Abstract / Summary
Abstract Background The COVID-19 pandemic has altered the epidemiology of numerous childhood pathogens, but its effect on pediatric Epstein–Barr virus (EBV) infection remains poorly defined due to a lack of multi-year laboratory data outside a few centers. Methods We initially collected a total of 51,056 EBV-DNA PCR records from pediatric patients at Hebei Children's Hospital (2019–2024). After exclusions, 30,254 specimens were included in the final analysis. These patients were stratified into three epidemiological periods: pre-COVID-19 (2019), during COVID-19 (2020–2022), and post-COVID-19 (2023–2024). Results Overall positivity was 14.26% (\(\:\text{4,313/30,254}\)), increasing from 10.45% pre-pandemic to 12.83% during and 17.44% post-pandemic ( p < 0.001). Viral loads and patient age also increased across periods (both p < 0.001). The post-COVID-19 period was an independent risk factor (adjusted OR = 1.87, 95% CI: 1.68–2.07). Pneumonia and upper respiratory tract infections were more common post-COVID-19. Conclusions In line with reports from other Chinese medical centers, these findings reveal a sustained post-COVID-19 surge in pediatric active EBV infection and a concurrent age shift toward school-aged children, highlighting the need for continued heightened surveillance in this population.