Molecular and clinical characterization of human adenovirus in hospitalized pediatric respiratory infections: a five-year study

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Abstract Background Human adenovirus (HAdV) is a major pathogen of responsible for respiratory tract infections (RTIs) in children in China. This study analyzed clinical data from hospitalized pediatric HAdV infections over a five-year period to characterize the epidemiology, clinical manifestations, and associations with different genotypes and co-detections. Methods A retrospective analysis was conducted on 42,044 hospitalized children with RTIs admitted to Hebei Children’s Hospital between 2016 and 2020. Sputum were collected for viral nucleic acid detection and HAdV genotyping, along with demographic, clinical, and laboratory data. Statistical analyses included χ² tests, Mann–Whitney U tests, and Kruskal–Wallis tests. Neighbor-joining method was used to construct the phylogenetic tree. Results Among 42,044 samples, 3,123 (7.43%) tested positive for HAdV. Of these, 1,954 (62.6%) had viral co-detection, most commonly with HRV, RSV, and HPIV. The highest HAdV infection rate occurred in children aged 1–3 years (χ² = 418.44, P < 0.001). HAdV-3 and HAdV-7 were the predominant genotypes in both single and co-infections (χ² = 22.227, P = 0.014). HAdV-7 was more frequently detected in patients with severe clinical manifestations, accompanied by decreased immune indices and elevated levels of procalcitonin, D-dimer, as well as cardiac and liver injury markers. Conclusion HAdV-3 and HAdV-7 are the predominant strains circulating in Hebei Province and primarily affect hospitalized children aged 1–3 years. HAdV-7 was associated with more severe diseases. HAdV genotyping sequence exhibit high genetic similarity across different countries.