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. 2026 Feb 4;81(6):1159-1169.
doi: 10.1093/cid/ciaf048.

Household Transmission and Genomic Diversity of Respiratory Syncytial Virus in the United States, 2022-2023

Sarah N Cox  1   2 , Pavitra Roychoudhury  3   4 , Collrane Frivold  1   2 , Zack Acker  5 , Tara M Babu  1 , Cassandra L Boisvert  6 , Marco Carone  7 , Brenna Ehmen  5 , Janet A Englund  8   9 , Leora R Feldstein  10 , Luis Gamboa  5 , Sally Grindstaff  5 , Hanna M Grioni  8 , Peter D Han  5 , Katherine L Hoffman  7 , Hyeong Geon Kim  3 , Jennifer L Kuntz  6 , Natalie K Lo  1 , Christina M Lockwood  3   5 , Kathryn McCaffrey  5 , Richard A Mularski  6 , Tara L Hatchie  1 , Sacha L Reich  6 , Mark A Schmidt  6 , Ning Smith  6 , Lea M Starita  5   11 , Alexandra Varga  6 , Neil Yetz  6 , Allison L Naleway  6 , Ana A Weil  1 , Helen Y Chu  1
Affiliations

Household Transmission and Genomic Diversity of Respiratory Syncytial Virus in the United States, 2022-2023

Sarah N Cox et al. Clin Infect Dis. .

Abstract

Background: Household transmission of respiratory viruses may drive community spread. Few recent studies have examined household respiratory syncytial virus (RSV) transmission in the United States.

Methods: We conducted a prospective community-based cohort study from 1 June 2022 to 31 May 2023. Participants had blood samples collected and completed nasal swabs and surveys at least weekly, irrespective of symptoms. We tested serum for RSV antibody, nasal swabs by quantitative reverse transcription polymerase chain reaction (RT-qPCR), and performed whole genome sequencing. We evaluated secondary RSV transmission and associated risk factors based on a log-linear Poisson regression model.

Results: RSV was detected among 310 (10%) participants within 200 (20%) households. Most (94%) index cases were symptomatic. We identified 37 cases of potential secondary transmission within 14 days of a distinct index case (10%, 95% confidence interval [CI]: 7%, 14%); median age of index and secondary cases were 6 (interquartile range [IQR]: 3-10) and 35 (7-41) years, respectively, with 89% (24/27) of index cases aged 6 months to 12 years. Factors associated with increased risk of RSV transmission included index case viral detection ≥1 week and contact age ≤12 years. Of 120 sequenced specimens, the main lineages represented were A.d.5.2 (n = 37) and A.d.1 (n = 30). Sequenced viruses from households with ≥2 RSV infections were similar when occurring within ≤14 days (mean pairwise difference 4 [range 0-13], n = 17 households), compared to those >14 days (137 [37-236], n = 2).

Conclusions: Most RSV household transmission occurs from infants and young children to adults. Viral genome sequencing demonstrated that multiple household infections within a 14-day period are likely due to within-household transmission.

Keywords: community surveillance; genomics; household transmission; respiratory syncytial virus; secondary attack rate.

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Conflict of interest statement

Potential conflicts of interest. S. N. C. is an employee of Pfizer, Inc. outside of the submitted work and may receive stock or stock options. J. A. E. reported consulting with Abbvie, Ark Biopharmaceuticals, Sanofi Pasteur, Moderna, Meissa Vaccines, AstraZeneca, and Pfizer, Inc. outside of the submitted work, and has received research funding from AstraZeneca, Merck, GlaxoSmithKline, and Pfizer. J. L. K. reported research funding not related to the submitted work from Pfizer, Novartis, and Vir Biotechnology. C. M. L. reported being on the Scientific Advisory Board for LGC group. R. A. M. reported research funding not related to the submitted work from PCORI, CDC, NHLBI, NIAID, GlaxoSmithKline, Merck, and Sanofi; his institution is funded by Pfizer, Inc. for RSV vaccine development as site principal investigator (PI). H. Y. C. reported consulting with Ellume, Pfizer, and the Bill and Melinda Gates Foundation. She has served on advisory boards for Vir, Merck and Abbvie. She has conducted CME teaching with Medscape, Vindico, and Clinical Care Options. She has received research funding from Gates Ventures, and support and reagents from Ellume and Cepheid outside of the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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