Burden of RSV-Associated Inpatient Care and Emergency Service Utilization in Two German Pediatric Centers Across Six Seasons Including the First Nirsevimab Year

<b>Background/Objectives:</b> Respiratory syncytial virus (RSV) is a major cause of infant respiratory morbidity, yet real-world data on healthcare utilization following universal immunoprophylaxis remain limited. <b>Methods:</b> We retrospectively analyzed RSV-positive inpatient and emergency department (ED) encounters from two German tertiary pediatric centers across six seasons (2019/20-2024/25). Augsburg contributed inpatient data for 2022/23-2024/25, including immunization status and severity metrics, while Erlangen provided inpatient and ED data across all seasons. <b>Results:</b> In Augsburg, RSV hospitalizations were higher in pre-immunization seasons than in 2024/25, accompanied by a reduced proportion of infants < 1 year. RSV season onset occurred later in 2024/25, while severity metrics remained stable. Among infants < 1 year hospitalized in 2024/25, all severe cases occurred in unimmunized infants; no severe outcomes were observed among the small number of immunized cases. <b>Conclusions:</b> Integrated multicenter data descriptively coincide with reduced RSV hospitalization burden following immunoprophylaxis introduction, without evidence of increased disease severity.