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Eur J Pediatr
. 2026 Jan 31;185(2):115.
doi: 10.1007/s00431-026-06767-z.
Comparison of febrile seizures associated with SARS-CoV-2 infection in pre-Omicron and Omicron-predominant periods: a systematic review and meta-analysis
Shannon M Seet 1 , Yi Zhao Tan 2 , Beuben M S Koh 2 , Yi Zhe Koh 2 , Rie Aoyama 3 , Olivia Leow 3 , Furene Wang 3 4 , Jeremy B Lin 3 4 , Hian Tat Ong 3 4 , Yazhini Ramasamy 4 , Arushi Gahlot Saini 5 , Nicholas Beng Hui Ng 6 7 , Velda X Han 3 4
Affiliations
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.
What is known: • Neurological complications, including febrile seizures, occur in children with SARS-CoV-2 infection. • Prior to the Omicron variant, febrile seizures were relatively uncommon in pediatric COVID-19 cases.
What is new: • There was a trend toward more reported febrile seizures among hospitalized children with SARS-CoV-2 during the Omicron-predominant period compared to the pre-Omicron period. • There are potential associations between SARS-CoV-2 variants and febrile seizure risks.
Keywords: Febrile seizures; Omicron variant; Pediatric neurology; SARS-CoV-2.
. 2026 Jan 31;185(2):115.
doi: 10.1007/s00431-026-06767-z.
Comparison of febrile seizures associated with SARS-CoV-2 infection in pre-Omicron and Omicron-predominant periods: a systematic review and meta-analysis
Shannon M Seet 1 , Yi Zhao Tan 2 , Beuben M S Koh 2 , Yi Zhe Koh 2 , Rie Aoyama 3 , Olivia Leow 3 , Furene Wang 3 4 , Jeremy B Lin 3 4 , Hian Tat Ong 3 4 , Yazhini Ramasamy 4 , Arushi Gahlot Saini 5 , Nicholas Beng Hui Ng 6 7 , Velda X Han 3 4
Affiliations
- PMID: 41618047
- DOI: 10.1007/s00431-026-06767-z
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.
What is known: • Neurological complications, including febrile seizures, occur in children with SARS-CoV-2 infection. • Prior to the Omicron variant, febrile seizures were relatively uncommon in pediatric COVID-19 cases.
What is new: • There was a trend toward more reported febrile seizures among hospitalized children with SARS-CoV-2 during the Omicron-predominant period compared to the pre-Omicron period. • There are potential associations between SARS-CoV-2 variants and febrile seizure risks.
Keywords: Febrile seizures; Omicron variant; Pediatric neurology; SARS-CoV-2.