A single center study of the pathogenic characteristics of children with pertussis with other pathogens co-infection in a children's hospital in Chongqing, China.

A single center study of the pathogenic characteristics of children with pertussis with other pathogens co-infection in a children's hospital in Chongqing, China. | 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 A single center study of the pathogenic characteristics of children with pertussis with other pathogens co-infection in a children's hospital in Chongqing, China. Yu Nie, Chuan Gan, Xiaoru Long, Ruling Yang, Hongmei Xu, Gaihuan Zheng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7262976/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective: Studying the pathogenic characteristics of children with pertussis with other pathogens co-infection. Methods: Retrospective analyzed the clinical data of the children with pertussis who were hospitalized at a Children's Hospital from 2016 to 2021. Results: Among the detected bacteria, there were 245 strains of Haemophilus influenzae (12.92%), 145 strains of Streptococcus pneumoniae (7.64%). Among the detected viruses , Respiratory syncytial virus(RSV) was the most common 441 strains (23.25%), followed by Parainfluenza virus 440 strains (23.19%). The average age of the co-infection group was smaller than that of the simple pertussis infection group(P<0.05). The percentages of children with pertussis co-infected with RSV, Staphylococcus aureus group, Escherichia coli , and Klebsiella pneumoniae in the 0-3 month age were 36.48%, 54.54%, 65.52%, and 78.95%, respectively. The proportions of children co-infected with Parainfluenza virus , and with Haemophilus influenzae at 3-6 months old were 29.55% and 36.49%, respectively. The percentage of children with pertussis with Mycoplasma pneumoniae co-infection aged 1 year or older were all 60%. RSV had a higher probability of co-infection in winter and spring (34.46%+36.21%), Parainfluenza virus had a higher probability of co-infection in spring and summer (83.48% (43.58%+39.91%). The median length of Hospitalization time in different co-infection groups was longer than that in the simple infection group. Conclusions： The top three pathogens in children with pertussis with other pathogen co-infections were RSV , Parainfluenza virus , and Haemophilus influenzae . RSV, Staphylococcus aureus. Escherichia coli and Klebsiella pneumoniae had the highest proportion at 0-3 months of age; Parainfluenza virus and Haemophilus influenzae had the highest proportion at 3-6 months of age, Mycoplasma was more common in children over 1 year old. RSV and Parainfluenza were more common in spring. Co-infection of other pathogens may lead to prolonged hospital stay. The more types co infection pathogens infected, the longer the hospital stay. Pertussis Children Co-infection Pathogen Age Season Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Pertussis is an acute respiratory infectious disease caused by Bordetella pertussis . With the increasing incidence of pertussis in recent years, this highly contagious acute respiratory infection has once again become the focus of global public health attention [ 1 ] . Pertussis poses a particularly serious threat to the health of children, especially infants and young children. Due to incomplete development of immune function,children, especially infants and young children, are more susceptible to infection with Bordetella pertussis , and easy to cause co-infections with other pathogens.This co-infection worsens the condition and prolongs the course of the disease, sometimes even endangers life. With the increasing incidence of pertussis in children, prevention and control of co-infections of other pathogens in children infected with pertussis are particularly urgent and important. In recent years, although there have been literature reports on co-infection of pertussis, there is still relatively little research on co-infection of pertussis in China, and the pathogenic characteristics of co-infection in children in different regions may be not the same [ 2 ][ 3 ] . In this study, the children with pertussis admitted to the Children's Hospital of Chongqing Medical University in China from 2016 to 2021 were collected and analyzed for a retrospective study on the pathogenic characteristics of co-infections with other pathogens, which may provide assistance for the clinical treatment of children with pertussis. Materials and Methods 1.1 Research subjects, clinical data collection and grouping: Retrieved clinical data of hospitalized children with pertussis at the the Children's Hospital of Chongqing Medical University China and analyzed the results of sputum pathogen, blood pathogen, and fecal pathogen in the children. All relevant clinical tests for each children with pertussis in the study were conducted with the informed consent of the patient's guardian during hospitalization. The study had been approved by the Medical Ethics Committee The ethical approval number was (2022)Year Ethics (Research) (No:556). According to the type of pathogen, the cases was divided into simple pertussis infection group and pertussis group with other pathogens co-infection.(In addition to being infected with pertussis bacteria, other pathogenic infections were also present). The pertussis group with other pathogens co-infection was further divided into pertussis group with one type of pathogen co-infection, pertussis group with two types of pathogen co-infection, pertussis group with multiple types of pathogen co-infection (Co-infection with more than or equal to three types of pathogens.) 1.2 Inclusion and Exclusion Criteria: Inclusion criteria: ① Age: 0–12 years old; ② Those who met the diagnostic criteria for pertussis [ 4 ][ 5 ] ② had clinical manifestations of pertussis, and at least once nasopharyngeal swab or sputum PCR positive for pertussis during hospitalization. ③ Those who met the secondary pathogen infection of pertussis (other respiratory pathogen tests, fecal rotavirus antigen or sputum culture, blood culture positive). Exclusion criteria: ① Age greater than 12 years old; ② Incomplete clinical data(Cases of confirmed pertussis patients with positive pertussis PCR but without other pathogen testing, and cases who had not completed the standardized treatment course and signed for discharge); ③ Individuals with underlying respiratory diseases such as asthma, bronchopulmonary dysplasia, tracheobronchial softening, congenital pulmonary vascular malformations, etc. ④ Those with severe underlying diseases such as heart failure, severe malnutrition, and malignant tumors prior to onset. 1.3 Pathogenic testing methods and judgment criteria All children with pertussis underwent sputum, blood, or fecal pathogen tests after hospitalization. Including sputum smear, sputum or lavage fluid culture, respiratory tract seven virus antigen testing ( Respiratory syncytial virus , Adenovirus , Influenza virus type A , Influenza virus type B , Parainfluenza virus type 1 , Parainfluenza virus type 2 , and Parainfluenza virus type 3 ), and respiratory pathogen DNA PCR detection ( Mycoplasma pneumoniae , Adenovirus , Bordetella pertussis , Streptococcus pneumoniae , etc.) A positive result in sputum smear, sputum or lavage culture, bacterial DNA PCR, or blood culture indicated a corresponding bacterial infection, If any test result of sputum smear, sputum or lavage culture, bacterial DNA PCR, or blood culture was positive, which indicated the corresponding bacterial infection. If any test result of sputum or lavage fluid virus antigen or DNA PCR was positive, which indicated the corresponding virus infection. A positive result of Mycoplasma pneumoniae DNA PCR test indicated Mycoplasma pneumoniae infection, and a positive result of Rrotavirus antigen test indicated Rotavirus infection. 1.4 Specimens Collection The specimens include sputum collected by specialized nurses using sterile suction tubes for negative pressure suction, lavage fluid obtained through fiberoptic bronchoscopy, venous blood collected by specialized nurses, and fresh fecal specimens within 2 hours. 1.5 Pathogenic testing: The specimens were sent to the Clinical Laboratory Center of the Children's Hospital of Chongqing Medical University China for routine pathogen testing, including respiratory virus antigen, Mycoplasma/Chlamydia PCR, sputum culture, blood culture, fecal Rotavirus antigen, etc. The pathogenic testing methods and procedures were carried out in accordance with the hospital laboratory testing operation norms and standard procedures. 1.6 Statistical Analysis R language statistical software was used for data analysis, where count data was represented by number of cases (percentage), metric data was represented by mean ± standard deviation if it followed a normal distribution, and non normal distribution data was represented by median/interquartile interval [M (P25, P75)]. Mamn Whitney U test was used for inter group comparison. Using chi square test, t-test, or rank sum test according to different data types and research requirements. P < 0.05 indicated a statistically significant difference. Results 2.1 Analysis results of pathogen types in pertussis group with other pathogens co-infection. Between 2016 and 2021, there were a total of 7050 hospitalized children with pertussis at the Children's Hospital of Chongqing Medical University China, of which 1261 cases were with other pathogens co-infection. Randomly sampled 1964 children who were only infected with pertussis bacteria as controls. A total of 1897 strains of pathogens were detected in 1261 pertussis children with other pathogens co-infection. Among them, there were 73 strains (3.85%) of special pathogens ( Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia trachomatis ), 686 strains (36.16%) of bacteria, and 1138 strains (59.99%) of viruses. Among the detected bacteria, 245 strains (12.92%) of Haemophilus influenzae were the most common, followed by 145 strains (7.64%) of Streptococcus pneumoniae . The remaining detected bacteria were: 82 strains of Escherichia coli (4.32%), 103 strains of Staphylococcus aureus (5.43%), 28 strains of Acinetobacter baumannii (1.48%), 66 strains of Klebsiella pneumoniae (3.48%), and 17 strains of Pseudomonas aeruginosa (0.90%). Among the detected viruses, RSV was the most common 441 strains (23.25%), followed by Parainfluenza virus 440 strains (23.19%), the remaining Adenovirus 82 strains (4.32%), Influenza virus 58 strains (3.06%), and Rotavirus 117 strains (6.17%). The results showed that the main pathogens of pertussis children with other pathogens co-infection were virus, especially RSV and Parainfluenza virus . Figure 1 . 2.2 Analysis of pathogen types of different co-infection groups 2.2.1 The proportion of the number of co infected pathogen types Among the 1261 cases in the group with other pathogens co-infection, there were 741(58.76%) cases with one type of pathogens co-infection, 415 cases (32.91%) with two types of pathogens co-infection, 96 cases (7.61%) with three types of pathogens co-infection, 7 cases (0.56%) with four types of pathogens co-infection, and 2 cases (0.16%) with five types of pathogens co-infection. The proportion of co-infection with one type of pathogens was the highest. Figure 2. 2.2.2 The Number of different pathogenic cases in with one type of pathogen co-infection group In with one type of pathogen co-infection group, the detected virus types included 232 cases of RSV , 218 cases of Parainfluenza Virus , 47 cases of Rotavirus , 24 cases of Influenza Virus , and 20 cases of Adenovirus . The detected bacteria included 74 cases of Haemophilus influenzae , 15 cases of Streptococcus pneumoniae , 33 cases of Staphylococcus aureus , 29 cases of Escherichia coli , 19 cases of Klebsiella pneumoniae , and 3 cases of Pseudomonas aeruginosa . There were fewer special pathogens, 20 cases of Mycoplasma pneumoniae , and 3 cases of Chlamydia pneumoniae . Figuer3. 2.2.3 The Number of different pathogenic cases in the two types of pathogens co-infection group In the two types of pathogens co-infection group, co-infected forms included virus + bacteria, virus + virus, bacteria + bacteria, bacteria + special pathogens. There were 60 cases of virus + virus, 30 cases of bacteria + bacteria, 274 cases of virus + bacteria, 16 cases of virus + special pathogen, and 13 cases of bacteria + special pathogen. Among viruses + viruses, there were 16 cases of Parainfluenza virus & RSV , 10 cases of RSV& Rotavirus , and 8 cases of Parainfluenza virus & Adenovirus . Among bacteria and viruses, there were 42 cases of Parainfluenza & Influenza hemophilus , 36 cases of Influenza hemophilus & RSV , 34 cases of Streptococcus pneumoniae & Parainfluenza , 28 cases of Streptococcus pneumoniae & RSV , 18 cases of Escherichia coli & Rotavirus , and 17 cases of Staphylococcus aureus & Parainfluenza virus . Among the co-infected with two other pathogens, the most detected virus was the RSV with 157 cases, followed by 167 cases of Parainfluenza virus , 46 cases of Rotavirus , 21 cases of Influenza virus , and 39 cases of Adenovirus . Among the detected bacteria, there were 122 cases of Haemophilus influenzae , 103 cases of Streptococcus pneumoniae , 47 cases of Staphylococcus aureus , 40 cases of Escherichia coli , 33 cases of Klebsiella pneumoniae , and 10 cases of Pseudomonas aeruginosa . There were fewer cases of co-infected with special pathogens, including 20 cases of Mycoplasma pneumoniae , 9 cases of Chlamydia trachomatis , and 2 cases of Chlamydia pneumoniae . Table 1 . Table 1 Specific combination forms of co-infected with 2 types of pathogens groups M.P C. P C.T RSV RV ADV IFV PIV HI SA E.coli AB KP SP PA M.P 0 0 4 1 2 0 2 1 2 1 0 0 6 1 C.P 0 0 0 0 0 0 2 0 0 0 0 0 0 0 C.T 0 0 1 1 0 1 2 1 2 0 0 1 0 0 RSV 4 0 1 10 6 3 16 36 13 18 4 15 28 3 RV 1 0 1 10 1 3 6 6 5 5 0 3 5 0 ADV 2 0 0 6 1 4 8 7 1 0 2 1 6 1 IFV 0 0 1 3 3 4 3 3 0 0 1 0 3 0 PIV 2 2 2 16 6 8 3 42 17 15 5 11 34 4 HI 1 0 1 36 6 7 3 42 4 0 1 1 20 0 SA 2 0 2 13 5 1 0 17 4 0 1 1 1 0 E.coli 1 0 0 18 5 0 0 15 0 0 0 0 0 1 AB 0 0 0 4 0 2 1 5 1 1 0 0 0 0 KP 0 0 1 15 3 1 0 11 1 1 0 0 0 0 SP 6 0 0 28 5 6 3 34 20 1 0 0 0 0 PA 1 0 0 3 0 1 0 4 0 0 1 0 0 0 N.O 20 2 9 157 46 39 21 167 122 47 40 14 33 103 10 Note: M.P was Mycoplasma pneumoniae , C.P was Chlamydia pneumoniae , C.T wa s Chlamydia trachomatis , RSV was Respiratory syncytial virus , RV was Rotavirus , ADV was Adenovirus , IFV was I nfluenza virus , PIV was Parainfluenza virus , HI was Haemophilus influenzae , SA was Staphylococcus aureus , E.coli was Escherichia coli , AB was Acinetobacter baumannii , KP was Klebsiella pneumoniae , SP was Streptococcus pneumoniae PA was Pseudomonas aeruginosa , 2.2.4 The Number of different pathogenic cases in the three types of pathogens co-infection group There were 96 cases in the three types of pathogens co-infection group. The co-infected forms included bacteria & virus, virus & virus, bacteria & virus, special pathogens & bacteria. Among them, there were 79 cases of bacteria & virus, 4 cases of virus & virus, 2 cases of bacteria & bacteria, and 13 cases of special pathogens & bacteria.The detected pathogens included 47 cases of Parainfluenza virus , 46 cases of RSV , 45 cases of Haemophilus influenzae , 33 cases of Streptococcus pneumoniae , 20 cases of Staphylococcus aureus and Adenovirus each, 19 cases of rotavirus , 13 cases of Klebsiella pneumoniae infection, 11 cases of Escherichia coli and Influenza virus each, 10 cases of Mycoplasma pneumoniae , 4 cases of Chlamydia trachomatis and 4 cases of Acinetobacter baumannii each, 3 cases of Pseudomonas aeruginosa , and 2 cases of Chlamydia pneumoniae . Figure 4 . 