The prevalence and role of human respiratory syncytial virus in pediatric respiratory tract infections: a systematic review and meta-analysis of global data

Background: Human respiratory syncytial virus (hRSV) is a major cause of respiratory tract infections in children worldwide. This study aims to describe the prevalence of hRSV in pediatric patients with respiratory tract infections, clarifying its association with such infections. Methods: We analyzed studies from PubMed, Scopus, and Web of Science up to August 15, 2025, focusing on polymerase chain reaction-confirmed cases in children under 18 years. Data from 539 studies (584 datasets) were included. Pooled prevalence was calculated using a random-effects model, with subgroup analyses by region, gender, age group, sampling time, type of respiratory disease, types of patient care, genotypes, and subtypes of hRSV. Odds ratios evaluated the association between hRSV infection and respiratory disease risk. Findings: The global prevalence among 1,733,341 children was 21.6%, with the highest rates in children aged less than 6 months (33.8%), and inpatients (25.9%). Bronchiolitis showed the highest prevalence (56.9%). Prevalence declined over time, possibly due to the coronavirus disease 2019 pandemic. hRSV-A (55.7%) was more common than hRSV-B (44.3%). Infection significantly increased respiratory infection risk (odds ratio = 7.0), especially for lower respiratory infections. Interpretation: hRSV is a key contributor to pediatric respiratory tract infections, with notable variations by age and region. Prevention strategies, including vaccines and monoclonal antibodies, are urgently needed for high-risk groups. Funding: None.