A Review of Changing Patterns of Pediatric Respiratory Infections in the Pre- and Post-COVID-19 Era: A Global and Indian Perspective

Respiratory tract infections remain an important cause of illness in children, and their epidemiology has changed noticeably during and after the COVID-19 pandemic. Non-pharmaceutical interventions, including masking, school closure, distancing, improved hand hygiene, and reduced travel, were associated with a fall in several common respiratory viruses, particularly influenza and respiratory syncytial virus (RSV), while rhinovirus/enterovirus continued to circulate in many settings. After restrictions were relaxed, many countries reported delayed or out-of-season activity of RSV, influenza, human metapneumovirus, and other respiratory pathogens. Multiplex molecular platforms such as the BioFire Respiratory Panel have helped document these shifts by enabling rapid, simultaneous detection of multiple viral and bacterial agents. This narrative review summarizes pre-pandemic, pandemic, and post-pandemic respiratory pathogen patterns with emphasis on pediatric infections, global observations, and Indian data. It also discusses the role of immunity gaps, disrupted routine immunization, altered healthcare-seeking behavior, co-detection, and regional variation in India. Strengthening respiratory virus surveillance, improving access to multiplex diagnostics in sentinel centers, restoring routine immunization, and integrating influenza, RSV, and COVID-19 prevention strategies into pediatric public health planning are essential in the post-COVID period.