2.3 Age comparison between simple pertussis infection group and groups with other different pathogens co-infection. Divided the group with other pathogens co-infection into the co-infected with virus group, the co-infected with other bacterial group, and the co-infected with bacterial&virus group. The age of each different co-infection groups was compared with the single pertussis infection group. To reduce the error caused by statistical analysis based on years, the age of the patient was compared and analyzed in days, such as 1 year old being represented as 365 days. The average age of the single pertussis infection group, the co-infected with virus group, the co-infected with bacterial group, and the co-infected with bacterial&virus group was 377.2 days (± 695), 272.4 days (± 486) ,118 days (± 401) and 225.4 days (± 274.3), respectively. Comparing the ages of different groups, the results showed that there was no statistically significant difference in age between co-infected with different pathogens groups. The result indicated that there was no correlation between the type and age of co-infection pathogens. The age of each co-infection group was compared with that of the simple pertussis group, and the results showed statistical differences (P < 0.05). The average age of the co-infection group was smaller than that of the single pertussis infection group, indicating that the younger the age, the more likely co-infection was to occur. Figure 5 . 2.4 Gender Characteristics comparison between simple pertussis infection group and groups with other different pathogens co-infection. The gender comparison between the single infection group and the mixed infection group showed no significant statistical difference (P > 0.05). The mixed infection of pertussis was not related to gender.Table 2 . Table 2 Gender distribution of single infection group and mixed infection group Gender Male Female simple pertussis infection group(n = 1964,%) 1101(56.06%) 863(43.94%) co-infection group (n = 1261,%) 749(59.40%) 512(40.60%) x 2 5.368 P 0.1468 2.5 Analysis of age characteristics of the different types of other pathogens co-infection groups 2.5.1 the age distribution of different specific pathogen groups To avoid the influence of different type of pathogens, the research group only selected the children with pertussis who were co-infected with one type of other pathogen. The age distribution of the children with pertussis with different specific pathogen co-infection was statistically analyzed. The results showed that children with pertussis with RSV co-infection, children with pertussis with Staphylococcus aureus co-infection, children with pertussis with Escherichia coli co-infection, and children with pertussis with Klebsiella pneumoniae co-infection all had the highest age ratio at 0–3 months, with 36.48%, 54.54%, 65.52%, and 78.95%, respectively. The age proportion of children with pertussis with Parainfluenza virus co-infection and the age proportion of children with pertussis with Hemophilus influenzae co-infection were the highest at 3–6 months old, were 29.55% and 36.49%, respectively. In the children with pertussis with Adenovirus coinfection, the proportion of children aged 1–3 years old was highest,with 42.86%. In the children with pertussis with Rotavirus co-infection, the proportions of children aged 0–3 months, 3–6 months, and 6 months to 1 year old all were 28%, which mean that children under 1 year old account for 84%. Among children with pertussis who were co-infected with Influenza virus , the proportions of children aged 0–3 months and 3–6 months all were 29.17%, so the total proportion of children under 6 months was 58.34%. In children with pertussis with Mycoplasma pneumoniae co-infection, the proportions of children aged 1–3 and over 3 years old all were 30%. Among children with pertussis co-infected with Klebsiella pneumoniae , Escherichia coli , Streptococcus pneumoniae , RSV , and Parainfluenza virus separately, the proportion of infants and young children under 6 months old was 94.74%, 89.66%, 90.9%, 68.24%, and 53.64%, respectively. The results indicated that when children with pertussis co-infected with other pathogens, Klebsiella pneumoniae , Escherichia coli , Streptococcus pneumoniae , RSV , and Parainfluenza virus mostly occurred in children under 6 months old, while Mycoplasma pneumoniae co-infection mostly occurred in children over 1 year old. Table 3 . Table 3 Age distribution of different pathogen types RSV (n = 233,%) PIV (n = 220,%) RV (n = 47,%) IFV (n = 24,%) ADV (n = 21,%) H.I (n = 74,%) S.P (n = 5,%) S.A (n = 33,%) E.Coli (n = 29,%) K.P (n = 19,%) M.P (n = 20,%) 0-3m 85(36.48%) 53(24.09%) 10(21.28%) 4(16.67%) 0(0%) 15(20.27%) 0(0%) 18(54.54%) 19(65.52%) 15(78.95%) 3(15%) 3-6m 74(31.76%) 65(29.55%) 10(21.28%) 7(29.17%) 4(19.05%) 27(36.49%) 1(20%) 12(36.36%) 7(24.14%) 3(15.79%) 2(10%) 0-6m 159(68.24%) 118(53.64%) 20(42.56%) 11(45.84%) 4(19.05%) 43(56.76%) 1(20%) 30(90.9%) 26(89.66%) 18(94.74%) 5(25%) 6m-1y 45(19.31%) 45(20.45%) 10(21.28%) 7(29.17%) 7(33.33%) 21(28.38%) 1(20%) 3(9.09%) 3(10.34%) 0(0%) 3(15%) 1-3y 24(10.30%) 24(10.90%) 8(17.02%) 5(20.83%) 9(42.86%) 7(9.46%) 2(40%) 0(0%) 0(36.5%) 1(5.26%) 6(30%) > 3y 5(2.15%) 6(2.73%) 1(2.13%) 1(4.17%) 1(4.77%) 4(5.40%) 1(20%) 0(0%) 0(0%) 0(0%) 6(30%) Note : RSV was Respiratory syncytial viru s , PIV was Parainfluenza virus , RV was Rotavirus , IFV was Influenza virus , ADV wa s Adenovirus , H.I was Haemophilus influenzae , SP was Streptococcus pneumoniae , SA was Staphylococcus aureus , E.coli was Escherichia coli, KP was Klebsiella pneumoniae , M.P was Mycoplasma pneumoniae . 2.5.2 Age comparison between different pathogen groups The age of the children with pertussis co-infected with RSV , Parainfluenza virus , Influenza virus co-infection, Rotaviru, Staphylococcus aureus , E.coli , Streptococcus pneumoniae , Mycoplasma pneumoniae separately was pairwise compared. The result showed that the age of the pertussis children with Mycoplasma pneumoniae co-infection was elder than those co-infected with other pathogens, and the difference was statistically significant, which indicated that Mycoplasma pneumoniae infection in children with pertussis was more common in elder age groups. Figure 6 . 2.6 Seasonal comparison results between different pathogen groups in the co-infection group The children with pertussis co-infected with RSV , Parainfluenza virus , Haemophilus influenzae , Rotavirus, Staphylococcus aureus , E.coli , Streptococcus pneumoniae , Mycoplasma pneumoniae separately, was compared with the simple pertussis infection group. The results showed significant seasonal differences (P < 0.05) between the RSV co-infection children with pertussis with the simple pertussis infection group, and the Parainfluenza virus co-infection children with pertussis with the simple infection pertussis group, The results showed that RSV had a higher probability of co-infection in winter and spring (34.46%+36.21%), while Parainfluenza virus had a higher probability of co-infection in spring and summer (83.48% (43.58%+39.91%). There was no significant seasonal difference (P > 0.05) in between the the children with pertussis co-infected with Haemophilus influenzae , Rotavirus ,and Staphylococcus aureus and the simple pertussis infection group, indicating that children with pertussis co-infected with the these pathogens might not be seasonal. Table 4 . Table 4 Seasonal distribution of different pathogen groups Spring Summer Autumn Winter p χ2 Single infection group (n = 1964,%) 680(34.46%) 752(38.39%) 308515.52%) 227(11.64%) RSV group (n = 232,%) 69(29.74%) 41(17.67%) 39(16.81%) 84(36.21%) 0.001 114.05 PIV group (n = 218,%) 95(43.58%) 87(39.91%) 26(11.92%) 12(5.50%) 0.005 12.99 IFV group (n = 122,%) 30(24.59%) 23(18.85%) 9(7.38%) 12(9.84%) 0.315 3.55 RV group (n = 46,%) 16(34.78%) 20(43.48%) 4(8.70%) 7(15.22%) 0.553 2.09 S.A group (n = 47,%) 11(23.40%) 13(27.66%) 8(17.02%) 1(2.13%) 0.297 3.69 Note : RSV was Respiratory syncytial virus , PIV was Parainfluenza virus , IFV was Influenza virus , RV was Rotavirus ,, SA was Staphylococcus aureus . 2.7 Analysis of the characteristics of hospitalization days in different co-infection children with pertussis groups. Divided the co-infection group into co-infection with one type of other pathogen group, co-infection with two types of other pathogen group, and co-infection with three types of other pathogen group based on the type of co-infection pathogens. Used a simple infection pertussis group as the control group, and compare between different co-infection groups. The different co-infection groups compared with the control group, and make pairwise comparisons between each group. The median length of hospital stay for children with a simple pertussis infection group was 6.0 days. The median length of hospital s tay for children in one type of other pathogen group, for children in two types of other pathogen group, and co-infected with three types of other pathogen group was 7.0 days, 8.0 days and 9days respectively. There was a statistically significant difference in the length of hospital stay of children in different groups(P < 0.05). The results showed that the median length of hospital stay in different co-infection groups was longer than that in the single infection group and the more types of pathogens co-infection, the longer the hospital stay. Which indicated that co-infection of other pathogens with pertussis could lead to prolonged hospital stay; The more type co infection pathogens were infected, the longer the hospital stay. Table 5 & Fig. 7 . Table 5 Number of hospitalization days in the simple infection group and the group with co infection of different number types of pathogens Simple pertussis infection co-infected with one type of other pathogen co-infected with two type of other pathogen co-infected with three type of other pathogen H P Number(cases) 1984 737 415 105 hospitalization(day) 6.0(5.0, 9.0) 7.0(5.0, 10.0) 8.0(6.0, 11.0) 9.0(7.0, 14.5) 32.648 0.000 Discussion The incidence rate of pertussis has been rising in many countries in the world in recent years [ 6 ][ 7 ] . The number of hospitalized children with pertussis admitted to the the Children's Hospital of Chongqing Medical University where the research group is located, has significantly increased. Due to the prolonged course of pertussis in children, they are often prone to co-infection with other pathogens, posing a serious threat to the health of children, especially infants and young children [ 8 ][ 9 ][ 10 ] . This study took children with pertussis with other pathogens co-infection as the research objects, and children with simple pertussis infection as the control, to statistically analyze the types of pathogens and related clinical data. This study included 1261 cases children with pertussis with other pathogens co-infection, and there were 1964 children who were only infected with pertussis bacteria as controls. In this study, total of 1897 strains of pathogens excluded pertussis bacilli were detected in 1261 children with pertussis with other pathogens co-infection. Among the detected viruses, RSV was the most common, with the top three viruses being RSV , Parainfluenza virus , and Rotavirus . This was consistent with the research findings of Zouari et al [ 11 ] . The results of this study showed that common co-infected bacteria of in children with pertussis included Haemophilus influenzae , Streptococcus pneumoniae , Escherichia coli , Staphylococcus aureus , Acinetobacter baumannii , and Klebsiella pneumoniae . Researchers Helen Marshall et al. reported that co-infection bacteria in children with pertussis also included the aforementioned strains [ 12 ] . The results of this study showed that the top three bacteria were Haemophilus influenzae , Streptococcus pneumoniae , and Staphylococcus aureus , respectively. The research results of Muloiwa R et al. indicated that the top four bacteria in co-infection of pertussis were Moraxella catarrhalis , Haemophilus influenzae , Streptococcus pneumoniae , and Staphylococcus aureus [ 13 ] . This could be related to different common infections in different countries and regions. Children with pertussis could