Etiological composition and epidemiological characteristics of acute respiratory infections in Hebei Province, 2023–2025

Background Acute respiratory tract infections (ARTIs) are a major global public health concern. This study aimed to characterize the pathogen spectrum and epidemiological features of 11 common respiratory pathogens among outpatients and hospitalized patients in Hebei Province. Methods A total of 11,942 patients with influenza-like illness (ILI) or severe acute respiratory infection (SARI) were enrolled from October 2023 to September 2025. Throat swabs, sputum, and bronchoalveolar lavage fluid were collected and screened using a multiplex PCR kit. Age distribution, temporal trends, and coinfection patterns were analyzed. Results The results showed that the pathogen positivity rate among SARI (45.71%) was higher than that among ILI (41.62%); influenza virus (IFV) had the highest detection rate among ILI, whilst Mycoplasma pneumoniae (M. pneumoniae) was the most frequently detected pathogen among SARI; In terms of age distribution: IFV had the highest detection rate across all age groups in ILI; in the 0–4-year-old SARI group, respiratory syncytial virus was predominant; in the 5–14-year-old group, the detection rate of M. pneumoniae reached 43.44 %; and in the group aged 15 years and over, IFV and Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2) were the predominant pathogens. SARS-CoV-2 were intermittently detected throughout the year, with three waves of epidemic peaks observed. IFV and RSV predominantly emerged during winter and spring, while rhinovirus showed higher activity in summer and autumn. M. pneumoniae exhibited a high incidence rate initially, which has been declining steadily since the end of 2024.The proportion of multi-pathogen co-infections among positive specimens was 14.88%, the proportion of co-infections among SARI (23.76 %) was significantly higher than that among ILI (9.28 %). Co-detection of M. pneumoniae and rhinovirus was the most common, followed by human bocavirus, parainfluenza virus and enterovirus, which were also among the pathogens frequently detected in combination. Conclusion This study elucidated the epidemiological characteristics of respiratory pathogens in Hebei Province, providing a scientific basis for the precise prevention and control of ARTIs.