Acute respiratory infections (ARIs) represent one of the most prevalent communicable diseases in clinical practice and stands as a primary cause of mortality among children under the age of 5 globally [1]. Viruses and atypical pathogens are predominant contributors to ARIs. Notable among these are Influenza A virus (IAV), Influenza B virus (IBV), Respiratory syncytial virus (RSV), Human rhinovirus (HRV) and Adenovirus (ADV), which stand out as the most prevalent viral pathogens [2], [3], [4], [5]. In addition to viruses, Mycoplasma pneumoniae (Mp) represents the most common atypical pathogen affecting children [6]. Due to the highly transmissible, rapid, and widespread nature of these pathogens, ARIs have the potential to trigger extensive outbreaks, posing a significant threat to global public health [7]. The prevalence of these pathogens varies across different regions, seasons, and time periods. It is reported that, with the outbreak of the novel coronavirus disease 2019 (COVID-19), there was a declining trend in the incidence of seasonal respiratory pathogens during COVID-19 pandemic [8], [9], [10], [11]. Although the COVID-19 pandemic has been gradually controlled globally, respiratory pathogens remain to be important causative factors in infectious diseases. However, since the comprehensive reopening of COVID-19 pandemic control measures in China on December 5, 2022, the epidemiological characteristics of respiratory pathogen infections and the spectrum of ARIs remain unknown. The simultaneous occurrence and interactive influences of COVID-19, influenza virus, and other respiratory infectious diseases may pose challenges to clinical diagnosis and treatment [12]. This situation heightens the complexity of epidemic management by amplifying the difficulty of conducting differential diagnoses. Therefore, timely understanding of the changes in the epidemiology of respiratory pathogens and the pathogens' spectrum of ARIs is of paramount importance in guiding future strategies for the prevention and control of ARIs.

In this study, we comprehensively depicted the epidemiological trends of respiratory pathogens from August 2022 to December 2023, including IAV, IBV, RSV, ADV, HRV, Mp, and novel coronavirus (SARS-CoV-2). The study aims to elucidate the dynamic changes in ARIs post the COVID-19 pandemic and provide essential insights for the prevention and control of ARIs in different seasons in the future.