be infected with one type of or multiple type of other pathogens simultaneously. This study showed that the proportion of children with pertussis who were infected with one type of other pathogen was higher than the proportion of those who were infected with multiple type of pathogens, but there was still a high proportion of 41.55% of children with pertussis with multiple type of other pathogenic infections. The mechanism why children with pertussis simultaneously infected with multiple other pathogens is still unclear. There are limited researches on the mechanisms of interactions between pertussis bacteria and other different pathogens. Some scholars believed that there was no direct evidence to suggest that pertussis infection was prone to secondary respiratory infections, and conversely, there was no evidence to suggest that respiratory infections make patients more susceptible to secondary pertussis infection [ 14 ][ 15 ][ 16 ][ 17 ] . Some researchers believed that there was a certain correlation between various pathogens in co-infections.In the review by Brealey, J. C et al. on viral bacterial co-infections, which was mentioned that some scholars believe that the occurrence of viral - bacterial co-infections was unidirectional. That is to say, the child first develops a viral infection, which activated the pathway of bacterial infection, which helped to promote the growth of opportunistic pathogens, leading to bacterial infection [ 18 ] . Some scholars also believed that virus bacterial co-infection occurs in both directions, and bacterial infection could also activate the host's susceptibility to the virus [ 19 ] . However, whether mixed infections occur simultaneously or continuously, and whether potential colonized respiratory pathogens will affect or promote infection with other pathogens, there is currently no definitive conclusion [ 20 ][ 21 ] . We analyzed the age distribution characteristics of co-infection pertussis groups infected with different types of pathogens. This study divided children with pertussis into five age ranges: 0–3 months, 3–6 months, 6 − 1 years old, 1–3 years old, and over 3 years old. The research results showed that the children with pertussis co-infected with Escherichia coli , Klebsiella pneumoniae , Staphylococcus aureus , RSV , and Parainfluenza virus respectively was mainly present in infants and young children aged 0–6 months. The majority of children with pertussis co-infected with Mycoplasma pneumoniae were children over 1 year old, which was consistent with Yuzhu Miao et.al’s research findings [ 22 ] . The results indicated that the distribution of different pathogens varies at different age stages. This may be due to the underdeveloped immune function of children under 6 months old, who have lower innate and specific immune functions against Escherichia coli , Klebsiella pneumoniae , Staphylococcus aureus , RSV pathogens. As children over 1 year old age, their immune function gradually improves, but their range of activity increases, and the probability of exposure to Mycoplasma pneumoniae increases. At the same time, the specific immune duration of the human body against Mycoplasma pneumoniae is not long lasting; the bacteria and its associated disease can relapse in patients even after adherence to an effective antibiotic regimen [ 23 ] . This study indicated that simple pertussis infection children were mainly in spring and summer, while the children with pertussis co-infected with other pathogens were more common in autumn and winter. This could be related to the susceptibility of pathogen outbreaks during the autumn and winter seasons. The results of this study showed that RSV infection in children with pertussis mostly occurred in winter and spring, while the incidence of concurrent Parainfluenza virus infection was higher in spring and summer. In most cases, RSV were more prevalent in autumn and winter seasons, while Parainfluenza viruses were more prevalent in spring and summer seasons. The results of this study were consistent with this. While our study results showed that children with pertussis co-infected with Haemophilus influenzae , Rotavirus , and Staphylococcus aureus were not related to seasons. This could be related to the obvious seasonal characteristics of most bacterial infections, as well as the prevalence of Rotavirus throughout the year in different regions. Due to the varying epidemiological characteristics of pathogens in different countries and regions, the results of this study only partially reflected the pathogenic characteristics of Chongqing, China. This study statistically analyzes the pathogenic characteristics of children with pertussis co-infected with other pathogens, providing evidence-based medicine for the clinical treatment of children with pertussis. Since this study did not include outpatient cases, the true incidence rate of children with pertussis co-infected with other pathogens could be higher. The monitoring and research on the increase in the incidence rate of children with pertussis, as well as the co-infection with other pathogens still need to be continued. Declarations Author contributions Gaihuan Zheng and Yu Nie conceived the article. All authors reviewed the first draft and contributed to the final draft. Declaration of Competing Interests All authors declare no competing interests. Funding Source: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Ethical Approval statement: The study was conducted following the ethical principles of the Declaration of Helsinki, and had been approved by the Medical Ethics Committee of Chongqing Medical University Affiliated Children's Hospital, in accordance with the ethical review requirements of the "Ethical Review Measures for Life Sciences and Medical Research Involving Human Beings" issued by the Health Commission of the People's Republic of China in 2023. The ethical approval number is (2022)Year Ethics (Research) (No:556) References Fung KS, Yeung WL, Wong TW, So KW. Cheng AF.Pertussis are emerging infection?J. Infect. 2004;48(2):145–8. Frassanito A, Nenna R, Nicolai A, Pierangeli A, Tozzi AE, Stefanelli P et al. Infants hospitalized for Bordetella pertussis infection commonly have respiratory viral coinfections. BMC Infect. Dis. Pandolfi Elisabetta,Panera Nadia,Alisi Anna. Cytokine expression patterns in hospitalized children with Bordetella pertussis, Rhinovirus or co-infection[. J] Sci Rep. 2021;11:10948. The Infectious Diseases Group of the Pediatric Branch of the Chinese Medical Association. Editorial Committee of Chinese Journal of Pediatrics.Diagnosis and treatment recommendations for pertussis in Chinese children. Chin J Pediatr. 2017;55(08):568–72. S. Filfilan.Utilization and modification of european-cdc guidelines for bordetella pertussis diagnosis using molecular approach.Journal of Infection and Public Health. 2020,13,(2) : 358–359. Ed Holt. Pertussis outbreak in Czech Republic. Lancet Infect Dis. 2024;24(6):e359. Bennai RM, Zouaki A, El Amin G, Rahani A et al. Pertussis outbreak in children hospitalized in Rabat (Morocco).Diagn Microbiol Infect Dis. 2024,109(2):116225. Jiang W, Wu M, Chen S, et al. Virus Co-infection is a Predictor of Radiologically Confirmed Pneumonia in Children with Bordetella pertussis Infection[J]. Infect Dis Therapy. 2021;10(1):335–46. Liming Xue Y, Wang C, Hao, et al. Clinical study on co infection of pertussis in children[J]. Chin J Practical Pediatr. 2018;33(9):712–6. Nelson WL, Hopkins RS, Roe MH, et al. Simultaneous infection with Bordetella pertussis and respiratory syncytial virus in hospitalized children[J]. Pediatr Infect disease. 1986;5(5):540–4. Zouari A, Touati A, Smaoui H, et al. Dual infection with Bordetella pertussis and Mycoplasma pneumoniae in three infants: case reports[J]. Infection. 2012;40(2):213–7. Marshall H, Clarke M, Rasiah K, et al. Predictors of Disease Severity in Children Hospitalized for Pertussis During an Epidemic[J]. Pediatr Infect Disease J. 2015;34(4):339–45. Muloiwa R, Dube FS, Nicol MP, et al. Co-detection of Bordetella pertussis and other respiratory organisms in children hospitalised with lower respiratory tract infection[J]. Sci Rep. 2020;10(1):16412. Ayala VI, Teijaro JR, Farber DL, et al. Bordetella pertussis Infection Exacerbates Influenza Virus Infection through Pertussis Toxin-Mediated Suppression of Innate Immunity[J]. E.N. Miyaji. PLoS ONE. 2011;6(4):e19016. Zhang Y, Ran Z, Tian M, et al. Commensal Microbes Affect Host Humoral Immunity to Bordetella pertussis Infection[J]. M Raffatellu Infect Immun. 2019;87(10):e00421–19. King PT, Buttery J. Emerging role of viral and bacterial co-infection in early childhood: Editorial[J]. Respirology. 2018;23(2):128–9. Debiaggi M, Canducci F, Ceresola ER, et al. The role of infections and coinfections with newly identified and emerging respiratory viruses in children[J]. Virol J. 2012;9(1):247. Brealey JC, Sly PD, Young PR et al. Viral bacterial co-infection of the respiratory tract during early childhood[J]. FEMS Microbiol Lett, 2015, 362(10). Dagan R, Hall CB, Menegus MA. Atypical bacterial infections explained by a concomitant virus infection[J]. Pediatrics. 1985;76(3):411–4. Pandolfi E, Panera N, Alisi A, et al. Cytokine expression patterns in hospitalized children with Bordetella pertussis, Rhinovirus or co-infection[J]. Sci Rep. 2021;11(1):10948. Jackson LA, Cherry JD, Wang S-P, et al. Frequency of Serological Evidence of Bordetella Infections and Mixed Infections with other Respiratory Pathogens in University Students with Cough Illnesses[J]. Clin Infect Dis. 2000;31(1):3–6. Yuzhu Miao J, Li L, Huang. Mycoplasma pneumoniae detections in children with acute respiratory infection, 2010–2023: a large sample study in China. Ital J Pediatr. 2025;23(1):11. Gretchen L, Parrott T, Kinjo. Jiro Fujita 1A Compendium for Mycoplasma pneumoniae. Front Microbiol2016, 12:7513. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 14 Sep, 2025 Reviewers agreed at journal 30 Aug, 2025 Reviewers invited by journal 29 Aug, 2025 Editor invited by journal 05 Aug, 2025 Editor assigned by journal 04 Aug, 2025 Submission checks completed at journal 04 Aug, 2025 First submitted to journal 31 Jul, 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. 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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-7262976","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":510425679,"identity":"70e53865-ce8f-4b38-b61b-a37f514491ed","order_by":0,"name":"Yu Nie","email":"","orcid":"","institution":"The Infection Department of Children’s Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Nie","suffix":""},{"id":510425681,"identity":"90ac809a-f33b-4047-97d2-228d64c26b7d","order_by":1,"name":"Chuan Gan","email":"","orcid":"","institution":"The Infection Department of 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Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hongmei","middleName":"","lastName":"Xu","suffix":""},{"id":510425691,"identity":"ae741110-0304-418d-a4a8-3787f0ef9fba","order_by":5,"name":"Gaihuan Zheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYFACxjYQycPP3nzgwIcfJGiRkew5lnhwZg9x1rCBCBuDGTnGhznYiFAv73647TFPzR0eA54zHw4z8DDI84sdwK/F8ExiuzHPsWc85uy9Gw4XWDAYzpydQEBLQ2KbNA/bYR7LnrMbDs/gYUgwuE1IS/9DoJZ/h3kMbuQ8OMzDRoQWeQmgLbxtYC0MxGkxkHjYJjm37zAPMJANgIEsQdgv8v3pzyTefDtsD4zKxx8+/LCR55cmZMsBVL4EfuVgWxoIqxkFo2AUjIKRDgAlskh196wnagAAAABJRU5ErkJggg==","orcid":"","institution":"The Infection Department of Children’s Hospital of Chongqing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Gaihuan","middleName":"","lastName":"Zheng","suffix":""}],"badges":[],"createdAt":"2025-07-31 13:53:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7262976/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7262976/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90894110,"identity":"37053f27-9871-4e59-b00d-d380a15929bb","added_by":"auto","created_at":"2025-09-09 11:29:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":21177,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe \u0026nbsp;\u0026nbsp;number of different pathogens detected in the co-infected with other \u0026nbsp;\u0026nbsp;pathogens group.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote：\u003cem\u003eRSV\u003c/em\u003e was\u003cem\u003e Respiratory syncytial virus\u003c/em\u003e,\u003cem\u003e PIV \u003c/em\u003ewas\u003cem\u003e Parainfluenza virus\u003c/em\u003e, ADV was \u003cem\u003eAdenovirus\u003c/em\u003e, \u003cem\u003e\u0026nbsp;IFV\u003c/em\u003e was\u003cem\u003e influenza virus\u003c/em\u003e, \u003cem\u003eRV\u003c/em\u003ewas \u003cem\u003eRotavirus\u003c/em\u003e, \u003cem\u003eHiB\u003c/em\u003e was \u003cem\u003eHaemophilus influenzae\u003c/em\u003e, \u003cem\u003eS.P\u003c/em\u003e was \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, \u003cem\u003eE.coli\u003c/em\u003ewas \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eSA\u003c/em\u003e was\u003cem\u003e Staphylococcus aureus\u003c/em\u003e, \u003cem\u003eAB\u003c/em\u003e was \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e,\u003cem\u003eKP\u003c/em\u003e was\u003cem\u003e klebsiella pneumoniae\u003c/em\u003e, \u003cem\u003e\u0026nbsp;PA\u003c/em\u003e was\u003cem\u003e Pseudomonas aeruginosa,\u003c/em\u003e \u003cem\u003eM.P\u003c/em\u003ewas \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e, \u003cem\u003eC.P \u003c/em\u003ewas\u003cem\u003e Chlamydia pneumoniae\u003c/em\u003e.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7262976/v1/13a972c872e135d33eed83ec.png"},{"id":90894112,"identity":"fce3351a-37b0-4bad-8087-0e421e73c1b6","added_by":"auto","created_at":"2025-09-09 11:29:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":15652,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe proportion of the number of co infected pathogen types.