{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:14:36Z","timestamp":1776903276774,"version":"3.51.2"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"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>Pediatric acute respiratory tract infection (ARTI) constitutes a major global health threat. Since 2020, global containment measures have disrupted pathogen circulation patterns, leading to altered epidemiological profiles across multiple pathogens with marked regional heterogeneity. Current research in Ningbo predominantly focuses on single-pathogen surveillance or short-term monitoring, lacking systematic analysis of multi-pathogen interactive dynamics, age-specific susceptibility mechanisms, and co-infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Clinical data from all 191,967 pediatric patients with ARTI at Ningbo LiHuili Hospital (2020\u20132024) were collected. Laboratory testing including influenza A\/B virus (IFV-A\/B) detection,\n                      <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                      (MP) testing, 13 respiratory pathogens analysis, and bacterial culture was systematically integrated and analyzed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 2020 and 2024, the number of ARTI cases initially increased and then decreased, peaking in 2023. The incidence was highest in autumn and lowest in summer. Among all cases, 75,001 (39.07%) were diagnosed with acute lower respiratory infection (ALRI), with children aged 6 years exhibiting the highest susceptibility. Of the 41,766 cases tested, the overall pathogen detection rate was 67.61%. IFV-A\/B, Human Parainfluenza Virus (HPIV), and Human Adenovirus (HAdV) were more frequently detected in acute upper respiratory tract infections (AURI) (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05), while Human Rhinovirus (HRV), Respiratory Syncytial Virus (RSV), and MP were predominantly identified in ALRI cases (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). Each pathogen exhibited age-specific susceptibility patterns. Several pathogens, such as IFV-A, MP, and HAdV, displayed distinctive epidemic peaks. Co-infections were common, with a 17.38% co-infection rate observed in the group tested for 13 respiratory pathogens, and a higher co-infection rate of 39.49% when testing combined respiratory pathogens and bacteria. Correlation analysis among pathogens revealed predominant antagonistic interactions between viruses, positive associations among bacteria, and generally positive interactions between viruses and bacteria, though overall correlation strengths were weak.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pediatric ARTI exhibit age-specific susceptibility and pathogen variation. The 2023\u20132024 resurgence demands precision control strategies for optimized intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1662777","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T06:32:39Z","timestamp":1770013959000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Multi-dimensional epidemiology of pediatric acute respiratory tract infection in Ningbo, China (2020\u20132024): age-specific susceptibility, pathogen dynamics, and epidemiological trends"],"prefix":"10.3389","volume":"16","author":[{"given":"Min","family":"Jiang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qian","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuedan","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qianru","family":"Mei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanye","family":"Tu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qingcao","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmni.2025.101563","article-title":"The surge of human metapneumovirus (hMPV) cases in China and global implications","volume":"63","author":"Al-Tawfiq","year":"2025","journal-title":"New Microbes New Infect."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.46175","article-title":"Prevalence of common infectious diseases after COVID-19 vaccination and easing of pandemic restrictions in Israel","volume":"5","author":"Amar","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"B3","doi-asserted-by":"publisher","first-page":"30547","DOI":"10.1073\/pnas.2013182117","article-title":"The impact of COVID-19 nonpharmaceutical interventions on the future dynamics of endemic infections","volume":"117","author":"Baker","year":"2020","journal-title":"Proc. Natl. Acad. Sci. U.S.A."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1900008","DOI":"10.1183\/13993003.00008-2019","article-title":"Tropism of influenza B viruses in human respiratory tract explants and airway organoids","volume":"54","author":"Bui","year":"2019","journal-title":"Eur. Respir. J."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2021.104992","article-title":"Return of other respiratory viruses despite the disappearance of influenza during COVID-19 control measures in Singapore","volume":"144","author":"Chan","year":"2021","journal-title":"J. Clin. Virol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1007\/s12519-022-00590-w","article-title":"Human adenovirus (HAdV) infection in children with acute respiratory tract infections in Guangzhou, China 2010--2021: a molecular epidemiology study","volume":"18","author":"Chen","year":"2022","journal-title":"World J. Pediatr."