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Multicenter Study
. 2025 Oct;53(5):1715-1723.
doi: 10.1007/s15010-025-02484-1. Epub 2025 Feb 19.

RSV is the main cause of severe respiratory infections in infants and young children in Germany - data from the prospective, multicenter PAPI study 2021-2023

Martin Wetzke  1 , Matthias Lange  2 , Cordula Koerner-Rettberg  3 , Alexander Kiefer  4 , Michael Kabesch  4 , Sven Armbrust  5 , Kerim Abdelkhalek  6 , Christiane Lex  7 , Markus Hufnagel  8 , Sebastian Bode  9 , Michael Dördelmann  10 , Michael Lorenz  11 , Stefan Arens  12 , Markus Panning  13 , Holger Köster  2 , Rolf Kramer  14 , Mathieu Bangert  14 , Frank Eberhardt  15 , Grit Barten-Neiner  15 , Christine Happle  16
Affiliations
Multicenter Study

RSV is the main cause of severe respiratory infections in infants and young children in Germany - data from the prospective, multicenter PAPI study 2021-2023

Martin Wetzke et al. Infection. 2025 Oct.

Abstract

Background: Respiratory syncytial virus (RSV) is one of the main causes of morbidity in infants and young children worldwide. Current data on RSV-associated disease burden in Germany before the introduction of new immunization strategies is lacking.

Methods: The PAPI study is a multicenter, prospective surveillance study of lower respiratory tract infections (LRTI) in children aged ≤ 24 months in Germany.

Results: Data from 1607 children with LRTI hospitalized in twelve German hospitals between September 2021 and May 2023 were analyzed. Among these children, RSV was the most frequently detected pathogen (57.1%), followed by rhino/entero-, metapneumo- and parainfluenza virus. Children with RSV were significantly younger than those with LRTI of other causes (mean of 5.6 ± SD 6.1 vs. mean of 10.1 ± SD 7.3 months, p < 0.001) and more frequently affected in their first six months of life. RSV positive children were significantly more likely to develop hypoxemia (61.9% vs. 44.3%, p < 0.001) and need for intravenous or enteral fluid supplementation (48.1% vs. 43.1%, p = 0.009; 13.2% vs. 5.9%, p < 0.001) than those without RSV.

Conclusion: RSV is the dominant pathogen for LRTI-associated hospitalizations in children ≤ 24 months in Germany and associated with a particularly high need for treatment. The ongoing implemented use of RSV immunization according to current recommendations could lead to significant reduction in early childhood morbidity in Germany.

Keywords: Disease burden; Hospitalization; Morbidity; RSV; Seasonality.

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Conflict of interest statement

Declarations. Ethical approval: The study was approved by the ethics committees of the participating centers (vote Medizinische Hochschule 9442_BO_K_2020 MHH). The legal guardians of each participating child were comprehensively informed about the study and gave their written consent. A strobe checklist added to the manuscript. Consent for publication: The manuscript does not contain any identifiable information about individual patients. Competing interests: The PAPI study is supported by funding from Sanofi and AstraZeneca. MW has received honoraria for lectures and consultancy work from AstraZeneca, Novartis, Sanofi, Pfizer and GSK. CH has received research funding from Novartis and Pari, in each case unrelated to the current project.

Figures

Fig. 1
Fig. 1
Flowchart with information on screened and included patients
Fig. 2
Fig. 2
Pathogen distribution by calendar week over the two seasons with RSV as the dominant pathogen in both years
Fig. 3
Fig. 3
Age distribution among RSV positive and RSV negative patients
See this image and copyright information in PMC

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