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7262976/v1/703571a35cbfe3e0f4426bcb.png"},{"id":90897875,"identity":"7b0fe43e-1c07-40cc-a675-bc34c200554d","added_by":"auto","created_at":"2025-09-09 11:53:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":16094,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe Number of different pathogenic cases in co-infected with one type of pathogens group.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote：\u003cem\u003eRSV\u003c/em\u003e was \u003cem\u003eRespiratory syncytial virus\u003c/em\u003e, \u003cem\u003ePIV \u003c/em\u003ewas\u003cem\u003e Parainfluenza virus\u003c/em\u003e, \u003cem\u003eRV\u003c/em\u003e was \u003cem\u003eRotavirus, IFV\u003c/em\u003e was \u003cem\u003eInfluenza virus\u003c/em\u003e,\u003cem\u003e ADV\u003c/em\u003e was \u003cem\u003eAdenovirus\u003c/em\u003e, \u003cem\u003eHiB\u003c/em\u003ewas\u003cem\u003e Haemophilus influenzae\u003c/em\u003e, \u003cem\u003eS.P\u003c/em\u003e was \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, \u003cem\u003eSA\u003c/em\u003e was\u003cem\u003e Staphylococcus aureus\u003c/em\u003e, \u003cem\u003eE.coli\u003c/em\u003e was \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eKP\u003c/em\u003e was \u003cem\u003eklebsiella pneumoniae\u003c/em\u003e,\u003cem\u003ePA \u003c/em\u003ewas \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e, \u003cem\u003eM.P \u003c/em\u003ewas M\u003cem\u003eycoplasma pneumoniae\u003c/em\u003e,\u003cem\u003e C.P\u003c/em\u003e was \u003cem\u003eChlamydia pneumoniae\u003c/em\u003e.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7262976/v1/e3e330fd8cce5b18c8edbeca.png"},{"id":90894111,"identity":"8e01e14c-1c53-48f4-9a5a-5b98c40f5e88","added_by":"auto","created_at":"2025-09-09 11:29:07","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":14905,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe Number of different pathogenic cases in co-infected with three types of pathogens group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote：\u003cem\u003ePIV\u003c/em\u003e was\u003cem\u003e Parainfluenza virus\u003c/em\u003e, \u003cem\u003eRSV\u003c/em\u003e was \u003cem\u003eRespiratory syncytial virus\u003c/em\u003e,\u003cem\u003e HiB\u003c/em\u003e was \u003cem\u003eHaemophilus influenzae\u003c/em\u003e,\u003cem\u003e S.P\u003c/em\u003e was\u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, \u003cem\u003eSA \u003c/em\u003ewas\u003cem\u003eStaphylococcus aureus\u003c/em\u003e, \u003cem\u003eADV\u003c/em\u003ewas \u003cem\u003eAdenoviru\u003c/em\u003es, \u003cem\u003eRV \u003c/em\u003ewas \u003cem\u003eRotavirus\u003c/em\u003e, \u003cem\u003eKP\u003c/em\u003e was \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, \u003cem\u003eE.coli\u003c/em\u003e was \u003cem\u003eEscherichia coli\u003c/em\u003e,\u003cem\u003e IFV\u003c/em\u003e was \u003cem\u003eInfluenza virus\u003c/em\u003e,\u003cem\u003e M.P\u003c/em\u003e was\u003cem\u003e Mycoplasma pneumoniae\u003c/em\u003e, AB was\u003cem\u003e Acinetobacter baumannii\u003c/em\u003e,\u003cem\u003e CT\u003c/em\u003e was\u003cem\u003e Chlamydia trachomatis\u003c/em\u003e,\u003cem\u003ePA\u003c/em\u003e wa\u003cem\u003es Pseudomonas aeruginosa\u003c/em\u003e, \u003cem\u003eC.P \u003c/em\u003ewas\u003cem\u003eChlamydia pneumoniae\u003c/em\u003e.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7262976/v1/960a8a763136bb28dcd88b92.png"},{"id":90896050,"identity":"be4aa86d-7184-49d7-ab07-6b5f233d4e9b","added_by":"auto","created_at":"2025-09-09 11:37:07","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":75044,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of the age of the simple infection group and the co- infection with different pathogens group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: **，P\u0026lt;0.01，****，P\u0026lt;0.0001，Compared with simple pertussis infection group\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7262976/v1/0c656cdd8f9ca75b9a564923.png"},{"id":90894116,"identity":"0784c773-b720-41ec-b507-326409d9d8a3","added_by":"auto","created_at":"2025-09-09 11:29:07","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":48438,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of age differences in different pathogen groups. Note: *，P\u0026lt;0.05，**，P\u0026lt;0.01，***，P\u0026lt;0.001****，P\u0026lt;0.0001，Compared with the pertussis children co-infected with \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eMP\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e。 \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eRSV \u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003ewas \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eRespiratory syncytial virus\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e,\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e PIV\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003ewas \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eParainfluenza virus\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e, \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eHib \u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003ewas\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e Haemophilus influenzae\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e,\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eRV\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e was \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eRotavirus\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e, \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eSA\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003ewas \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eStaphylococcus aureus\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e, \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eE.coli \u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003ewas\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e Escherichia coli\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e, \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e,IFV\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003ewas \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eInfluenza virus\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e, \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eADV\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003ewas\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e Adenovirus\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e, \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eKP\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e was\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e klebsiella pneumoniae\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e, \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eKP\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e was\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e Klebsiella pneumoniae,\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cem\u003eAB\u003c/em\u003e wa\u003cem\u003es Acinetobacter baumannii\u003c/em\u003e, \u003cem\u003e\u003cstrong\u003eSP \u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003ewas \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eStreptococcus pneumoniae\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e, \u003c/strong\u003e\u003cem\u003ePA\u003c/em\u003e was \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7262976/v1/cebfe6f022d8479e0e76c5c1.png"},{"id":90896052,"identity":"aa9cf3b1-5d59-44e1-854a-b778113e6d48","added_by":"auto","created_at":"2025-09-09 11:37:07","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":105325,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDifference of hospitalization days between the simple infection group and the group with different pathogens co-infection.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e**，P\u0026lt;0.01，****，P\u0026lt;0.0001，Compared between the two groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-7262976/v1/c9a9f38d1cd87c1f0919f6f8.png"},{"id":90899574,"identity":"7fed7ac6-d837-4e40-aaee-afc111f5096e","added_by":"auto","created_at":"2025-09-09 12:01:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2996895,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7262976/v1/35f7d40d-3a9f-454d-a7a8-3039f8cb6285.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eA single center study of the pathogenic characteristics of children with pertussis with other pathogens co-infection in a children's hospital in Chongqing, China.\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePertussis is an acute respiratory infectious disease caused by \u003cem\u003eBordetella pertussis\u003c/em\u003e. With the increasing incidence of pertussis in recent years, this highly contagious acute respiratory infection has once again become the focus of global public health attention\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Pertussis poses a particularly serious threat to the health of children, especially infants and young children. Due to incomplete development of immune function,children, especially infants and young children, are more susceptible to infection with \u003cem\u003eBordetella pertussis\u003c/em\u003e, and easy to cause co-infections with other pathogens.This co-infection worsens the condition and prolongs the course of the disease, sometimes even endangers life. With the increasing incidence of pertussis in children, prevention and control of co-infections of other pathogens in children infected with pertussis are particularly urgent and important. In recent years, although there have been literature reports on co-infection of pertussis, there is still relatively little research on co-infection of pertussis in China, and the pathogenic characteristics of co-infection in children in different regions may be not the same\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e][\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. In this study, the children with pertussis admitted to the Children's Hospital of Chongqing Medical University in China from 2016 to 2021 were collected and analyzed for a retrospective study on the pathogenic characteristics of co-infections with other pathogens, which may provide assistance for the clinical treatment of children with pertussis.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e1.1 Research subjects, clinical data collection and grouping:\u003c/h2\u003e\u003cp\u003eRetrieved clinical data of hospitalized children with pertussis at the the Children's Hospital of Chongqing Medical University China and analyzed the results of sputum pathogen, blood pathogen, and fecal pathogen in the children. All relevant clinical tests for each children with pertussis in the study were conducted with the informed consent of the patient's guardian during hospitalization. The study had been approved by the Medical Ethics Committee The ethical approval number was (2022)Year Ethics (Research) (No:556).\u003c/p\u003e\u003cp\u003eAccording to the type of pathogen, the cases was divided into simple pertussis infection group and pertussis group with other pathogens co-infection.(In addition to being infected with pertussis bacteria, other pathogenic infections were also present). The pertussis group with other pathogens co-infection was further divided into pertussis group with one type of pathogen co-infection, pertussis group with two types of pathogen co-infection, pertussis group with multiple types of pathogen co-infection (Co-infection with more than or equal to three types of pathogens.)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Inclusion and Exclusion Criteria:\u003c/h2\u003e\u003cp\u003eInclusion criteria: ① Age: 0\u0026ndash;12 years old; ② Those who met the diagnostic criteria for pertussis\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e][\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e ② had clinical manifestations of pertussis, and at least once nasopharyngeal swab or sputum PCR positive for pertussis during hospitalization. ③ Those who met the secondary pathogen infection of pertussis (other respiratory pathogen tests, fecal rotavirus antigen or sputum culture, blood culture positive).\u003c/p\u003e\u003cp\u003eExclusion criteria: ① Age greater than 12 years old; ② Incomplete clinical data(Cases of confirmed pertussis patients with positive pertussis PCR but without other pathogen testing, and cases who had not completed the standardized treatment course and signed for discharge); ③ Individuals with underlying respiratory diseases such as asthma, bronchopulmonary dysplasia, tracheobronchial softening, congenital pulmonary vascular malformations, etc. ④ Those with severe underlying diseases such as heart failure, severe malnutrition, and malignant tumors prior to onset.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e1.3 Pathogenic testing methods and judgment criteria\u003c/h2\u003e\u003cp\u003eAll children with pertussis underwent sputum, blood, or fecal pathogen tests after hospitalization. Including sputum smear, sputum or lavage fluid culture, respiratory tract seven virus antigen testing (\u003cem\u003eRespiratory syncytial virus\u003c/em\u003e, \u003cem\u003eAdenovirus\u003c/em\u003e, \u003cem\u003eInfluenza virus type A\u003c/em\u003e, \u003cem\u003eInfluenza virus type B\u003c/em\u003e, \u003cem\u003eParainfluenza virus type 1\u003c/em\u003e, \u003cem\u003eParainfluenza virus type 2\u003c/em\u003e, and \u003cem\u003eParainfluenza virus type 3\u003c/em\u003e), and respiratory pathogen DNA PCR detection (\u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e, \u003cem\u003eAdenovirus\u003c/em\u003e, \u003cem\u003eBordetella pertussis\u003c/em\u003e, \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, etc.) A positive result in sputum smear, sputum or lavage culture, bacterial DNA PCR, or blood culture indicated a corresponding bacterial infection,\u003c/p\u003e\u003cp\u003eIf any test result of sputum smear, sputum or lavage culture, bacterial DNA PCR, or blood culture was positive, which indicated the corresponding bacterial infection. If any test result of sputum or lavage fluid virus antigen or DNA PCR was positive, which indicated the corresponding virus infection. A positive result of \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e DNA PCR test indicated \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e infection, and a positive result of \u003cem\u003eRrotavirus\u003c/em\u003e antigen test indicated \u003cem\u003eRotavirus\u003c/em\u003e infection.