},{"key":"B7","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1038\/s41579-022-00807-9","article-title":"The effects of the COVID-19 pandemic on community respiratory virus activity","volume":"21","author":"Chow","year":"2023","journal-title":"Nat. Rev. Microbiol."},{"key":"B8","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":"B9","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/s2352-4642(23)00030-5","article-title":"The effect of early childhood respiratory infections and pneumonia on lifelong lung function: a systematic review","volume":"7","author":"Collaro","year":"2023","journal-title":"Lancet Child Adolesc. Health"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.857003","article-title":"China's COVID-19 control strategy and its impact on the global pandemic","volume":"10","author":"Ding","year":"2022","journal-title":"Front. Public Health"},{"key":"B11","doi-asserted-by":"publisher","first-page":"10246","DOI":"10.1038\/s41598-020-66748-6","article-title":"Interferon-dependent and respiratory virus-specific interference in dual infections of airway epithelia","volume":"10","author":"Essaidi-Laziosi","year":"2020","journal-title":"Sci. Rep."},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2023.104593","article-title":"Viral respiratory infections in a rapidly changing climate: the need to prepare for the next pandemic","volume":"93","author":"He","year":"2023","journal-title":"EBioMedicine"},{"key":"B13","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1038\/s41586-020-2404-8","article-title":"The effect of large-scale anti-contagion policies on the COVID-19 pandemic","volume":"584","author":"Hsiang","year":"2020","journal-title":"Nature"},{"key":"B14","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.ijid.2020.06.051","article-title":"Epidemiological characteristics of respiratory viruses in patients with acute respiratory infections during 2009\u20132018 in southern China","volume":"98","author":"Huang","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2024.1405710","article-title":"Influence of non-pharmaceutical interventions on epidemiological characteristics of Mycoplasma pneumoniae infection in children during and after the COVID-19 epidemic in Ningbo, China","volume":"15","author":"Jiang","year":"2024","journal-title":"Front. Microbiol."},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.clim.2020.108510","article-title":"Development of child immunity in the context of COVID-19 pandemic","volume":"217","author":"Kloc","year":"2020","journal-title":"Clin. Immunol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1016\/j.jaci.2023.08.008","article-title":"Childhood respiratory viral infections and the microbiome","volume":"152","author":"Kloepfer","year":"2023","journal-title":"J. Allergy Clin. Immunol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"581","DOI":"10.3343\/alm.2023.0484","article-title":"Increased trend of adenovirus activity after the COVID-19 pandemic in South Korea: analysis of national surveillance data","volume":"44","author":"Lee","year":"2024","journal-title":"Ann. Lab. Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"5026","DOI":"10.1038\/s41467-021-25120-6","article-title":"Etiological and epidemiological features of acute respiratory infections in China","volume":"12","author":"Li","year":"2021","journal-title":"Nat. Commun."},{"key":"B20","doi-asserted-by":"publisher","first-page":"11936","DOI":"10.1038\/s41598-025-96604-4","article-title":"Analysis of the results of 13 combined pathogen detection in 3966 hospitalised children with acute lower respiratory tract infection","volume":"15","author":"Li","year":"2025","journal-title":"Sci. Rep."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2024.106209","article-title":"Evidence of immunity gap: Decline in antibodies against M. pneumoniae during the COVID-19 pandemic","volume":"89","author":"Liu","year":"2024","journal-title":"J. Infect."},{"key":"B22","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1146\/annurev-virology-012420-022445","article-title":"Seasonality of respiratory viral infections","volume":"7","author":"Moriyama","year":"2020","journal-title":"Annu. Rev. Virol."},{"key":"B23","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 Afric","volume":"20","author":"Olsen","year":"2020","journal-title":"Am. J. Transplant."},{"key":"B24","doi-asserted-by":"publisher","first-page":"3481","DOI":"10.1111\/ajt.16049","article-title":"Changes in influenza and other respiratory virus activity during the COVID-19 pandemic-United States 2020-2021","volume":"21","author":"Olsen","year":"2021","journal-title":"Am. J. Transplant."