National Center for Immunization & Respiratory Diseases

Update: Epidemiologic 

Characteristics of Long COVID

Sharon Saydah, PhD, MHS, CDR USPHS

Coronaviruses and Other Respiratory Viruses Division, 

Epidemiology Branch

Post COVID Conditions-Longer Term Sequelae Team Lead

September 12, 2023 
A general framework for Post-COVID Conditions

Conditions frequently overlap

Patients may experience any combination

*ME/CFS: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

** MIS-C: Multisystem Inflammatory Syndrome in Children

Wide range of physical and mental health consequences continue or 

develop at least 4 weeks after initial COVID-19 or SARS-CoV-2 infection

General consequences of illness and 

hospitalization

• Post ICU syndrome

• Other complications of treatment 

or illness

Post acute sequelae of SARS-CoV-2 

infection

• System specific pathology (e.g. 

lung fibrosis, stroke)

• Clinically significant symptoms 

with unclear pathology (e.g. 

ME/CFS*-like, dysautonomia) 

• On-going symptoms following 

MIS-C**

Long COVID commonly used term for Post-COVID 

Conditions
Estimating the Occurrence of Post-COVID Conditions
Prevalence of on-going symptoms lasting at least 3 months 

after COVID-19 by age, regardless of COVID status: U.S. 

1 0.8

1.9

6.8

9

7.4

4.2

0.2 0.3

0.8

2.7

4.7

3.8

2.3

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

0 - 5 years 6 - 11 years 12 - 17 years 18-34 years 35-49 years 50-64 years ≥ 65 years

Prevalence (%)

Ever Current

UNPUBLISHED CDC DATA – Preliminary estimates from 2022 National Health Interview Survey

Nationally representative of non-institutional population in the U.S., statistical software was used to account for NHIS’s complex sampling design.
Trends of Long COVID and significant activity limitations among 

adults- United States, June 1–13, 2022, to June 7–19, 2023

The prevalence of Long COVID 

(currently reporting symptoms lasting ≥ 

3 months) among non-institutionalized 

adults:

• Decreased from June 2022 to January 

2023

• Remained unchanged through June 

2023

Almost 1 in 4 adults with Long COVID 

report significant activity limitations

Long COVID and Significant Activity Limitation Among Adults, by Age — United States, June 1–13, 2022, to June 7–19, 2023 | 

MMWR (cdc.gov)
Using electronic health records and comparing patients with COVID-19 to those 

without evidence of COVID-19:

• Among children and adolescents, increased risk of four symptoms and eight 

conditions 31–365 days following COVID-19 1,2

– Associated with an increased risk of heart conditions, kidney failure, blood clots, 

diabetes, fatigue, smell and taste disorders, neurological conditions

• Among adults, 1 in 5 COVID-19 survivors may have a health condition associated 

with previous COVID-19 in the 31 – 365 days following COVID-19 3

– Associated with an increased risk of cardiovascular events, kidney disease, 

respiratory conditions, diabetes, and neurological conditions 2,4,5,6

SARS-CoV-2 infection associated with diagnosis of 

incident conditions

1) Post–COVID-19 Symptoms and Conditions Among Children and Adolescents — United States, March 1, 2020–January 31, 2022 | MMWR (cdc.gov)

2) Hernandez-Romieu AC et al. JAMA Netw Open. 2022; 5(2)

3) Bull-Otterson et al. Post-COVID Conditions Among Adult COVID-19 Survivors Aged 18–64 and ≥65 Years – United States, March 2020–November 2021. MMWR May 27, 2022. 

4) Post –acute sequalae of COVID-19 and cardiac outcomes in U. S. military members - ScienceDirect

5) Risk of persistent and new clinical sequelae among adults aged 65 years and older during the post-acute phase of SARS-CoV-2 infection: retrospective cohort study | The BMJ

6) Long-term neurologic outcomes of COVID-19 | Nature Medicine
In a prospective study of adults testing positive and negative for COVID-19:

• Following acute-COVID-like illness among adults, on-going symptoms decrease after 

3 months, but 16% continue to experience on-going symptoms at 12 months

• Many adults reported new emerging or re-emerging symptoms at 6, 9, and 12 

months following acute COVID-like illness

• Symptoms were not unique to SARS-CoV-2 infection

In the Veterans Affairs patient population:

• Post-COVID Conditions decreased 90 days after acute COVID-19, with increased risk 

of new conditions continuing for up to 2 years.

