Characteristics of Young Children Hospitalized With Acute Respiratory Failure From Infection With Respiratory Syncytial Virus, SARS-CoV-2, or Both, November 2023–March 2024

Authors

• Regina M. Simeone, U.S. Centers for Disease Control and Prevention, Atlanta, GA
• Margaret M. Newhams, Boston Children's Hospital, Boston, MA
• Laura D. Zambrano, U.S. Centers for Disease Control and Prevention, Atlanta, GA
• Jemima M. Calixte, Boston Children's Hospital, Boston, MA
• Katherine Lindsey, U.S. Centers for Disease Control and Prevention, Atlanta, GA
• Amber Orzel-Lockwood, Boston Children's Hospital, Boston, MA
• Amanda B. Payne, U.S. Centers for Disease Control and Prevention, Atlanta, GA
• Natasha B. Halasa, Vanderbilt University Medical Center, Nashville, TN
• Satoshi Kamidani, Emory University, Atlanta, GA
• Aline B. Maddux, University of Colorado, Aurora, CO
• Kathleen Chiotos, Children's Hospital of Philadelphia, Philadelphia, PA
• Hillary Crandall, University of Utah, Salt Lake City, UT
• Jennifer E. Schuster, Children's Mercy Kansas City, Kansas City, MO
• Danielle M. Zerr, University of Washington, Seattle, WA
• Lora M. Martin, University of Mississippi, Jackson, MS
• Melissa A. Cameron, UC San Diego-Rady Children's Hospital, San Diego, CA
• Katherine Irby, Arkansas Children's Hospital, Little Rock, AR
• Shira J. Gertz, Cooperman Barnabas Medical Center, Livingston, NJ
• Steven L. Shein, Rainbow Babies & Children's Hospital, Cleveland, OH
• Ryan A. Nofziger, Akron Children's Hospital, Akron, OH
• Samina S. Bhumbra, Indiana University, Indianapolis, IN
• Janet R. Hume, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
• Michele Kong, University of Alabama at Birmingham, Birmingham, AL
• Mia Maamari, University of Texas Southwestern, Dallas, TX
• Bria M. Coates, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
• Judith A. Guzman-Cottrill, Oregon Health and Science University, Portland, OR
• Mary Allen Staat, Cincinnati Children's Hospital, Cincinnati, OH
• Thomas J. Connors, Columbia University, New York, NY
• Tamara T. Bradford, LSU Health Sciences Center - New OrleansFollow
• et al

Document Type

Article

Publication Date

3-4-2026

Publication Title

Open Forum Infectious Diseases

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; P < .001). Twenty percent of children with RSV and 43.8% with COVID-19 had an underlying medical condition. Among infants aged <1 year for whom preterm status was available, 31.5% with RSV and 50% with COVID-19 had either prematurity or a comorbidity. Children with SARS-CoV-2 were more likely to require invasive mechanical ventilation, receive vasoactive infusions, and die compared with RSV with and without SARS-CoV-2. 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.

PubMed ID

41822373

Volume

13

Issue

3

Comments

See article for full author list.

Rights

Copyright © 2026, Published by Oxford University Press on behalf of Infectious Diseases Society of America 2026

Recommended Citation

Simeone, Regina M.; Newhams, Margaret M.; Zambrano, Laura D.; Calixte, Jemima M.; Lindsey, Katherine; Orzel-Lockwood, Amber; Payne, Amanda B.; Halasa, Natasha B.; Kamidani, Satoshi; Maddux, Aline B.; Chiotos, Kathleen; Crandall, Hillary; Schuster, Jennifer E.; Zerr, Danielle M.; Martin, Lora M.; Cameron, Melissa A.; Irby, Katherine; Gertz, Shira J.; Shein, Steven L.; Nofziger, Ryan A.; Bhumbra, Samina S.; Hume, Janet R.; Kong, Michele; Maamari, Mia; Coates, Bria M.; Guzman-Cottrill, Judith A.; Staat, Mary Allen; Connors, Thomas J.; Bradford, Tamara T.; and al, et, "Characteristics of Young Children Hospitalized With Acute Respiratory Failure From Infection With Respiratory Syncytial Virus, SARS-CoV-2, or Both, November 2023–March 2024" (2026). School of Medicine Faculty Publications. 4482.
https://digitalscholar.lsuhsc.edu/som_facpubs/4482
10.1093/ofid/ofag088