The resurgence of respiratory viruses after COVID-19: Molecular insights from pediatric SARI in Kashmir

BACKGROUND: Respiratory viruses are major contributors to severe acute respiratory infections (SARI) in children. Data on their molecular epidemiology in northern India remains limited, particularly in the post-COVID-19 period. This study aimed to determine the prevalence and distribution of respiratory viral pathogens among hospitalized pediatric SARI patients in Kashmir. METHODS: A prospective study was conducted from October 2023 to April 2025 at Sher-i-Kashmir Institute of Medical Sciences, Srinagar. Children aged ≤15 years meeting the World Health Organization SARI case definition were enrolled. Nasopharyngeal and/or oropharyngeal samples were collected and tested using real-time polymerase chain reaction assays for SARS-CoV-2, Influenza A and B, Respiratory Syncytial virus (RSV) A and B, Adenovirus, Human metapneumovirus, Rhinovirus, and Para-influenza viruses. RESULTS: A total of 326 pediatric SARI cases were included. At least one respiratory virus was detected in 200 patients (61.3%). RSV was the most frequently detected virus, with RSV-B identified in 111 cases (34.0%) and RSV-A in 26 cases (7.9%). Influenza viruses accounted for a smaller proportion, including influenza A (H1N1) in 12 cases (3.6%), influenza A(H3N2) in 6 cases (1.8%), and influenza B (Victoria lineage) in 21 cases (6.4%). Other viruses detected included Adenovirus, Para-influenza virus, Rhinovirus, and Human metapneumovirus. Most infections occurred during winter months and predominantly affected infants. CONCLUSION: Respiratory viruses account for a substantial proportion of pediatric SARI cases in Kashmir, with RSV emerging as the predominant pathogen in the post-pandemic period. Strengthening molecular surveillance may improve diagnostic stewardship and guide targeted prevention strategies.