Abstract
BACKGROUND: Acute respiratory infections impose a disproportionate burden on pediatric populations, yet climate-pathogen interactions remain poorly characterized in rural China. METHODS: We conducted a retrospective analysis of 7627 nasopharyngeal samples from children (<18 years) presenting with ARI symptoms at Wuxi People's Hospital (April 2023-March 2025). Six major pathogens--respiratory syncytial virus (RSV), influenza A/B (IAV/IBV), human rhinovirus (HRV), adenovirus (HAdV), and Mycoplasma pneumoniae (MP)--were detected by quantitative PCR. The association between meteorological factors and pathogen prevalence was examined. RESULTS: HRV (22.18 %), IAV (18.54 %), and RSV (16.56 %) were the most prevalent pathogens, with RSV and HAdV showing higher hospitalization rates. Male children were more susceptible to all pathogens, particularly RSV (p = 0.024). Age-specific distributions revealed RSV dominance in infants (28 days-1 year) and toddlers (1-3 years), HRV and HAdV in preschoolers (3-6 years), and IAV and MP in school-aged children (6-18 years). Seasonal trends included year-round HRV and HAdV circulation, winter peaks for IAV and RSV, and an unexpected summer MP surge (26.88 % in June 2024). RSV exhibited an initial epidemic in 2023 (peak positivity: 52.27 % in April) with resurgence in October 2024. Climate analysis revealed temperature-dependent transmission: IAV/IBV correlated with colder temperatures. Notably, MP displayed atypical summer predominance in 2024, peaking at 26.88 % in June (25.2 °C, 77.3 % humidity). CONCLUSION: This study characterizes the epidemiological and climatic drivers of pediatric ARIs in Wuxi, China, underscoring pathogen-specific age distributions, seasonal anomalies, and climate interactions. The findings emphasize the need for sustained surveillance to monitor emerging respiratory threats and inform targeted interventions.