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Background: Acute respiratory tract infection (ARTI) is the leading cause of paediatric hospitalisations in India, especially ≤5 years of age.

Aim: The study attempts to investigate RSV disease burden in the under-five and any association between NP carriage and viral ARTI.

Methods: This study was conducted from 2019-2020 in Chennai (South India) on hospitalised children with ARTI, between 1 to 60 months of age. Multiplex real-time PCR was employed on nasopharyngeal (NP) samples (n=256) for respiratory pathogens including respiratory syncytial virus (RSV) and Streptococcus pneumoniae (SPN).

Results:). Viral and RSV positivity was 81% and 48.6% respectively. Viral co-infections were evidenced in about a quarter of RSV positive children, common being human parechovirus with RSV. Fever, high respiratory rate, severe respiratory distress, cough, difficulty in breathing, chest indrawing and bronchiolitis were significant clinical findings in paediatric viral ARTI. Pneumococcal conjugate vaccine uptake was high (89.4%) in subjects yet 31.87% of vaccinated children had NP pneumococcal carriage. 75% of those with SPN carriage had viral ARTI of which 35.6% were RSV positive. We observed statistically significant association between NP carriage and viral ARTI (p<0.05). Antibiotic usage in suspected RSV versus non-RSV viral ARTI was 68% and 93.8% respectively.

Conclusion: Significant RSV disease burden in children < 5 years of age, with ARTI is evidenced with a positive association between SPN carriage and viral acute respiratory tract infections.