Objective:

To systematically review the landscape of pediatric RSV co-infections, including their epidemiological characteristics, impact on clinical severity, and advances in diagnostic approaches, potentially including meta-analysis.

Key Findings:

• RSV co-infection rates are approximately 29.9%, with HRV being the most common viral co-pathogen, supported by specific studies.
• Co-infections significantly increase disease severity, leading to longer hospital stays and higher ICU admissions, with data references.
• Post-pandemic, there has been a notable rise in RSV positivity rates and co-infection incidence due to 'immunity debt', with specific statistics.
• Inflammatory markers are elevated in post-COVID RSV patients, indicating increased severity of infections, with study references.

Interpretation:

The COVID-19 pandemic has altered the epidemiology of RSV, leading to increased co-infection rates and severity of respiratory illnesses in children, necessitating enhanced surveillance and targeted interventions, exemplified by recent data.

Limitations:

• Gaps in understanding the pathogenic synergies between RSV and co-infecting pathogens, which could inform treatment strategies.
• Inequities in access to novel interventions and prophylactics, highlighting the need for policy changes.
• Need for ongoing research to adapt to the evolving epidemiology of RSV, emphasizing the urgency of addressing these gaps.

Conclusion:

The findings highlight the urgent need for improved surveillance, equitable access to prevention strategies, and targeted research to address the burden of pediatric RSV co-infections in the post-COVID era.