Objective: Respiratory tract infections remain a major cause of morbidity, with a disproportionate burden in the Caribbean. We aimed to characterize the seasonality and burden of key respiratory viruses across the Caribbean region of the Kingdom of the Netherlands.
Methods: We analysed virological detection data from 2018 to 2024 collected across all six islands. Seasonal patterns of rhinovirus, influenza virus, respiratory syncytial viruses (RSV) and human metapneumovirus (hMPV) were modelled using generalized additive models. Associations with climate, tourism, age, and disease severity were assessed.
Results: Rhinovirus was most frequently detected. Influenza peaked between November and March (P < 0.001), coinciding with periods of high tourism (e.g., Aruba: OR 8.72; 95% CI: 6.37-12.10). In contrast, RSV peaked between June and December (P < 0.001), closely aligning with the rainy season (e.g., Aruba: OR 6.42; 95% CI: 4.26-9.75). HMPV showed a distinct seasonal peak between November and December (P < 0.001), partially overlapping with both RSV and influenza circulation. Rhinovirus detection was significantly associated with increased disease severity, including oxygen therapy need (OR 2.78; 95% CI: 1.72-4.50) and respiratory distress (OR 2.26; 95% CI: 1.42-3.67).
Conclusions: RSV seasonality in the Caribbean differs substantially from that observed in temperate regions such as Europe, indicating that prevention schedules developed for temperate climates may be systematically misaligned with local transmission dynamics. Our region-wide data offer insights to guide locally tailored prevention strategies and underscore the need for climate- and mobility-aware respiratory virus preparedness in tropical island regions.
Keywords: Disease burden; Respiratory virus surveillance; Seasonal patterns; Tourism; Tropical epidemiology.
Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.