Postpandemic Trends in Pediatric Respiratory Virus Hospitalizations: A Multicenter Study, 2019–2025
Federica Attaianese, Silvia Campani, Sandra Trapani, Ilaria Alberti, Maurizio Aricò, Marina Attanasi, Giulia Bertolucci, Silvia Bressan, Désirée Caselli, Veronica Casotto, Salvatore Cazzato, Francesco Chiarelli, Enrico Felici, Anna Frusciante, Maria Antonia Galeone, Silvia Garazzino, Antonietta Giannattasio, Eloisa Gitto, Antonio Guerriero, Fiorentina Guida, Giovanna Iudica, Marcello Lanari, Claudia Mandato, Alice Manzini, Gaia Martelli, Gregorio Paolo Milani, Maria Moriondo, Lucia Dora Notarangelo, Felice Nunziata, Roberta Pellegrino, Diego Peroni, Emanuela Piccotti, Eduardo Ponticiello, Silvia Ricci, Immacolata Rulli, Fabio Savoia, Erika Silvestro, Antonella Sisto, Federica Soro, Stefania Tonetto, Alessandro Zago, Carlo Dani, Chiara Azzari, Giuseppe IndolfiABSTRACT
Background
The COVID‐19 pandemic profoundly altered the circulation of respiratory viruses in children, changing the epidemiology of acute lower respiratory tract infections. In the postpandemic period, respiratory pathogens showed marked temporal variability. The 2024–2025 season was the first respiratory syncytial virus (RSV) season in Italy during which RSV immunoprophylaxis with nirsevimab was implemented, allowing evaluation of recent trends in pediatric hospitalizations.
Methods
We conducted a retrospective multicenter study across 16 pediatric hospitals in Italy. Hospitalizations of children younger than 18 years with RSV, influenza, adenovirus, parainfluenza virus, rhinovirus infection, or bronchiolitis of unspecified viral etiology were identified from January 2019 to March 2025 using ICD‐9‐CM diagnostic codes. Annual and monthly hospitalization rates per 100,000 children were calculated using national demographic data. Temporal trends were assessed across six consecutive seasons.
Results
Overall, 23,981 hospitalizations were recorded. RSV was the most frequent pathogen (42.5%), followed by influenza (18.6%), adenovirus (9.9%), and rhinovirus (7.3%). Hospitalizations declined sharply in 2020 and subsequently increased, peaking in 2024 ( n = 4903; +30.8% vs. 2022). During the 2024–2025 season, total admissions decreased by 17.2% compared with 2023–2024 (3390 vs. 4095), mainly due to a marked reduction in RSV‐related hospitalizations (−41.6%, 1230 vs. 2107), with modest increases in influenza‐, adenovirus‐, and rhinovirus‐associated admissions.
Conclusions
This nationwide analysis describes postpandemic trends in pediatric respiratory virus hospitalizations in Italy, highlighting changing pathogen‐specific patterns and the need for continued viral surveillance.