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Pediatric patients who underwent the respiratory pathogens tests were enrolled in the study and divided into four groups by age: Infant group, Toddler group, Preschool group, and School-age group. The nasopharyngeal swab or bronchoalveolar lavage fluid (BALF) samples were collected for real-time fluorescence quantitative polymerase chain reaction (qPCR) test of respiratory pathogens. Ten common respiratory pathogens, including respiratory syncytial virus (RSV), Mycoplasma pneumoniae (MP) and Influenza A virus (FluA), were detected. In addition, the study period was divided into three phases: Pre-COVID-19 (2018\u20132019), COVID-19 (2020\u20132022), and Post-COVID-19 (2023). Detection rates, distribution patterns, and seasonal variations of respiratory pathogens were analyzed between different phases and different age groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>This study included 317,828 pediatric patients (median age: 3.4 years, IQR: 1.3-6.0), from whom 1,160,764 respiratory pathogen tests were conducted. The overall pathogen detection rate was 8.02% (93,108\/1,160,764). The positive rate during the COVID-19 phase (18.44%, 95% CI 14.89-22.00%) was significantly lower than that of the Pre-COVID-19 (27.55%, 95% CI 23.95\u201331.16%) and Post-COVID-19 (27.15, 95% CI 21.47\u201332.84%) phases (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). No significant difference was observed between Pre-COVID-19 and Post-COVID-19 phases (<jats:italic>P<\/jats:italic>\u2009=\u20090.948). Different pathogens exhibited varying levels of suppression and recovery patterns, with some demonstrating altered seasonal patterns. The primary affected age groups shifted from infants and toddlers during the Pre-COVID-19 and COVID-19 phases to preschool and school-age children in the Post-COVID-19 phase. Co-infections were identified in 2,515 cases, with the highest rate observed during the Pre-COVID-19 phase (3.40%), followed by the COVID-19 (2.26%) and Post-COVID-19 (2.46%) phases.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>NPIs implemented during the early COVID-19 pandemic effectively suppressed the transmission of respiratory pathogens and disrupted their seasonal patterns. However, some pathogens gradually resumed activity during the mid-to-late COVID-19 phase, leading to atypical outbreaks. Following NPI relaxation, multiple pathogens rebounded during the Post-COVID-19 phase, posing significant challenges for the healthcare system. These findings offer valuable insights for guiding public health strategies and optimizing the prevention and control of respiratory infections.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical trial number<\/jats:title>\n            <jats:p>Not applicable.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12879-025-11215-8","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T09:40:09Z","timestamp":1751362809000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Changes in the epidemic patterns of respiratory pathogens of children in guangzhou, China during the COVID-19 pandemic"],"prefix":"10.1186","volume":"25","author":[{"given":"De-Feng","family":"Liang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Lin","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan-Ping","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su-Yun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Dong","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Qing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"issue":"10258","key":"11215_CR1","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","volume":"396","author":"GBD Diseases","year":"2020","unstructured":"Diseases GBD, Injuries C. 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All participants voluntarily signed a written informed consent with a full understanding of the purpose and process of the research. All procedures performed involving human participants were in accordance with the ethical standards of the institutional and\/or National Research Committee and consistent with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"833"}}