Respiratory Syncytial Virus Vaccination in Pregnancy and Social Determinants of Health

Abstract

Objective

Social determinants of health (SDOH) may impact the incidence of respiratory syncytial virus (RSV) infection and the uptake of vaccinations in pregnancy. The objective of this study is to identify contributors to disparities in RSV vaccination in pregnancy.

Study Design

This is a retrospective cohort study of patients delivering at term within three hospitals during February and March 2024, comparing pregnant patients identified as receiving versus not receiving RSV vaccinations. This period and gestational age were chosen to include patients who would have qualified for RSV vaccination administration. Vaccination status was extracted from standardized admission templates where these variables were recorded as discrete fields. Patients without RSV vaccination information were excluded. Sociodemographic factors, COVID-19 vaccination status, and delivery campus were evaluated. Outcomes were analyzed using chi-squared, t-test, and McNemar test.

Results

A total of 2,181 patients met inclusion criteria and RSV vaccination information was available for 1,548 patients (71%) with a 14% vaccination rate. Compared with those not vaccinated (n = 1,332), RSV-vaccinated patients (n = 216) were more likely to be older (30.7 vs. 34.8, p < 0.001), have private insurance (42 vs. 85%, p < 0.001), speak English (82 vs. 95%, p < 0.001), and deliver at our regional perinatal center (26 vs. 77%, p < 0.001). Fifty percent of RSV-vaccinated patients had a history of COVID-19 vaccination compared with 33% of those not vaccinated against RSV (p < 0.001).

Conclusion

SDOH was associated with differences in RSV vaccination status. In addition, patients without RSV vaccination were less likely to have had COVID-19 vaccination. These findings highlight the need to address SDOH to increase vaccination rates for vulnerable populations.

Key Points

• The rate of RSV vaccination in pregnant patients is low.

• Patients vaccinated against RSV tended to be older, privately insured, and English-speaking.

• SDOH and COVID-19 vaccination status are associated with RSV vaccination rates.

Keywords

obstetrics - public health - RSV - vaccination - social determinants of health

Publication History

Received: 20 February 2025

Accepted: 28 March 2025

Accepted Manuscript online:
28 March 2025

Article published online:
22 April 2025

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