. 2026 Mar 4;13(3):ofag088.

doi: 10.1093/ofid/ofag088. eCollection 2026 Mar.

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

Regina M Simeone¹, Margaret M Newhams², Laura D Zambrano¹, Jemima M Calixte², Katherine Lindsey^{1

3}, Amber Orzel-Lockwood², Amanda B Payne¹, Natasha B Halasa⁴, Satoshi Kamidani⁵, Aline B Maddux⁶, Kathleen Chiotos⁷, Hillary Crandall⁸, Jennifer E Schuster⁹, Danielle M Zerr¹⁰, Lora M Martin¹¹, Melissa A Cameron¹², Katherine Irby¹³, Shira J Gertz¹⁴, Steven L Shein¹⁵, Ryan A Nofziger¹⁶, Samina S Bhumbra¹⁷, Janet R Hume¹⁸, Michele Kong¹⁹, Mia Maamari²⁰, Bria M Coates²¹, Judith A Guzman-Cottrill²², Mary Allen Staat²³, Thomas J Connors²⁴, Matt S Zinter²⁵, Jigar C Chauhan²⁶, Tamara T Bradford²⁷, Kari Wellnitz²⁸, Angela P Campbell¹, Adrienne G Randolph^{2

29

30}; Overcoming COVID-19 Investigators

Collaborators, Affiliations

Collaborators

Overcoming COVID-19 Investigators:
Michele Kong, Meghan Murdock, Heather Kelley, Candice Colston, Neelima Marupudi, Katherine Irby, Ronald C Sanders, Masson Yates, Ashlyn Madding, Shahwar Yousuf, Melissa A Cameron, Matt S Zinter, Kanokporn Mongkolrattanothai, Aline B Maddux, Ariana Valenzuela, Natasha Baig, Lexi Petruccelli, Rachel Greer, Heidi Sauceda, Frances Zorensky, Alexander H Hogan, Katherine Herbst, Carlie Defelice, Jigar C Chauhan, Scott L Weiss, Rebecca Clifford, Jenna Lapira, Satoshi Kamidani, Mark D Gonzalez, Caroline R Ciric, Jong-Ha C Choi, Gabriella Ess, Anna K Mitchell, Luis W Salazar, Sarah Jae Wershil, Kelly N Michelson, Bria M Coates, Samina S Bhumbra, Mary Stumpf, Kari Wellnitz, Tamara T Bradford, Adrienne G Randolph, Margaret M Newhams, Amber O Orzel-Lockwood, Jemima M Calixte, Benjamin Schattman, Allison Zaff, Amira Toivonen, Janet R Hume, Lora Martin, Joseph M Majure, Lacy Malloch, Maygan Martin, Jennifer E Schuster, Berenice Marrufo, Abigail Kietzman, Shira J Gertz, Elizabeth Ricciardi, Thomas J Connors, Melissa S Stockwell, Celibell Y Vargas, Raul A Silverio Francisco, Saul R Hymes, Ilana Harwayne-Gidansky, Stephanie P Schwartz, Tracie C Walker, Alison Mathers, Miriam Davis, Ryan A Nofziger, Nicole Twinem, Olivia Kennedy, Mary Allen Staat, Chelsea C Rohlfs, Steven Shein, Rajashri Rasal, Judith A Guzman-Cottrill, Chelsea Heisler, Kathleen Chiotos, Alanah Mckelvey, Jenny Bush, Rebecca Douglas, Mickael Boustany, Austin Biggs, Zach Rusler, Natasha B Halasa, Laura S Stewart, Kristina Betters, Julie A Boom, Leila C Sahni, Mia Maamari, Cindy Bowens, Hillary Crandall, Danielle Zerr, Amanda Adler

