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Background: The association between nasopharyngeal carriage of viruses and mild to moderate lower respiratory tract infections is poorly understood. We explore this association in an ongoing trial of fast breathing pneumonia with an objective to estimate the proportions of viral carriage in children with fast breathing pneumonia. Methods & Materials: The study is being conducted in two primary health care centers in low income communities located in Karachi, Pakistan. Children 2 to 59 months old identified to have cough and tachypnea defined by WHO without danger signs and other illness like T.B., asthma, enteric illness are included. Viral carriages are assessed by taking nasopharyngeal swabs and are analyzed using LUMINEX xTAG Respiratory Viral Panel assay. The data has been collected for the period from September 2014 to August 2015. Results: About 2126 (20%) of children in our community, who presented with respiratory symptoms at primary health center, are tachypnic. From these, 1055 are enrolled, nasopharyngeal results are available on 712 children. Rhinovirus is detected in 49% of the children, followed by Respiratory Syncytial Virus (RSV) in 6%, Human Metapnuemovirus in 5% and Human Bocavirus and Adenovirus in 3% of the cases. ParaInfluenza type III was detected in 7% and type IV in 5% of children, while rest of viral targets are found in ≤ 2% of the cases. The peak of Rhinovirus is found to be corresponding with increased presentation of cough in the months of October and January suggesting a positive epidemiological association. The rise of Human Metapneumovirus can be seen during early summer with peak in May and RSV in late summer (August to October) corresponding to increased episodes of fast breathing pneumonia. The peak of parainfluenza III coincides with increased episodes of tachypnea during January and February and Parainfluenza IV during December, March and May which seems to follow conventional seasonality pattern. Conclusion: The variation and pattern in detection of virus among children is corresponding with symptoms of fast breathing pneumonia indicating their possible role in pathogenesis of the disease. This makes a case for exploring the role of antibiotics and conducting association studies with carriage rates in controls. [ABSTRACT FROM AUTHOR]