BACKGROUND: Respiratory syncytial virus (RSV) infections are one of the leading causes of lower respiratory tract infections and have a major burden on society. For prevention and control to be deployed effectively, an improved understanding of the seasonality of RSV is necessary. OBJECTIVES: The main objective of this study was to contribute to a better understanding of RSV seasonality by examining the GERi multi-country surveillance dataset. METHODS: RSV seasons were included in the analysis if they contained ≥100 cases. Seasonality was determined using the "average annual percentage" method. Analyses were performed at a subnational level for the United States and Brazil. RESULTS: We included 601 425 RSV cases from 12 countries. Most temperate countries experienced RSV epidemics in the winter, with a median duration of 10-21 weeks. Not all epidemics fit this pattern in a consistent manner, with some occurring later or in an irregular manner. More variation in timing was observed in (sub)tropical countries, and we found substantial differences in seasonality at a subnational level. No association was found between the timing of the epidemic and the dominant RSV subtype. CONCLUSIONS: Our findings suggest that geographical location or climatic characteristics cannot be used as a definitive predictor for the timing of RSV epidemics and highlight the need for (sub)national data collection and analysis.

Centre for Respiratory Disease and Meningitis National Institute for Communicable Diseases Johannesburg South Africa

Department of Epidemiology and Biostatistics 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Immunization and Communicable Diseases Ministry of Health Brasilia Brazil

Department of Infectious Diseases Epidemiology National Institute of Public Health Prague Czech Republic

Institute of Environmental Science and Research Limited Upper Hutt New Zealand

Instituto Nacional de Investigación en Salud Pública Centro de Referencia Nacional de Influenza y otros Virus Respiratorios Guayaquil Ecuador

Instituto Nacional de Saúde Doutor Ricardo Jorge Lisbon Portugal

Ministry of Health Singapore

National Centre for Infectious Diseases Singapore

National Centre of Epidemiology CIBER Epidemiología y Salud Pública Madrid Spain

National Institute for Public Health and the Environment Bilthoven The Netherlands

National Reference Laboratory for Influenza and Other Respiratory Viruses National Institute of Public Health Prague Czech Republic

Nivel Utrecht The Netherlands

Royal Centre for Disease Control Ministry of Health Thimphu Bhutan

Sanofi Pasteur Lyon France

Saw Swee Hock School of Public Health Singapore

School of Public Health University of Witwatersrand Johannesburg South Africa

Sección Virus Respiratorios Subdepartamento Enfermedades Virales Instituto de Salud Publica de Chile Santiago Chile

Subdepartamento Enfermedades Virales Instituto de Salud Pública de Chile Santiago Chile

Universidad Agraria del Ecuador Guayaquil Ecuador

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