An unusually early surge in respiratory syncytial virus (RSV) disease occurred in the United States in the autumn of 2022 (Figure 1A and 1B), the causes of which are unknown. To investigate whether the emergence of a highly transmissible or virulent variant contributed to the surge, we sequenced RSV genomes from a convenience sample of symptomatic patients with RSV infection who presented to Massachusetts General Hospital or its outpatient practices in the greater Boston area in November 2022.