Newborn RSV immunization rates and reasons compared to family COVID-19 and influenza immunization status

Respiratory syncytial virus (RSV) is a common viral infection with the potential for severe illness in infants, leading to thousands of pediatric hospitalizations annually. In late 2023, Beyfortus (nirsevimab), a long-acting monoclonal antibody, became available to provide passive RSV immunization for all newborns meeting eligibility criteria. This study aimed to explore parental decision-making regarding RSV immunization, particularly in comparison to family uptake of COVID-19 and influenza vaccines, within an urban, predominantly Medicaid population in North Philadelphia.

This qualitative study was conducted at Temple University Hospital and Temple Pediatric Care outpatient clinic. Semi-structured interviews were performed with 25 parents and primary caregivers of newborns who received RSV immunization during the 2023-2024 season. Participants were recruited from a retrospective list and interviewed by phone using a standardized questionnaire. Grounded Theory methodology was applied for data analysis using iterative coding to identify themes related to immunization perceptions and acceptance.

Participants expressed high levels of trust in healthcare providers and prioritized safety and efficacy when making immunization decisions. Parents accepted RSV immunization due to personal or family experiences with RSV, general desire to protect their newborns, or pediatrician recommendation. In contrast, COVID-19 and influenza vaccine decisions were less consistent. Concerns about side effects and perceived lack of effectiveness were common reasons for declining COVID-19 vaccines, despite similar motivations for protection. Social media and political beliefs had minimal reported influence. Parents reported a lack of consistent, reliable online sources for vaccine information, often relying on general internet searches. Many misunderstood immunization/vaccine efficacy, equating it with complete immunity rather than reduced disease severity.

Parental acceptance of RSV immunization was driven by protective instincts for newborns and familiarity with RSV as a disease. Hesitancy toward COVID-19 vaccination stemmed largely from concerns about effectiveness and confusion around immunization/vaccine purpose. Trust in medical professionals influenced decision-making, though participants lacked a consistent source of immunization information. Improved public education on immunization efficacy and centralized access to trustworthy information may enhance immunization uptake and address ongoing hesitancy across all pediatric immunizations.