Characterizing acute and persistent symptoms of COVID-19 among adults and children in rural Zambia, 2020-2022.

Since emerging in December 2019, SARS-CoV-2 has led to significant morbidity and mortality globally. While much is known about SARS-CoV-2 infection and sequelae, fewer studies have been conducted in sub-Saharan Africa. This study was conducted to characterize acute and persistent symptoms of COVID-19 among adults and children in rural Zambia. From December 2020 to March 2022, individuals of all ages with acute SARS-CoV-2 infection (n = 132) were recruited into a cohort study. For comparison, individuals with acute influenza infection (n = 56) were also recruited. Participants were followed at 30, 90, 180, and 365 days. Most adult COVID-19 participants (median age: 36 years; 54% male; 11% had received the COVID-19 vaccine) were symptomatic at enrollment (92%), but few were hospitalized (9%). The most common symptoms were cough, headache, fever, and body aches. Most symptoms resolved by 30 days; the proportion reporting symptoms at follow-up visits ranged from 11% to 19%. Common symptoms at follow-up visits included cough, runny nose, headache, body aches, and fatigue. Similarly, most child COVID-19 participants (86%) were symptomatic at enrollment (median age: 13 years; 57% male; none had received the COVID-19 vaccine) and none were hospitalized. The most common symptoms were cough, fever, headache, and runny nose with most symptoms resolving by 30 days. The proportion reporting symptoms at follow-up visits ranged from 13% to 20%. Common symptoms included cough, fever, headache and runny nose. For comparison, adult and child participants with influenza virus infection were evaluated. The proportion reporting symptoms at follow-up visits ranged from 16% to 32%. This study adds to the literature on the clinical characteristics of acute SARS-CoV-2 infection and persistent symptoms in the first two years of the pandemic in an underrepresented region.