A retrospective study of respiratory infections in children following the COVID-19 pandemic in Wuhan, China

Abstract

Introduction: Acute respiratory infections cause over 4 million deaths annually worldwide, half of which occur in children under 5 years, primarily in developing countries. This study investigated the impact of the coronavirus disease 2019 (COVID-19) pandemic on the epidemiological and clinical characteristics of pediatric patients with respiratory infections.

Methodology: This study retrospectively analyzed 8,815 pediatric cases (0–18 years) with laboratory-confirmed respiratory infections at Wuhan Children’s Hospital in pre-pandemic (November 2019–February 2020) and post-pandemic (November 2020–February 2021) periods. Included cases were symptomatic and tested positive for at least one pathogen: influenza A (FluA), influenza B (FluB), respiratory syncytial virus (RSV), Chlamydia pneumoniae (CP), Mycoplasma pneumoniae (MP), adenovirus (ADV), or coxsackievirus (CV). The pathogen distribution spectrum between periods was compared. Routine blood parameters – platelet count, white blood cell count, red blood cell count, lymphocyte percentage, neutrophil percentage, monocyte percentage, C-reactive protein, and hemoglobin – were also compared across groups and periods.

Results: The post-pandemic pathogen spectrum shifted significantly. MP detection increased across all age groups (28 days–2 years, 2–8 years, 8–18 years), while other pathogens (RSV, ADV, CV, CP) decreased, with patterns varying by age. Post-pandemic platelet count and lymphocyte percentage increased, while neutrophil percentage decreased in the CP group.

Conclusions: COVID-19 control measures were temporally associated with marked changes in respiratory pathogen detection; notably a rise in MP. However, changes in healthcare-seeking behavior and testing intensity are important confounders. The observed shift in pathogen spectrum requires careful interpretation within this complex context.