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.