Etiological Characteristics and Risk Factors for Severe Disease in Bocavirus-Associated Community-Acquired Pneumonia in Children: A Multicenter Retrospective Study

Etiological Characteristics and Risk Factors for Severe Disease in Bocavirus-Associated Community-Acquired Pneumonia in Children: A Multicenter Retrospective Study | 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 Etiological Characteristics and Risk Factors for Severe Disease in Bocavirus-Associated Community-Acquired Pneumonia in Children: A Multicenter Retrospective Study Yuqi Wang, Zhemmei Wei, Chan Su, Junmei Fang, Zhong Hu, Yingshuo Wang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8162495/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Jan, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted 23 You are reading this latest preprint version Abstract Objective This is a multicenter retrospective study aimed to evaluate the concordance between nucleic acid testing and targeted next-generation sequencing (tNGS) for etiologic detection, and to identify potential risk factors for severe community-acquired pneumonia (SCAP), thereby providing evidence for precision clinical management. Methods We retrospectively analyzed 191 pediatric Community-Acquired Pneumonia(CAP) cases positive for bocavirus by tNGS from April 2023 to June 2025. Etiologic concordance and coinfection patterns were evaluated. Univariate and multivariate logistic regression identified independent risk factors for SCAP. Results There are 191 children were included. Significant heterogeneity was observed among the four centers in age distribution, SCAP incidence, imaging findings, and treatment patterns ( P < 0.05). Children’s Hospital, Zhejiang University School of Medicine (ZCH) reported the highest SCAP incidence (50.0%), with markedly higher rates of pulmonary consolidation (66.7%), atelectasis (100.0%), and pleural effusion (16.7%) compared with other centers, whereas DY had the lowest SCAP incidence (11.0%). The bocavirus positivity rate by tNGS was 100.0%, significantly higher than that of nucleic acid testing (51.3%). tNGS identified 44 cases of mixed infection (23.0%), including 35 bacterial (18.3%) and 7 viral coinfections (3.7%), whereas nucleic acid testing identified only 9 mixed infections (4.7%). tNGS demonstrated a clear advantage in detecting mixed and bacterial infections ( P < 0.001). Multivariate logistic regression revealed that age < 3 years, oxygen supplementation, dyspnea, wheezing, plastic bronchitis, pulmonary consolidation, atelectasis, and pleural effusion were independent risk factors for SCAP ( P < 0.05). Conclusion Clinical profiles of bocavirus-associated CAP vary significantly across centers. tNGS offers superior sensitivity and breadth in pathogen detection. Early recognition of high-risk children—particularly those < 3 years, requiring oxygen, exhibiting respiratory distress, or showing radiologic abnormalities—is essential for timely SCAP management. Bocavirus tNGS community-acquired pneumonia children severe pneumonia Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 27 Jan, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 15 Dec, 2025 Reviews received at journal 15 Dec, 2025 Reviews received at journal 13 Dec, 2025 Reviewers agreed at journal 13 Dec, 2025 Reviewers agreed at journal 13 Dec, 2025 Reviewers agreed at journal 13 Dec, 2025 Reviews received at journal 12 Dec, 2025 Reviewers agreed at journal 12 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviews received at journal 11 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers invited by journal 11 Dec, 2025 Editor invited by journal 26 Nov, 2025 Editor assigned by journal 24 Nov, 2025 Submission checks completed at journal 24 Nov, 2025 First submitted to journal 20 Nov, 2025 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-8162495","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":560331334,"identity":"52b44d72-3c5a-4f3c-b08b-4ad3afc78473","order_by":0,"name":"Yuqi Wang","email":"","orcid":"","institution":"Children's Hospital of Zhejiang University","correspondingAuthor":false,"prefix":"","firstName":"Yuqi","middleName":"","lastName":"Wang","suffix":""},{"id":560331335,"identity":"3a0d6b43-ffbe-44cb-8e3b-b7074ebee164","order_by":1,"name":"Zhemmei Wei","email":"","orcid":"","institution":"Children's Hospital of Zhejiang University","correspondingAuthor":false,"prefix":"","firstName":"Zhemmei","middleName":"","lastName":"Wei","suffix":""},{"id":560331336,"identity":"58304c3d-f487-4230-9a19-e4822954d961","order_by":2,"name":"Chan