{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T09:48:00Z","timestamp":1782467280057,"version":"3.54.5"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Medical Virology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Human adenoviruses (HAdVs) are important causes of pediatric acute respiratory tract infections (ARTIs), with disease severity potentially varying by type. The impact of COVID\u201019\u2013related non\u2010pharmaceutical interventions (NPIs) and their relaxation on the relative prevalence of various HAdV types, RNase P\u2010normalized viral load distributions, and associated clinical outcomes remains incompletely defined. We conducted a retrospective cohort study of children hospitalized for ARTIs at Shanghai Children's Hospital from 2021 to 2023, integrating epidemiologic trends, clinical phenotypes, HAdV typing and RNase P\u2013normalized HAdV DNA quantification by droplet digital PCR (ddPCR). Multivariable logistic regression was used to identify independent correlates of severe community\u2010acquired pneumonia (SCAP). Among 19,537 hospitalized children, HAdV was detected in 600 (3.07%), with annual detection rates of 2.85%, 2.36% and 3.44% in 2021, 2022 and 2023, respectively (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002). A marked type replacement occurred, shifting from species C (predominantly HAdV\u2010108) in 2021\u20132022 to species B (predominantly HAdV\u20103) in 2023. Among 507 HAdV\u2010positive cases with complete data, post\u2010pandemic cases in 2023 involved older children and showed higher proportions of species B infection,\n                    <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                    (MP) co\u2010infection, and SCAP (14.74% vs. 3.08% in 2021\u20132022;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). In multivariable analyses, MP co\u2010infection (aOR 4.16) and HAdV\u2010B species (aOR 3.34) remained independently associated with SCAP. RNase P\u2013normalized viral loads were highest in acute tonsillitis and comparatively lower in severe pneumonia and in patients with comorbidities or complications (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05), supporting a limited role of viral burden alone in severe outcomes. In conclusion, hospitalized pediatric ARTIs at Shanghai Children's Hospital during 2021\u20132023 showed a post\u2010pandemic shift toward species B predominance and more severe phenotypes, closely linked to MP co\u2010infection. Integrated molecular surveillance and routine MP screening may support earlier risk stratification for severe HAdV\u2010associated respiratory disease in children.\n                  <\/jats:p>","DOI":"10.1002\/jmv.71011","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T10:32:50Z","timestamp":1781778770000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Molecular Epidemiology, Viral Load and Clinical Severity of Human Adenovirus\u2013Associated Respiratory Infections in Hospitalized Children in Shanghai, 2021\u20132023"],"prefix":"10.1002","volume":"98","author":[{"given":"Leijun","family":"Meng","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China"},{"name":"Institute of Pediatric Infection, Immunity, and Critical Care Medicine Shanghai Jiao Tong University 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