Molecular Epidemiology, Viral Load and Clinical Severity of Human Adenovirus-Associated Respiratory Infections in Hospitalized Children in Shanghai, 2021-2023.

Publication date: Jun 01, 2026

Human adenoviruses (HAdVs) are important causes of pediatric acute respiratory tract infections (ARTIs), with disease severity potentially varying by type. The impact of COVID-19-related non-pharmaceutical interventions (NPIs) and their relaxation on the relative prevalence of various HAdV types, RNase P-normalized viral load distributions, and associated clinical outcomes remains incompletely defined. We conducted a retrospective cohort study of children hospitalized for ARTIs at Shanghai Children’s Hospital from 2021 to 2023, integrating epidemiologic trends, clinical phenotypes, HAdV typing and RNase P-normalized HAdV DNA quantification by droplet digital PCR (ddPCR). Multivariable logistic regression was used to identify independent correlates of severe community-acquired pneumonia (SCAP). Among 19,537 hospitalized children, HAdV was detected in 600 (3. 07%), with annual detection rates of 2. 85%, 2. 36% and 3. 44% in 2021, 2022 and 2023, respectively (p = 0. 002). A marked type replacement occurred, shifting from species C (predominantly HAdV-108) in 2021-2022 to species B (predominantly HAdV-3) in 2023. Among 507 HAdV-positive cases with complete data, post-pandemic cases in 2023 involved older children and showed higher proportions of species B infection, Mycoplasma pneumoniae (MP) co-infection, and SCAP (14. 74% vs. 3. 08% in 2021-2022; p 

Concepts Keywords
Adenoviruses Adenovirus Infections, Human
Pcr Adenoviruses, Human
Severe Child
Shanghai Child, Hospitalized
Child, Preschool
children
China
clinical profiles
Coinfection
Community-Acquired Pneumonia
COVID-19
Female
Hospitalization
human adenovirus
Humans
Infant
Male
Molecular Epidemiology
molecular typing
Prevalence
Respiratory Tract Infections
Retrospective Studies
Viral Load
viral load

Semantics

Type Source Name
disease MESH Respiratory Infections
disease MESH COVID-19
disease MESH community-acquired pneumonia
disease MESH infection Mycoplasma
disease MESH co-infection
disease MESH Adenovirus Infections Human

Original Article

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