Su","email":"","orcid":"","institution":"Jinhua Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chan","middleName":"","lastName":"Su","suffix":""},{"id":560331337,"identity":"db652573-3a45-4fe4-a314-6b7a3c70e34a","order_by":3,"name":"Junmei Fang","email":"","orcid":"","institution":"Dongyang Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Junmei","middleName":"","lastName":"Fang","suffix":""},{"id":560331338,"identity":"d243223d-0c11-42ab-9139-d36111d94e94","order_by":4,"name":"Zhong Hu","email":"","orcid":"","institution":"Yongkang Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhong","middleName":"","lastName":"Hu","suffix":""},{"id":560331339,"identity":"43f66582-75ba-4c51-8bc8-14e0fd9a97e1","order_by":5,"name":"Yingshuo Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYNACAyCWAOIPDGwwLpFaGGcQr4UBooWZB2ECHvOPnz38mqfgjt382T2Gj23+8CU2sDdvk2CouYNby5m8NGseg2fJG+6cMTbO4WFLbOA5VibBcOwZTi1mB3LMjHkMDicbSOSYSedIALUAGRKMDYdxazn/BqJFfgZQi4UBUIv8GwJabuQYPwZqsWO4AdTCkACyhQe/Fvsbb8wY5xgcTjC4kVZs2HOAzbiNJ63YIuEYbi2S/TnGH978OWwvPyN544Mff47J9rMf3njjQw1uLUDAJgWMjsQGCOcYJDIT8GkARuDHH0AHQjk1+NWOglEwCkbBiAQA3C9TXZNF9Q8AAAAASUVORK5CYII=","orcid":"","institution":"Children's Hospital of Zhejiang University","correspondingAuthor":true,"prefix":"","firstName":"Yingshuo","middleName":"","lastName":"Wang","suffix":""},{"id":560331340,"identity":"fe293778-d0fb-4f03-bec3-8a527d778a4c","order_by":6,"name":"Zhimin Chen","email":"","orcid":"","institution":"Children's Hospital of Zhejiang University","correspondingAuthor":false,"prefix":"","firstName":"Zhimin","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2025-11-20 08:53:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8162495/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8162495/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-026-12543-z","type":"published","date":"2026-01-27T15:58:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":98315778,"identity":"d1b2a2f7-a75c-458d-8a7e-b038d5614798","added_by":"auto","created_at":"2025-12-16 13:12:05","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":411170,"visible":true,"origin":"","legend":"","description":"","filename":"tNGS20251123.docx","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/696f79de1483b9c06cb3566d.docx"},{"id":98435580,"identity":"c22e6c06-8ce7-4611-a487-58ca53f55c14","added_by":"auto","created_at":"2025-12-17 16:54:05","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8845,"visible":true,"origin":"","legend":"","description":"","filename":"b1486e6be4684355bf8eea03f7d5ffdf.json","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/8bd9c80f7707db6fd0fa0702.json"},{"id":98315782,"identity":"86c041e4-59bb-46c5-ad53-c98f43a090fd","added_by":"auto","created_at":"2025-12-16 13:12:05","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":149558,"visible":true,"origin":"","legend":"","description":"","filename":"b1486e6be4684355bf8eea03f7d5ffdf1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/c6abf2853ade2ba7a85976a8.xml"},{"id":98435469,"identity":"609cc6ec-dd34-49d3-9306-faa3fb18c753","added_by":"auto","created_at":"2025-12-17 16:53:53","extension":"png","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49835,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/181b727bd711e37c566bb393.png"},{"id":98315785,"identity":"3ee9a662-1c5e-4695-9643-51cd4c5de4f4","added_by":"auto","created_at":"2025-12-16 13:12:05","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":25205,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/da84535ac96c6e1d36e46bcd.png"},{"id":98315774,"identity":"e53859fa-091f-4173-893e-37615bd39b9c","added_by":"auto","created_at":"2025-12-16 13:12:04","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":52804,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/f65fb597682f8c658c8de51a.png"},{"id":98315775,"identity":"2613d070-9ac5-4c98-9406-03eca8785a2b","added_by":"auto","created_at":"2025-12-16 13:12:04","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":63655,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/7aad53cc3eedc527a7528618.png"},{"id":98315779,"identity":"abf1c71d-5259-4344-a180-2737ea8a90c8","added_by":"auto","created_at":"2025-12-16 13:12:05","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30789,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/8df0ae7bdbf6d6a3e5214d09.png"},{"id":98315786,"identity":"90db0766-38dd-4397-9f2a-516b007ad62c","added_by":"auto","created_at":"2025-12-16 