Racial and Ethnic Differences in the Association Between Maternal RSV Awareness and Vaccine Uptake

Respiratory syncytial virus (RSV) is the leading cause of infant hospitalization in the United States. Following FDA approval of the maternal RSVpreF vaccine in August 2023, uptake has remained low, with emerging evidence of racial and ethnic disparities. Whether RSV awareness translates equally into vaccination across racial/ethnic groups is unknown. The purpose of this study was to examine racial/ethnic disparities in the association between RSV awareness and maternal vaccine uptake among pregnant women in the US.

We analyzed data from a cross-sectional, electronic survey of pregnant and postpartum women in the United States (June 2023-June 2024; n = 650). We used adjusted logistic regression with an interaction term between RSV awareness and race/ethnicity (White, Black, Hispanic) to test effect moderation, and estimated average marginal effects using the delta method.

The awareness × race/ethnicity interaction was statistically significant (χ²(2) = 6.11, p = 0.047). RSV awareness was associated with a 26.4%-point increase in vaccination probability among White women (p < 0.001) and a 23.2%-point increase among Black women (p < 0.001), but a non-significant 6.9%-point increase among Hispanic women (p = 0.311). Flu vaccine acceptance, underlying health conditions, having a healthcare background, and perceived better treatment quality were independent predictors of uptake.

The RSV awareness-vaccination pathway is significantly attenuated among Hispanic pregnant women, suggesting that awareness efforts alone are insufficient for this population. Equitable RSV vaccine coverage requires structural and system-level interventions together with broad awareness interventions, particularly for Hispanic women.