Background: Influenza is a leading cause of pediatric morbidity and hospitalization worldwide, yet data from the Middle East, including Oman, remain limited. This study aimed to describe the epidemiological and clinical burden of laboratory-confirmed pediatric influenza in Oman and to assess the impact of the COVID-19 pandemic on influenza circulation.Method: We conducted a retrospective cross-sectional review of pediatric patients (≤13 years) with laboratory-confirmed influenza A or B admitted to two tertiary care hospitals in Oman between January 2018 and December 2022. Demographic, clinical, laboratory, and outcome data were extracted from electronic medical records. Descriptive and temporal trend analysis of influenza were performed to compare between pre-post COVID-19 periods.Results: A total of 684 children were included (mean age 3.4 years; 52.6% male). The majority (53.4%) had underlying comorbidities, most commonly hematologic/oncologic and pulmonary conditions. Fever (90.8%), cough (80.4%), and coryza (69.9%) were the predominant presenting features, while gastrointestinal symptoms were reported in >30% of cases. Pneumonia was the most common complication (23%), followed by bronchiolitis (7.6%) and acute kidney injury (3.2%). ICU admission rates declined sharply during 2020–2021 but rebounded in 2022, coinciding with a shift from influenza A predominance to influenza B. Documented influenza vaccination was very low (4.7%), and most severe outcomes occurred in unvaccinated children. Overall mortality was 1.3%.Conclusion: Pediatric influenza remains a major cause of hospitalization in Oman, particularly among children under five and those with comorbidities. The COVID-19 pandemic profoundly disrupted influenza circulation, with a resurgence and altered subtype distribution in 2022.Improving vaccine coverage and strengthening surveillance are essential to mitigate future influenza burden in children.
