Pregnant women and parents of young children generally preferred maternal vaccination over infant antibody administration to protect infants against respiratory syncytial virus infection, and a strong physician recommendation increased acceptance among some hesitant respondents.
The researchers conducted two concurrent national cross-sectional online surveys in April 2024 using a representative panel of US adults. The analysis included 174 pregnant women and 1,765 parents of children aged 0 to 5 years. The surveys assessed preferences, intentions, and behaviors related to respiratory syncytial virus (RSV) immunization, including maternal RSV vaccination during pregnancy and RSV antibody administration to infants.
The primary outcomes were positive intention to receive maternal RSV vaccination among eligible pregnant women and positive intention to have infants receive an RSV antibody shot among pregnant women and parents. Secondary outcomes included preferences between the two immunization strategies, the effect of physician recommendations on vaccine acceptance, and reasons for vaccine hesitancy.
Overall, respondents favored maternal vaccination over infant antibody administration. Fifty-eight percent of pregnant women preferred maternal vaccination compared with 6% who preferred an infant RSV antibody shot. Among parents, 48% preferred maternal vaccination, whereas 9% preferred infant antibody administration.
Among pregnant women eligible for maternal vaccination, 56% reported a positive intention to receive the vaccine. Of those who were initially negative or unsure, 36% said they would probably or definitely accept vaccination following a strong physician recommendation, although 64% said they would remain unwilling.
Intentions toward infant RSV antibody administration were similar. Fifty-six percent of pregnant women reported positive intentions to have their infant receive the antibody shot if eligible. Among pregnant women who were hesitant, 27% said a strong physician recommendation would change their decision, while 73% remained unwilling to accept the intervention.
Among parents, 60% reported positive intentions to have their child receive an RSV antibody shot, including 10% whose child had already received one. Among parents who initially expressed negative or uncertain intentions, 27% said they would probably or definitely accept the antibody shot following a strong physician recommendation, although 73% indicated they would still decline.
Across both surveys, the most common reasons for negative or uncertain intentions were insufficient information about RSV immunization and safety concerns. Among pregnant women, concerns centered on vaccine safety for both mother and infant, while parents most frequently cited uncertainty about the long-term safety of the infant antibody shot.
The authors noted that the survey measured intended rather than actual immunization behavior, vaccination status was self-reported and not verified, the relatively small sample of pregnant women limited subgroup analyses, and the independently surveyed parent and pregnancy cohorts prevented direct assessment of how prenatal intentions translated into infant immunization decisions.
Maternal RSV vaccination was the preferred infant protection strategy among survey respondents, and physician recommendations may improve acceptance among some hesitant families. However, persistent information gaps and safety concerns indicate that additional communication strategies may be needed to support informed RSV immunization decisions.
"The survey findings highlight an information gap as the key barrier to immunization and reinforce the importance of health care practitioner recommendations to encourage immunization," wrote lead study author Rachael M. Porter, MPH, of the Hubert Department of Global Health, Rollins School of Public Health, Emory University, and colleagues.
Dr Walter Orenstein reported consulting for Sanofi, Moderna, and Merck outside the submitted work. Dr Lavanya Vasudevan reported grants from the National Institutes of Health and the National Science Foundation outside the submitted work. No other disclosures were reported.
Source: JAMA Network Open
