Publication date: Jun 25, 2025

In 2023, a resurgence of acute lower respiratory tract infections (ALRTI) linked to respiratory syncytial virus (RSV) was noted following the COVID-19 pandemic. Patients’ outcomes, disease severity, and demographics all changed. This study aims to identify risk factors for severe disease and the impact of other viral co-infection on severity, which has not yet been extensively studied in China. This observational cohort study comprised cases of RSV-associated ALRTI among children younger than 5 years who were admitted to the hospital from January to December 2023. Demographic characteristics, co-infection status, and laboratory parameters were compared between severe and mild groups. Logistic regression analysis was used to identify risk factors for severe RSV-ALRTI and viral co-infection, with the corresponding 95% CI and P value. Receiver Operating Characteristic (ROC) curve was drawn to analyze the efficacy of specific risk factors. A total of 1036 cases with a median age of 16 (6, 38) months; 662 boys (63. 9%) were admitted with RSV-associated ALRTI; 764 (73. 7%) were younger than 3 years. The cohort suggests out-of-season epidemic of RSV. Severe disease was documented for 405 cases (39. 1%), with a younger median age (10 (4, 32) and a higher proportion with a history of prematurity and low-body weight (P 

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