ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Infectious Diseases
Epidemiological Characteristics of Single and Co-infections with Upper Respiratory Tract Pathogens among Children in Eastern China: A Retrospective Study
Provisionally accepted
- Children's Hospital of Nanjing Medical University, Nanjing, China
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Background: The epidemiology of pediatric respiratory tract infections (RTIs) has shifted since the COVID-19 pandemic. This study aimed to characterize the prevalence and co-infection patterns of seven key respiratory pathogens in children in Eastern China following the relaxation of pandemic-related non-pharmaceutical interventions. Methods: We conducted a large-scale, retrospective study involving pediatric patients aged under 18 years who presented with symptoms of acute respiratory tract infection (RTI) to a tertiary academic children's hospital between April 2023 and March 2024. Nasopharyngeal or oropharyngeal swab specimens were collected and tested using multiplex reverse transcription polymerase chain reaction (RT-PCR) for seven common respiratory pathogens: Mycoplasma pneumoniae (M. pneumoniae), adenovirus (ADV), influenza A virus (IAV), influenza B virus (IBV), human rhinovirus (HRV), respiratory syncytial virus (RSV), and SARS-CoV-2. Stratified analyses were performed across four predefined age groups. Results: Pathogen distribution showed distinct age-related patterns. Among high-risk pathogens, infants with RSV infection were the most common. Conversely, IAV and M. pneumoniae prevalence rose with age. Infants with IAV infection increased in school-age children with IAV infection, while Infants with M. pneumoniae infection to a peak in the oldest group with M. pneumoniae infection. For lower-risk pathogens, Children with ADV infection and those with IBV infection also increased steadily with age, respectively in school-age children. Toddlers with HRV infection peaked, while Infants with SARS-CoV-2 infection were the most common, followed by school-age children with SARS-CoV-2 infection. Co-infections were significant, with children with M. pneumoniae infection being the most likely to have co-infections — frequently paired with HRV infection, ADV infection, and IAV infection. Discussion: The distinct epidemiological patterns and high rates of co-infection highlight the need for age-specific prevention strategies. The significant role of M. pneumoniae in both single and co-infections underscores the clinical utility of multiplex diagnostics to guide appropriate antimicrobial stewardship. Conclusion: This study reveals significant age-dependent variations and high co-infection rates for seven respiratory pathogens in a large pediatric cohort. These findings are crucial for informing public health policies and optimizing the clinical management of pediatric RTIs in the post-pandemic era.
Keywords: Children, Co-infection, eastern China, Epidemiological characteristics, Upper Respiratory Tract Pathogens
Received: 17 Sep 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 Yang, Meng, Wang, Zhao, Zhou and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jing Zhou
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