From Selective Prophylaxis to Broad Infant RSV Protection: A Bibliometric Analysis and Evidence Gap Map, 1998-2025

Infant respiratory syncytial virus (RSV) prevention has moved from selective palivizumab prophylaxis toward broader protection through long-acting monoclonal antibodies and maternal vaccination. We examined how this research area evolved and whether original studies address evidence needed for implementation at scale.

We conducted a bibliometric analysis and evidence-gap mapping study of Web of Science Core Collection records from 1998 to 2025. The bibliometric corpus included 2004 publications; 1581 original articles underwent relevance screening and targeted audit, yielding 1227 studies for evidence-gap mapping. Analyses compared 1998-2022 with 2023-2025. A random sample of 150 articles was used to validate relevance screening.

Publication output rose sharply after 2022, with 2023-2025 accounting for 35.0% of the bibliometric corpus. Earlier work centered on palivizumab, preterm infants, and hospitalization; recent studies increasingly addressed nirsevimab, maternal RSV vaccination, implementation, and vaccine candidates. Hospitalization outcomes, disease burden, monoclonal antibody strategies, and real-world effectiveness were well represented, whereas coverage/uptake, acceptance, equity, safety monitoring, economic evaluation, applicability to low- and middle-income countries, and coordination between maternal vaccination and infant monoclonal antibodies were less common. Validation showed 86.7% agreement (Cohen's kappa = 0.52).

The literature has shifted toward broad infant RSV protection, but implementation-relevant evidence remains uneven. Comparative and program-level research is needed to determine how maternal vaccination and infant monoclonal antibody strategies can be implemented and coordinated across health systems while minimizing missed opportunities for protection.