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Disease Severity of Respiratory Syncytial Virus Infection in Hospitalized Children

Costanza Di Chiara1, Vera Rigamonti2, Beatrice Rita Campana3

  • 1Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada.

Viruses
|April 27, 2026
PubMed

Insights

Coinfections with rhinovirus or other viruses did not increase the severity of respiratory syncytial virus (RSV) acute respiratory tract infections in hospitalized children. Understanding RSV coinfection impacts disease management and prevention strategies.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Virology

Background:

  • Respiratory syncytial virus (RSV) is a primary cause of pediatric acute respiratory tract infection (ARTI) hospitalizations.
  • The impact of viral coinfections in RSV-related ARTIs on disease severity is debated and requires clarification.
  • Evolving RSV prevention strategies necessitate a better understanding of RSV coinfection phenotypes.

Purpose of the Study:

  • To investigate the association between RSV monoinfection, RSV-rhinovirus coinfection, and RSV-non-rhinovirus coinfection and disease severity in hospitalized children.
  • To evaluate the clinical implications of viral coinfections in the context of RSV prevention.

Main Methods:

  • A multicenter retrospective cohort study included 231 children aged ≤5 years hospitalized with laboratory-confirmed RSV infection.
  • Patients were categorized into RSV monoinfection, RSV-rhinovirus coinfection, or RSV-non-rhinovirus coinfection groups.
  • Severe disease was defined as ICU admission, need for respiratory/hemodynamic support, or death; Poisson regression analysis was used.

Main Results:

  • RSV monoinfection occurred in 51.1%, RSV-rhinovirus coinfection in 28.1%, and RSV-non-rhinovirus coinfection in 20.8% of cases.
  • Severe disease rates were 80.5% for monoinfection, 70.8% for RSV-rhinovirus, and 75.0% for RSV-non-rhinovirus coinfection.
  • Adjusted analyses showed no significant association between RSV-rhinovirus or RSV-non-rhinovirus coinfection and increased disease severity.

Conclusions:

  • RSV-rhinovirus and RSV-non-rhinovirus coinfections were not associated with increased disease severity in hospitalized children.
  • Findings support pathogen-specific interpretation of multiplex diagnostic results for RSV infections.
  • Results inform clinical risk stratification for pediatric ARTI management amid expanding RSV prevention.

Keywords:
multiplex polymerase chain reactionpediatric hospitalizationpediatric infectious diseasesrespiratory syncytial virusrhinovirusviral coinfection

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