RSV Hits Children Harder Than Flu or COVID-19, Qatar Study Finds, as New Reviews Back 2026-27 Vaccines

DOHA, Qatar — Respiratory syncytial virus, or RSV, sent children to hospital far more often than influenza or COVID-19 did, even though it caused only a small share of childhood respiratory illnesses, according to a large new study from Qatar. The findings land just as an independent evidence review in the United States concludes that immunizations against all three viruses continue to protect against severe illness and death heading into the 2026-27 respiratory season.

The Qatar study, published in The Lancet Regional Health – Eastern Mediterranean, compared the three viruses head to head in the same hospital, over the same four years, across the full pediatric age range — a comparison researchers say had not been done before in the region. Separately, the Vaccine Integrity Project, run by the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP) with the American Medical Association (AMA), announced the completion of its 2026-27 evidence review, with the underlying reviews published in the Journal of the American Medical Association (JAMA) and used to inform new immunization recommendations from four major American medical societies.

Illustration: A young child rests in a pediatric hospital ward while a nurse checks a monitor.

What Happened

Researchers at Weill Cornell Medicine-Qatar and Sidra Medicine, working with Qatar's Ministry of Public Health and Hamad Medical Corporation, analyzed 4,360 respiratory illness episodes among 3,932 children younger than 18 who attended Sidra Medicine's emergency department between January 2022 and December 2025. Sidra Medicine is Qatar's national referral center for specialized pediatric care. Severity was assessed on the basis of hospital admission and intensive care unit (ICU) admission.

Influenza accounted for 65 percent of the illness episodes studied, followed by COVID-19 at 22 percent and RSV at just 13 percent. Yet despite its smaller share of illnesses, RSV was associated with substantially more severe disease: hospital admission was approximately four times as common with RSV as with either of the other infections, and intensive care admission was more than three times as common. The pattern held after accounting for differences in patient characteristics and was consistent across age groups, although RSV predominantly affected younger children.

Underlying health conditions mattered enormously. Children with pre-existing medical conditions had nearly seven times greater chances of hospitalization and twelve times greater chances of requiring intensive care compared with children without these conditions, according to Dr. Andres Perez-Lopez, chief of the Microbiology Division at Sidra Medicine, who co-led the study.

Dr. Hiam Chemaitelly, assistant professor of research in population health sciences at Weill Cornell Medicine-Qatar, who designed and co-led the epidemiological component, said the frequency with which RSV led to hospitalization showed how much could be gained through prevention. Effective interventions are now available, she said, including RSV vaccination during pregnancy to protect newborns and long-acting monoclonal antibodies that protect infants during their most vulnerable early months — and improving uptake of influenza and COVID-19 vaccination among children matters too, since those infections can also cause serious illness.

At the same time, the Vaccine Integrity Project announced its completed 2026-27 respiratory virus evidence review. The project reviewed hundreds of peer-reviewed studies published since August 2025, building on its 2025-26 review, and reported that the latest evidence confirms continued protection against severe illness, hospitalization and death, with no new safety concerns in comparative studies. The review informed the 2026-27 respiratory virus immunization recommendations released by the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Infectious Diseases Society of America.

“Immunization continues to be one of our best tools for preventing severe illness from respiratory viruses,” said Vaccine Integrity Project Executive Director Michael T. Osterholm, adding that this year's review confirms the newest evidence remains consistent with research showing the immunizations reduce the risk of hospitalization and death among the people most likely to experience serious disease.

Illustration: Scientists review vaccine research data in a bright laboratory.

Background

RSV is a common respiratory virus that usually causes mild, cold-like symptoms, but it can cause severe lung infections, particularly in infants and older adults. Unlike influenza and COVID-19, which have long had seasonal vaccination programs, RSV prevention for infants and older adults is comparatively new: long-acting monoclonal antibodies such as nirsevimab have been available since 2022, and RSV vaccination during pregnancy and for older adults has been rolled out in several countries in recent years.

That newness is part of why the European data presented this week matters. Two studies presented at the Congress of the European Paediatric Academic Societies (CEPAS) 2026 on October 29, reported by Medscape, examined how national RSV programs are working in practice — and found wide variation in how they are implemented between countries, particularly for children born preterm.

