Purpose: Respiratory Syncytial Virus (RSV) is a leading cause of infant morbidity and mortality. The purpose of this study was to identify barriers to timely and equitable uptake of RSV prevention and evaluate their clinical impact.
Methods: This was an IRB-exempted, single-center, retrospective chart review of infants born at Penn State Health Golisano Children’s Hospital from September 1, 2024 – March 31, 2025, with a first newborn follow up-visit post-hospital discharge within our system. The primary outcome was the percentage of mother-infant pairs who received RSV prophylaxis of any kind. Secondary outcomes included timing of infant RSV prophylaxis (age at administration of nirsevimab), time from discharge to first outpatient follow-up, and incidence of RSV infection and resulting hospitalization.
Results: 1364 infants were screened, and 946 met inclusion criteria. Of these, 76.7% of infants received RSV prophylaxis; 41.6% received nirsevimab, 35.1% with maternal vaccination, and 23.2% received no prophylaxis. Among prophylaxis recipients, 56.6% were White, 82.9% were not Hispanic, Latino, or Spanish origin, and 88.6% noted English as the preferred maternal language. Overall, 99.6% of infants who received RSV prophylaxis also received hepatitis B vaccine at a median age of 1 day of life, compared to 77.7% without RSV prophylaxis. Median time to outpatient follow-up post-hospital discharge was 2 days, with the median age of nirsevimab administration at 12 days (range 2-262). Commercial insurance was most common across groups.
Conclusion: RSV prophylaxis uptake was lower than hepatitis B vaccine administration (76.7% vs 94.5%) in our study cohort. Hepatitis B vaccine is given inpatient at our health system, while nirsevimab is deferred to the outpatient setting. Given high hepatitis B vaccine uptake, lower nirsevimab use likely reflects access barriers rather than hesitancy. These findings highlight gaps in equitable access and the need to improve timely provision of RSV prevention.
PGY1, Penn State Health Milton S. Hershey Medical Center
I’m originally from Dallas, PA, and got my PharmD from the University of Pittsburgh. I’ll be staying at Hershey next year to complete a PGY2 in Critical Care.
