Multi-pathogen respiratory surveillance in western China: Synchronized circulation patterns and predictive modeling.

Respiratory pathogen dynamics in western China following COVID-19 restrictions remain poorly characterized. We analyzed 50,247 specimens across 14 pathogens from January 2020-December 2024 using multiplex PCR at Sichuan Provincial People's Hospital. Pathogen positivity is increased by 314% post-pandemic, with H1N1 showing 1,826% and Mycoplasma pneumoniae showing 519% increases. Human rhinovirus exhibited highest overall detection at 9.05%. Correlation analysis revealed 89% of pathogen pairs showed positive temporal associations, contrasting with typical competitive endemic patterns. School-aged children experienced disproportionate burden, with M. pneumoniae reaching 30.0% positivity versus 9.1% in younger children. Seasonal autoregressive integrated moving average (SARIMA) forecasting models achieved 15.2%-24.8% mean absolute percentage errors, enabling 12-month predictions. Winter months concentrated six pathogen peaks. These findings demonstrate synchronized multi-pathogen resurgence following prolonged control measures, supporting integrated surveillance approaches monitoring pathogen interactions alongside individual dynamics for enhanced epidemic preparedness.