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Objective <p>This study characterizes the epidemiological features of key respiratory pathogens across four regions of China following the COVID-19 pandemic, aiming to enhance understanding of post-pandemic circulation patterns and supporting the development of targeted prevention strategies.</p> Methods <p>Surveillance data on seven respiratory pathogens were collected (October 2023-February 2025) using a direct-to-consumer (DTC) testing approach. Demographic distributions, temporal trends, pairwise correlation analyses and symptom profiles were assessed.</p> Results <p>Respiratory syncytial virus (RSV) and human rhinovirus (HRV) exhibited a child pattern. Influenza B virus (IFV-B), human adenovirus (HAdV), and <i>Mycoplasma pneumoniae</i> (<i>M. pneumoniae</i>) demonstrated a school-age child pattern. In contrast, influenza A virus (IFV-A) and SARS-CoV-2 showed an elderly pattern. The epidemic patterns of pathogens were categorized into seasonal and year-round circulation. Correlation analyses revealed positive pairwise correlations between IFV-A and RSV, and between HRV and <i>M. pneumoniae</i>, while a negative correlation was observed between IFV-A and SARS-CoV-2. Clustering analysis based on symptom profiles identified three distinct categories: an upper respiratory tract symptom cluster (RSV, HRV), a systemic and respiratory symptom cluster (influenza viruses, SARS-CoV-2), and a systemic symptom cluster (HAdV, <i>M. pneumoniae</i>). Analysis of typical symptom (fever, cough, throat pain) co-occurrence for the seven pathogens showed that only IFV-A (50.14%) met the current Chinese respiratory pathogen surveillance case definition (fever with cough or throat pain); for the other six pathogens, the proportion was below 50%.</p> Conclusions <p>Pathogen distribution exhibited significant age-specific variation. The seasonality of different pathogens exhibited regional variations, providing valuable references for future preventive interventions. Notably, half of the individuals with single-pathogen detection reported symptoms that did not meet the current influenza-like illness (ILI) surveillance criteria. Therefore, case definitions should be optimized according to pathogen type in future surveillance efforts.</p>

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Epidemic dynamics and age-specific distribution of respiratory pathogens: a direct-to-consumer surveillance study in four regions of China, October 2023–February 2025

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月30日

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  • Huili Jiang,
  • Yuping Duan,
  • Mingyue Jiang,
  • Zeni Wu,
  • Yanxia Sun,
  • Luzhao Feng

摘要

Objective

This study characterizes the epidemiological features of key respiratory pathogens across four regions of China following the COVID-19 pandemic, aiming to enhance understanding of post-pandemic circulation patterns and supporting the development of targeted prevention strategies.

Methods

Surveillance data on seven respiratory pathogens were collected (October 2023-February 2025) using a direct-to-consumer (DTC) testing approach. Demographic distributions, temporal trends, pairwise correlation analyses and symptom profiles were assessed.

Results

Respiratory syncytial virus (RSV) and human rhinovirus (HRV) exhibited a child pattern. Influenza B virus (IFV-B), human adenovirus (HAdV), and Mycoplasma pneumoniae (M. pneumoniae) demonstrated a school-age child pattern. In contrast, influenza A virus (IFV-A) and SARS-CoV-2 showed an elderly pattern. The epidemic patterns of pathogens were categorized into seasonal and year-round circulation. Correlation analyses revealed positive pairwise correlations between IFV-A and RSV, and between HRV and M. pneumoniae, while a negative correlation was observed between IFV-A and SARS-CoV-2. Clustering analysis based on symptom profiles identified three distinct categories: an upper respiratory tract symptom cluster (RSV, HRV), a systemic and respiratory symptom cluster (influenza viruses, SARS-CoV-2), and a systemic symptom cluster (HAdV, M. pneumoniae). Analysis of typical symptom (fever, cough, throat pain) co-occurrence for the seven pathogens showed that only IFV-A (50.14%) met the current Chinese respiratory pathogen surveillance case definition (fever with cough or throat pain); for the other six pathogens, the proportion was below 50%.

Conclusions

Pathogen distribution exhibited significant age-specific variation. The seasonality of different pathogens exhibited regional variations, providing valuable references for future preventive interventions. Notably, half of the individuals with single-pathogen detection reported symptoms that did not meet the current influenza-like illness (ILI) surveillance criteria. Therefore, case definitions should be optimized according to pathogen type in future surveillance efforts.