{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T03:22:21Z","timestamp":1779938541650,"version":"3.53.1"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Science and Technology Project of Sooshow university, China","award":["2023ZDPY03"],"award-info":[{"award-number":["2023ZDPY03"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background: This study investigated the epidemiology of Mycoplasma pneumoniae (MP) in children with acute respiratory tract infections (ARTIs) and explored the risk factors for severe mycoplasma pneumoniae pneumonia (SMPP) in children. Methods: A retrospective analysis was conducted on 36,380 children with acute respiratory infections who underwent multiplex real-time polymerase chain reaction (RT-PCR) assays for nine respiratory pathogens from September 2021 to November 2024. Results: A total of 36,380 children with ARTIs were enrolled in this study. The co-detection rate of MP with other pathogens was significantly higher in the post-NPIs period than in the NPIs period (36.5% vs. 25.7%, p &lt; 0.01). Multivariate regression identified the detection of influenza A virus (InfA), InfB, human parainfluenza virus (HPIV), human bocaparvovirus (HBoV), human rhinovirus (HRV), adenovirus (ADV), human respiratory syncytial virus (HRSV), and human metapneumovirus (HMPV) as protective factors against MP epidemics (p &lt; 0.01); meanwhile, older age, the cancellation of NPIs, and summer\u2013autumn seasons were found to be risk factors. After adjusting for sex, age, period, season, and pathogens, InfB (OR: 3.009, 95%CI: 1.041\u20138.697, p = 0.042), HPIV (OR: 2.226, 95%CI: 1.170\u20134.235, p = 0.015), and ADV (OR: 2.035, 95%CI: 1.105\u20133.750, p = 0.023) were identified as independent risk factors for SMPP. Conclusions: These findings highlight post-NPI shifts in MP epidemiology and identify ADV, InfB, and HPIV as early warning markers for SMPP.<\/jats:p>","DOI":"10.3390\/v17091266","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T08:11:01Z","timestamp":1758269461000},"page":"1266","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Co-Detection of ADV, Influenza B, and HPIV: Independent Risk Factors for SMPP with Changes in NPIs"],"prefix":"10.3390","volume":"17","author":[{"given":"Linlin","family":"Huang","sequence":"first","affiliation":[{"name":"Pediatric Intensive Care Unit, Children\u2019s Hospital of Soochow University, Suzhou 215000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Children\u2019s Hospital of Soochow University, Suzhou 215000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1056\/NEJMoa1500245","article-title":"Community-Acquired Pneumonia Requiring Hospitalization among, U.S. Adults","volume":"373","author":"Jain","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Sauteur, P.M.M., Jacobs, B.C., Spuesens, E.B.M., Jacobs, E., Nadal, D., Vink, C., van Rossum, A.M.C., and Haldar, K. (2014). Antibody responses to Mycoplasma pneumoniae: Role in pathogenesis and diagnosis of encephalitis. PLoS Pathog., 10.","DOI":"10.1371\/journal.ppat.1003983"},{"key":"ref_3","doi-asserted-by":"crossref","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":"ref_4","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.ijid.2014.07.020","article-title":"Clinical and laboratory profiles of refractory Mycoplasma pneumoniae pneumonia in children","volume":"29","author":"Wang","year":"2014","journal-title":"Int. J. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1128\/CMR.17.4.697-728.2004","article-title":"Mycoplasma pneumoniae and its role as a human pathogen","volume":"17","author":"Waites","year":"2004","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Gao, J., Xu, L., Xu, B., Xie, Z., and Shen, K. (2020). Human adenovirus Coinfection aggravates the severity of Mycoplasma pneumoniae pneumonia in children. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05152-x"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"20075","DOI":"10.2807\/ese.17.05.20075-en","article-title":"European Working Group on Mycoplasma pneumoniae surveillance. Surveillance status and recent data for Mycoplasma pneumoniae infections in the European Union and European Economic Area, January 2012","volume":"17","author":"Lenglet","year":"2012","journal-title":"Euro Surveill."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/cid\/ciy419","article-title":"Mycoplasma pneumoniae Among Children Hospitalized with Community-acquired Pneumonia","volume":"68","author":"Kutty","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","first-page":"2100746","article-title":"Mycoplasma pneumoniae detections before and during the COVID-19 pandemic: Results of a global survey, 2017 to 2021","volume":"27","author":"Beeton","year":"2022","journal-title":"Euro Surveill."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e13361","DOI":"10.1111\/irv.13361","article-title":"The Epidemiology of Pathogens in Community-Acquired Pneumonia Among Children in Southwest China Before, During and After COVID-19 Non-pharmaceutical Interventions: A Cross-Sectional Study","volume":"18","author":"Yang","year":"2024","journal-title":"Influenza Other Respir. Viruses"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Yang, M.C., Su, Y.T., Chen, P.H., Tsai, C.C., Lin, T.I., and Wu, J.R. (2023). Changing patterns of infectious diseases in children during the COVID-19 pandemic. Front. Cell Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1200617"},{"key":"ref_12","unstructured":"Association RGotPBotCM, and Clinics EBotCJoPP (2015). Expert consensus on the diagnosis and management of Mycoplasma pneumoniae pneumonia in children. Chin. J. Pract. Paediatr., 30, 1304\u20131308."},{"key":"ref_13","unstructured":"China NHCotPsRo (2019). Medicine SAoC. diagnosis and treatment standard of community acquired pneumonia in Children (2019 Edition). Chin. J. Clin. Infect. Dis., 12, 6\u201313."