13:12:05","extension":"jpeg","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":414628,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/289a3d368c85a5516f1848b0.jpeg"},{"id":98435845,"identity":"e3b43452-e536-456d-95ea-bd5d376513e2","added_by":"auto","created_at":"2025-12-17 16:54:30","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":14497,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/59be55a20e28e16e31f251b3.png"},{"id":98315780,"identity":"fa2a5227-4324-478c-af9a-9868a2132e7a","added_by":"auto","created_at":"2025-12-16 13:12:05","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8563,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/acdf5e5605d0ac33ffd352bf.png"},{"id":98315783,"identity":"583bed96-c3fa-465f-8bca-976aaa787906","added_by":"auto","created_at":"2025-12-16 13:12:05","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":15308,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/781a0b8afac69176dbebb7ea.png"},{"id":98436790,"identity":"abed5c29-c542-4ff0-8d07-70cea4f4581b","added_by":"auto","created_at":"2025-12-17 16:56:15","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":17791,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/7a4a48025315e381267033ab.png"},{"id":98315788,"identity":"f515ac97-c6eb-4eb6-9abe-bb86f7662615","added_by":"auto","created_at":"2025-12-16 13:12:05","extension":"png","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10460,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/dfcfef6229a80e1ed7a69ad4.png"},{"id":98437330,"identity":"9239f4ec-cf8b-45f2-a04d-504190ada102","added_by":"auto","created_at":"2025-12-17 16:57:13","extension":"png","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69838,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/e9637e8f4462970fda39d226.png"},{"id":98315790,"identity":"f1857422-3051-4e20-b871-c1c4b83c60cc","added_by":"auto","created_at":"2025-12-16 13:12:05","extension":"xml","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":150312,"visible":true,"origin":"","legend":"","description":"","filename":"b1486e6be4684355bf8eea03f7d5ffdf1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/8c2cfd6fbef6adacb1367e39.xml"},{"id":98315789,"identity":"876d49e1-469c-4293-8b49-254e0d66cc7d","added_by":"auto","created_at":"2025-12-16 13:12:05","extension":"html","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":160123,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1/42467f93c62ae9d37efdd9b0.html"},{"id":101690570,"identity":"9ec46b9a-7025-4cd0-a17a-d1ead5a206f1","added_by":"auto","created_at":"2026-02-02 16:05:50","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1011393,"visible":true,"origin":"","legend":"","description":"","filename":"tNGS20251123.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8162495/v1_covered_32e70523-53de-4a55-a920-44abf8d41fd7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Etiological Characteristics and Risk Factors for Severe Disease in Bocavirus-Associated Community-Acquired Pneumonia in Children: A Multicenter Retrospective Study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Bocavirus, tNGS, community-acquired pneumonia, children, severe pneumonia","lastPublishedDoi":"10.21203/rs.3.rs-8162495/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8162495/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a multicenter retrospective study aimed to evaluate the concordance between nucleic acid testing and targeted next-generation sequencing (tNGS) for etiologic detection, and to identify potential risk factors for severe community-acquired pneumonia (SCAP), thereby providing evidence for precision clinical management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe retrospectively analyzed 191 pediatric Community-Acquired Pneumonia(CAP) cases positive for bocavirus by tNGS from April 2023 to June 2025. Etiologic concordance and coinfection patterns were evaluated. Univariate and multivariate logistic regression identified independent risk factors for SCAP.