Comparison of febrile seizures associated with SARS-CoV-2 infection in pre-Omicron and Omicron-predominant periods: a systematic review and meta-analysis
摘要
Emerging studies suggest increased febrile seizures during the Omicron period of SARS-CoV-2. This study compares the incidence of seizures before and during the Omicron variant period to determine if certain variants increase risk. Using PRISMA-P protocol, four databases (PubMed, Embase, Scopus, Web of Science) were searched. Cohort studies reporting febrile seizures in children (up to 18 years of age) with confirmed SARS-CoV-2 infection were included. We provide descriptive summaries of the incidence of febrile seizures across hospital, emergency, and community settings, as well as a meta-analysis between Omicron-predominant and pre-Omicron periods. We included 36 studies comprising 82,591 children with SARS-CoV-2 infection, of whom 2051 experienced febrile seizures. In 29 studies of hospitalized children with SARS-CoV-2, the incidence of febrile seizures varied widely, with a median of 7 per 100 (range 1.06–25.54) children. High heterogeneity was observed, and studies from emergency and community settings were underpowered. Seven studies found that unvaccinated children hospitalized with SARS-CoV-2 had more febrile seizures during the Omicron-predominant (median 11.8 per 100) than during the pre-Omicron period (median 0.7 per 100). The pooled incidence was 11.27 per 100 cases for the Omicron-predominant and 0.66 per 100 for the pre-Omicron period (p < 0.0001).
Conclusion: There was a trend toward more reported febrile seizures among hospitalized children with SARS-CoV-2 during the Omicron-predominant than the pre-Omicron period. However, estimates are limited by small samples and moderate heterogeneity and should not be considered population-based incidences. We hypothesize that SARS-CoV-2 variants may influence febrile seizure risk in children; larger studies are needed to better understand this association.
PROSPERO registration: CRD420251054193.