Spain introduced nirsevimab immunization for all infants in autumn 2023, followed by the same universal coverage in the Netherlands from autumn 2025, although maternal vaccination had been available out of pocket in the Netherlands from December 2023. The United Kingdom introduced year-round maternal RSV vaccination in September 2024, adding nirsevimab for high-risk infants and those born before 32 weeks' gestation from September 2025. Researchers used routine hospital administrative data, and for some institutions laboratory data, to study infants aged 24 months or younger hospitalized with lower respiratory tract infection or RSV-related infection across four consecutive RSV seasons between June 2022 and May 2026.

A second presentation mapped immunization strategies across 11 countries in the European Union-funded IMPROVE PRETERM project: Denmark, Estonia, Finland, France, Germany, Norway, Poland, Portugal, Sweden, Switzerland and the United Kingdom. France, Finland, Germany, Portugal, Sweden and Switzerland offered universal protection for all infants, while the remaining five countries had some form of restriction based on weeks of gestation. Preterm-born children are at increased risk of respiratory infections requiring hospitalization, with a 10-fold increased risk in extremely preterm children — those born before 28 weeks' gestation — according to presenter Sara Marie Nilsen of the Norwegian University of Science and Technology.

The American review has its own backstory. Before 2025, the US Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices routinely reviewed vaccine data to guide recommendations. According to the Vaccine Integrity Project's announcement, that process was disrupted last year when the US Department of Health and Human Services dismissed the committee's members and appointed replacements; despite a successful court challenge in March, an expert-led committee has yet to be restored. The Vaccine Integrity Project, launched by CIDRAP in 2025, was set up to provide independent evidence reviews so that recommendations remain grounded in the best available science.

Why It Matters

First, the Qatar study changes how the three viruses should be ranked for children. Influenza caused the most illnesses by far in the study, but RSV caused the most severe illness per case. For parents and clinicians, that distinction matters: a virus that is less common can still be the one most likely to put a child in hospital, and prevention aimed at RSV — maternal vaccination and infant monoclonal antibodies — targets exactly that risk. The study's authors argue that raising awareness among families and encouraging the use of preventive measures during routine pregnancy care could prevent avoidable hospitalizations.

Second, the findings underline who is most vulnerable. The nearly seven-fold hospitalization risk and twelve-fold intensive care risk for children with pre-existing conditions is a reminder that “children” is not one uniform risk group. Identifying vulnerable children early, and ensuring they receive monitoring, preventive care and medical care, was singled out by the study's co-lead as a priority.

Third, the evidence review gives clinicians and families a single, transparent summary at the start of a new respiratory season. Its headline numbers are striking. During the 2025-26 season in the United States, interim CDC estimates cited in the review put influenza-related hospitalizations at more than 390,000, with roughly 24,000 deaths. COVID-19 was associated with an estimated 4.6 million to 12.9 million illnesses, 140,000 to 240,000 hospitalizations and 15,000 to 42,000 deaths, although its peak weekly hospitalization rate, 2.0 per 100,000 people, was less than half the previous season's peak and about 80 percent below the 2022-23 peak. RSV caused an estimated 2.8 million to 5.8 million outpatient visits, 170,000 to 340,000 hospitalizations and as many as 25,000 deaths.

Fourth, the review's effectiveness figures show protection where it counts most. For influenza, the review screened more than 5,800 studies and identified 69 newly published studies, including 21 randomized controlled trials. Among adults over 65, flu vaccination increased protection against hospitalization by 31 percent. A case-cohort analysis over eight seasons reported 80 percent vaccine effectiveness against laboratory-confirmed influenza-associated deaths among infants and children aged 6 months to 17 years, and vaccination during pregnancy improved protection against symptomatic disease in infants aged 0 to 6 months by 44 percent. For children aged 6 months to 17 years with underlying health conditions, effectiveness was 48 percent against influenza-related hospitalization or emergency department visits. High-dose flu vaccines showed greater protection against hospitalization in older adults than standard-dose formulations.

For COVID-19, researchers screened more than 11,000 studies and included 155. Updated vaccines cut the risk of COVID-related hospitalization by 53 percent for adults over 65 in the 2025-26 season, lowered emergency department and urgent care visits for pregnant women by 58 percent with extended protection to infants, and reduced COVID-related pediatric emergency department visits by 76 percent for children aged 9 months to 4 years. For adults with immunocompromising conditions, vaccination cut the risk of intensive care admission or death by 32 to 53 percent, depending on the condition and other factors.

