Disruption and change in positivity of respiratory pathogen epidemiology in children during and after the COVID-19 pandemic, 2018–2023: a large-scale period-comparison study in Guangzhou, southern China
- 1Department of Clinical Laboratory, Guangdong Women and Children Hospital
- 2Graduate School, Guangzhou Medical University
Abstract
Background: Non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic disrupted respiratory pathogen transmission, but post-pandemic change in positivity patterns across pathogens, age groups, and co-infections remain incompletely characterized in children.
Methods: We conducted a retrospective period-comparison study at two Guangzhou hospitals, encompassing 230,333 patient-period records (2018–2023). Using logistic regression, we compared adjusted odds ratios (aOR) for 16 pathogens across three pandemic periods (Pandemic-I: strict NPIs; Pandemic-II: relaxed NPIs; Post-pandemic: full reopening) versus pre-pandemic baseline, with age-period interactions tested by likelihood-ratio.
Results: Most respiratory viruses and M. pneumoniae were suppressed in Pandemic-I, with notable exceptions such as rhinovirus, CMV, and bocavirus (influenza A aOR = 0.23; B aOR = 0.08). Post-pandemic changes in test positivity diverged: influenza A showed increased positivity across all ages (aOR = 1.23–1.74); RSV showed increased positivity in children <5 years (aOR = 1.50–1.86); M. pneumoniae showed a marked increase in positivity in school-aged children (5–9 years: aOR = 3.32); influenza B remained suppressed in young children (aOR = 0.53–0.58) but showed increased positivity in adolescents (aOR = 2.88). Age-period interactions were significant for all four ( p < 0.001). Bacterial changes were modest and should be interpreted cautiously because culture positivity is influenced by specimen type, hospitalization, antibiotic exposure, and culture indications. Co-infections shifted from bacterial–bacterial dominance in Pandemic-I (49.0%) to bacterial–influenza co-infections post-pandemic (22.9%).
Conclusion: The pandemic reshaped pediatric respiratory pathogen epidemiology in pathogen- and age-specific ways, and may warrant consideration of age-stratified surveillance and tailored prevention.
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BibTeX
@article{li2026disruption,
title = {{Disruption and change in positivity of respiratory pathogen epidemiology in children during and after the COVID-19 pandemic, 2018–2023: a large-scale period-comparison study in Guangzhou, southern China}},
author = {Huan Li and Ru Bai and Zishan Tang and Ping Li and Lingling Tang and Xianhua Zheng and Chunming Gu and Cunwei Ji and Yasha Luo and Mingyong Luo},
journal = {Frontiers in Microbiology},
year = {2026},
month = oct,
doi = {10.3389/fmicb.2026.1992791},
url = {https://www.frontiersin.org/articles/10.3389/fmicb.2026.1992791/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Disruption and change in positivity of respiratory pathogen epidemiology in children during and after the COVID-19 pandemic, 2018–2023: a large-scale period-comparison study in Guangzhou, southern China
AU - Huan Li
AU - Ru Bai
AU - Zishan Tang
AU - Ping Li
AU - Lingling Tang
AU - Xianhua Zheng
AU - Chunming Gu
AU - Cunwei Ji
AU - Yasha Luo
AU - Mingyong Luo
PY - 2026
DA - 2026/10/20
JO - Frontiers in Microbiology
DO - 10.3389/fmicb.2026.1992791
UR - https://www.frontiersin.org/articles/10.3389/fmicb.2026.1992791/full
AB - Background: Non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic disrupted respiratory pathogen transmission, but post-pandemic change in positivity patterns across pathogens, age groups, and co-infections remain incompletely characterized in children. Methods: We conducted a retrospective period-comparison study at two Guangzhou hospitals, encompassing 230,333 patient-period records (2018–2023). Using logistic regression, we compared adjusted odds ratios (aOR) for 16 pathogens across three pandemic periods (Pandemic-I: strict NPIs; Pandemic-II: relaxed NPIs; Post-pandemic: full reopening) versus pre-pandemic baseline, with age-period interactions tested by likelihood-ratio. Results: Most respiratory viruses and M. pneumoniae were suppressed in Pandemic-I, with notable exceptions such as rhinovirus, CMV, and bocavirus (influenza A aOR = 0.23; B aOR = 0.08). Post-pandemic changes in test positivity diverged: influenza A showed increased positivity across all ages (aOR = 1.23–1.74); RSV showed increased positivity in children <5 years (aOR = 1.50–1.86); M. pneumoniae showed a marked increase in positivity in school-aged children (5–9 years: aOR = 3.32); influenza B remained suppressed in young children (aOR = 0.53–0.58) but showed increased positivity in adolescents (aOR = 2.88). Age-period interactions were significant for all four ( p < 0.001). Bacterial changes were modest and should be interpreted cautiously because culture positivity is influenced by specimen type, hospitalization, antibiotic exposure, and culture indications. Co-infections shifted from bacterial–bacterial dominance in Pandemic-I (49.0%) to bacterial–influenza co-infections post-pandemic (22.9%). Conclusion: The pandemic reshaped pediatric respiratory pathogen epidemiology in pathogen- and age-specific ways, and may warrant consideration of age-stratified surveillance and tailored prevention.
SN - 1664-302X
ER -