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Pathogens
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Pediatric Viral Infections: Epidemiology, Treatment, and Emerging Challenges
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Pediatric Viral Infections: Epidemiology, Treatment, and Emerging Challenges

A special issue of Pathogens (ISSN 2076-0817). This special issue belongs to the section "Viral Pathogens".

Deadline for manuscript submissions: 30 September 2026 | Viewed by 7811

Special Issue Editors

Prof. Dr. Maria Pokorska-Śpiewak

E-Mail Website
Guest Editor
1. Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 02-091 Warsaw, Poland
2. Hospital of Infectious Diseases, 01-201 Warsaw, Poland
Interests: pediatric infectious diseases; hepatology; viral hepatitis
Special Issues, Collections and Topics in MDPI journals
Dr. Magdalena Rutkowska

E-Mail Website
Guest Editor
1. Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
2. Hospital of Infectious Diseases, Warsaw, Poland
Interests: pediatric infectious diseases; HIV; mother-to-child transmission; viral hepatitis

Special Issue Information

Dear Colleagues,

Viral infectious diseases still pose a significant problem worldwide and lead to significant morbidity and mortality in children. The COVID-19 pandemic impacted the epidemiology and course of other infections. Many viral infections encountered in the pediatric population are vaccine-preventable. However, despite the World Health Organization’s (WHO) Elimination Programs, which rely primarily on universal access to vaccinations, a decline in the rate of routine vaccinations has been observed in recent years. One of the reasons for this trend was undoubtedly the COVID-19 pandemic and difficulties in access to health services. However, the growing activity of anti-vaccination and anti-scientific organizations must also be considered.

Another challenge is the increasing number of children (especially newborns) exposed to vertically transmitted viral diseases, e.g., the human immunodeficiency virus (HIV). This problem may be particularly significant among the population of war, economic, and climate migrants. An important issue in preventing vertical HIV infection is an effective screening program for pregnant women.

On the other hand, we should consider new therapeutic options for viral diseases. An example is direct-acting antivirals (DAA), which revolutionized the HCV treatment. Their safety and very high efficacy have also been confirmed in the pediatric population with hepatitis C.

Potential topics are not limited to the issues mentioned above. Both original research and review articles are welcome.

Prof. Dr. Maria Pokorska-Śpiewak
Dr. Magdalena Rutkowska
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pathogens is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric infectious diseases
  • viral infections
  • viral hepatitis
  • COVID-19
  • HIV
  • mother-to-child transmission
  • vaccines

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Related Special Issue

Published Papers (7 papers)

