{
  "abstract": "Background: Respiratory Syncytial Virus (RSV) remains a significant public health concern globally, with distinct seasonal patterns in temperate regions, while tropical settings experience RSV year-round with seasonal fluctuations. This study investigated seasonality and exogenous factors influencing RSV cases among hospitalized children under 12 years in Negeri Sembilan, Malaysia.\n\nMethods: Weekly laboratory-confirmed RSV-positive cases among hospitalized pediatric patients presenting with acute lower respiratory tract infections (LRTIs) across 417 continuous WHO epidemiological weeks (EpiWeek 1, 2017 to EpiWeek 52, 2024) were analyzed using decomposition and autocorrelation functions. Relationships between RSV and co-circulating viruses, meteorological variables, and holidays were assessed via cross-correlation and Autoregressive Integrated Moving Average with Exogenous variables (ARIMAX) modeling.\n\nResults: A total of 6,545 (14.29%) samples were RSV-positive from a total of 45,817 tested. Historical peaks (July–September) were disrupted during 2020–2023 but re-established in 2024. The ARIMAX (2,0,4) (1,0,0) ₅₂ model revealed that RSV dynamics were driven primarily by internal autoregressive patterns rather than meteorological factors. Major public holidays exhibited a significant dual effect, with an immediate decrease in reported cases ( p = 0.012) followed by a significant surge ( p = 0.014). Influenza activity was a significant predictor with a one-week lag ( p = 0.012).\n\nConclusion: The pandemic temporarily shifted RSV seasonality, which has since normalized. The associations with holiday periods and influenza activity suggests that behavioral factors and viral interference may influence RSV circulation. These findings emphasize the need for dynamic surveillance to optimize the timing of future RSV immunizations in Malaysia.",
  "abstract_shown": true,
  "affiliations": [
    "Biomedical Epidemiology Unit, Special Resource Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health",
    "Hospital Tuanku Jaafar, Ministry of Health",
    "Department of Pediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia",
    "Department of Pediatrics, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia",
    "National Public Health Laboratory, Ministry of Health",
    "Special Resource Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Nuur Hafizah Md Iderus"
    },
    {
      "affs": [
        0
      ],
      "name": "Sarbhan Singh"
    },
    {
      "affs": [
        1
      ],
      "name": "David Chun-Ern Ng"
    },
    {
      "affs": [
        0
      ],
      "name": "Sumarni Mohd Ghazali"
    },
    {
      "affs": [
        0
      ],
      "name": "Nur’ain Mohd Ghazali"
    },
    {
      "affs": [
        0
      ],
      "name": "Mei Cheng Lim"
    },
    {
      "affs": [
        0
      ],
      "name": "Nur Ar Rabiah Ahmad"
    },
    {
      "affs": [
        0
      ],
      "name": "Qistina Ruslan"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Chuin-Hen Liew"
    },
    {
      "affs": [
        1
      ],
      "name": "Marlindawati Mohd Ali"
    },
    {
      "affs": [
        1
      ],
      "name": "Nor Zanariah Zainol Abidin"
    },
    {
      "affs": [
        1
      ],
      "name": "Nurul Hafizah Mohd Yusoff"
    },
    {
      "affs": [
        4
      ],
      "name": "Balvinder Singh Gill"
    },
    {
      "affs": [
        5
      ],
      "name": "Mohd Azahadi Omar"
    },
    {
      "affs": [
        0
      ],
      "name": "Lonny Chen Rong Qi Ahmad"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/889m8vytj50p8.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1947126",
  "fulltext_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1947126/full",
  "id": "889m8vytj50p8",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1947126/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RA1-1270"
    ],
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      "openalex",
      "2713|Respiratory viral infections research"
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  "openalex": "W7223666002",
  "pdf_url": "https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1947126/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-26",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/889m8vytj50p8.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:24Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Respiratory viral infections research",
      "subfield": "epidemiology-public-health"
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  ],
  "title": "Epidemiology and seasonality of respiratory syncytial virus among hospitalized pediatric patients with lower respiratory tract infections in Negeri Sembilan, Malaysia (2017–2024)",
  "title_text": "Epidemiology and seasonality of respiratory syncytial virus among hospitalized pediatric patients with lower respiratory tract infections in Negeri Sembilan, Malaysia (2017–2024)",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:47:32Z",
  "url": "https://research.draconitic.com/paper/889m8vytj50p8",
  "venue": "Frontiers in Public Health",
  "versions": []
}