{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:27:51Z","timestamp":1785432471227,"version":"3.56.0"},"reference-count":19,"publisher":"American Society for Microbiology","issue":"9","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100018916","name":"Suzhou Municipal Health Commission","doi-asserted-by":"publisher","award":["KJXW2023025"],"award-info":[{"award-number":["KJXW2023025"]}],"id":[{"id":"10.13039\/100018916","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,9,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      This study aimed to compare the epidemiological features and clinical manifestations of adenovirus (ADV)-associated pediatric respiratory tract infections during and after the lockdown due to coronavirus disease 2019 (COVID\u201019) pandemic to explore potential immunity debt. A retrospective analysis was conducted to evaluate ADV detection rates, co-infection rates, serotype distribution, age distribution of infected children, proportions of mild, moderate, and severe ADV pneumonia cases, and relevant laboratory indicators (e.g., white blood cell count, granulocyte-to-lymphocyte ratio, high-sensitivity C-reactive protein, and lactate dehydrogenase) during and after the lockdown. Post-lockdown ADV detection and co-infection rates were significantly higher than those during the lockdown (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). The predominant co-infection pathogens shifted from rhinovirus and bocavirus to rhinovirus and\n                      <jats:italic toggle=\"yes\">Mycoplasma pneumoniae<\/jats:italic>\n                      . A marked increase in ADV detection was observed from October to December post-lockdown (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). The age distribution of infected children also changed, with notable rises in cases aged 4\u20136 and &gt;6 years. The dominant ADV serotype shifted from type 1 pre-pandemic to type 3 post-lockdown. The proportion of severe ADV pneumonia cases increased significantly (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05), although laboratory indicators showed no significant differences. Following the COVID-19 pandemic, significant alterations have emerged in the clinical and epidemiological profiles of pediatric ADV-associated respiratory tract infections. The observed rise in severe ADV pneumonia cases may correlate with pandemic-associated immunity debt in children, underscoring the necessity to reevaluate prevention and therapeutic strategies to mitigate potential escalations in critical illnesses and evolving infection patterns.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>The coronavirus disease 2019 pandemic has significantly altered the epidemiology of adenoviral (ADV) infections in children, revealing phenomena such as \u201cimmunity debt.\u201d A comparative analysis of ADV detection rates, co-infection frequencies, age distributions, subtype shifts, and clinical manifestations during and after the lockdown indicates increased detection rates, a shift from type 1 to type 3, and a rise in severe cases of ADV pneumonia, necessitating reevaluation of public health strategies for pediatric viral infections.<\/jats:p>\n       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