Genomic surveillance in the UAE reveals the global origins and local diversification of RSV lineages

Respiratory syncytial virus (RSV) remains a major cause of severe respiratory disease in young children, and the rollout of vaccines and monoclonal antibodies has increased the importance of genomic surveillance. Here, we combined epidemiological analysis of 2,350 laboratory confirmed RSV infections recorded in the United Arab Emirates between 2018 and 2023 with genomic surveillance of 312 RSV positive clinical isolates collected during the 2023 to 2024 season, integrating global phylogenetic contextualization and model based variant prioritization. Severe RSV disease in the UAE was concentrated in infants and young children, who accounted for most hospital and intensive care admissions. Phylogenetic analysis showed that RSV circulation in the UAE was shaped by repeated introductions of globally circulating RSV-A and RSV-B lineages, followed by local transmission and diversification. UAE RSV-B variants also showed elevated model predicted escape burden relative to year and substitution count matched public sequences, with the strongest signals arising from a subset of circulating variants rather than the most common recurrent substitutions. Together, these findings highlight the value of surveillance in the UAE for understanding RSV circulation in a globally connected setting and show how integrated epidemiological, genomic, and evolutionary analyses can prioritize variants for continued surveillance and experimental evaluation.