Disease burden and outcomes of pediatric human bocavirus mono-infections: a three-year retrospective study from a large tertiary cohort

Human bocavirus 1 (HBoV1) is a respiratory virus predominantly affecting young children. Its independent pathogenic role has been increasingly recognized. This study aimed to evaluate the clinical course, risk factors, and outcomes of pediatric HBoV1 mono-infections over a three-year period. This retrospective cohort included 1215 children (1 month–18 years) with HBoV1 mono-infection diagnosed by multiplex RT-PCR between 2021 and 2023 at a tertiary hospital. Patients were grouped based on chronic comorbidities: asthma, immunodeficiency, congenital heart disease, chronic respiratory disease, and none. Demographic, clinical, laboratory, and radiologic data were compared across groups. Logistic regression identified predictors of hospitalization and respiratory support. Among 1215 cases, the median age was 3 years and 56.4% were male. A total of 414 patients (34.1%) were hospitalized, 99 (8.1%) required intensive care, and 33 (2.7%) were intubated. Overall, 23.2% had hypoxia at presentation. Chronic conditions were present in 309 patients (25.4%), and these children had significantly higher rates of severe outcomes. Respiratory support was required in 33.4% of the cohort. Multivariate analysis showed younger age (OR: 0.86), hypoxia (OR: 5.90), and abnormal chest imaging (OR: 26.2) as strong predictors of hospitalization (p < 0.001 for all). All 13 deaths (1.1%) occurred in patients with serious chronic illnesses, mostly immunodeficiencies and malignancies. HBoV1 mono-infection can result in substantial morbidity, including hospitalization, respiratory failure, and death—particularly in children with chronic comorbidities. Key predictors such as age, hypoxia, and radiologic findings may help early risk stratification. Our findings reinforce the clinical significance of HBoV1 and highlight the need for vigilance in high-risk groups. This study does not involve any clinical trials. Therefore, no clinical trial registration is required.