Maternal Perceptions Regarding the Respiratory Syncytial Virus (RSV) Vaccine Following FDA Approval of Abrysvo®

Background: Respiratory syncytial virus (RSV) is the leading cause of hospitalization in the US for infants. Pfizer’s Abrysvo® RSV vaccine was approved in August 2023 for pregnant patients reaching 32-36 weeks gestational age (GA) between September and January to prevent RSV-related infant morbidity. The American College of Obstetrics and Gynecology (ACOG) published a practice advisory recommending seasonal Abrysvo® vaccination for all pregnant patients. Data on 2023 vaccination rates are available, but there is no information on how/why patients decide to obtain or refuse the Abrysvo® vaccine. Provider recommendation is a known major contributor to improve vaccine uptake in pregnant patients. However, CDC surveys assessing other vaccine acceptability rates indicate the presence of additional factors influence patient’s decisions for vaccine adherence including: perceived safety or the need for the vaccine, socioeconomic status and education level. Still, these factors are unpredictably related, as vaccines differ in the way they are perceived, and we anticipate that Abrysvo® will have a unique acceptability profile. The ACOG practice advisory briefly mentions the need for personalized considerations to ensure each patient has access to Abrysvo® and includes suggested counseling techniques to fully inform patients of the importance of this vaccine. However, there are no specific guidelines to assist providers. Study Purpose: We aimed to fill a knowledge gap that exists in the early stages of Abrysvo® implementation. These data will inform providers how to counsel patients and improve patient education regarding Abrysvo® more effectively. Methods: This study was approved by the local Institutional Review Board (# 24-612). To assess our patient’s perception of Abrysvo®, a pre-education survey was administered at prenatal visits between 28w0d to 31w6d GA. At subsequent prenatal visits, each provider counseled patients and answered questions regarding Abrysvo®. All patient discussions about Abrysvo® and vaccination status were documented in the electronic medical record (EMR). Once vaccination season ended, a follow-up postpartum survey was administered to assess potential changes in perception after education and barriers to obtaining the vaccine. Results: A total of 49 patients completed the pre-education survey. The majority of patients were 21-25 years old (38%), followed by ages 26-30 (30%), 31-35 (16%), ≤ 20 (10%) and 6% were between 36-40 years of age. The racial distribution of our patient population was 71.4% White, 20.4% Black, 4.1% mixed race/other and 4.1% declined to answer. Only 2.1% of patients reported Hispanic ethnicity. Most of these patients have a low socioeconomic status, indicated by a high percentage (81.6%) of Medicaid-insured patients and a low level of education, with most patients completing high school or less (40%) followed by some college courses (26%), college graduates (20%), trade school (10%) and master/doctorate (2%). Specific to RSV, 80% of the surveyed patients indicated they were previously aware of RSV, and 72% knew of the existence of the RSV vaccine for pregnant women. The majority reported hearing about Abrysvo® from healthcare providers (83.3%), with some reporting they learned about it through social media and/or the news (33.3%). When asked if they would receive Abrysvo® in pregnancy upon provider recommendation, 60% indicated they would receive the vaccine, with 22% not willing to get Abrysvo® and 18% unsure. Most patients indicated that the most important factors to consider in their decision to receive Abrysvo® were potential RSV-related health consequences to their infant (91.3%) and/or to themselves (45.7%). Those not planning to receive Abrysvo® were primarily concerned about possible side effects/safety (31.8%) and/or indicated a lack of information provided (15.9%). Patient’s preferred educational method to learn more about Abrysvo® was direct provider discussion (40.4%) and/or information with links to reputable websites (25.5%), with a lower number preferring self-education (12.8%), brochures (4.3%) or videos (4.3%). In particular, 12.8% indicated they did not think that any further education would help them. At the end of the season, only 19% of the surveilled patients were documented as having received Abrysvo®. The follow-up survey identified the inconvenience of obtaining the vaccine in a timely manner as the primary barrier to Abrysvo® vaccination. Interestingly, there was a discrepancy between the vaccination status reported in the survey vs. that documented in the EMR. Indeed, 54% of the patients who reported having received Abrysvo® had no documented evidence of receiving it, suggesting this patient population has a low level of health literacy and involvement in their own health status and treatments received. Conclusions: While 60% of the surveyed patients indicated a willingness to receive Abrysvo® upon provider recommendation and ~20% were unsure, overall, only 19% received Abrysvo® by the end of the season, suggesting the existence of additional barriers (other than low acceptability) affecting vaccination rates. Our results also indicate that the standard education delivered to these patients fell short in raising awareness regarding RSV prevention and highlight the need for personalized education strategies tailored to our vulnerable population.