Document Type

Article

Publication Date

3-4-2026

Identifier

DOI: 10.1093/ofid/ofag088; PMCID: PMC12978529

Abstract

BACKGROUND: Respiratory syncytial virus (RSV) and SARS-CoV-2 can cause acute respiratory failure in children. We compared characteristics and outcomes of children aged < 2 years with respiratory failure from infection with RSV, SARS-CoV-2, or both viruses.

METHODS: We used data from a US pediatric respiratory virus hospitalization surveillance network including children with ICU admission for acute respiratory failure (receiving high-flow oxygen or mechanical ventilation) with RSV and/or SARS-CoV-2 during November 2023-March 2024. Demographic, clinical characteristics, and hospitalization outcomes were stratified by a positive test for RSV, SARS-CoV-2, or both viruses, and compared using chi-squared or Kruskal-Wallis tests. Multivariable analyses assessed independent associations between outcomes and infection.

RESULTS: Overall, 1406 children were included: 1253 (89.1%) for RSV, 105 (7.5%) for COVID-19, and 48 (3.4%) with RSV + SARS-CoV-2 detected. Children with RSV or RSV + SARS-CoV-2 had lower median ages (3.9 and 5.4 months, respectively) compared with those with SARS-CoV-2 (8.8 months;

CONCLUSIONS: Critically ill children < 2 years of age infected with SARS-CoV-2 had more severe illness presentation and outcomes and were older compared with those with RSV and RSV + SARS-CoV-2 codetection. Most children were previously healthy, highlighting the need for prevention measures.

Journal Title

Open Forum Infect Dis

Volume

13

Issue

3

First Page

088

Last Page

088

PubMed ID

41822373

Keywords

COVID-19; pediatric; respiratory failure; respiratory syncytial virus

Comments

This work is written by (a) US Government employee(s) and is in the public domain in the US. This article is a work of the United States government. Such works are not entitled to domestic copyright protection under U.S. law and are therefore in the public domain.

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