More than 133,000 children passed through the emergency departments of the “Agia Sofia” and “Panagiotis & Aglaia Kyriakou” Children’s Hospitals in Athens in 2025 alone. Fever, cough and respiratory symptoms account for a large share of daily visits to pediatric emergency departments, but the most common symptoms do not necessarily indicate serious illness.
As another winter begins, data from Greece offer a picture of what actually brings children to the hospital and which of them ultimately need to be admitted. At the same time, defenses against infections are changing: alongside the annual flu vaccine, new forms of protection against respiratory syncytial virus (RSV) have been introduced, particularly for younger and more vulnerable infants.
“As we approach the winter season, we expect increased circulation of respiratory viruses, with influenza, respiratory syncytial virus (RSV) and SARS-CoV-2 being the main ones. At the same time, other respiratory viruses will circulate, such as rhinoviruses, adenoviruses and human metapneumovirus,” Evanthia Botsa, a pediatric infectious disease specialist and chair of the Hospital Infections Committee at Agia Sofia Children’s Hospital, told TO BHMA.
What brings children to the ER
A large retrospective study of around 2,300 children examined in the emergency department of Agia Sofia from January through June 2024 provides a representative picture. Fever was the leading reason for visits, accounting for 31%, followed by respiratory symptoms at 21.2%, gastrointestinal disorders at 17.2%, ear, nose and throat (ENT) symptoms at 13.8%, and the need for a child psychiatric assessment at 9.3%.
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More than one in four children had experienced symptoms for less than 24 hours, while 67.6% were discharged after examination. The study data are also particularly revealing when it comes to the severity of symptoms. Of the 2,300 visits, 489 resulted in hospitalization, or 21.3%. Nearly 45% of children who arrived with shortness of breath needed to be admitted, compared with about 20% of those with fever and 15% of those with mild respiratory symptoms.
“Particular attention is required for infants, especially during the first six months of life, premature newborns and children with chronic underlying conditions or immunosuppression, as they face an increased risk of severe illness,” Botsa emphasizes.
An entire winter season
Data from outside Athens complement the picture from the capital’s emergency departments, this time covering almost an entire winter season. A study by the Pediatric Clinic of the General Hospital of Edessa in Northern Greece recorded emergency visits from September 2025 through March 2026.
Of the 1,780 children examined in the emergency department, 308, or 17.3%, had a respiratory infection, and the overwhelming majority — 96.4% — had an upper respiratory tract infection.
Among the pathogens detected, influenza A ranked first at 56.8%, followed by streptococcus at 25.7%, RSV at 8.4% and SARS-CoV-2 at 3.4%. Despite the frequency of these infections, only 6.8% of the children required hospitalization.
The environment in which the infections occurred is also noteworthy. Some 90.5% of the children either attended school or had older siblings who attended school, while 8.2% had experienced more than five episodes of respiratory infection during the previous year. In 63.9% of cases, the parents smoked or vaped, while 21.4% of the children were not fully vaccinated for their age. These figures show associations and do not establish that the specific factors caused the infections.
More weapons before infection
While winter viruses return every year, what has changed significantly is the range of prevention options available.
“The important thing is that today we have more prevention tools than we did in the past. Timely flu vaccination, vaccination of pregnant women against RSV and the administration of specific monoclonal antibodies to infants are important tools for reducing severe illness and hospitalizations,” Botsa says.
The flu vaccine is administered every year because influenza viruses change and immunity weakens over time. According to Botsa, vaccination is recommended in Greece for all children ages 6 months to 5 years, as well as for older children with risk factors. For children and adolescents ages 2 to 18, there is also the option of a nasal vaccine, provided they have no contraindications.
“It contains live attenuated viruses and is not recommended, among others, for immunocompromised children or children with a history of asthma or recent recurrent wheezing. In these cases, the appropriate injectable inactivated vaccine is selected,” she explains.
The big change in RSV
The change in protection against RSV is even greater. The virus is one of the leading causes of bronchiolitis and hospitalization during the first year of life.
“Today we have two important protection strategies: vaccination during pregnancy and administration of a monoclonal antibody to the infant,” Botsa says.
Vaccination during pregnancy allows antibodies to be produced and transferred through the placenta to the fetus, providing protection during the first months of life. The second strategy involves a long-acting monoclonal antibody, nirsevimab.
“It is important to clarify that this is not a vaccine, but ready-made antibodies administered through a single intramuscular injection,” she stresses.
According to the recommendations she cites, in Greece nirsevimab is administered, among others, to newborns born during the period of increased RSV circulation when the mother was not vaccinated during pregnancy, as well as to specific categories of premature or otherwise high-risk infants.
“As a rule, when the mother has been vaccinated in time during pregnancy, the infant does not need additional nirsevimab. There are, however, exceptions, such as when delivery occurs less than 14 days after maternal vaccination or when particular risk factors are present,” she adds.
The difficult “no” to antibiotics
Finally, there is an old problem that returns every winter: the expectation that persistent fever or a cough requires an antibiotic.
“Antibiotics have no role in treating simple viral infections. Their indiscriminate use does not speed recovery and contributes to the development of antimicrobial resistance,” Botsa stresses.
Here, too, Greek data are revealing. In a study by the National Health System’s First Pediatric Clinic at Agia Sofia involving children with acute bronchiolitis, 55 of the 98 children had received antibiotics, or 56.1%. The researchers noted that antimicrobial treatment was frequently administered without clear evidence of a bacterial infection, even though acute bronchiolitis is generally a viral disease.
The new map of the pediatric winter, therefore, is not limited to which virus will dominate. Emergency department data show that many visits involve common infections that do not lead to hospitalization, while a smaller share of children — particularly infants and children with risk factors — require greater vigilance. At the same time, the ability to prevent severe illness has expanded considerably.
And perhaps that is the key message to carry into this winter.
“Our goal is not to cause concern among parents,” Botsa concludes, “but to inform them that we now have effective means of prevention which, when applied correctly and in a timely manner, can provide protection, particularly for the most vulnerable children.”