---
title: "Seasonal patterns and national burden of RSV, influenza, and COVID-19 in Brazil (2019–2023)"
id: "pubmed-42659036"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42659036"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42659036/"
doi: "10.7189/jogh.16.04251"
published_at: "2026-08-28T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Seasonal patterns and national burden of RSV, influenza, and COVID-19 in Brazil (2019–2023)
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42659036
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42659036/)
- **DOI:** [10.7189/jogh.16.04251](https://doi.org/10.7189%2Fjogh.16.04251)
- **Published At:** 2026-08-28T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This retrospective, population-based surveillance study used Brazil's SIVEP national system to evaluate seasonality and burden of **respiratory syncytial virus (RSV)**, **influenza**, and **COVID-19** from 2019 to 2023. - The analysis included laboratory-confirmed severe acute respiratory infection (SARI) cases: 69,389 RSV, 45,881 influenza, and 2,299,712 COVID-19 records reported in SIVEP. - Age patterns differed by pathogen: over 90% of **RSV** diagnoses occurred in children aged 0–10 years; **influenza** and **COVID-19** were more frequent among older adults. - The proportion of paediatric deaths attributed to RSV rose substantially, from 19.2% in 2020 to 62.0% in 2023, per SARI surveillance data. - Seasonal timing varied: **RSV** peaks generally occurred March–June, **influenza** peaked in January, and **COVID-19** showed inconsistent seasonality across the study period. - Geographic heterogeneity was observed, with higher concentrations of reported cases in Brazil's Southeast and South regions. - Analytic approach: time-series decomposition and seasonal trend analysis using multiple seasonal-trend decomposition via locally estimated scatterplot smoothing; monthly mean values were calculated to quantify seasonal burden. - The authors note that observed patterns may be influenced by changes in testing strategies and limited diagnostic sensitivity, especially for adult **RSV** where underreporting is likely. - Public health implications include reinforcing diagnostic capacity and surveillance, maintaining and optimizing seasonal influenza vaccination programs, and considering integration of new preventive measures such as **RSV vaccination for older adults** and **maternal immunisation** to protect infants. - Conflicts of interest: many authors were employees of Pfizer or IQVIA; disclosure details and affiliations are reported in the source.
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Affiliations Expand ### Affiliations * 1 Pfizer, São Paulo, São Paulo, Brazil. * 2 Pfizer, New York, USA. * 3 IQVIA, São Paulo, São Paulo, Brazil. * PMID: **42659036** * DOI: [ 10.7189/jogh.16.04251 ](https://doi.org/10.7189/jogh.16.04251) Item in Clipboard Observational Study # Seasonal dynamics and burden of respiratory syncytial virus, influenza, and COVID-19 in Brazil: a national surveillance study (2019-2023) Guilherme Silva Julian et al. J Glob Health. 2026. Show details Display options Display options Format Abstract PubMed PMID J Glob Health Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Glob+Health%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Glob+Health%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42659036/) . 2026 Aug 28:16:04251. doi: 10.7189/jogh.16.04251. ### Authors [Guilherme Silva Julian](https://pubmed.ncbi.nlm.nih.gov/?term=Julian+GS&cauthor_id=42659036)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42659036/#short-view-affiliation-1 "Pfizer, São Paulo, São Paulo, Brazil."), [Julia Regazzini Spinardi](https://pubmed.ncbi.nlm.nih.gov/?term=Spinardi+JR&cauthor_id=42659036)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42659036/#short-view-affiliation-1 "Pfizer, São Paulo, São Paulo, Brazil."), [Ana Paula Flora](https://pubmed.ncbi.nlm.nih.gov/?term=Flora+AP&cauthor_id=42659036)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42659036/#short-view-affiliation-1 "Pfizer, São Paulo, São Paulo, Brazil."), [Srinivas Rao Valluri](https://pubmed.ncbi.nlm.nih.gov/?term=Valluri+SR&cauthor_id=42659036)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42659036/#short-view-affiliation-2 "Pfizer, New York, USA."), [Florence Lefebvre