Background With increasing global incidence in children younger than 5 years of age group, Respiratory Syncytial Virus (RSV) found to be the most common viral infection. In comparison to healthy adults, premature infants, young children, elderly and immunocompromised are most likely to present with increased severity. Hence, the aim of our study is to aims to assess the prevalence and risk factors for RSV infection in children under five at a tertiary-care hospital in Salem district. Materials and Methods: Hospitalized children aged < 5years with a diagnosis of acute lower respiratory infections (ALRI) admitted between period of October 2022 – December 2024 were included. Nasal & throat swab obtained from 434 cases presenting as a severe ARI taken for molecular analysis of RSV. Ribo nucleic acid (RNA) was extracted using the QiAmp Mini kit, and RSV detection was performed using real-time RT-PCR with manufacturer-specified primers. Data was analyzed using IBM SPSS software. Results: Among 434 children, 253 were boys and 181 were girls. Age distribution as follows : <1 year (n = 149), 1-2 years (n= 183), 2-5 years (n= 102). RT-PCR confirmed RSV in 69 children (16%), while 365 (84%) tested negative (Figure 2). Among RSV-positive children, 89.8% (n = 62) were born at term, and most had no underlying comorbidities Conclusion: A prevalence rate of 16% for RSV was recorded in Salem during the present study. It is utmost important to fasten community surveillance for the identification of high-risk patient and initiate effective infection control measures for RSV that will help to reduce the spread among public