Abstract
OBJECTIVE: To investigate the epidemiological characteristics and climate-sensitive transmission patterns of rotavirus (RV), adenovirus (AdV), and RV-AdV coinfections among children with acute gastroenteritis in Wuhan, China, during the post-COVID-19 era. METHODS: We conducted a retrospective time-series study of 53,088 pediatric patients tested for RV and AdV from April 2020 to August 2024. Age-stratified positivity rates were analyzed alongside temporal trends. Daily meteorological data (temperature, relative humidity, wind speed) and air pollutants were incorporated into a generalized additive model (GAM) framework with distributed lag nonlinear models (DLNMs) to assess delayed and nonlinear associations between weather exposures and virus positivity. RESULTS: RV was the most frequently detected virus (7.74%), peaking in preschool-aged children (3-6 years), while AdV showed broader age distribution with highest positivity in toddlers (1-3 years). Coinfections were most common in children under 2 years. Significant seasonal and interannual fluctuations were observed, particularly a post-pandemic RV surge in 2024. Spearman analysis revealed inverse correlations between RV/AdV positivity and temperature. DLNMs showed that RV risk increased significantly under low wind (RR = 1.79, lag 0), cold (RR = 1.47, lag 21), and dry conditions (RR = 1.23, lag 15). AdV exhibited a U-shaped humidity-risk curve and increased risk with cold and moderately humid conditions. Coinfection risk was primarily driven by cold temperatures. Significant interactions were found between temperature and wind (RV) and between temperature and humidity (AdV). Season-stratified analysis indicated atypical spring and summer RV peaks. CONCLUSION: This study is the first in China to apply DLNMs in a large pediatric cohort to evaluate climate-driven risk of RV and AdV infections. Findings reveal pathogen-specific, delayed meteorological sensitivities and post-COVID shifts in transmission patterns, providing a foundation for climate-informed surveillance and targeted interventions in pediatric gastroenteritis control.