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e1.4 Specimens Collection\u003c/h2\u003e\u003cp\u003eThe specimens include sputum collected by specialized nurses using sterile suction tubes for negative pressure suction, lavage fluid obtained through fiberoptic bronchoscopy, venous blood collected by specialized nurses, and fresh fecal specimens within 2 hours.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e1.5 Pathogenic testing:\u003c/h2\u003e\u003cp\u003eThe specimens were sent to the Clinical Laboratory Center of the Children's Hospital of Chongqing Medical University China for routine pathogen testing, including respiratory virus antigen, \u003cem\u003eMycoplasma/Chlamydia\u003c/em\u003e PCR, sputum culture, blood culture, fecal \u003cem\u003eRotavirus\u003c/em\u003e antigen, etc. The pathogenic testing methods and procedures were carried out in accordance with the hospital laboratory testing operation norms and standard procedures.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e1.6 Statistical Analysis\u003c/h2\u003e\u003cp\u003eR language statistical software was used for data analysis, where count data was represented by number of cases (percentage), metric data was represented by mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation if it followed a normal distribution, and non normal distribution data was represented by median/interquartile interval [M (P25, P75)]. Mamn Whitney U test was used for inter group comparison. Using chi square test, t-test, or rank sum test according to different data types and research requirements. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated a statistically significant difference.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Analysis results of pathogen types in pertussis group with other pathogens co-infection.\u003c/h2\u003e\u003cp\u003eBetween 2016 and 2021, there were a total of 7050 hospitalized children with pertussis at the Children's Hospital of Chongqing Medical University China, of which 1261 cases were with other pathogens co-infection. Randomly sampled 1964 children who were only infected with pertussis bacteria as controls. A total of 1897 strains of pathogens were detected in 1261 pertussis children with other pathogens co-infection. Among them, there were 73 strains (3.85%) of special pathogens (\u003cem\u003eMycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia trachomatis\u003c/em\u003e), 686 strains (36.16%) of bacteria, and 1138 strains (59.99%) of viruses. Among the detected bacteria, 245 strains (12.92%) of \u003cem\u003eHaemophilus influenzae\u003c/em\u003e were the most common, followed by 145 strains (7.64%) of \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e. The remaining detected bacteria were: 82 strains of \u003cem\u003eEscherichia coli\u003c/em\u003e (4.32%), 103 strains of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (5.43%), 28 strains of \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (1.48%), 66 strains of \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e (3.48%), and 17 strains of \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (0.90%). Among the detected viruses, \u003cem\u003eRSV\u003c/em\u003e was the most common 441 strains (23.25%), followed by \u003cem\u003eParainfluenza virus\u003c/em\u003e 440 strains (23.19%), the remaining \u003cem\u003eAdenovirus\u003c/em\u003e 82 strains (4.32%), \u003cem\u003eInfluenza virus\u003c/em\u003e 58 strains (3.06%), and \u003cem\u003eRotavirus\u003c/em\u003e 117 strains (6.17%). The results showed that the main pathogens of pertussis children with other pathogens co-infection were virus, especially \u003cem\u003eRSV\u003c/em\u003e and \u003cem\u003eParainfluenza virus\u003c/em\u003e. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Analysis of pathogen types of different co-infection groups\u003c/h2\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003e2.2.1 The proportion of the number of co infected pathogen types\u003c/h2\u003e\u003cp\u003eAmong the 1261 cases in the group with other pathogens co-infection, there were 741(58.76%) cases with one type of pathogens co-infection, 415 cases (32.91%) with two types of pathogens co-infection, 96 cases (7.61%) with three types of pathogens co-infection, 7 cases (0.56%) with four types of pathogens co-infection, and 2 cases (0.16%) with five types of pathogens co-infection. The proportion of co-infection with one type of pathogens was the highest. Figure\u0026nbsp;2.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003e2.2.2 The Number of different pathogenic cases in with one type of pathogen co-infection group\u003c/h2\u003e\u003cp\u003eIn with one type of pathogen co-infection group, the detected virus types included 232 cases of \u003cem\u003eRSV\u003c/em\u003e, 218 cases of \u003cem\u003eParainfluenza Virus\u003c/em\u003e, 47 cases of \u003cem\u003eRotavirus\u003c/em\u003e, 24 cases of \u003cem\u003eInfluenza Virus\u003c/em\u003e, and 20 cases of \u003cem\u003eAdenovirus\u003c/em\u003e. The detected bacteria included 74 cases of \u003cem\u003eHaemophilus influenzae\u003c/em\u003e, 15 cases of \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, 33 cases of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, 29 cases of \u003cem\u003eEscherichia coli\u003c/em\u003e, 19 cases of \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, and 3 cases of \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e. There were fewer special pathogens, 20 cases of \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e, and 3 cases of \u003cem\u003eChlamydia pneumoniae\u003c/em\u003e. Figuer3.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003e2.2.3 The Number of different pathogenic cases in the two types of pathogens co-infection group\u003c/h2\u003e\u003cp\u003eIn the two types of pathogens co-infection group, co-infected forms included virus\u0026thinsp;+\u0026thinsp;bacteria, virus\u0026thinsp;+\u0026thinsp;virus, bacteria\u0026thinsp;+\u0026thinsp;bacteria, bacteria\u0026thinsp;+\u0026thinsp;special pathogens. There were 60 cases of virus\u0026thinsp;+\u0026thinsp;virus, 30 cases of bacteria\u0026thinsp;+\u0026thinsp;bacteria, 274 cases of virus\u0026thinsp;+\u0026thinsp;bacteria, 16 cases of virus\u0026thinsp;+\u0026thinsp;special pathogen, and 13 cases of bacteria\u0026thinsp;+\u0026thinsp;special pathogen. Among viruses\u0026thinsp;+\u0026thinsp;viruses, there were 16 cases of \u003cem\u003eParainfluenza\u003c/em\u003e virus \u0026amp; \u003cem\u003eRSV\u003c/em\u003e, 10 cases of \u003cem\u003eRSV\u0026amp; Rotavirus\u003c/em\u003e, and 8 cases of \u003cem\u003eParainfluenza virus\u003c/em\u003e \u0026amp; \u003cem\u003eAdenovirus\u003c/em\u003e. Among bacteria and viruses, there were 42 cases of \u003cem\u003eParainfluenza\u003c/em\u003e \u0026amp; \u003cem\u003eInfluenza hemophilus\u003c/em\u003e, 36 cases of \u003cem\u003eInfluenza hemophilus\u003c/em\u003e \u0026amp; \u003cem\u003eRSV\u003c/em\u003e, 34 cases of \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e \u0026amp; \u003cem\u003eParainfluenza\u003c/em\u003e, 28 cases of \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e \u0026amp; \u003cem\u003eRSV\u003c/em\u003e, 18 cases of \u003cem\u003eEscherichia coli\u003c/em\u003e \u0026amp; \u003cem\u003eRotavirus\u003c/em\u003e, and 17 cases of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e \u0026amp; \u003cem\u003eParainfluenza virus\u003c/em\u003e. Among the co-infected with two other pathogens, the most detected virus was the \u003cem\u003eRSV\u003c/em\u003e with 157 cases, followed by 167 cases of \u003cem\u003eParainfluenza virus\u003c/em\u003e, 46 cases of \u003cem\u003eRotavirus\u003c/em\u003e, 21 cases of \u003cem\u003eInfluenza virus\u003c/em\u003e, and 39 cases of \u003cem\u003eAdenovirus\u003c/em\u003e. Among the detected bacteria, there were 122 cases of \u003cem\u003eHaemophilus influenzae\u003c/em\u003e, 103 cases of \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, 47 cases of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, 40 cases of \u003cem\u003eEscherichia coli\u003c/em\u003e, 33 cases of \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, and 10 cases of \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e. There were fewer cases of co-infected with special pathogens, including 20 cases of \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e, 9 cases of \u003cem\u003eChlamydia trachomatis\u003c/em\u003e, and 2 cases of \u003cem\u003eChlamydia pneumoniae\u003c/em\u003e. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSpecific combination forms of co-infected with 2 types of pathogens groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"16\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM.P\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eC. P\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eC.T\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRSV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eADV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eIFV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ePIV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eSA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eE.coli\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eAB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003eKP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003eSP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c16\"\u003e\u003cp\u003ePA\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM.P\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC.P\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c16\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eC.T\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRSV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e36\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e18\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e15\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e28\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eADV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIFV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePIV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e42\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e17\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e15\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e34\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e36\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e42\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e20\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSA\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e17\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eE.coli\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e18\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e15\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e15\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e28\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e34\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e20\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePA\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eN.O\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e20\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e157\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e46\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e39\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e21\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e167\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e122\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e47\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e40\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e\u003cp\u003e\u003cb\u003e103\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e\u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"16\"\u003eNote: \u003cem\u003eM.P\u003c/em\u003e was \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e, \u003cem\u003eC.P\u003c/em\u003e was \u003cem\u003eChlamydia pneumoniae\u003c/em\u003e, \u003cem\u003eC.T\u003c/em\u003e wa\u003cem\u003es Chlamydia trachomatis\u003c/em\u003e, \u003cem\u003eRSV\u003c/em\u003e was \u003cem\u003eRespiratory syncytial virus\u003c/em\u003e, \u003cem\u003eRV\u003c/em\u003e was \u003cem\u003eRotavirus\u003c/em\u003e, \u003cem\u003eADV\u003c/em\u003e was \u003cem\u003eAdenovirus\u003c/em\u003e, \u003cem\u003eIFV\u003c/em\u003e was I\u003cem\u003enfluenza virus\u003c/em\u003e, \u003cem\u003ePIV\u003c/em\u003e was \u003cem\u003eParainfluenza virus\u003c/em\u003e, \u003cem\u003eHI\u003c/em\u003e was \u003cem\u003eHaemophilus influenzae\u003c/em\u003e, \u003cem\u003eSA\u003c/em\u003e was \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, \u003cem\u003eE.coli\u003c/em\u003e was \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eAB\u003c/em\u003e was \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e, \u003cem\u003eKP\u003c/em\u003e was \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, \u003cem\u003eSP\u003c/em\u003e was \u003cem\u003eStreptococcus pneumoniae PA\u003c/em\u003e was \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e,\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e2.2.4 The Number of different pathogenic cases in the three types of pathogens co-infection group\u003c/h2\u003e\u003cp\u003eThere were 96 cases in the three types of pathogens co-infection group. The co-infected forms included bacteria \u0026amp; virus, virus \u0026amp; virus, bacteria \u0026amp; virus, special pathogens \u0026amp; bacteria. Among them, there were 79 cases of bacteria \u0026amp; virus, 4 cases of virus \u0026amp; virus, 2 cases of bacteria \u0026amp; bacteria, and 13 cases of special pathogens \u0026amp; bacteria.The detected pathogens included 47 cases of \u003cem\u003eParainfluenza virus\u003c/em\u003e, 46 cases of \u003cem\u003eRSV\u003c/em\u003e, 45 cases of \u003cem\u003eHaemophilus influenzae\u003c/em\u003e, 33 cases of \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, 20 cases of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e and \u003cem\u003eAdenovirus\u003c/em\u003e each, 19 cases of \u003cem\u003erotavirus\u003c/em\u003e, 13 cases of \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e infection, 11 cases of \u003cem\u003eEscherichia coli\u003c/em\u003e and \u003cem\u003eInfluenza virus\u003c/em\u003e each, 10 cases of \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e, 4 cases of \u003cem\u003eChlamydia trachomatis\u003c/em\u003e and 4 cases of \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e each, 3 cases of \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e, and 2 cases of \u003cem\u003eChlamydia pneumoniae\u003c/em\u003e. