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\begin{document}

\title{Impact of COVID-19 pandemic on the etiology and characteristics of
community-acquired pneumonia among children requiring bronchoalveolar
lavage in northern China}



\author[1]{Lei Yang}%
\author[2]{Yuyan Zhang}%
\author[2]{Zhouhua Lu}%
\author[2]{Changqing Shen}%
\author[2]{Jin Wang}%
\author[2]{Qing Zhao}%
\author[3]{Tongshu Hou}%
\author[2]{Fenghai Niu}%
\author[2]{Qingxia Kong}%
\author[2]{Jun Ning}%
\author[1]{Ruihan Liu}%
\affil[1]{Shandong University of Traditional Chinese Medicine}%
\affil[2]{Affiliated Hospital of Jining Medical University}%
\affil[3]{Binzhou Medical University - Yantai Campus}%


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  \date{May 23, 2024}


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\begin{abstract}
\textbf{Objective:} To investigate the etiology and the clinical
characteristics of community-acquired~pneumonia (CAP) among children
requiring bronchoalveolar lavage and analyze the impact of spreading of
COVID-19 on the pathogens and clinical manifestations. \textbf{Study
design:} Children \textless{}14 years old hospitalized with CAP
requiring bronchoalveolar lavage were enrolled between February 2019 to
January 2020 and August 2021 to July 2022. Multiplex reverse
transcription polymerase chain reaction (mRT-PCR) was used for pathogen
detection. The demographic and clinical characteristics were compared
between different type pathogen infection groups and between before and
during COVID-19 pandemic. \textbf{Results:} Among 1487 children studied,
[?]1 pathogen was detected in 1363 (91.66\%) children and co-infection was
detected in 79 (5.31\%) children. \emph{M.pneumoniae}, Adenovirus and
Human Rhinovirus were the most frequently detected pathogens. During the
COVID-19 pandemic, it was found that the proportion of children under 3
years was appreciably reduced and the proportion of children over 7
years was appreciably increased. The frequency of virus and co-infection
was decreased except for that of atypical bacteria. The results of
clinical manifestations, CT scan and fiberoptic bronchoscopy showed
significant difference with different pathogen infection and the lung
inflammation of the enrolled children were relatively mild compared to
those before the COVID-19 pandemic. \textbf{Conclusions:}
\emph{M.pneumoniae} infection might be the greatest pediatric disease
burden leading to CAP in northern China. Wearing masks and social
distancing in public places could effectively reduce the transmission of
respiratory viruses, but could not reduce the infection rate of
\emph{M.pneumoniae}. In addition, precautions could significantly
reduced the lung inflammation compared with those before the pandemic.%
\end{abstract}%



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