Regional variation in maternal RSV vaccine access and attitudes across two California cohorts

Objective To compare maternal RSV vaccination rates, attitudes, and vaccine information sources between an urban academic hospital in San Francisco and a regional hospital serving a predominantly rural population in Fresno, California. Methods Individuals eligible for RSV vaccination during pregnancy were recruited on postpartum units between 11/2024–3/2025 using convenience sampling. Participants completed a survey assessing vaccination status, attitudes, and information sources. Results Of 149 approached patients, 94 completed the survey (63.09% response rate; San Francisco, 62/114 [54.39%]; Fresno, 32/35 [91.43%]). San Francisco participants were older (mean [SD], 36.11 [4.06] vs. 29.19 [5.60] years; p < 0.01), more often privately insured (87.10% vs. 6.25%; p < 0.01), and less likely Hispanic-identifying (6.45% vs. 75.00%; p < 0.01). RSV vaccine uptake was higher in San Francisco than in Fresno (77.42% vs 31.25%; p < 0.01). San Francisco participants more often reported receiving vaccine information from healthcare providers (93.55% vs 62.50%; p < 0.01). Among unvaccinated participants, lack of awareness (36.36%) and not being offered the vaccine (27.27%) predominated in Fresno, whereas safety concerns (42.86%) predominated in San Francisco. Conclusions Marked regional differences in maternal RSV vaccination highlight the need for system-level strategies to ensure equitable vaccine access and education, alongside continued vaccine safety research to build patient confidence.