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Age comparison between simple pertussis infection group and groups with other different pathogens co-infection.\u003c/h2\u003e\u003cp\u003eDivided the group with other pathogens co-infection into the co-infected with virus group, the co-infected with other bacterial group, and the co-infected with bacterial\u0026amp;virus group. The age of each different co-infection groups was compared with the single pertussis infection group. To reduce the error caused by statistical analysis based on years, the age of the patient was compared and analyzed in days, such as 1 year old being represented as 365 days. The average age of the single pertussis infection group, the co-infected with virus group, the co-infected with bacterial group, and the co-infected with bacterial\u0026amp;virus group was 377.2 days (\u0026plusmn;\u0026thinsp;695), 272.4 days (\u0026plusmn;\u0026thinsp;486) ,118 days (\u0026plusmn;\u0026thinsp;401) and 225.4 days (\u0026plusmn;\u0026thinsp;274.3), respectively. Comparing the ages of different groups, the results showed that there was no statistically significant difference in age between co-infected with different pathogens groups. The result indicated that there was no correlation between the type and age of co-infection pathogens. The age of each co-infection group was compared with that of the simple pertussis group, and the results showed statistical differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The average age of the co-infection group was smaller than that of the single pertussis infection group, indicating that the younger the age, the more likely co-infection was to occur. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Gender Characteristics comparison between simple pertussis infection group and groups with other different pathogens co-infection.\u003c/h2\u003e\u003cp\u003eThe gender comparison between the single infection group and the mixed infection group showed no significant statistical difference (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The mixed infection of pertussis was not related to gender.Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGender distribution of single infection group and mixed infection group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003esimple pertussis infection group(n\u0026thinsp;=\u0026thinsp;1964,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1101(56.06%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e863(43.94%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eco-infection group (n\u0026thinsp;=\u0026thinsp;1261,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e749(59.40%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e512(40.60%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ex\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.1468\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Analysis of age characteristics of the different types of other pathogens co-infection groups\u003c/h2\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003e2.5.1 the age distribution of different specific pathogen groups\u003c/h2\u003e\u003cp\u003eTo avoid the influence of different type of pathogens, the research group only selected the children with pertussis who were co-infected with one type of other pathogen. The age distribution of the children with pertussis with different specific pathogen co-infection was statistically analyzed. The results showed that children with pertussis with \u003cem\u003eRSV\u003c/em\u003e co-infection, children with pertussis with \u003cem\u003eStaphylococcus aureus\u003c/em\u003e co-infection, children with pertussis with \u003cem\u003eEscherichia coli\u003c/em\u003e co-infection, and children with pertussis \u003cem\u003ewith Klebsiella pneumoniae\u003c/em\u003e co-infection all had the highest age ratio at 0\u0026ndash;3 months, with 36.48%, 54.54%, 65.52%, and 78.95%, respectively.\u003c/p\u003e\u003cp\u003eThe age proportion of children with pertussis with \u003cem\u003eParainfluenza virus\u003c/em\u003e co-infection and the age proportion of children with pertussis with \u003cem\u003eHemophilus influenzae\u003c/em\u003e co-infection were the highest at 3\u0026ndash;6 months old, were 29.55% and 36.49%, respectively. In the children with pertussis with \u003cem\u003eAdenovirus\u003c/em\u003e coinfection, the proportion of children aged 1\u0026ndash;3 years old was highest,with 42.86%. In the children with pertussis with \u003cem\u003eRotavirus\u003c/em\u003e co-infection, the proportions of children aged 0\u0026ndash;3 months, 3\u0026ndash;6 months, and 6 months to 1 year old all were 28%, which mean that children under 1 year old account for 84%. Among children with pertussis who were co-infected with \u003cem\u003eInfluenza virus\u003c/em\u003e, the proportions of children aged 0\u0026ndash;3 months and 3\u0026ndash;6 months all were 29.17%, so the total proportion of children under 6 months was 58.34%. In children with pertussis with \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e co-infection, the proportions of children aged 1\u0026ndash;3 and over 3 years old all were 30%. Among children with pertussis co-infected with \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, \u003cem\u003eRSV\u003c/em\u003e, and \u003cem\u003eParainfluenza virus\u003c/em\u003e separately, the proportion of infants and young children under 6 months old was 94.74%, 89.66%, 90.9%, 68.24%, and 53.64%, respectively. The results indicated that when children with pertussis co-infected with other pathogens, \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, \u003cem\u003eRSV\u003c/em\u003e, and \u003cem\u003eParainfluenza virus\u003c/em\u003e mostly occurred in children under 6 months old, while \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e co-infection mostly occurred in children over 1 year old. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAge distribution of different pathogen types\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRSV\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;233,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePIV\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;220,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRV\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIFV\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eADV\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;21,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eH.I\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;74,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eS.P\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eS.A\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eE.Coli\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;29,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eK.P\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19,%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eM.P\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;20,%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0-3m\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85(36.48%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53(24.09%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(21.28%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(16.67%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15(20.27%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e18(54.54%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e19(65.52%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e15(78.95%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e3(15%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3-6m\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74(31.76%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65(29.55%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(21.28%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7(29.17%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4(19.05%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27(36.49%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1(20%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e12(36.36%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e7(24.14%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3(15.79%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2(10%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e0-6m\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e159(68.24%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e118(53.64%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e20(42.56%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e11(45.84%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e4(19.05%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e43(56.76%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1(20%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e30(90.9%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e26(89.66%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e18(94.74%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e5(25%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e6m-1y\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e45(19.31%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e45(20.45%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e10(21.28%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e7(29.17%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e7(33.33%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e21(28.38%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1(20%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e3(9.09%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e3(10.34%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e0(0%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e3(15%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1-3y\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e24(10.30%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e24(10.90%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e8(17.02%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e5(20.83%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e9(42.86%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e7(9.46%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e2(40%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0(0%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0(36.5%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e1(5.26%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e6(30%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;3y\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e5(2.15%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e6(2.73%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1(2.13%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1(4.17%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1(4.77%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e4(5.40%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1(20%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0(0%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0(0%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e0(0%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e6(30%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eNote\u003c/b\u003e: \u003cb\u003eRSV\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eRespiratory syncytial viru\u003c/b\u003e\u003cb\u003es\u003c/b\u003e, \u003cb\u003ePIV\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eParainfluenza virus\u003c/b\u003e, \u003cb\u003eRV\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eRotavirus\u003c/b\u003e, \u003cb\u003eIFV\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eInfluenza virus\u003c/b\u003e,\u003cb\u003eADV\u003c/b\u003e \u003cb\u003ewa\u003c/b\u003e\u003cb\u003es Adenovirus\u003c/b\u003e, \u003cb\u003eH.I\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eHaemophilus influenzae\u003c/b\u003e, \u003cb\u003eSP\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eStreptococcus pneumoniae\u003c/b\u003e, \u003cb\u003eSA\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eStaphylococcus aureus\u003c/b\u003e, \u003cb\u003eE.coli\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eEscherichia coli, KP\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eKlebsiella pneumoniae\u003c/b\u003e, \u003cb\u003eM.P\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eMycoplasma pneumoniae\u003c/b\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003e2.5.2 Age comparison between different pathogen groups\u003c/h2\u003e\u003cp\u003eThe age of the children with pertussis co-infected with \u003cem\u003eRSV\u003c/em\u003e, \u003cem\u003eParainfluenza virus\u003c/em\u003e, \u003cem\u003eInfluenza