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e29929","DOI":"10.1002\/jmv.29929","article-title":"Analyzing infections caused by 11 respiratory pathogens in children: Pre- and post-COVID-19 pandemic trends in China","volume":"96","author":"Li","year":"2024","journal-title":"J. Med. Virol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Zhu, X., Liu, P., Yu, H., Wang, L., Zhong, H., Xu, M., Lu, L., Jia, R., Su, L., and Cao, L. (2024). An outbreak of Mycoplasma pneumoniae in children after the COVID-19 pandemic, Shanghai, China, 2023. Front Microbiol, 15.","DOI":"10.3389\/fmicb.2024.1427702"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s12519-023-00793-9","article-title":"Current Mycoplasma pneumoniae epidemic among children in Shanghai: Unusual pneumonia caused by usual pathogen","volume":"20","author":"Zhang","year":"2024","journal-title":"World J. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1186\/s12985-024-02579-5","article-title":"Epidemiological characteristics of respiratory pathogens infections among children after the removal of non-pharmaceutical interventions in central China","volume":"21","author":"Liu","year":"2024","journal-title":"Virol. J."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Cheng, Y., Cheng, Y., Dai, S., Hou, D., Ge, M., Zhang, Y., Fan, L., Pei, Y., Yu, L., and Xue, G. (2022). The Prevalence of Mycoplasma Pneumoniae Among Children in Beijing Before and During the COVID-19 Pandemic. Front. Cell Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.854505"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13052-025-01846-7","article-title":"Mycoplasma pneumoniae detections in children with acute respiratory infection, 2010\u20132023: A large sample study in China","volume":"51","author":"Miao","year":"2025","journal-title":"Ital. J. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"6789","DOI":"10.21037\/jtd-24-729","article-title":"Analysis of Mycoplasma pneumoniae pneumonia and viral coinfection in southern Guangzhou after the COVID-19 pandemic","volume":"16","author":"Wu","year":"2024","journal-title":"J. Thorac. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Wang, W., Luo, X., Ren, Z., Fu, X., Chen, Y., Wang, W., Bao, Y., Zheng, Y., Cao, K., and Chen, J. (2025). Impact of COVID-19 pandemic measures on hospitalizations and epidemiological patterns of twelve respiratory pathogens in children with acute respiratory infections in southern China. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-10463-y"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zhao, P., Zhang, Y., Wang, J., Li, Y., Wang, Y., Gao, Y., Zhao, M., Zhao, M., Tan, H., and Tie, Y. (2024). Epidemiology of respiratory pathogens in patients with acute respiratory infections during the COVID-19 pandemic and after easing of COVID-19 restrictions. Microbiol. Spectr., 12.","DOI":"10.1128\/spectrum.01161-24"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Pinky, L., and Dobrovolny, H.M. (2016). Coinfections of the Respiratory Tract: Viral Competition for Resources. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0155589"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jmii.2013.06.006","article-title":"Impact of bacterial and viral coinfection on mycoplasmal pneumonia in childhood community-acquired pneumonia","volume":"48","author":"Chiu","year":"2015","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jcv.2016.04.019","article-title":"Respiratory viral coinfection and disease severity in children: A systematic review and meta-analysis","volume":"80","author":"Scotta","year":"2016","journal-title":"J. Clin. Virol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1111\/resp.12741","article-title":"Systematic review and meta-analysis of respiratory viral coinfections in children","volume":"21","author":"Lim","year":"2016","journal-title":"Respirology"},{"key":"ref_27","first-page":"15666","article-title":"Effects of bacterial and viral co-infections of mycoplasma pneumoniae pneumonia in children: Analysis report from Beijing Children\u2019s Hospital between 2010 and 2014","volume":"8","author":"Song","year":"2015","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1002\/jmv.21271","article-title":"Viruses in community-acquired pneumonia in children aged less than 3 years old: High rate of viral coinfection","volume":"80","author":"Cilla","year":"2008","journal-title":"J. Med. Virol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chen, Q., Lin, L., Zhang, N., and Yang, Y. (2024). Adenovirus and Mycoplasma pneumoniae co-infection as a risk factor for severe community-acquired pneumonia in children. Front. Pediatr., 12.","DOI":"10.3389\/fped.2024.1337786"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Li, F., Zhang, Y., Shi, P., Cao, L., Su, L., Fu, P., Abuduxikuer, K., Wang, L., Wang, Y., and Lu, R. (2022). Mycoplasma pneumoniae and Adenovirus Coinfection Cause Pediatric Severe Community-Acquired Pneumonia. Microbiol. Spectr., 10.","DOI":"10.1128\/spectrum.00026-22"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e00607-19","DOI":"10.1128\/IAI.00607-19","article-title":"Transcriptional and Pathological Host Responses to Coinfection with Virulent or Attenuated Mycoplasma gallisepticum and Low-Pathogenic Avian Influenza A Virus in Chickens","volume":"88","author":"Canter","year":"2019","journal-title":"Infect. Immun."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1177\/1040638719861686","article-title":"Coinfection of Swiss cattle with bovine parainfluenza virus 3 and Mycoplasma bovis at acute and chronic stages of bovine respiratory disease complex","volume":"31","author":"Mehinagic","year":"2019","journal-title":"J. Vet. Diagn. Investig."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2353298","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."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/9\/1266\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:48Z","timestamp":1760035728000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/9\/1266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,19]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["v17091266"],"URL":"https:\/\/doi.org\/10.3390\/v17091266","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,19]]}}}