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16 pages, 706 KB  
Article
Age-Dependent Clinical Patterns of Primary Epstein–Barr Virus Infection in Children: Insights for Diagnostic Accuracy
by Demet Teker-Düztaş, Ayşe Kaman and Gönül Tanır
Pathogens 2026, 15(5), 554; https://doi.org/10.3390/pathogens15050554 - 20 May 2026
Viewed by 112
Abstract
Primary Epstein–Barr virus (EBV) infection in children exhibits substantial clinical heterogeneity, often complicating early diagnosis and leading to unnecessary antibiotic use. This retrospective study evaluated 695 children (0–18 years) diagnosed with primary EBV infection at a tertiary pediatric center between 2010 and 2015, [...] Read more.
Primary Epstein–Barr virus (EBV) infection in children exhibits substantial clinical heterogeneity, often complicating early diagnosis and leading to unnecessary antibiotic use. This retrospective study evaluated 695 children (0–18 years) diagnosed with primary EBV infection at a tertiary pediatric center between 2010 and 2015, defined by positive viral capsid antigen (VCA) IgM and negative Epstein–Barr nuclear antigen (EBNA) IgG. Clinical, laboratory, and ultrasonographic findings were compared according to age group (≤4 vs. >4 years) and clinical setting (inpatient vs. outpatient). The median age was 3.75 years (IQR: 2–6.25), and more than half of the patients were ≤4 years. Younger children more frequently presented with nonspecific respiratory and gastrointestinal symptoms, whereas older children more commonly exhibited the classic infectious mononucleosis (IM) phenotype, including sore throat, dysphagia, lymphadenopathy, and hepatosplenomegaly (p < 0.001). Antibiotics were prescribed in 64.2% of patients, while 21.7% required hospitalization. Multivariable logistic regression analyses demonstrated that age was not an independent predictor of hospitalization, classic IM phenotype, or antibiotic use. Instead, specific clinical and laboratory findings—such as lymphopenia, lymphadenopathy, vomiting, thrombocytosis, and tonsillar hypertrophy—emerged as the key determinants of clinical outcomes. To enhance diagnostic discrimination, receiver operating characteristic (ROC) analysis of ANC/ALC and AST/ALT ratios was performed, and a composite risk score (0–2) was derived. Although both markers showed modest discriminative ability (AUC 0.607 and 0.575), their high negative predictive values (>90%) suggest potential utility as rule-out tools. The composite score demonstrated a stepwise increase in the probability of classic IM presentation across age groups. In conclusion, primary EBV infection demonstrates a clear age-related clinical spectrum; however, clinical and laboratory features rather than age alone drive key outcomes. These findings highlight the need for age-specific diagnostic strategies and improved antimicrobial stewardship, while the proposed risk score provides a foundation for future validation studies. Full article
(This article belongs to the Special Issue Pediatric Viral Infections: Epidemiology, Treatment, and Emerging Challenges)
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9 pages, 721 KB  
Article
Challenges in Achieving Viral Suppression Among Adolescents and Young Adults Under a Dolutegravir-Based Regimen: Living with HIV in Gabon
by Berthold Bivigou-Mboumba, Pamela Moussavou-Boundzanga, Falone L. Akombi, Carine Eyi Zang, Aurore F. Bouassa-Bouassa, Sahara Luzolo, Pélagie Okome, Augustin Mouinga-Ondeme and Simon Ategbo
Pathogens 2026, 15(5), 502; https://doi.org/10.3390/pathogens15050502 - 7 May 2026
Viewed by 276
Abstract
Background: Children, adolescents and young adults living with HIV represent a vulnerable population. Achieving viral suppression in this population remains a major challenge in sub-Saharan Africa. Methods: We conducted a cross-sectional study among HIV-positive individuals aged 0–24 years in Gabon. Data were collected, [...] Read more.
Background: Children, adolescents and young adults living with HIV represent a vulnerable population. Achieving viral suppression in this population remains a major challenge in sub-Saharan Africa. Methods: We conducted a cross-sectional study among HIV-positive individuals aged 0–24 years in Gabon. Data were collected, including viral load (VL), CD4 counts, and immunosuppression levels. Viral suppression was defined as VL < 1000 copies/mL. Statistical comparisons across age groups and immunosuppression categories were performed. Results: Of the 130 (100%) participants included, 59 (45.4%) were males and 71 (54.6%) females. Overall, 72 (55.4%) achieved viral suppression, while 58 (44.6%) remained uncontrolled. Viral suppression increased with age (23.8% (5/21) in 0–7 years; 29.2% (14/48) in 8–15 year and 42.6% (26/61) in 16–24 years), yet uncontrolled VL were predominant across all groups. Median VL values were low but showed wide interquartile ranges, indicating heterogeneity in viral control. Mean CD4 counts declined significantly with age (780 in 0–8 years vs. 470 in 16–24 years; p = 0.001). Immunosuppression levels correlated inversely with virological control (p < 0.001). Conclusions: Despite moderate overall viral suppression, nearly half of adolescents and young adults failed to achieve virological control. The decline in CD4 counts with age highlights increased vulnerability in this population. Full article
(This article belongs to the Special Issue Pediatric Viral Infections: Epidemiology, Treatment, and Emerging Challenges)
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15 pages, 1476 KB  
Article
Genotypic Diversity of Human Rhinovirus in Children with Pneumonia Before and During the COVID-19 Pandemic in Mexico
by Janet Sánchez-Ramos, Miguel Leonardo García-León, Patricia Bautista-Carbajal, Luis Alfonso Salazar-Soto, Daniel E. Noyola, María Susana Juárez-Tobías, Pedro Antonio Martínez-Arce, María Del Carmen Espinosa-Sotero, Verónica Tabla-Orozco, Gerardo Martínez-Aguilar, Fabian Rojas-Larios, Izveidy Mondragón-Salinas and Rosa María Wong-Chew
Pathogens 2025, 14(12), 1236; https://doi.org/10.3390/pathogens14121236 - 4 Dec 2025
Viewed by 869
Abstract
Human rhinovirus (HRV) is one of the most common viral causes of respiratory tract infections worldwide. The COVID-19 pandemic and non-pharmaceutical interventions significantly altered the epidemiology of respiratory viruses. This study compared HRV genotypic diversity in Mexican children with pneumonia before and during [...] Read more.
Human rhinovirus (HRV) is one of the most common viral causes of respiratory tract infections worldwide. The COVID-19 pandemic and non-pharmaceutical interventions significantly altered the epidemiology of respiratory viruses. This study compared HRV genotypic diversity in Mexican children with pneumonia before and during the pandemic. A total of 1983 children with pneumonia were included: 1404 pre-pandemic (2010–2013) and 579 pandemic (2021–2023). Multiplex RT-PCR was used for HRV detection. Genotyping was conducted on 136 samples with Ct < 30 by sequencing the VP4/VP2 region. Species and genotype assignments were validated using BLAST and maximum-likelihood phylogenetic analysis (MEGA XII). HRV positivity increased from 16% (233/1404) before the pandemic to 60.4% (350/579) during the pandemic period. HRV-A and HRV-C predominated in both periods; HRV-C infection was significantly associated with severe pneumonia in the pre-pandemic period (OR 3.520; p = 0.012), but this association was not observed during the pandemic. A total of 72 genotypes were identified without a dominant type in either period. HRV circulation patterns shifted in the context of the COVID-19 pandemic, with a marked increase in prevalence. The high genotypic diversity observed across both periods underscores the importance of continuous molecular surveillance to better understand HRV circulation and its clinical relevance. Full article
