{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:20:20Z","timestamp":1791264020445,"version":"4.1.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Human respiratory syncytial virus (HRSV) is a leading cause of acute respiratory infections in children. COVID-19 NPIs significantly suppressed HRSV transmission. This study analyzed six-year epidemiological dynamics of pediatric HRSV infections in Henan Province, China, focusing on NPI suppression effects, the 2023 resurgence, and \u201cImmune debt\u201d impact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively collected respiratory specimens from 80,920 children with acute respiratory diseases at Henan Children\u2019s Hospital (2019-2024). HRSV was detected using RT-qPCR. Positivity rates were analyzed by year, season, and age group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During 2019\u20132024, HRSV positivity fluctuated markedly: 14.65% (2019), 16.34% (2021), 3.27% (2022 under strict NPIs), 21.47% (2023 post-NPIs), and 6.80% (2024). Interrupted time-series analysis indicated that NPI lifting in 2023 was associated with a significant surge in infection risk (OR = 668.77, 95% CI: 47.03\u20139509.28). Seasonal patterns shifted substantially, with the characteristic winter peak replaced by an off-season spring outbreak in April 2023 (57.41%). Multivariable logistic regression identified age as the strongest predictor, with infants &amp;lt;1 year having the highest risk (aOR = 9.02, 95% CI: 8.31\u20139.79) and a 4.91-fold higher positivity rate than school-aged children (22.98% vs. 4.68%; 95% CI: 4.59\u20135.25; P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>NPIs dramatically affected HRSV epidemiology. The intense post-suppression rebound strongly supports the \u201cImmune debt\u201d theory\u2014accumulation of susceptible children driving resurgence. Establishing year-round, multi-pathogen surveillance systems is crucial for post-pandemic public health challenges.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2025.1691957","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T06:32:25Z","timestamp":1768285945000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Six-year epidemiological dynamics of human respiratory syncytial virus infections in children in central China (2019-2024): pandemic suppression, 2023 resurgence, and immune debt effect"],"prefix":"10.3389","volume":"15","author":[{"given":"Zhiyi","family":"Xia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adong","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Mokrousov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengbo","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaodong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1007\/s12016-013-8368-9","article-title":"Respiratory syncytial virus\u2013a comprehensive review","volume":"45","author":"Borchers","year":"2013","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e103","DOI":"10.1016\/S2213-2600(21)00364-7","article-title":"Circulation of influenza, rsv, and SARS-cov-2: an uncertain season ahead","volume":"9","author":"Burki","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1111\/irv.12726","article-title":"Human respiratory syncytial virus and influenza seasonality patterns-early findings from the who global respiratory syncytial virus surveillance","volume":"14","author":"Chadha","year":"2020","journal-title":"Influenza Other Respir. Viruses"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1336077","article-title":"The effect of nonpharmaceutical interventions on influenza virus transmission","volume":"12","author":"Chen","year":"2024","journal-title":"Front. Public Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1016\/j.idnow.2021.05.004","article-title":"Pediatric infectious disease group (gpip) position paper on the immune debt of the covid-19 pandemic in childhood, how can we fill the immunity gap","volume":"51","author":"Cohen","year":"2021","journal-title":"Infect. Dis. Now"},{"key":"B6","doi-asserted-by":"publisher","first-page":"104638","DOI":"10.1016\/j.idnow.2022.12.003","article-title":"Immune debt: recrudescence of disease and confirmation of a contested concept","volume":"53","author":"Cohen","year":"2023","journal-title":"Infect. Dis. Now"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e2829","DOI":"10.1093\/cid\/ciaa1906","article-title":"The interseasonal resurgence of respiratory syncytial virus in Australian children following the reduction of coronavirus disease 2019-related public health measures","volume":"73","author":"Foley","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"558","DOI":"10.3390\/idr14040059","article-title":"Impact of covid-19 on the changing patterns of respiratory syncytial virus infections","volume":"14","author":"Garg","year":"2022","journal-title":"Infect. Dis. Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/S0140-6736(14)61682-2","article-title":"Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the global burden of disease study 2013","volume":"385","year":"2015","journal-title":"Lancet"},{"key":"B10","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1128\/CMR.00010-16","article-title":"Respiratory syncytial virus: infection, detection, and new options for prevention and treatment","volume":"30","author":"Griffiths","year":"2017","journal-title":"Clin. Microbiol. Rev."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e44","DOI":"10.1016\/S2352-4642(21)00333-3","article-title":"Respiratory syncytial virus: paying the immunity debt with interest","volume":"5","author":"Hatter","year":"2021","journal-title":"Lancet Child Adolesc. Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e70066","DOI":"10.1111\/irv.70066","article-title":"Assessing the impact of non-pharmaceutical interventions during the covid-19 pandemic on rsv seasonality in europe","volume":"19","author":"Heemskerk","year":"2025","journal-title":"Influenza Other Respir. Viruses"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.1186\/s12889-024-19460-3","article-title":"Changes in the epidemiological characteristics of influenza in children in zhengzhou, China, in the post-covid-19 era","volume":"24","author":"Jia","year":"2024","journal-title":"BMC Public Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"429","DOI":"10.3390\/v16030429","article-title":"Impact of nonpharmaceutical interventions during the covid-19 pandemic on the prevalence of respiratory syncytial virus in hospitalized children with lower respiratory tract infections: a systematic review and meta-analysis","volume":"16","author":"Leija-Martinez","year":"2024","journal-title":"Viruses"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2201172","DOI":"10.1183\/13993003.01172-2022","article-title":"Respective roles of non-pharmaceutical interventions in bronchiolitis outbreaks: an interrupted time-series analysis based on a multinational surveillance system","volume":"61","author":"Lenglart","year":"2023","journal-title":"Eur. Respir. J."