Affiliations

¹ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
² Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
³ 4ES Corporation, Atlanta, Georgia, USA.
⁴ Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee,USA.
⁵ The Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and the Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
⁶ Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
⁷ Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁸ Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
⁹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.
¹⁰ Division of Infectious Diseases, Department of Pediatrics, University of Washingtonand Seattle Children's Research Institute, Seattle, Washington, USA.
¹¹ Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA.
¹² Division of Pediatric Hospital Medicine, UC San Diego-Rady Children's Hospital, San Diego, California, USA.
¹³ Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
¹⁴ Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA.
¹⁵ Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA.
¹⁶ Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio, USA.
¹⁷ Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
¹⁸ Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA.
¹⁹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
²⁰ Department of Pediatrics, Division of Critical Care Medicine, Children's Medical Center Dallas, University of Texas Southwestern, Dallas, Texas, USA.
²¹ Division of Pediatric Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
²² Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA.
²³ Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.
²⁴ Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork, New York, USA.
²⁵ Department of Pediatrics, Divisions of Critical Care Medicine and Allergy, Immunology, and Bone Marrow Transplant, University of California SanFrancisco, San Francisco, California, USA.
²⁶ Division of Pediatric Critical Care, Nemours Children's Hospital, Wilmington, Delaware, USA.
²⁷ Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans, New Orleans, Louisiana, USA.
²⁸ Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
²⁹ Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA.
³⁰ Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 41822373
PMCID: PMC12978529
DOI: 10.1093/ofid/ofag088

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

Regina M Simeone et al. Open Forum Infect Dis. 2026.

. 2026 Mar 4;13(3):ofag088.

doi: 10.1093/ofid/ofag088. eCollection 2026 Mar.

Authors

Collaborators

Overcoming COVID-19 Investigators:
Michele Kong, Meghan Murdock, Heather Kelley, Candice Colston, Neelima Marupudi, Katherine Irby, Ronald C Sanders, Masson Yates, Ashlyn Madding, Shahwar Yousuf, Melissa A Cameron, Matt S Zinter, Kanokporn Mongkolrattanothai, Aline B Maddux, Ariana Valenzuela, Natasha Baig, Lexi Petruccelli, Rachel Greer, Heidi Sauceda, Frances Zorensky, Alexander H Hogan, Katherine Herbst, Carlie Defelice, Jigar C Chauhan, Scott L Weiss, Rebecca Clifford, Jenna Lapira, Satoshi Kamidani, Mark D Gonzalez, Caroline R Ciric, Jong-Ha C Choi, Gabriella Ess, Anna K Mitchell, Luis W Salazar, Sarah Jae Wershil, Kelly N Michelson, Bria M Coates, Samina S Bhumbra, Mary Stumpf, Kari Wellnitz, Tamara T Bradford, Adrienne G Randolph, Margaret M Newhams, Amber O Orzel-Lockwood, Jemima M Calixte, Benjamin Schattman, Allison Zaff, Amira Toivonen, Janet R Hume, Lora Martin, Joseph M Majure, Lacy Malloch, Maygan Martin, Jennifer E Schuster, Berenice Marrufo, Abigail Kietzman, Shira J Gertz, Elizabeth Ricciardi, Thomas J Connors, Melissa S Stockwell, Celibell Y Vargas, Raul A Silverio Francisco, Saul R Hymes, Ilana Harwayne-Gidansky, Stephanie P Schwartz, Tracie C Walker, Alison Mathers, Miriam Davis, Ryan A Nofziger, Nicole Twinem, Olivia Kennedy, Mary Allen Staat, Chelsea C Rohlfs, Steven Shein, Rajashri Rasal, Judith A Guzman-Cottrill, Chelsea Heisler, Kathleen Chiotos, Alanah Mckelvey, Jenny Bush, Rebecca Douglas, Mickael Boustany, Austin Biggs, Zach Rusler, Natasha B Halasa, Laura S Stewart, Kristina Betters, Julie A Boom, Leila C Sahni, Mia Maamari, Cindy Bowens, Hillary Crandall, Danielle Zerr, Amanda Adler