For RSV, the review assessed more than 2,000 studies and included 75. Adults over 60 saw vaccine effectiveness against hospitalization ranging from 69 to 83 percent within the same season as vaccination. Maternal vaccination reduced infant hospitalization risk by 51 to 70 percent. The infant monoclonal antibody nirsevimab reduced the risk of RSV-related hospitalization by 63.6 to 93.0 percent within the first RSV season, regardless of the timing of administration. None of the comparative studies found an association between RSV vaccination during pregnancy and preterm birth or other adverse pregnancy outcomes.

Note: This article reports published research findings and is general information, not medical advice. Decisions about vaccination should be discussed with a qualified health professional.

Illustration: A parent holds an infant while speaking with a doctor in a clinic.

What Happens Next

Several questions remain open. One is whether older Americans need an RSV vaccine booster: in one study examined by the Vaccine Integrity Project, effectiveness against hospitalization and laboratory-confirmed RSV illness among older adults was higher during the first season after vaccination than at 12 to 18 months of follow-up, while another study showed no significant difference. More data is needed, the review concluded.

Another is implementation. The European mapping shows that even where effective RSV tools exist, access depends on where a child is born and how many weeks early. The researchers' message is that harmonizing protection — especially for preterm infants — could narrow those gaps, and the Qatar findings add urgency, given how much more severe RSV proved to be per case.

A third is uptake. The AMA has launched a digital resource hub with immunization materials for clinicians and patients based on the evidence review and the medical societies' recommendations, aimed at putting this season's guidance into practice. Whether families and clinicians act on it will shape how heavy the coming respiratory season becomes — and whether the hospitalization burden documented in Qatar and in the American season estimates can be reduced.

For now, the verified picture is this: in one of the largest head-to-head pediatric comparisons yet, RSV was the most dangerous of the three common respiratory viruses for children, case for case. And in the most comprehensive independent review of the season's vaccine evidence, the tools to blunt that danger — along with influenza and COVID-19 — held up, with no new safety concerns found in comparative studies.

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FAQ

What did the Qatar study find about RSV in children?

RSV accounted for only 13 percent of respiratory illness episodes among children at Sidra Medicine's emergency department, but hospital admission was approximately four times as common with RSV as with influenza or COVID-19, and intensive care admission was more than three times as common.

How large was the Qatar study?

It analyzed 4,360 respiratory illness episodes among 3,932 children younger than 18 who attended Sidra Medicine's emergency department in Qatar between January 2022 and December 2025, and was published in The Lancet Regional Health – Eastern Mediterranean.

What is nirsevimab?

Nirsevimab is a long-acting monoclonal antibody given to infants to protect against RSV during their most vulnerable early months. The evidence review found it reduced the risk of RSV-related hospitalization by 63.6 to 93.0 percent within the first RSV season.

What did the 2026-27 evidence review conclude about vaccines?

The Vaccine Integrity Project review, published in JAMA, found that influenza, COVID-19 and RSV immunizations continue to provide meaningful protection against severe illness, hospitalization and death, with no new safety concerns identified in comparative studies.

Who is most at risk from severe respiratory illness?

Infants, older adults, pregnant women, people with compromised immune systems, and children with pre-existing medical conditions. In the Qatar study, children with pre-existing conditions had nearly seven times greater chances of hospitalization and twelve times greater chances of intensive care.

Sources

• Vaccine Integrity Project / CIDRAP, “2026-27 Respiratory Season Evidence Review” (2026) — evidence review announcement, JAMA reviews, and recommendations from the American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and Infectious Diseases Society of America.
• Weill Cornell Medicine-Qatar / Sidra Medicine via Qatar PR Network, “RSV Poses Greater Risk of Hospitalization for Children Than Flu or COVID-19, Qatar Study Finds” (28 October 2026) — study in The Lancet Regional Health – Eastern Mediterranean, 4,360 episodes among 3,932 children, January 2022 to December 2025.
• Medscape, “RSV Immunization Linked to Drop in Infant Hospitalizations” (2026) — studies presented at the Congress of the European Paediatric Academic Societies (CEPAS) 2026 on 29 October 2026, including the IMPROVE PRETERM mapping across 11 countries.