{
  "abstract": "BackgroundThe COVID-19 pandemic substantially altered respiratory pathogen circulation worldwide. However, longitudinal analyses of changes in respiratory pathogen ecology across the pandemic and post-pandemic periods remain limited.\n\nMethodsWe analyzed 19,968 respiratory samples tested with the BioFire(R) FilmArray(R) Respiratory Panel at a hospital in Tokyo, Japan, between January 2020 and March 2026. We evaluated temporal changes in pathogen circulation, age-specific epidemiology, co-detection patterns, pairwise pathogen associations, and clinical parameters.\n\nResultsAt least one respiratory pathogen was detected in 27.8% of tests. Respiratory pathogens resurged asynchronously following the relaxation of COVID-19-related public health measures. Influenza virus circulation remained markedly suppressed until late 2022 before re-emerging in successive large seasonal epidemics, whereas other pathogens, including RSV, human metapneumovirus, and Mycoplasma pneumoniae, exhibited distinct resurgence patterns. Pathogen distributions also varied by age. Human rhinovirus/enterovirus remained predominant among young children, whereas SARS-CoV-2 predominated among older adults. Co-detection occurred in 14.0% of positive specimens and was significantly more frequent in younger patients. Pairwise analysis identified both positive and negative pathogen associations; however, the patterns varied across age groups and study periods.\n\nConclusionsRespiratory pathogen circulation changed substantially during the transition from the COVID-19 pandemic to the post-pandemic period, with pathogen-specific, age- and period-dependent patterns. Continued surveillance is warranted to determine how respiratory pathogen circulation will evolve and to inform infection control strategies in the post-pandemic era.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Academic-Industrial Partnerships Promotion, Center for Clinical Sciences, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku-ku, Tokyo 1"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "J. S. Takeuchi"
    },
    {
      "name": "M. Kurokawa"
    },
    {
      "name": "K. Yamamoto"
    },
    {
      "name": "J. Yamanaka"
    },
    {
      "name": "E. Morino"
    },
    {
      "name": "S. Takayanagi-Nishisako"
    },
    {
      "name": "N. Ohmagari"
    },
    {
      "name": "W. Sugiura"
    },
    {
      "name": "M. Kimura"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1eaqmz1e7b9yp.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.08.28.26360747",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26360747v1.full",
  "id": "1eaqmz1e7b9yp",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26360747v1",
  "language": null,
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "infectious diseases"
    ],
    [
      "openalex",
      "2713|Respiratory viral infections research"
    ]
  ],
  "openalex": "W7206211243",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26360747v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/1eaqmz1e7b9yp.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:31Z",
      "native_id": "10.64898/2026.08.28.26360747",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26360747v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:infectious diseases",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Post-pandemic ecological reshaping of respiratory pathogen circulation: A six-year FilmArray(R)-based surveillance study in Tokyo, Japan (2020-2026)",
  "title_text": "Post-pandemic ecological reshaping of respiratory pathogen circulation: A six-year FilmArray(R)-based surveillance study in Tokyo, Japan (2020-2026)",
  "type": "preprint",
  "updated_at": "2026-10-30T12:17:31Z",
  "url": "https://research.draconitic.com/paper/1eaqmz1e7b9yp",
  "venue": "medRxiv",
  "versions": []
}