(This article belongs to the Special Issue Pediatric Viral Infections: Epidemiology, Treatment, and Emerging Challenges)
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12 pages, 723 KB  
Article
Viral Infection Correlates with a Better Clinical Outcome than Pulmonary Exacerbation of Bacterial Origin in Paediatric Patients with Cystic Fibrosis
by Zuzanna Stachowiak, Marta Andrzejewska, Katarzyna Jończyk-Potoczna, Beata Narożna, Anna Musiał, Anna Wiesner, Anna Bręborowicz, Aleksandra Szczepankiewicz and Irena Wojsyk-Banaszak
Pathogens 2025, 14(9), 850; https://doi.org/10.3390/pathogens14090850 - 26 Aug 2025
Viewed by 1239
Abstract
Cystic fibrosis is a progressive disease affecting various organs of the human body, including the respiratory system. While the effect of bacterial infection on cystic fibrosis outcome has been comprehensively described, little is known about the impact of viruses. We collected 49 nasopharyngeal [...] Read more.
Cystic fibrosis is a progressive disease affecting various organs of the human body, including the respiratory system. While the effect of bacterial infection on cystic fibrosis outcome has been comprehensively described, little is known about the impact of viruses. We collected 49 nasopharyngeal swabs derived from cystic fibrosis paediatric patients during pulmonary exacerbation and tested them for the presence of respiratory viruses to elucidate the influence of the viral infection on their clinical outcome. We found that patients infected with a virus, compared to those in whom molecular testing for viruses was negative, are characterised by a better clinical outcome, as measured by the Shwachman–Kulczycki score (p = 0.006) and have better chest radiographs, as indicated by the Brasfield score (p = 0.002). Moreover, these patients have lower C-reactive protein levels (p = 0.002). We assume this unexpected association of better clinical outcomes during viral infection should be studied further. Full article
(This article belongs to the Special Issue Pediatric Viral Infections: Epidemiology, Treatment, and Emerging Challenges)
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13 pages, 3015 KB  
Article
Epidemiological and Clinical Characteristics of Respiratory Syncytial Virus Infection in Children in Hangzhou (2022–2023)
by Qin-Rui Lai, Xiao-Li Chu, Ying-Ying Chen, Wei Li, Ya-Jun Guo and Shi-Qiang Shang
Pathogens 2025, 14(6), 603; https://doi.org/10.3390/pathogens14060603 - 19 Jun 2025
Cited by 2 | Viewed by 1608
Abstract
Human respiratory syncytial virus (HRSV) is a highly contagious RNA virus that causes respiratory infections, especially in children. This study evaluated the impact of COVID-19 control measure changes on HRSV infection patterns in Hangzhou by comparing epidemiological and clinical characteristics. We conducted a [...] Read more.
Human respiratory syncytial virus (HRSV) is a highly contagious RNA virus that causes respiratory infections, especially in children. This study evaluated the impact of COVID-19 control measure changes on HRSV infection patterns in Hangzhou by comparing epidemiological and clinical characteristics. We conducted a retrospective analysis of 12,993 pediatric nasopharyngeal swab samples from children with acute respiratory infections at The Children’s Hospital of Zhejiang University School of Medicine. These samples, collected between February 2022 and January 2024, were screened for HRSV and 12 other respiratory pathogens using capillary electrophoresis technology. From February 2022 to January 2023, the HRSV positivity rate was 7.06%. In 2023, it increased to 9.26%. The highest positivity rates were in infants aged 0–6 months and children aged 6 months to 1 year. Coinfections were most common with rhinovirus in 2022 and Mycoplasma pneumoniae in 2023. HRSV positivity rates were low from April to September 2022, peaking in December. In 2023, the peak occurred from April to September. Symptoms ranged from mild to severe pneumonia, with higher hospitalization rates in children with underlying conditions. The study revealed significant changes in HRSV infection rates following pandemic restriction relaxations, emphasizing the need for the early identification and prevention of severe cases. Full article
(This article belongs to the Special Issue Pediatric Viral Infections: Epidemiology, Treatment, and Emerging Challenges)
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8 pages, 194 KB  
Communication
Neurodevelopmental Outcomes in Children with Neonatal Parechovirus CNS Infections
by Anna Piwowarczyk, Julia Śladowska, Agata Lipiec, Ernest Kuchar and Elżbieta Stawicka
Pathogens 2025, 14(6), 600; https://doi.org/10.3390/pathogens14060600 - 18 Jun 2025
Viewed by 2162
Abstract
Human parechoviruses, officially known as Parechovirus A (PeV-A), are more frequently reported as a significant cause of serious infections in newborns and young infants. We aimed to describe the clinical features and neurological outcomes of PeV-A encephalitis cases identified in Warsaw. Infants with [...] Read more.
Human parechoviruses, officially known as Parechovirus A (PeV-A), are more frequently reported as a significant cause of serious infections in newborns and young infants. We aimed to describe the clinical features and neurological outcomes of PeV-A encephalitis cases identified in Warsaw. Infants with suspected encephalitis were retrospectively identified in three hospitals in the summer of 2022. Cases of confirmed PeV-A infection had their comprehensive demographic, clinical, laboratory, imaging, and outcome data reviewed. The psychomotor development of the children up to the age of 2 years was assessed by using the standardized tools. We identified 18 cases of confirmed encephalitis with a PeV-A infection. Their median age was 16 days. Fourteen cases were included in the analysis, while one patient dropped out after the first visit. Most were boys (9/14), and one patient was born preterm. Three patients had white matter alterations on brain MRI at discharge. No significant neurologic sequelae were observed after acute illness. At the 24-month follow-up, based on the Bayley Scales of Infant and Toddler Development (BSID-IV) and the Brunet–Lézine Scale, the children showed no neurodevelopmental sequelae. Brain MRIs were obtained in all of the participants up to 12 months of age and revealed no significant lesions. Neurodevelopmental complications are not frequent in children after PeV-A encephalitis at 24 months of age. Continued follow-up in larger cohorts is needed to explore the predictors of long-term morbidity. Full article
(This article belongs to the Special Issue Pediatric Viral Infections: Epidemiology, Treatment, and Emerging Challenges)