},{"key":"B25","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1093\/cid\/ciz1249","article-title":"Unraveling the pneumonia burden associated with human metapneumovirus infection","volume":"72","author":"Papenburg","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0253451","article-title":"Respiratory virus surveillance in Canada during the COVID-19 pandemic: An epidemiological analysis of the effectiveness of pandemic-related public health measures in reducing seasonal respiratory viruses test positivity","volume":"16","author":"Park","year":"2021","journal-title":"PloS One"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1080\/21505594.2024.2310873","article-title":"Rhinovirus infection and co-infection in children with severe acute respiratory infection during the COVID-19 pandemic period","volume":"15","author":"Regina Malveste Ito","year":"2024","journal-title":"Virulence"},{"key":"B28","doi-asserted-by":"publisher","first-page":"3021","DOI":"10.1172\/jci125505","article-title":"Respiratory syncytial virus infection exacerbates pneumococcal pneumonia via Gas6\/Axl-mediated macrophage polarization","volume":"130","author":"Shibata","year":"2020","journal-title":"J. Clin. Invest."},{"key":"B29","doi-asserted-by":"publisher","first-page":"114","DOI":"10.3238\/arztebl.m2023.0261","article-title":"The increase in invasive bacterial infections with respiratory transmission in Germany 2022\/2023","volume":"121","author":"Singer","year":"2024","journal-title":"Dtsch Arztebl Int."},{"key":"B30","doi-asserted-by":"publisher","first-page":"25876","DOI":"10.1038\/s41598-024-77456-w","article-title":"The circulating characteristics of common respiratory pathogens in Ningbo, China, both before and following the cessation of COVID-19 containment measures","volume":"14","author":"Sun","year":"2024","journal-title":"Sci. Rep."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2023.100702","article-title":"The end of zero-COVID-19 policy is not the end of COVID-19 for China","volume":"30","year":"2023","journal-title":"Lancet Reg. Health West Pac"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1080\/22221751.2022.2078228","article-title":"Mycoplasma pneumoniae triggers pneumonia epidemic in autumn and winter in Beijing: a multicentre, population-based epidemiological study between 2015 and 2020","volume":"11","author":"Wang","year":"2022","journal-title":"Emerg. Microbes Infect."},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.70139","article-title":"An outbreak of human adenovirus infection among children post COVID-19 pandemic in southern China","volume":"96","author":"Wang","year":"2024","journal-title":"J. Med. Virol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1186\/s12985-023-02218-5","article-title":"Analysis of respiratory virus detection in hospitalized children with acute respiratory infection during the COVID-19 pandemic","volume":"20","author":"Wu","year":"2023","journal-title":"Virol. J."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e154","DOI":"10.1016\/s2542-5196(20)30297-7","article-title":"Seasonal association between viral causes of hospitalised acute lower respiratory infections and meteorological factors in China: a retrospective study","volume":"5","author":"Xu","year":"2021","journal-title":"Lancet Planet Health"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2024.2353298","article-title":"Epidemic features and megagenomic analysis of childhood Mycoplasma pneumoniae post COVID-19 pandemic: a 6-year study in southern China","volume":"13","author":"Xu","year":"2024","journal-title":"Emerg. Microbes Infect."},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2024.1424554","article-title":"Epidemiological characteristics of mycoplasma pneumoniae in hospitalized children before, during, and after COVID-19 pandemic restrictions in Chongqing, China","volume":"14","author":"You","year":"2024","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"6319","DOI":"10.1038\/s41598-023-33627-9","article-title":"The epidemiological features of respiratory tract infection using the multiplex panels detection during COVID-19 pandemic in Shandong province, China","volume":"13","author":"Zhang","year":"2023","journal-title":"Sci. Rep."},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01161-24","article-title":"Epidemiology of respiratory pathogens in patients with acute respiratory infections during the COVID-19 pandemic and after easing of COVID-19 restrictions","volume":"12","author":"Zhao","year":"2024","journal-title":"Microbiol. Spectr."},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2024.1486953","article-title":"Prevalence of respiratory pathogens among hospitalised patients with acute respiratory infection during and after the COVID-19 pandemic in Shijiazhuang, China","volume":"14","author":"Zheng","year":"2024","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1186\/s12879-025-10670-7","article-title":"Prevalence and distribution of respiratory pathogens in pediatric acute respiratory infections in Putian, China","volume":"25","author":"Zhu","year":"2025","journal-title":"BMC Infect. Dis."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1662777\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T06:32:40Z","timestamp":1770013960000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1662777\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":41,"alternative-id":["10.3389\/fcimb.2026.1662777"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1662777","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]},"article-number":"1662777"}}