Predicting societal risk factors for respiratory co-infections: a cross-sectional study based on multi-source fever clinic data

This study aimed to analyze epidemiological characteristics, clinical manifestations, and socio- environmental risk factors of viral-mycoplasma mixed respiratory infections in children presenting at fever clinics, providing evidence for clinical decision-making. In this cross-sectional study, we analyzed clinical data from 132 pediatric patients with respiratory co-infections confirmed by direct immunofluorescence assay at the Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine (May 1, 2023 – April 30, 2024). Data collection included demographic characteristics, clinical symptoms, laboratory results, and pathogen profiles. Social behaviors and environmental factors were also evaluated. An age- and season-matched comparison group of 185 children with single respiratory infections was included. Statistical analyses involved t-tests, χ² tests, and multivariate logistic regression. The majority of patients were aged 4–9 years (75.76%), with a male predominance (64.39%). Adenovirus was the most frequently detected pathogen (100 cases) and demonstrated the highest co-infection rate with Mycoplasma pneumoniae. Cases were primarily concentrated in the main urban area of Fuzhou City, notably in Jin’an (38 cases) and Gulou (34 cases) districts. The co-infection group had a significantly longer duration of fever than the single infection group (P < 0.001) and more severe systemic clinical manifestations. Laboratory parameters, including white blood cell, neutrophil, and C-reactive protein levels, were significantly elevated in the co-infection group (P < 0.05). Among environmental factors, both low ambient temperature (P < 0.001) and humidity (P = 0.011) were significantly associated with co-infection. Multivariate logistic regression analysis identified several independent risk factors for co-infection: Low ambient temperature (OR = 1.144), poor hand hygiene practices (OR = 3.4691), attendance at childcare facilities (OR = 2.042), recent family member infection history (OR = 1.989), and not having received the influenza vaccine (OR = 2.266). Viral-mycoplasma co-infections in pediatric patients demonstrate distinct epidemiological patterns and more severe outcomes. Social behaviors and environmental factors represent pivotal risk factors, warranting targeted public health interventions during high-risk periods and in key locations.