Demographics and Barriers to Pediatric Respiratory Syncytial Virus Immunization

Respiratory syncytial virus (RSV) is a leading cause of infant morbidity and mortality worldwide. In response, multiple prevention strategies have been implemented, including maternal vaccination and postnatal monoclonal antibody (mAb) administration. The United States Advisory Committee on Immunization Practices (ACIP) recommends routine post-natal use of RSV monoclonal antibody (mAb); however, only 70% of eligible infants receive vaccination. The objective of this study is to describe the demographics and vaccine beliefs associated with those who are not immunized against RSV.

We conducted a preliminary cross-sectional study in an urban pediatric emergency department in upstate New York between 10/1/25 and 12/19/25. Patient–parent dyads of infants aged 0–9 months were eligible. Exclusion criteria included critical illness, trauma, suspected non-accidental trauma, lack of a consenting guardian, or non-English-speaking caregivers. Caregivers completed surveys assessing demographics, vaccine beliefs, and intent to vaccinate. Non-intent was defined as answering “unsure,” “probably not,” or “definitely not.”

Among 47 enrolled dyads, 19 (40.4%) infants were not immunized against RSV through maternal vaccination or postnatal mAb. Of immunized infants, 23 (45%) had vaccinated mothers and 28 (54.9%) received mAb. Of infants not immunized, 11 (55%) of caregivers were categorized as non-intent to vaccinate their child. Being non-intent was more common among caregivers identifying as a minority race (87.5%), with household income ≤$89,000 (70%), and with undergraduate/technical degree or less (64.7%).

Nearly 2 in 5 infants were not immunized against RSV. Non-intent caregivers were more likely non-Caucasian, having an undergraduate/technical degree or less, and those with a household income of $89,000 or less. Further research should focus on identifying interventions that improve immunization coverage within these at-risk cohorts.