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Objective <p>This study aimed to analyze the epidemiological characteristics and hematologic and inflammatory markers of influenza A in children aged 0–18 years before and after the COVID-19 pandemic to guide future prevention and control strategies.</p> Methods <p>We conducted a single-center retrospective analysis of 238,494 children tested for influenza A at Shanghai Children’s Medical Center (2019.1-2023.12). Positivity rates and serological parameters were evaluated across age groups seasons, and years.</p> Results <p>During the pandemic period, influenza A positivity remained consistently low without seasonal peaks. Conversely, post-pandemic positivity (33.3% in 2023) markedly exceeded pre-pandemic levels (13.7% in 2019), exhibiting winter-spring seasonality with bimodal peaks in February-March and December. School-aged children (≥ 6 years) indicated the highest post-pandemic positivity rate (38.9%). Hospitalization rates among influenza A-positive children inversely correlated with age: 16.7% in neonates (≤ 28 days) vs. 1.4% in infants (29d-3y) vs. 0.4% in preschoolers (3-6y) vs. 0.33% in older children (≥ 6y). Children &lt; 6 years predominated in severe diagnoses and comorbid conditions.</p> Conclusions <p>This study delineates the evolving epidemiology of influenza A from 2019 to 2023. Post-pandemic resurgence suggested heightened positivity rates and prolonged seasonal activity exceeding pre-pandemic patterns. Young children and those with comorbidities exhibited greater disease severity requiring hospitalization. Enhanced pediatric influenza A prevention is imperative.</p> Clinical trial number <p>Not applicable. This study is a retrospective observational study and does not meet the definition of a clinical trial requiring registration.</p>

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Resurgence and clinical evolution of influenza A in Chinese children: shifting epidemiology and serological dynamics across pre-, intra-, and post-pandemic eras (2019–2023)

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月17日

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  • Guiling Xu,
  • Yu Chen,
  • Yu Zhu,
  • Qing Fang,
  • Xiaotong Xue,
  • Kejun Hu,
  • Sha Zhou,
  • Li Hong,
  • Ying Xiang

摘要

Objective

This study aimed to analyze the epidemiological characteristics and hematologic and inflammatory markers of influenza A in children aged 0–18 years before and after the COVID-19 pandemic to guide future prevention and control strategies.

Methods

We conducted a single-center retrospective analysis of 238,494 children tested for influenza A at Shanghai Children’s Medical Center (2019.1-2023.12). Positivity rates and serological parameters were evaluated across age groups seasons, and years.

Results

During the pandemic period, influenza A positivity remained consistently low without seasonal peaks. Conversely, post-pandemic positivity (33.3% in 2023) markedly exceeded pre-pandemic levels (13.7% in 2019), exhibiting winter-spring seasonality with bimodal peaks in February-March and December. School-aged children (≥ 6 years) indicated the highest post-pandemic positivity rate (38.9%). Hospitalization rates among influenza A-positive children inversely correlated with age: 16.7% in neonates (≤ 28 days) vs. 1.4% in infants (29d-3y) vs. 0.4% in preschoolers (3-6y) vs. 0.33% in older children (≥ 6y). Children < 6 years predominated in severe diagnoses and comorbid conditions.

Conclusions

This study delineates the evolving epidemiology of influenza A from 2019 to 2023. Post-pandemic resurgence suggested heightened positivity rates and prolonged seasonal activity exceeding pre-pandemic patterns. Young children and those with comorbidities exhibited greater disease severity requiring hospitalization. Enhanced pediatric influenza A prevention is imperative.

Clinical trial number

Not applicable. This study is a retrospective observational study and does not meet the definition of a clinical trial requiring registration.