Epidemiology and burden of acute respiratory infections associated with respiratory viruses: A multi-source integrated population-based surveillance study in Chongqing

Epidemiology and burden of acute respiratory infections associated with respiratory viruses: A multi-source integrated population-based surveillance study in Chongqing | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiology and burden of acute respiratory infections associated with respiratory viruses: A multi-source integrated population-based surveillance study in Chongqing Yuping Duan, Mingyue Jiang, Ju Wang, Bosong Li, Qing Wang, Jule Yang, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9285948/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Acute respiratory infections (ARIs), particularly severe acute respiratory infections (SARIs), impose a huge disease burden globally. Respiratory viruses are key etiological agents of ARIs. Population-based data on respiratory virus disease burden in China are limited, with most studies focusing on single pathogens and lacking population-level incidence and hospitalization estimates. Methods We integrated data from national hospital-based surveillance, local health system electronic medical records (EMRs), and census records in Chongqing from October 2023 to April 2025. We also conducted a community-based healthcare utilization survey and a pilot survey. We analyzed the seasonality of six respiratory viruses and used Joinpoint software to characterize age-specific epidemiological trends. Furthermore, we identified risk factors for severe acute respiratory infection (SARI). A modified multiplier model was employed to estimate population-based incidence and hospitalization rates of ARI associated with these viruses. Results We included 16,363 respiratory infection patients (12,669 outpatients, 3,694 inpatients). Most viruses resumed pre-COVID-19 seasonal patterns. The detection rate of influenza virus (IFV) peaked in adolescents and adults; respiratory syncytial virus (RSV) and human parainfluenza virus (HPIV) mainly affected infants and the elderly; human adenovirus (HAdv), human rhinovirus (HRV), and human metapneumovirus (HMPV) were most prevalent in preschoolers. RSV infection was significantly associated with a higher risk of SARI compared with other respiratory viruses (RSV vs. IFV: adjusted odds ratio [aOR], 95% confidence interval [CI]: 7.88, 5.4–11.51; RSV vs. HRV: 1.52, 1.13–2.04; RSV vs. HAdv: 3.21, 2.14–4.81; RSV vs. HMPV: 1.76, 1.24–2.50; RSV vs. HPIV: 1.63, 1.14–2.33). Incidence and hospitalization rates (per 100,000 person-years) of HRV (30,183; 2,153), HMPV (22,774; 514), RSV (22,181; 2,065), IFV (13,086; 807), HPIV (7,824; 556), and HAdv (6,991; 1,487) were highest in children under 5 years of age. Hospitalization rates rose again in those aged ≥ 60 years: HRV (170), RSV (80), IFV (70), HMPV (54), HAdv (27), HPIV (23). Conclusions Distinct age distributions and the high SARI risk of specific viruses such as RSV support targeted prevention. Integrating multi-source surveillance with sentinel surveys and standardizing the ARI case definition can yield population-level, real-world estimates of incidence and hospitalization rates for these viruses. Respiratory viruses incidence hospitalization rate clinical severity Full Text Additional Declarations No competing interests reported. Supplementary Files appendix.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 20 Apr, 2026 Editor assigned by journal 02 Apr, 2026 Submission checks completed at journal 02 Apr, 2026 First submitted to journal 31 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9285948","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631091543,"identity":"da8648a6-667a-4b2b-a60a-c190536d65d4","order_by":0,"name":"Yuping Duan","email":"","orcid":"","institution":"Chinese Academy of Medical Sciences \u0026 Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Yuping","middleName":"","lastName":"Duan","suffix":""},{"id":631091544,"identity":"aecc1a3d-c758-45c0-b8b2-42c0ea9cc03a","order_by":1,"name":"Mingyue Jiang","email":"","orcid":"","institution":"National institute of 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03:24:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9285948/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9285948/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108183168,"identity":"d7fb0bf9-51b7-4259-9fb6-6225a124c51e","added_by":"auto","created_at":"2026-04-30 08:59:50","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":780686,"visible":true,"origin":"","legend":"","description":"","filename":"manuscriptnew.