Published in PLOS One on 2026-05-21, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: James Arinaitwe, Barnabas Bakamutumaho, Levicatus Mugenyi, Noah Kiwanuka, Patricia Alupo, Aida N. Kawuma, Karen Ndahura, Maria Sekimpi, Eva Akurut, Winters Muttamba, Moses Joloba, Moses Ocan, Eddie Wampande, Jacqueline Kyosiimire Lugemwa, Jane Nakibuuka, John Lusiba, Joseph Okia, Darius Owachi, Pauline Byakika-Kibwika, Bruce Kirenga
Source: PLOS One • DOI 10.1371/journal.pone.0344869
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Acute respiratory infections (ARI) caused by viruses such as SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) posed significant public health challenges, particularly in low-income countries. Understanding the co-circulation dynamics of these pathogens is crucial for effective public health monitoring, surveillance, and control interventions. This study aimed to characterize the epidemiology of SARS-CoV-2, influenza, and RSV co-circulation among patients with ARI in Uganda’s central business districts.
A retrospective cohort study was conducted among 1,265 adult outpatients aged 18 years and older presenting with ARI in Kampala, Wakiso, and Mukono districts. Data were collected for the period from March 2023 through April 2024. Nasopharyngeal swabs were collected and tested for SARS-CoV-2, influenza A/B, and RSV using RT-PCR. Data on demographics, clinical presentation, and SARS-CoV-2 vaccination status were analyzed using descriptive statistics and time series analysis.
RSV was the most prevalent pathogen (5.5%), followed by SARS-CoV-2 (5.1%), Influenza A (4.4%), and Influenza B (1.7%). Individuals aged 45 and older were more likely to test positive for SARS-CoV-2. There was a significant difference in pathogen presence by occupation (p = 0.03), with health workers showing the highest prevalence of SARS-CoV-2 infection, while prevalence did not differ significantly by sex. Seasonal trends showed bimodal peaks for SARS-CoV-2, influenza A, and RSV, with the highest frequency observed between April 2023 to June 2023 and November 2023 to February 2024. However, Influenza B exhibited a single prolonged peak. SARS-CoV-2 vaccination was associated with a higher prevalence of SARS-CoV-2 (8.7% vs. 2.8%, p = 0.023) but not with influenza or RSV prevalence.
The co-circulation of SARS-CoV-2, influenza, and RSV highlights Uganda’s ongoing respiratory virus burden. Seasonal patterns and recurrent outbreaks underscore the need for sustained surveillance, targeted vaccination, and public health interventions to mitigate the impact of these pathogens, particularly in vulnerable populations.
Background
Acute respiratory infections (ARIs) remain a leading cause of morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) [1]. When these infections involve the lower respiratory tract referred to as lower respiratory tract infections (LRTIs), they can result in life-threatening complications, especially among the children, elderly, immunocompromised individuals, and those with underlying health conditions. The clinical presentation of ARIs ranges from mild upper respiratory symptoms such as cough, nasal congestion, and sore throat, to more severe manifestations including dyspnea, high fever, and respiratory distress. In LMICs, mortality associated with ARI-related LRTIs is disproportionately high due to constrained health system capacity, limited access to diagnostics, and delayed treatment [2–5]. Alongside influenza and SARS-CoV-2, RSV-associated infection also contributes significant burden, particularly affecting premature infants and the elderly, exacerbating global respiratory disease morbidity [6]. RSV exposure among these vulnerable populations often results in LRTI, hospitalizations, and adverse health outcomes [7]. Moreover, the co-circulation of SARS-CoV-2 with Influenza A and B viruses has been linked to exacerbated morbidity and mortality.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 James Arinaitwe, Barnabas Bakamutumaho, Levicatus Mugenyi, Noah Kiwanuka, Patricia Alupo, Aida N. Kawuma, Karen Ndahura, Maria Sekimpi, Eva Akurut, Winters Muttamba, Moses Joloba, Moses Ocan, Eddie Wampande, Jacqueline Kyosiimire Lugemwa, Jane Nakibuuka, John Lusiba, Joseph Okia, Darius Owachi, Pauline Byakika-Kibwika, Bruce Kirenga. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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