Abstract Background During the COVID-19 pandemic, nonpharmaceutical interventions (NPIs) were introduced and altered circulation of common respiratory viruses, including the parainfluenza viruses (PIVs). Our aim was to describe the circulation of PIVs in Nashville, Tennessee before and during the pandemic. Methods We retrieved records of all respiratory specimens tested using a clinician-ordered respiratory pathogen panel (RPP) test between 01/01/2018, and 12/01/2022, at Vanderbilt University Medical Center. Using the results of RPP testing, we evaluated the proportion of PIV-positive tests before and during the COVID-19 pandemic, including by age groups (0–4, 5–17, 18–64, ≥65), and by PIV types 1-4. Any individual with a medical encounter >14 days was considered a distinct case. We used 04/01/2020, the day Tennessee’s stay-at-home order took effect, as the start date of the pandemic period. Results Of the 58,001 tests ordered during the 60-month study period, 2,601 (4.5%) tests were positive for PIV. PIV-3 was the most common serotype (1,493, 57.4%), followed by PIV-4 (374,14.4%), PIV-2 (356,13.7%), and PIV-1 (351,13.5%). The median age of those who tested PIV-positive was 2.6 years (IQR, 0.9–7.3 years) and 1,395 (53.6%) were male. PIV-1 and PIV-2 were more common children compared to adults. Before the pandemic, PIV-1 and PIV-2 peaked biennially, with PIV-1 peaking in the fall of odd months and PIV-2 peaking in the fall of even years. (Figure 1). PIV-3 and PIV-4 circulated annually, with PIV-3 peaking in the spring and PIV-4 peaking in the fall. During the pandemic, all PIV serotypes skipped a season, but resurfaced the following season. The distribution of detections across age groups was comparable before and during the pandemic. Figure 1. Monthly proportions of RPP tests positive for parainfluenza virus (PIV) in Nashville, Tennessee before and during the COVID-19 pandemic (January 2018–December 2022). The dashed line represents the first day Tennessee’s stay-at-home order was in effect. Co-detection refers to detection of more than one PIV serotype simultaneously. Conclusion The circulation of PIV in Nashville, Tennessee was disrupted during the COVID-19 pandemic, with PIVs not circulating for an entire season. However, circulation resumed the following season. Further investigation is needed to determine if clinical outcomes differed before and during the pandemic and the influence of NPIs shaped PIV transmission.