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Updated: Mar 13, 2026

Author Spotlight: Advancements in Multiplex Detection of Respiratory Viruses
Published on: November 10, 2023
Epidemiological characteristics and driving factors of co-circulation and co-detection of multiple respiratory
Huihui Zhang1, Rongrong Qu1, Qianqian Feng1
1Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, 310058, China.
Objectives:
Acute respiratory infections (ARIs) are driven by multiple co-circulating pathogens. We investigated pathogen co-detection patterns and interactions at multiple levels to identify factors shaping their dynamics.
Study Design:
Population-based surveillance study.
Methods:
From November 2023 to December 2024, a multi-center surveillance of ARIs was conducted in 26 sentinel hospitals across Zhejiang Province, China. 14 respiratory pathogens were tested using PCR-based capillary electrophoresis. Population-level pathogen associations were assessed by Spearman's rank correlation and Granger causality tests. Pathogen interactions at the host level were analyzed using proportional distribution model and multivariable logistic regression.
Results:
Of 39,115 enrolled ARIs cases, 38,606 were tested for 14 respiratory pathogens. The overall pathogen positivity was 54.84% (21,173/38,606), with co-detections observed in 12.47% (4815/38,606) of ARIs cases. Streptococcus pneumoniae was the most prevalent pathogen and the primary driver of co-detections. A directed predictive network was identified, with RSV, HRV, and HPIV as key hubs. Viral-bacterial synergy was common in children, while adults and the elderly showed significant viral interference, most notably between IFV-A and IFV-B (OR = 0.06). Strong influenza interference was observed in the cold season (IFV-A-IFV-B, OR = 0.10), whereas the warm season was dominated by broader pathogen synergy, alongside notable negative associations such as IFV-A-SARS-CoV-2 (OR = 0.17).
Conclusions:
This study reveals that age- and season-dependent pathogen interactions may shape the dynamic patterns of multiple respiratory pathogens, thereby highlighting the importance of considering such interactions in public health strategies.
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