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.
Hu et al. (Fri,) studied this question.