal care. The prerequisites for this are good intersectoral cooperation as well as comprehensive education and training on the clinical picture. The national network PEDNET-LC offers the opportunity to harmonize and further develop pediatric PAIVS care and research structures.