d'Hellencourt](https://pubmed.ncbi.nlm.nih.gov/?term=d%27Hellencourt+FL&cauthor_id=42659036)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42659036/#short-view-affiliation-2 "Pfizer, New York, USA."), [Caihua Liang](https://pubmed.ncbi.nlm.nih.gov/?term=Liang+C&cauthor_id=42659036)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42659036/#short-view-affiliation-2 "Pfizer, New York, USA."), [Elizabeth Begier](https://pubmed.ncbi.nlm.nih.gov/?term=Begier+E&cauthor_id=42659036)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42659036/#short-view-affiliation-2 "Pfizer, New York, USA."), [Thaís Zamboni Berra](https://pubmed.ncbi.nlm.nih.gov/?term=Berra+TZ&cauthor_id=42659036)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42659036/#short-view-affiliation-3 "IQVIA, São Paulo, São Paulo, Brazil."), [Lucas Vieira Cortez](https://pubmed.ncbi.nlm.nih.gov/?term=Cortez+LV&cauthor_id=42659036)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42659036/#short-view-affiliation-3 "IQVIA, São Paulo, São Paulo, Brazil."), [Renato Vitorasso](https://pubmed.ncbi.nlm.nih.gov/?term=Vitorasso+R&cauthor_id=42659036)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42659036/#short-view-affiliation-3 "IQVIA, São Paulo, São Paulo, Brazil."), [Moe Hein Kyaw](https://pubmed.ncbi.nlm.nih.gov/?term=Kyaw+MH&cauthor_id=42659036)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42659036/#short-view-affiliation-2 "Pfizer, New York, USA.") ### Affiliations * 1 Pfizer, São Paulo, São Paulo, Brazil. * 2 Pfizer, New York, USA. * 3 IQVIA, São Paulo, São Paulo, Brazil. * PMID: **42659036** * DOI: [ 10.7189/jogh.16.04251 ](https://doi.org/10.7189/jogh.16.04251) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** The burden and seasonal patterns of respiratory syncytial virus (RSV), influenza, and COVID-19 remain poorly characterised in Brazil and other Latin American countries. Understanding their epidemiological patterns is essential to inform public health interventions and preventive strategies. We aimed to assess respiratory virus seasonality using national surveillance data to guide vaccination timing and strengthen preparedness strategies in Brazil. **Methods:** We conducted a retrospective, observational, descriptive population-based study using national surveillance data collected through the SIVEP system between 2019 and 2023. We analysed confirmed cases, hospitalisations, and deaths attributed to RSV, influenza, and COVID-19. We performed time-series decomposition and seasonal trend analysis using the multiple seasonal-trend decomposition via locally estimated scatterplot smoothing method. We calculated monthly mean values for each aetiology component to assess their seasonal burden. **Results:** There were 69,389 RSV, 45,881 influenza, and 2,299,712 COVID-19 cases among the laboratory-confirmed severe acute respiratory infection (SARI) cases reported in SIVEP. Each year, more than 90% of RSV diagnoses were reported in children aged 0-10 years, while influenza and COVID-19 were more common among older adults. The proportion of deaths in children related to RSV increased from 19.2% in 2020 to 62.0% in 2023. Seasonal peaks occurred from March to June for RSV, influenza cases peaked in January, while COVID-19 showed less consistent seasonality. Geographic variation was observed, with higher case concentrations in the Southeast and South regions of Brazil. **Conclusions:** The burden of respiratory viruses among SARI cases reported in the national surveillance system in Brazil differed by pathogen, age group, region, and season, and may be influenced by variations in testing strategies. Strengthening diagnostic capacity and surveillance is critical, particularly for adult RSV cases, which are likely underreported due to limited testing and reduced diagnostic sensitivity. Seasonal vaccination programmes, such as those for influenza, remain essential and may be further enhanced by integrating new preventive measures, such as RSV vaccination for older adults and maternal immunisation to protect infants. **Keywords:** Brazil; COVID-19; influenza virus; respiratory syncytial virus; seasonality; surveillance data analysis. © 2026 The Authors. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose the following activities and/or relationships: at the time of the study, GSJ, JRS, APF, SRV, FLH, CL, EB, and MHK were employees of Pfizer, São Paulo, Brazil. 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