Affiliations

¹ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
² Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
³ 4ES Corporation, Atlanta, Georgia, USA.
⁴ Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee,USA.
⁵ The Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and the Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
⁶ Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
⁷ Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁸ Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
⁹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.
¹⁰ Division of Infectious Diseases, Department of Pediatrics, University of Washingtonand Seattle Children's Research Institute, Seattle, Washington, USA.
¹¹ Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA.
¹² Division of Pediatric Hospital Medicine, UC San Diego-Rady Children's Hospital, San Diego, California, USA.
¹³ Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
¹⁴ Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA.
¹⁵ Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA.
¹⁶ Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio, USA.
¹⁷ Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
¹⁸ Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA.
¹⁹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
²⁰ Department of Pediatrics, Division of Critical Care Medicine, Children's Medical Center Dallas, University of Texas Southwestern, Dallas, Texas, USA.
²¹ Division of Pediatric Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
²² Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA.
²³ Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.
²⁴ Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork, New York, USA.
²⁵ Department of Pediatrics, Divisions of Critical Care Medicine and Allergy, Immunology, and Bone Marrow Transplant, University of California SanFrancisco, San Francisco, California, USA.
²⁶ Division of Pediatric Critical Care, Nemours Children's Hospital, Wilmington, Delaware, USA.
²⁷ Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans, New Orleans, Louisiana, USA.
²⁸ Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
²⁹ Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA.
³⁰ Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 41822373
PMCID: PMC12978529
DOI: 10.1093/ofid/ofag088

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.

Keywords: COVID-19; pediatric; respiratory failure; respiratory syncytial virus.

Published by Oxford University Press on behalf of Infectious Diseases Society of America 2026.

PubMed Disclaimer

Conflict of interest statement

Potential Conflicts of interest. A. B. M., A. B. P., A. O., A. P. P., J. A. G., J. C. C., J. M. C., K. C., K. L., L. D. Z., L. M. M., M. A. C., M. M, M. M. N., M. S. Z., R. A. N., R. M. S., S. J. G., S. L. S., S. S. B., and T. T. B.: No conflicts. A. G. R. reports grant or contract support from NIH to Boston Children's Hospital, royalties or licenses from UpToDate, consulting fees from Inotrem, Inc., payment or honoraria from ThermoFisher, Inc., and unpaid council member rolls in the International Sepsis Forum and Families Fighting Flu. B. M. C. reports grant or contract support from NIH/NHLBI and NIH/NIAID to Ann and Robert H. Lurie Children's Hospital. D. M. Z. reports grant or contract support from Columbia University and Merck to the University of Washington and Seattle Children's Research Institute and participation on a Data Safety Monitoring Board for Allovir. H. C. reports grant or contract support from NIH/NIGMS to the University of Utah and payment for expert testimony from Mortensen and Milne. J. E. S. reports grant or contract support from NIH, FDA, and the State of Missouri to Children's Mercy Kansas City, consulting fees from the Association of Professionals in Infection Control and Epidemiology, speaking honoraria from the Missouri American Academy of Pediatrics, Payment from CDC for a review panel, and participation as an advisory board member for a grant awarded to the Association of American Medical Colleges for vaccine confidence. J. R. H. reports grant or contract support from NIH/NIAID and NIH/NICHD to Minnesota Masonic Children's Hospital and unpaid participation on a Data Safety Monitoring Board. K. I. reports grant or contract support from NIH to Arkansas Children's Hospital. K. W. reports grant or contract support from NHLBI, NIH, and ASPR to University of Iowa Carver College of Medicine. M. A. S. reports grant or contract support from NIH, Cepheid, Merck to Cincinnati Children's Hospital, royalties or licenses from UpToDate, and consulting fees from Merck. M. K. reports grant or contract support from NIH to the University of Alabama and unpaid board membership on the Jefferson Board of Health, UAB Callahan, and KultureCity. NBH reports grant or contract support from Merck to Vanderbilt University Medical Center and has served as a consultant for CSL-Seqirus. S. K. reports grant or contract support from NIH, Pfizer, Moderna, Meissa, Bavarian Nordic, and Sanofi to Emory University and payment or honoraria from the American Academy of Pediatrics. T. J. C. reports grant or contract support from NIH to Columbia University Irving Medical Center. 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.

Figures

**Figure 1.**
Maximum level of respiratory support of children <2 y hospitalized with acute respiratory failure with respiratory syncytial virus (RSV), COVID-19, or RSV and SARS-CoV-2, 1 November 2023–31 March 2024, United States. Bars represent proportion of children with invasive mechanical ventilation (n = 253), noninvasive ventilation (n = 620), and high flow nasal cannula (n = 533), by virus and age. Numbers above bars represent the total number of children requiring respiratory support within each group (RSV, COVID-19, or RSV and SARS-CoV-2); within bars represent proportion of children by age and group.

See this image and copyright information in PMC

References

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

Collaborators

Affiliations

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

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

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