Objective:

To investigate the viral etiology, frequency of viral mono- and co-detections, and associated clinical characteristics of children presenting with acute respiratory infections in pediatric primary care practices during the late phase of the COVID-19 pandemic, specifically after the relaxation of COVID-19 preventive measures in Germany.

Key Findings:

• 85% of participants had at least one virus detected, with a total of 638 virus detections, highlighting the prevalence of viral infections.
• 30% of children had co-detections of two or more viruses, indicating a significant trend in viral co-infections.
• HRV was the most frequently detected virus (30%), followed by RSV (22%) and SARS-CoV-2 (16%), suggesting a shift in viral dynamics.
• Cough was significantly more frequent in children with lower respiratory tract infections compared to upper respiratory tract infections, emphasizing the clinical relevance of symptoms.

Interpretation:

The study highlights a significant increase in viral co-infections among pediatric outpatients with ARIs following the relaxation of COVID-19 preventive measures, indicating a shift in respiratory virus dynamics that may require adjustments in public health strategies.

Limitations:

• The study was limited to five practices in Wuerzburg, which may not represent the broader population, potentially affecting the generalizability of the findings.
• The observational nature of the study limits causal inferences, suggesting the need for further research to establish direct relationships.

Conclusion:

The findings underscore the need for ongoing surveillance of respiratory viruses in pediatric populations, particularly in the context of changing public health measures, to inform timely interventions.