},{"key":"B16","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.1016\/S0140-6736(22)00478-0","article-title":"Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis","volume":"399","author":"Li","year":"2022","journal-title":"Lancet"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2024.1381107","article-title":"Epidemiology of respiratory syncytial virus in hospitalized children over a 9-year period and preventive strategy impact","volume":"15","author":"Lodi","year":"2024","journal-title":"Front. Pharmacol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s11908-020-0711-8","article-title":"Respiratory virus co-infection in acute respiratory infections in children","volume":"22","author":"Meskill","year":"2020","journal-title":"Curr. Infect. Dis. Rep."},{"key":"B19","doi-asserted-by":"publisher","first-page":"e763","DOI":"10.1016\/S2666-5247(23)00182-9","article-title":"Mycoplasma pneumoniae: gone forever","volume":"4","author":"Meyer","year":"2023","journal-title":"Lancet Microbe"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae493","article-title":"Cycles of susceptibility: immunity debt explains altered infectious disease dynamics post -pandemic","author":"Munro","year":"2024","journal-title":"Clin. Infect. Dis"},{"key":"B21","doi-asserted-by":"publisher","first-page":"3681","DOI":"10.1111\/ajt.16381","article-title":"Decreased influenza activity during the covid-19 pandemic-United States, Australia, Chile, and South Africa, 2020","volume":"20","author":"Olsen","year":"2020","journal-title":"Am. J. Transplant."},{"key":"B22","doi-asserted-by":"publisher","first-page":"4164","DOI":"10.1038\/s41467-024-48528-2","article-title":"Impacts of human mobility on the citywide transmission dynamics of 18 respiratory viruses in pre- and post-covid-19 pandemic years","volume":"15","author":"Perofsky","year":"2024","journal-title":"Nat. Commun."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.3390\/v15051160","article-title":"Epidemiology of respiratory infections during the covid-19 pandemic","volume":"15","author":"Principi","year":"2023","journal-title":"Viruses"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e312124","DOI":"10.1128\/spectrum.03121-24","article-title":"Epidemiological changes of mycoplasma pneumoniae among children before, during, and post the covid-19 pandemic in henan, China, from 2017 to 2024","volume":"13","author":"Qi","year":"2025","journal-title":"Microbiol. Spectr."},{"key":"B25","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1186\/s12879-024-09438-2","article-title":"Mycoplasma pneumoniae detections in children with lower respiratory infection before and during the covid-19 pandemic: a large sample study in China from 2019 to 2022","volume":"24","author":"Qiu","year":"2024","journal-title":"BMC Infect. Dis."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1892","DOI":"10.3390\/v16121892","article-title":"Seasonal shifts in influenza, respiratory syncytial virus, and other respiratory viruses after the covid-19 pandemic: an eight-year retrospective study in jalisco, Mexico","volume":"16","author":"Quintero-Salgado","year":"2024","journal-title":"Viruses"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e42781","DOI":"10.2196\/42781","article-title":"The effect of nonpharmaceutical interventions implemented in response to the covid-19 pandemic on seasonal respiratory syncytial virus: analysis of google trends data","volume":"24","author":"Ravkin","year":"2022","journal-title":"J. Med. Internet Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1002\/ppul.22781","article-title":"Predictors of severity and mortality in children hospitalized with respiratory syncytial virus infection in a tropical region","volume":"49","author":"Rodriguez","year":"2014","journal-title":"Pediatr. Pulmonol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1001\/jama.2023.26608","article-title":"From \u201cimmunity debt\u201d to \u201cimmunity theft\u201d-how covid-19 might be tied to recent respiratory disease surges","volume":"331","author":"Rubin","year":"2024","journal-title":"Jama"},{"key":"B30","doi-asserted-by":"publisher","first-page":"S10","DOI":"10.1093\/infdis\/jiaa751","article-title":"Risk factors for poor outcome or death in young children with respiratory syncytial virus-associated acute lower respiratory tract infection: a systematic review and meta-analysis","volume":"226","author":"Shi","year":"2022","journal-title":"J. Infect. Dis."},{"key":"B31","doi-asserted-by":"publisher","first-page":"159","DOI":"10.3760\/cma.j.cn112140-20230723-00025","article-title":"Pathogenic agents causing acute respiratory tract infections in pediatric patients in spring, 2023, in beijing","volume":"62","author":"Sun","year":"2024","journal-title":"Zhonghua Er Ke Za Zhi"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2025.1549497","article-title":"Changes in children respiratory infections pre and post covid-19 pandemic","volume":"15","author":"Yue","year":"2025","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.05.020417","article-title":"Burden of respiratory syncytial virus infections in China: systematic review and meta-analysis","volume":"5","author":"Zhang","year":"2015","journal-title":"J. Glob Health"}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2025.1691957\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T06:32:30Z","timestamp":1768285950000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2025.1691957\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":33,"alternative-id":["10.3389\/fcimb.2025.1691957"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2025.1691957","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]},"article-number":"1691957"}}