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9285948/v1_covered_b85b9b2b-1632-475c-bf6e-407d4d364740.pdf"},{"id":108127277,"identity":"3496a2f8-0153-49ef-9c29-dcada2ab87c6","added_by":"auto","created_at":"2026-04-29 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Chongqing","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"virology-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"virj","sideBox":"Learn more about [Virology Journal](http://virologyj.biomedcentral.com/)","snPcode":"12985","submissionUrl":"https://submission.nature.com/new-submission/12985/3","title":"Virology Journal","twitterHandle":"@VirologyJ","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Respiratory viruses, incidence, hospitalization rate, clinical severity","lastPublishedDoi":"10.21203/rs.3.rs-9285948/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9285948/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAcute respiratory infections (ARIs), particularly severe acute respiratory infections (SARIs), impose a huge disease burden globally. Respiratory viruses are key etiological agents of ARIs. Population-based data on respiratory virus disease burden in China are limited, with most studies focusing on single pathogens and lacking population-level incidence and hospitalization estimates.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe integrated data from national hospital-based surveillance, local health system electronic medical records (EMRs), and census records in Chongqing from October 2023 to April 2025. We also conducted a community-based healthcare utilization survey and a pilot survey. We analyzed the seasonality of six respiratory viruses and used Joinpoint software to characterize age-specific epidemiological trends. Furthermore, we identified risk factors for severe acute respiratory infection (SARI). A modified multiplier model was employed to estimate population-based incidence and hospitalization rates of ARI associated with these viruses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe included 16,363 respiratory infection patients (12,669 outpatients, 3,694 inpatients). Most viruses resumed pre-COVID-19 seasonal patterns. The detection rate of influenza virus (IFV) peaked in adolescents and adults; respiratory syncytial virus (RSV) and human parainfluenza virus (HPIV) mainly affected infants and the elderly; human adenovirus (HAdv), human rhinovirus (HRV), and human metapneumovirus (HMPV) were most prevalent in preschoolers. RSV infection was significantly associated with a higher risk of SARI compared with other respiratory viruses (RSV vs. IFV: adjusted odds ratio [aOR], 95% confidence interval [CI]: 7.88, 5.4\u0026ndash;11.51; RSV vs. HRV: 1.52, 1.13\u0026ndash;2.04; RSV vs. HAdv: 3.21, 2.14\u0026ndash;4.81; RSV vs. HMPV: 1.76, 1.24\u0026ndash;2.50; RSV vs. HPIV: 1.63, 1.14\u0026ndash;2.33). Incidence and hospitalization rates (per 100,000 person-years) of HRV (30,183; 2,153), HMPV (22,774; 514), RSV (22,181; 2,065), IFV (13,086; 807), HPIV (7,824; 556), and HAdv (6,991; 1,487) were highest in children under 5 years of age. Hospitalization rates rose again in those aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years: HRV (170), RSV (80), IFV (70), HMPV (54), HAdv (27), HPIV (23).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDistinct age distributions and the high SARI risk of specific viruses such as RSV support targeted prevention. Integrating multi-source surveillance with sentinel surveys and standardizing the ARI case definition can yield population-level, real-world estimates of incidence and hospitalization rates for these viruses.\u003c/p\u003e","manuscriptTitle":"Epidemiology and burden of acute respiratory infections associated with respiratory viruses: A multi-source integrated population-based surveillance study in Chongqing","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-29 15:32:47","doi":"10.21203/rs.3.rs-9285948/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-20T17:25:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-02T15:21:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-02T15:20:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"Virology Journal","date":"2026-04-01T03:12:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"virology-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"virj","sideBox":"Learn more about [Virology Journal](http://virologyj.biomedcentral.com/)","snPcode":"12985","submissionUrl":"https://submission.nature.com/new-submission/12985/3","title":"Virology Journal","twitterHandle":"@VirologyJ","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"883e48ae-d966-4a3c-9f55-d67a04967a20","owner":[],"postedDate":"April 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T15:32:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-29 15:32:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9285948","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9285948","identity":"rs-9285948","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}