Narrative review on pediatric RSV co-infections and post-pandemic rebound

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Frontiers in Medicine Published April 24, 2026 Medically reviewed April 24, 2026 DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Consider that pediatric RSV co-infections are frequent and associated with greater severity, requiring enhanced surveillance.

This is a global narrative review on pediatric RSV co-infections. The scope covers the frequency, common co-pathogens, and clinical impact of these co-infections in the context of relaxed non-pharmaceutical interventions compared to the pre-pandemic period.

The authors synthesize that RSV co-infections are frequent. The most common viral co-pathogen is human rhinovirus (HRV). Predominant bacterial co-infections are Streptococcus pneumoniae (Spn) and Haemophilus influenzae (Hi). Co-infections are significantly associated with heightened disease severity, more intense clinical presentations, prolonged hospitalizations, increased ICU admission rates, and greater therapeutic complexity. Co-infection rates have rebounded.

Key limitations noted by the authors include gaps in understanding pathogenic synergies and inequities in access to novel interventions. The review does not report specific study populations, sample sizes, or numerical effect sizes.

Practice relevance emphasizes enhanced surveillance, equitable prevention, and targeted research. The findings are qualitative and should be interpreted with caution given the narrative nature of the review.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

The coronavirus disease 2019 (COVID-19) pandemic profoundly disrupted the global epidemiology of respiratory syncytial virus (RSV), leading to atypical off-season surges and altering infection dynamics across different climatic zones. This review synthesizes evidence on the landscape of pediatric RSV co-infections in this transformed post-pandemic context. RSV co-infection is frequent, with human rhinovirus (HRV) being the most common viral co-pathogen and Streptococcus pneumoniae (Spn) and Haemophilus influenzae (Hi) predominating as bacterial co-infections. Critically, these co-infections are significantly associated with heightened disease severity, including more intense clinical presentations, prolonged hospitalizations, increased intensive care unit (ICU) admission rates, and greater therapeutic complexity. The relaxation of non-pharmaceutical interventions has been linked to a rebound in co-infection rates. While advances in molecular diagnostics have improved detection, and new prophylactics like nirsevimab offer promise, significant challenges remain. These include gaps in understanding pathogenic synergies, inequities in access to novel interventions, and the need for strategies to manage the ongoing evolution of RSV epidemiology. This underscores the necessity for enhanced surveillance, equitable prevention, and targeted research to mitigate the substantial burden of pediatric RSV co-infections.