Pediatric RSV-associated lower respiratory tract infection burden in G20 countries in 2023.

Respiratory syncytial virus (RSV) is a leading cause of childhood lower respiratory infections, but updated G20 burden estimates are lacking. Using the Global Burden of Disease 2023 database, we analyzed deaths and disability-adjusted life years (DALYs) for RSV-associated lower respiratory infections in children aged 0-14 years across G20 members from 1990 to 2023, with stratification by sex, age, and country. In 2023, an estimated 5,373 deaths and 483,162 DALYs occurred, with mortality and DALY rates having declined by ∼5.5% annually since 1990. The COVID-19 pandemic drove burden to a historic low in 2021, but a marked rebound followed in 2022-2023, though rates remained below pre-pandemic levels. Infants aged <1 year bore the heaviest burden (mortality 8.688 per 100,000), and India ranked highest, whereas Australia ranked lowest. Burden strongly correlated inversely with Sociodemographic Index. These findings highlight the need for precision prevention, targeting the youngest children and lower-resource G20 members.