virus\u003c/em\u003e co-infection, \u003cem\u003eRotaviru, Staphylococcus aureus\u003c/em\u003e, \u003cem\u003eE.coli\u003c/em\u003e, \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e separately was pairwise compared. The result showed that the age of the pertussis children with \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e co-infection was elder than those co-infected with other pathogens, and the difference was statistically significant, which indicated that \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e infection in children with pertussis was more common in elder age groups. Figure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Seasonal comparison results between different pathogen groups in the co-infection group\u003c/h2\u003e\u003cp\u003eThe children with pertussis co-infected with \u003cem\u003eRSV\u003c/em\u003e, \u003cem\u003eParainfluenza virus\u003c/em\u003e, \u003cem\u003eHaemophilus influenzae\u003c/em\u003e, \u003cem\u003eRotavirus, Staphylococcus aureus\u003c/em\u003e, \u003cem\u003eE.coli\u003c/em\u003e, \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e separately, was compared with the simple pertussis infection group. The results showed significant seasonal differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between the \u003cem\u003eRSV\u003c/em\u003e co-infection children with pertussis with the simple pertussis infection group, and the \u003cem\u003eParainfluenza virus\u003c/em\u003e co-infection children with pertussis with the simple infection pertussis group, The results showed that \u003cem\u003eRSV\u003c/em\u003e had a higher probability of co-infection in winter and spring (34.46%+36.21%), while \u003cem\u003eParainfluenza virus\u003c/em\u003e had a higher probability of co-infection in spring and summer (83.48% (43.58%+39.91%). There was no significant seasonal difference (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) in between the the children with pertussis co-infected with \u003cem\u003eHaemophilus influenzae\u003c/em\u003e, \u003cem\u003eRotavirus\u003c/em\u003e,and \u003cem\u003eStaphylococcus aureus\u003c/em\u003e and the simple pertussis infection group, indicating that children with pertussis co-infected with the these pathogens might not be seasonal. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSeasonal distribution of different pathogen groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpring\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSummer\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAutumn\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWinter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eχ2\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle infection group (n\u0026thinsp;=\u0026thinsp;1964,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e680(34.46%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e752(38.39%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e308515.52%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e227(11.64%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRSV group (n\u0026thinsp;=\u0026thinsp;232,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69(29.74%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41(17.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39(16.81%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e84(36.21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e114.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePIV group (n\u0026thinsp;=\u0026thinsp;218,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e95(43.58%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87(39.91%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26(11.92%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e12(5.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e12.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIFV group (n\u0026thinsp;=\u0026thinsp;122,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30(24.59%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23(18.85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9(7.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e12(9.84%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.315\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRV group (n\u0026thinsp;=\u0026thinsp;46,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16(34.78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20(43.48%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4(8.70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7(15.22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.553\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eS.A group (n\u0026thinsp;=\u0026thinsp;47,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11(23.40%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13(27.66%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8(17.02%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1(2.13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eNote\u003c/b\u003e: \u003cb\u003eRSV\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eRespiratory syncytial virus\u003c/b\u003e, \u003cb\u003ePIV\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eParainfluenza virus\u003c/b\u003e, \u003cb\u003eIFV\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eInfluenza virus\u003c/b\u003e, \u003cb\u003eRV\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eRotavirus\u003c/b\u003e,, \u003cb\u003eSA\u003c/b\u003e \u003cb\u003ewas\u003c/b\u003e \u003cb\u003eStaphylococcus aureus\u003c/b\u003e.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e2.7 Analysis of the characteristics of hospitalization days in different co-infection children with pertussis groups.\u003c/h2\u003e\u003cp\u003eDivided the co-infection group into co-infection with one type of other pathogen group, co-infection with two types of other pathogen group, and co-infection with three types of other pathogen group based on the type of co-infection pathogens. Used a simple infection pertussis group as the control group, and compare between different co-infection groups. The different co-infection groups compared with the control group, and make pairwise comparisons between each group. The median length of hospital stay for children with a simple pertussis infection group was 6.0 days. The median length of hospital s\u003c/p\u003e\u003cp\u003etay for children in one type of other pathogen group, for children in two types of other pathogen group, and co-infected with three types of other pathogen group was 7.0 days, 8.0 days and 9days respectively. There was a statistically significant difference in the length of hospital stay of children in different groups(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The results showed that the median length of hospital stay in different co-infection groups was longer than that in the single infection group and the more types of pathogens co-infection, the longer the hospital stay. Which indicated that co-infection of other pathogens with pertussis could lead to prolonged hospital stay; The more type co infection pathogens were infected, the longer the hospital stay. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e \u0026amp; Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNumber of hospitalization days in the simple infection group and the group with co infection of different number types of pathogens\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSimple pertussis infection\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eco-infected with one type of other pathogen\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eco-infected with two type of other pathogen\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eco-infected with three type of other pathogen\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eH\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber(cases)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1984\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e737\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e415\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ehospitalization(day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.0(5.0, 9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.0(5.0, 10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.0(6.0, 11.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.0(7.0, 14.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e32.648\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe incidence rate of pertussis has been rising in many countries in the world in recent years\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e][\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. The number of hospitalized children with pertussis admitted to the the Children's Hospital of Chongqing Medical University where the research group is located, has significantly increased. Due to the prolonged course of pertussis in children, they are often prone to co-infection with other pathogens, posing a serious threat to the health of children, especially infants and young children\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e][\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e][\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis study took children with pertussis with other pathogens co-infection as the research objects, and children with simple pertussis infection as the control, to statistically analyze the types of pathogens and related clinical data. This study included 1261 cases children with pertussis with other pathogens co-infection, and there were 1964 children who were only infected with pertussis bacteria as controls. In this study, total of 1897 strains of pathogens excluded pertussis bacilli were detected in 1261 children with pertussis with other pathogens co-infection. Among the detected viruses, \u003cem\u003eRSV\u003c/em\u003e was the most common, with the top three viruses being \u003cem\u003eRSV\u003c/em\u003e, \u003cem\u003eParainfluenza virus\u003c/em\u003e, and \u003cem\u003eRotavirus\u003c/em\u003e. This was consistent with the research findings of Zouari et al\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. The results of this study showed that common co-infected bacteria of in children with pertussis included \u003cem\u003eHaemophilus influenzae\u003c/em\u003e, \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e, and \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e. Researchers Helen Marshall et al. reported that co-infection bacteria in children with pertussis also included the aforementioned strains\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. The results of this study showed that the top three bacteria were \u003cem\u003eHaemophilus influenzae\u003c/em\u003e, \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, and \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, respectively. The research results of Muloiwa R et al. indicated that the top four bacteria in co-infection of pertussis were \u003cem\u003eMoraxella catarrhalis\u003c/em\u003e, \u003cem\u003eHaemophilus influenzae\u003c/em\u003e, \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e, and \u003cem\u003eStaphylococcus aureus\u003c/em\u003e\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. This could be related to different common infections in different countries and regions.\u003c/p\u003e\u003cp\u003eChildren with pertussis could be infected with one type of or multiple type of other pathogens simultaneously. This study showed that the proportion of children with pertussis who were infected with one type of other pathogen was higher than the proportion of those who were infected with multiple type of pathogens, but there was still a high proportion of 41.55% of children with pertussis with multiple type of other pathogenic infections. The mechanism why children with pertussis simultaneously infected with multiple other pathogens is still unclear. There are limited researches on the mechanisms of interactions between pertussis bacteria and other different pathogens. Some scholars believed that there was no direct evidence to suggest that pertussis infection was prone to secondary respiratory infections, and conversely, there was no evidence to suggest that respiratory infections make patients more susceptible to secondary pertussis infection\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e][\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e][\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e][\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Some researchers believed that there was a certain correlation between various pathogens in co-infections.In the review by Brealey, J. C et al. on viral bacterial co-infections, which was mentioned that some scholars believe that the occurrence of viral - bacterial co-infections was unidirectional. That is to say, the child first develops a viral infection, which activated the pathway of bacterial infection, which helped to promote the growth of opportunistic pathogens, leading to bacterial infection\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Some scholars also believed that virus bacterial co-infection occurs in both directions, and bacterial infection could also activate the host's susceptibility to the virus\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. However, whether mixed infections occur simultaneously or continuously, and whether potential colonized respiratory pathogens will affect or promote infection with other pathogens, there is currently no definitive conclusion\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e][\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eWe analyzed the age distribution characteristics of co-infection pertussis groups infected with different types of pathogens. This study divided children with pertussis into five age ranges: 0\u0026ndash;3 months, 3\u0026ndash;6 months, 6\u0026thinsp;\u0026minus;\u0026thinsp;1 