Relaxation of COVID-19 NPIs in Nanjing children showed high pathogen detection rates with preschoolers having the highest burden.
This retrospective cohort study analyzed data from 7,473 children aged 18 years or younger presenting with acute respiratory tract infections at a tertiary hospital in Nanjing, eastern China. The primary focus was on pathogen detection rates, temporal trends, and co-infection dynamics following the relaxation of COVID-19 non-pharmaceutical interventions. No comparator group was reported for this observational analysis.
The overall pathogen detection rate was 61.8% (4,618 of 7,473 samples). Sex disparity was not significant (p = 0.267). Pathogen burden varied by age, with preschoolers aged 4 to 6 years experiencing the highest burden at 68.3%, significantly exceeding other age groups (p < 0.008). The most prevalent pathogens were rhinovirus (16.9%), Mycoplasma pneumoniae (12.4%), and respiratory syncytial virus (9.0%).
Seasonal patterns were observed for specific pathogens. Respiratory syncytial virus peaked in winter, reaching 25.3% in March 2025. Mycoplasma pneumoniae dominated in mid-summer, accounting for 22.8% in August 2024. Rhinovirus maintained high activity year-round. The co-infection rate was 17.5% of positive samples, with the most frequent combinations being Mycoplasma pneumoniae-rhinovirus and adenovirus-rhinovirus. Network analysis identified rhinovirus and Mycoplasma pneumoniae as central connectors.
Safety data, adverse events, and discontinuations were not reported. The study has limitations inherent to its retrospective design and lack of a comparator. Practice relevance includes enhanced multiplex surveillance and expansion of vaccination programs for RSV and influenza.
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