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The COVID-19 pandemic caused significant shifts in seasonality of RSV, and changes in disease severity have been matter of intense discussion. Between September 2020 and February 2023, the multicentric, prospective PAPI study analyzed rates and phenotypes of hospitalized RSV patients aged\u2009\u2264\u200924 months across three German hospitals. Pseudonymized patient data were analyzed employing Mann\u2013Whitney\n                    <jats:italic>U<\/jats:italic>\n                    and chi-square testing, or one-way ANOVA or Kruskal\u2013Wallis testing when more than two groups were compared. Additionally, RSV cases from seasons 2017\/2018\u20132020\/2021 were retrospectively analyzed. After its absence in 2020\/2021, RSV returned approximately 2 months earlier than usual in late 2021. Overall duration of the season and patient numbers were comparable to previous seasons, and no significant shifts in age and gender distributions occurred in our cohort. While duration of hospitalization did not differ between the periods before vs. after the emergence of SARS-CoV-2, a significantly higher rate of patients with hypoxemia and respiratory failure occurred after the onset of the pandemic (oxygen supplementation post vs. pre: 59.4% vs. 54.8%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001, non-invasive ventilation post vs. pre: 12.4% vs. 7.2%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). No deaths occurred during the entire observational period.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    : We present comprehensive data on distinct seasonality and increased disease severity in children hospitalized with RSV bronchiolitis before and after the onset of the SARS-CoV-2 pandemic. Our data aids in understanding the impact of the pandemic on RSV disease in infants and provides valuable information on the impact of RSV on pediatric healthcare prior to broad introduction of novel prevention measures such as nirsevimab.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Respiratory syncytial virus (RSV) is a leading cause of infant morbidity and mortality globally<\/jats:italic>\n                              .\u2022\n                              <jats:italic>COVID-19 has led to significant shifts in RSV seasonality, and concerns about shifts in RSV severity<\/jats:italic>\n                              .\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>This study shows distinct seasonality and significant shifts in diseases severity amongst children with RSV associated hospitalization under the age of 2 yrs in the last years in Germany<\/jats:italic>\n                              .\u2022\n                              <jats:italic>It reports significantly higher rates of RSV associated respiratory failures in children\u2009&lt;\u20092 yrs. of age after emergence of the pandemic<\/jats:italic>\n                              .\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-025-06057-0","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T07:29:14Z","timestamp":1741850954000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Distinct seasonality and increased respiratory failure in RSV patients\u2009&lt;\u20092 years of age after emergence of SARS-CoV-2: data from the multicentric, prospective PAPI study"],"prefix":"10.1007","volume":"184","author":[{"given":"Jessica","family":"B\u00e4hre","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Lange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Salaschek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Twardella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Arens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Eberhard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grit","family":"Barten-Neiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Panning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger","family":"K\u00f6ster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cordula","family":"K\u00f6rner-Rettberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Wetzke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Happle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"6057_CR1","unstructured":"Pneumonia Etiology Research for Child Health Study G (2019) Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. 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J Clin Virol 166:105530","journal-title":"J Clin Virol"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-025-06057-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-025-06057-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-025-06057-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T15:03:00Z","timestamp":1744729380000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-025-06057-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,13]]},"references-count":43,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["6057"],"URL":"https:\/\/doi.org\/10.1007\/s00431-025-06057-0","relation":{},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,13]]},"assertion":[{"value":"5 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 February 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 February 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 March 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All study procedures were conducted in accordance with the Declaration of Helsinki, and all local Medical Ethics Committees of the participating centers approved the study protocol (e.g., ethics approval Hannover Medical School #9442_BO_K_2020 MHH). For the prospective data analysis, the legal guardians of all participants gave written informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"This manuscript contains no individual patient data in any form.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The PAPI study was funded by Sanofi\/AstraZeneca to MW. The funder did not influence the design of the study or the collection, analysis, and interpretation of the data or writing of the manuscript. Martin Wetzke received funding from the German Center for Infection Research (DZIF). Christine Happle received funding from the Excellence Cluster RESIST in infection research. MW received consulting and speaking fees from Novartis, GSK und Abbott.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"246"}}