years old, 1\u0026ndash;3 years old, and over 3 years old. The research results showed that the children with pertussis co-infected with \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, \u003cem\u003eRSV\u003c/em\u003e, and \u003cem\u003eParainfluenza virus\u003c/em\u003e respectively was mainly present in infants and young children aged 0\u0026ndash;6 months. The majority of children with pertussis co-infected with \u003cem\u003eMycoplasma pneumoniae\u003c/em\u003e were children over 1 year old, which was consistent with Yuzhu Miao et.al\u0026rsquo;s research findings\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. The results indicated that the distribution of different pathogens varies at different age stages. This may be due to the underdeveloped immune function of children under 6 months old, who have lower innate and specific immune functions against \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, \u003cem\u003eRSV\u003c/em\u003e pathogens. As children over 1 year old age, their immune function gradually improves, but their range of activity increases, and the probability of exposure to Mycoplasma pneumoniae increases. At the same time, the specific immune duration of the human body against Mycoplasma pneumoniae is not long lasting; the bacteria and its associated disease can relapse in patients even after adherence to an effective antibiotic regimen\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis study indicated that simple pertussis infection children were mainly in spring and summer, while the children with pertussis co-infected with other pathogens were more common in autumn and winter. This could be related to the susceptibility of pathogen outbreaks during the autumn and winter seasons. The results of this study showed that \u003cem\u003eRSV\u003c/em\u003e infection in children with pertussis mostly occurred in winter and spring, while the incidence of concurrent \u003cem\u003eParainfluenza virus\u003c/em\u003e infection was higher in spring and summer. In most cases, \u003cem\u003eRSV\u003c/em\u003e were more prevalent in autumn and winter seasons, while \u003cem\u003eParainfluenza viruses\u003c/em\u003e were more prevalent in spring and summer seasons. The results of this study were consistent with this. While our study results showed that children with pertussis co-infected with \u003cem\u003eHaemophilus influenzae\u003c/em\u003e, \u003cem\u003eRotavirus\u003c/em\u003e, and \u003cem\u003eStaphylococcus aureus\u003c/em\u003e were not related to seasons. This could be related to the obvious seasonal characteristics of most bacterial infections, as well as the prevalence of \u003cem\u003eRotavirus\u003c/em\u003e throughout the year in different regions. Due to the varying epidemiological characteristics of pathogens in different countries and regions, the results of this study only partially reflected the pathogenic characteristics of Chongqing, China.\u003c/p\u003e\u003cp\u003eThis study statistically analyzes the pathogenic characteristics of children with pertussis co-infected with other pathogens, providing evidence-based medicine for the clinical treatment of children with pertussis. Since this study did not include outpatient cases, the true incidence rate of children with pertussis co-infected with other pathogens could be higher. The monitoring and research on the increase in the incidence rate of children with pertussis, as well as the co-infection with other pathogens still need to be continued.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGaihuan Zheng and Yu Nie conceived the article. All authors reviewed the first draft and contributed to the final draft.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Source:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp skip=\"true\"\u003e\u003cstrong\u003eEthical Approval statement: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted following the ethical principles of the Declaration of Helsinki, and had been approved by the Medical Ethics Committee of Chongqing Medical University Affiliated Children\u0026apos;s Hospital, in accordance with the ethical review requirements of the \u0026quot;Ethical Review Measures for Life Sciences and Medical Research Involving Human Beings\u0026quot; issued by the Health Commission of the People\u0026apos;s Republic of China in 2023. The ethical approval number is \u003cstrong\u003e(2022)Year Ethics (Research) (No:556)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFung KS, Yeung WL, Wong TW, So KW. Cheng AF.Pertussis are emerging infection?J. Infect. 2004;48(2):145\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFrassanito A, Nenna R, Nicolai A, Pierangeli A, Tozzi AE, Stefanelli P et al. Infants hospitalized for Bordetella pertussis infection commonly have respiratory viral coinfections. BMC Infect. Dis.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePandolfi Elisabetta,Panera Nadia,Alisi Anna. Cytokine expression patterns in hospitalized children with Bordetella pertussis, Rhinovirus or co-infection[. J] Sci Rep. 2021;11:10948.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe Infectious Diseases Group of the Pediatric Branch of the Chinese Medical Association. Editorial Committee of Chinese Journal of Pediatrics.Diagnosis and treatment recommendations for pertussis in Chinese children. Chin J Pediatr. 2017;55(08):568\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eS. Filfilan.Utilization and modification of european-cdc guidelines for bordetella pertussis\u0026ensp;diagnosis using molecular approach.Journal of Infection and Public Health. 2020,13,(2) : 358\u0026ndash;359.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEd Holt. Pertussis outbreak in Czech Republic. Lancet Infect Dis. 2024;24(6):e359.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBennai RM, Zouaki A, El Amin G, Rahani A et al. Pertussis\u0026ensp;outbreak in children hospitalized in Rabat (Morocco).Diagn Microbiol Infect Dis. 2024,109(2):116225.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJiang W, Wu M, Chen S, et al. Virus Co-infection is a Predictor of Radiologically Confirmed Pneumonia in Children with Bordetella pertussis Infection[J]. Infect Dis Therapy. 2021;10(1):335\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiming Xue Y, Wang C, Hao, et al. Clinical study on co infection of pertussis in children[J]. Chin J Practical Pediatr. 2018;33(9):712\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNelson WL, Hopkins RS, Roe MH, et al. Simultaneous infection with Bordetella pertussis and respiratory syncytial virus in hospitalized children[J]. Pediatr Infect disease. 1986;5(5):540\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZouari A, Touati A, Smaoui H, et al. Dual infection with Bordetella pertussis and Mycoplasma pneumoniae in three infants: case reports[J]. Infection. 2012;40(2):213\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarshall H, Clarke M, Rasiah K, et al. Predictors of Disease Severity in Children Hospitalized for Pertussis During an Epidemic[J]. Pediatr Infect Disease J. 2015;34(4):339\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMuloiwa R, Dube FS, Nicol MP, et al. Co-detection of Bordetella pertussis and other respiratory organisms in children hospitalised with lower respiratory tract infection[J]. Sci Rep. 2020;10(1):16412.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAyala VI, Teijaro JR, Farber DL, et al. Bordetella pertussis Infection Exacerbates Influenza Virus Infection through Pertussis Toxin-Mediated Suppression of Innate Immunity[J]. E.N. Miyaji. PLoS ONE. 2011;6(4):e19016.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang Y, Ran Z, Tian M, et al. Commensal Microbes Affect Host Humoral Immunity to Bordetella pertussis Infection[J]. M Raffatellu Infect Immun. 2019;87(10):e00421\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKing PT, Buttery J. Emerging role of viral and bacterial co-infection in early childhood: Editorial[J]. Respirology. 2018;23(2):128\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDebiaggi M, Canducci F, Ceresola ER, et al. The role of infections and coinfections with newly identified and emerging respiratory viruses in children[J]. Virol J. 2012;9(1):247.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrealey JC, Sly PD, Young PR et al. Viral bacterial co-infection of the respiratory tract during early childhood[J]. FEMS Microbiol Lett, 2015, 362(10).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDagan R, Hall CB, Menegus MA. Atypical bacterial infections explained by a concomitant virus infection[J]. Pediatrics. 1985;76(3):411\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePandolfi E, Panera N, Alisi A, et al. Cytokine expression patterns in hospitalized children with Bordetella pertussis, Rhinovirus or co-infection[J]. Sci Rep. 2021;11(1):10948.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJackson LA, Cherry JD, Wang S-P, et al. Frequency of Serological Evidence of Bordetella Infections and Mixed Infections with other Respiratory Pathogens in University Students with Cough Illnesses[J]. Clin Infect Dis. 2000;31(1):3\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYuzhu Miao J, Li L, Huang. Mycoplasma pneumoniae detections in children with acute respiratory infection, 2010\u0026ndash;2023: a large sample study in China. Ital J Pediatr. 2025;23(1):11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGretchen L, Parrott T, Kinjo. Jiro Fujita 1A Compendium for Mycoplasma pneumoniae. Front Microbiol2016, 12:7513.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"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":"Pertussis, Children, Co-infection, Pathogen, Age, Season","lastPublishedDoi":"10.21203/rs.3.rs-7262976/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7262976/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eStudying the pathogenic characteristics of children with pertussis with other pathogens co-infection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Retrospective analyzed the clinical data of the children with pertussis who were hospitalized at a Children's Hospital from 2016 to 2021.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong the detected bacteria, there were 245 strains of \u003cem\u003eHaemophilus influenzae\u003c/em\u003e (12.92%), 145 strains of \u003cem\u003eStreptococcus pneumoniae \u003c/em\u003e(7.64%). Among the detected viruses\u003cem\u003e, Respiratory syncytial virus(RSV) \u003c/em\u003ewas the most common 441 strains (23.25%), followed by\u003cem\u003e Parainfluenza virus\u003c/em\u003e 440 strains (23.19%). The average age of the co-infection group was smaller than that of the simple pertussis infection group(P\u0026lt;0.05). The percentages of children with pertussis co-infected with RSV, \u003cem\u003eStaphylococcus aureus\u003c/em\u003e group, \u003cem\u003eEscherichia coli\u003c/em\u003e, and \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e in the 0-3 month age were 36.48%, 54.54%, 65.52%, and 78.95%, respectively. The proportions of children co-infected with \u003cem\u003eParainfluenza virus\u003c/em\u003e, and with \u003cem\u003eHaemophilus influenzae\u003c/em\u003e at 3-6 months old were 29.55% and 36.49%, respectively. The percentage of children with pertussis with \u003cem\u003eMycoplasma pneumoniae \u003c/em\u003eco-infection aged 1 year or older were all 60%. RSV had a higher probability of co-infection in winter and spring (34.46%+36.21%), \u003cem\u003eParainfluenza\u003c/em\u003evirus had a higher probability of co-infection in spring and summer (83.48% (43.58%+39.91%). The median length of \u003cem\u003eHospitalization\u003c/em\u003e time in different co-infection groups was longer than that in the simple infection group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions：\u003c/strong\u003eThe top three pathogens in children with pertussis with other pathogen co-infections were \u003cem\u003eRSV\u003c/em\u003e, \u003cem\u003eParainfluenza virus\u003c/em\u003e, and \u003cem\u003eHaemophilus influenzae\u003c/em\u003e. \u003cem\u003eRSV, Staphylococcus aureus. Escherichia coli\u003c/em\u003e and \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e had the highest proportion at 0-3 months of age; \u003cem\u003eParainfluenza virus\u003c/em\u003e and \u003cem\u003eHaemophilus influenzae \u003c/em\u003ehad the highest proportion at 3-6 months of age,\u003cem\u003e Mycoplasma \u003c/em\u003ewas more common in children over 1 year old. \u003cem\u003eRSV\u003c/em\u003e and\u003cem\u003e Parainfluenza\u003c/em\u003e were more common in spring. Co-infection of other pathogens may lead to prolonged hospital stay. The more types co infection pathogens infected, the longer the hospital stay.\u003c/p\u003e","manuscriptTitle":"A single center study of the pathogenic characteristics of children with pertussis with other pathogens co-infection in a children's hospital in Chongqing, China.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 11:29:02","doi":"10.21203/rs.3.rs-7262976/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-09-14T14:27:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"111048721531136337275472000459042408573","date":"2025-08-30T06:48:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-29T07:13:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-05T08:55:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-05T01:20:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-05T01:20:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-07-31T13:41:06+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":"26ce163d-5c40-4c04-a0b2-9d4577a1de56","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T11:29:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 11:29:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7262976","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7262976","identity":"rs-7262976","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}