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are 191 children were included. Significant heterogeneity was observed among the four centers in age distribution, SCAP incidence, imaging findings, and treatment patterns (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). Children’s Hospital, Zhejiang University School of Medicine (ZCH) reported the highest SCAP incidence (50.0%), with markedly higher rates of pulmonary consolidation (66.7%), atelectasis (100.0%), and pleural effusion (16.7%) compared with other centers, whereas DY had the lowest SCAP incidence (11.0%). The bocavirus positivity rate by tNGS was 100.0%, significantly higher than that of nucleic acid testing (51.3%). tNGS identified 44 cases of mixed infection (23.0%), including 35 bacterial (18.3%) and 7 viral coinfections (3.7%), whereas nucleic acid testing identified only 9 mixed infections (4.7%). tNGS demonstrated a clear advantage in detecting mixed and bacterial infections (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Multivariate logistic regression revealed that age \u0026lt; 3 years, oxygen supplementation, dyspnea, wheezing, plastic bronchitis, pulmonary consolidation, atelectasis, and pleural effusion were independent risk factors for SCAP (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical profiles of bocavirus-associated CAP vary significantly across centers. tNGS offers superior sensitivity and breadth in pathogen detection. Early recognition of high-risk children—particularly those \u0026lt; 3 years, requiring oxygen, exhibiting respiratory distress, or showing radiologic abnormalities—is essential for timely SCAP management.\u003c/p\u003e","manuscriptTitle":"Etiological Characteristics and Risk Factors for Severe Disease in Bocavirus-Associated Community-Acquired Pneumonia in Children: A Multicenter Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-16 13:11:53","doi":"10.21203/rs.3.rs-8162495/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-15T06:43:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-15T06:23:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-13T21:24:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274561728634584889280103902548704658372","date":"2025-12-13T18:30:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267372739259107016702361091277643918895","date":"2025-12-13T18:20:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215500708360800645580089675732744800578","date":"2025-12-13T08:19:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-12T16:04:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181787913219661009101010894911193095014","date":"2025-12-12T07:03:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79454997390328426004274908410026275195","date":"2025-12-12T03:16:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206471724276191260748252828313568387507","date":"2025-12-11T20:10:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166225048240551161548396125031818116511","date":"2025-12-11T14:22:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318581581847397578329622818154493906459","date":"2025-12-11T13:34:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-11T12:07:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288549794894129863622554715944915016007","date":"2025-12-11T11:04:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285474294135196812970476162345856385667","date":"2025-12-11T10:06:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75070158061298464218128915755085712808","date":"2025-12-11T08:34:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48127364048519342456691508408507842596","date":"2025-12-11T08:29:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37966672554504748894930973994389644794","date":"2025-12-11T08:21:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-11T08:08:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-26T05:14:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-24T09:22:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-24T09:20:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-11-20T08:51:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e15af421-dcd6-4864-a8c6-a0a01a892af3","owner":[],"postedDate":"December 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T16:02:09+00:00","versionOfRecord":{"articleIdentity":"rs-8162495","link":"https://doi.org/10.1186/s12879-026-12543-z","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2026-01-27 15:58:13","publishedOnDateReadable":"January 27th, 2026"},"versionCreatedAt":"2025-12-16 13:11:53","video":"","vorDoi":"10.1186/s12879-026-12543-z","vorDoiUrl":"https://doi.org/10.1186/s12879-026-12543-z","workflowStages":[]},"version":"v1","identity":"rs-8162495","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8162495","identity":"rs-8162495","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}