Post-COVID Conditions symptoms and duration

Prevalence of Symptoms ≤12 Months After Acute Illness, by COVID-19 Testing Status Among Adults — United States, 

December 2020–March 2023 | MMWR (cdc.gov)

Postacute sequelae of COVID-19 at 2 years | Nature Medicine
• Female sex

• Older age (sometimes)

– Adolescents compared to younger children

– Middle-aged adults compared to younger and older adults for symptoms

– Older adults compared to younger adults for incident conditions

• Severity of COVID-19 illness

• Underlying health conditions prior to COVID-19

• Lower socio-economic status

• Did not get COVID-19 vaccine

Groups associated with a higher likelihood of 

developing Long COVID

Maglietta G et al. Prognostic Factors for Post-COVID-19 Syndrome: A Systematic Review and Meta-Analysis. JCM 

2022

Socioeconomic inequalities of Long COVID-UK. Shabnam et al. 2023 (sagepub.com)

Hastie. et al. Outcomes among confirmed cases and matched comparison group in the Long COVID in Scotland 

Study. Nature 2022

Epidemiology of Long Coronavirus Disease in US Adults | Clinical Infectious Diseases | Oxford Academic (oup.com)

Frontiers | Hospital admission and vaccination as predictive factors of long COVID-19 symptoms (frontiersin.org)
COVID-19 Vaccines and Post-COVID Conditions
COVID-19 vaccination 

(1 or 2 doses) reduces 

Post-COVID Conditions 

compared to no 

vaccination among 

those with SARS-CoV-2 

infection

Protective effect of COVID-19 vaccination against 

long COVID syndrome: A systematic review and 

meta-analysis - ScienceDirect
• COVID

-19 cases diagnosed from 

March 2021 – February 2022, 

followed through August 2022

• 161,531 with COVID vaccination 

prior to infection matched 1:1 

with patients without 

vaccination

Associations of prior 

COVID-19 vaccination and 

risk of PCC categories 6 

months following SARS-

CoV-2 infection, by age 

group: Mar 2021-Feb 2022

UNPUBLISHED DATA

Adjusted RR (95% CI) Vaccine Safety Datalink 
COVID-19 mRNA vaccination associated with reduced occurrence of Post COVID 

Conditions following SARS-CoV-2 infection in a US cohort of adult essential workers, 

June 2021--September 2022

Unpublished data from the HEROES/RECOVER cohort. HEROES Protocol; RECOVER Protocol

Total (N =936)

Unvaccinated

(n= 157)

Vaccinated 2 doses (≥ 14 days)

(n= 301)

Vaccinated 3 doses (≥ 7 days) 

(n=478)

N (Col %) N (Row %) N (Row%) aOR (95% CI)a N (Row%) aOR (95% CI)a

1 or more symptoms 221 (23.6) 42 (19.0) 74 (33.5) 1.00 (0.80 - 1.27) 105 (47.5) 0.84 (0.67 - 1.06)

2 or more symptoms 158 (16.9) 27 (17.1) 62 (39.2) 1.22 (0.94 - 1.59) 69 (43.7) 0.76 (0.58 - 0.99)

Cardiovascular symptoms 107 (11.4) 19 (17.8) 44 (41.1) 1.32 (0.98 - 1.78) 44 (41.1) 0.73 (0.54 - 0.99)

Gastrointestinal 

symptoms 46 (4.9) 12 (26.1) 17 (37.0) 1.04 (0.67 - 1.61) 17 (37.0) 0.60 (0.39 - 0.94)

General symptoms 142 (15.2) 26 (18.3) 58 (40.8) 1.22 (0.94 - 1.60) 58 (40.8) 0.81 (0.62 - 1.05)

Neurological symptoms 128 (13.7) 26 (20.3) 44 (34.4) 1.08 (0.81 - 1.43) 58 (45.3) 0.75 (0.57 - 0.99)

Other symptoms 80 (8.5) 19 (23.8) 29 (36.3) 1.08 (0.77 - 1.51) 32 (40.0) 0.68 (0.48 - 0.95)
COVID-19 mRNA vaccination associated with reduced occurrence of 

Post COVID Conditions following Omicron SARS-CoV-2 infection in a US 

cohort of children aged 5-17 years, July 2021--September 2022

Unvaccinated, 

148 (row %)

Vaccinated1,

474 (row %)

OR (95% CI) Adjusted OR2

(95% CI)

1 or more PCC symptoms 12 (43) 16 (57) 0.63 (0.43 - 0.93) 0.66 (0.43 - 0.99)

2 or more PCC symptoms 11 (52) 10 (48) 0.52 (0.34 - 0.81) 0.52 (0.32 - 0.83)

Respiratory PCC symptoms 10 (53) 9 (47) 0.52 (0.33 - 0.82) 0.53 (0.32 - 0.86)

Non-Respiratory PCC symptoms 10 (42) 14 (58) 0.64 (0.42 - 0.98) 0.70 (0.45 - 1.10)

PCC Impact on function 9 (56) 7 (44) 0.51 (0.22 - 1.15) 0.62 (0.21 - 1.83)

Unpublished data from the PROTECT cohort. PROTECT Protocol
Summary
• Post-COVID Conditions are common following SARS-CoV-2 infection, decrease 

with time since infection, and has decreased since the start of the pandemic

• Symptoms and conditions associated with Post-COVID Conditions are not 

unique to having had SARS-CoV-2 infection

• Post-COVID Conditions are associated with increased health care utilization and 

significant activity limitations

• Accumulating evidence that COVID-19 vaccination reduces Post-COVID 

Conditions among both children and adults

Important take home messages
For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the 

official position of the Centers for Disease Control and Prevention.

For more information:

Sharon Saydah, PhD, MHS zle0@cdc.gov

Questions?