The Burden of Respiratory Syncytial Virus in Children With Acute Otitis Media: A Systematic Review and Meta-Analysis

Acute otitis media (AOM) affects over 709 million individuals globally each year, more than half of whom are children < 5 years. Respiratory syncytial virus (RSV) is a leading viral cause of pediatric respiratory illness. We aimed to estimate the burden of RSV in children < 5 years with AOM METHODS: We performed a systematic review of studies reporting RSV identified through laboratory testing in children < 5 years with AOM. We searched eight databases from January 1, 1996, to May 9, 2025. We extracted data on RSV proportion in AOM and on co-detection of bacterial pathogens. We reported pooled proportions using random-effects meta-analysis.

We included 27 studies encompassing 8342 children with AOM. The pooled proportion of RSV in children with AOM was 16.9% (95% CI 11.0-23.8, I² = 94.9%). RSV proportion was higher in inpatient-based studies, in studies conducted during peak RSV seasons, and in children aged < 12 months. Among RSV-positive AOM cases, an estimated 67.4% (95% CI 15.4-100) had at least one bacterial co-detection. The most frequent bacteria co-detected were Streptococcus pneumoniae, followed by Haemophilus influenzae and Moraxella catarrhalis.

RSV is a common contributor to AOM in children < 5 years. Our findings indicate that RSV-associated AOM often involves concurrent bacterial detection. These results highlight the potential impact of recently introduced passive RSV immunization, such as maternal immunization and long-acting monoclonal antibody, in reducing AOM incidence and its complications. Preventing RSV in early childhood could lower the overall burden of AOM and decrease the need for antibiotics.