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7 pages, 483 KB  
Case Report
Autoimmune Hepatitis After Successful Treatment of Chronic Hepatitis C Virus Infection with Direct-Acting Antivirals: A Pediatric Case Report
by Ewa Talarek, Małgorzata Aniszewska, Anna Dobrzeniecka, Jakub Kmiotek and Maria Pokorska-Śpiewak
Pathogens 2025, 14(12), 1244; https://doi.org/10.3390/pathogens14121244 - 5 Dec 2025
Cited by 1 | Viewed by 769
Abstract
More than 3 million children are infected with hepatitis C virus (HCV) worldwide. Therapies with direct-acting antivirals (DAAs) are characterized by high efficiency and acceptable tolerability. Rare cases of autoimmune hepatitis (AIH) following HCV elimination have been reported in adults. Here, we present [...] Read more.
More than 3 million children are infected with hepatitis C virus (HCV) worldwide. Therapies with direct-acting antivirals (DAAs) are characterized by high efficiency and acceptable tolerability. Rare cases of autoimmune hepatitis (AIH) following HCV elimination have been reported in adults. Here, we present the first pediatric case of AIH after successful treatment with DAAs. A girl, born in 2012, was diagnosed with vertical HCV infection in 2013. In 2023, she was treated with the DAA glecaprevir/pibrentasvir. HCV RNA was undetectable after 4 weeks of treatment and at the end of treatment (EOT). However, at the EOT, the aminotransferase concentration elevated with further increase, despite a confirmed sustained viral response (SVR) 12 weeks after the EOT. Gamma-globulins were elevated, with positive anti-nuclear antibodies (ANA) and anti-liver kidney microsome (LKM) antibodies. Other causes were excluded. Elastography revealed no fibrosis. Aminotransferase levels decreased but did not normalize. A liver biopsy was performed, confirming a diagnosis of AIH. Immunosuppressive therapy with prednisone and azathioprine resulted in normalization of aminotransferase levels, and the titers of both ANA and LKM antibodies decreased. Monitoring aminotransferase levels should not be omitted in patients after successful DAA treatment of HCV infection. Full article
(This article belongs to the Special Issue Pediatric Viral Infections: Epidemiology, Treatment, and Emerging Challenges)
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