38 - Racial and Ethnic Disparities in Maternal and Newborn RSV Immunization in the Birth Hospitalization

Publication Number: 2035.38

Ann Cheung, MassGeneral Hospital for Children, Boston, MA, United States; Leela Sarathy, Mass General Brigham for Children, Boston, MA, United States; Ananya Jain, MassGeneral Hospital for Children, Wilmington, DE, United States

Background: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections (LRTI) in children and a major cause of hospitalization among young children. Both maternal and infant RSV immunization have shown efficacy in reducing RSV-associated LRTI hospitalization among infants with favorable safety profiles. Research has shown inequities in nirsevimab uptake in the outpatient setting, however outcomes in the inpatient setting have been less studied.

Objective: To assess disparities in RSV immunization among mothers and newborns in the birth hospitalization based on race and ethnicity.

Design/Methods: A retrospective cohort study assessed RSV immunization across admitted mother-infant dyads at a single tertiary medical center between November 2024-February 2025. Other data collected included gestational age, gender, delivery type, and newborn medication receipt or declination, and maternal race, ethnicity, preferred language, age at delivery, religion, and insurance type. Women with fetal demise were excluded from the study. Chi-square analyses were performed to study the relationship between RSV immunization and race/ethnicity as well as language as primary outcomes. The relationship between RSV immunization and other patient characteristics were also studied.

Results: Of 1156 mothers, 854 (74%) received Abrysvo prior to delivery. Asian mothers had the highest vaccination rates (85%) while non-Hispanic Black mothers had the lowest rates (59%). Statistically significant associations between race and Abrysvo receipt were observed (p < 0.05).

Among 302 newborns, 135 (55%) infants received nirsevimab during hospitalization. Asian infants had the highest uptake (83%) and non-Hispanic White infants had the lowest uptake (47%). Statistically significant associations between race and nirsevimab receipt were observed (p < 0.05). The association between RSV immunization and language for both mothers and infants was not significant.

Secondary analyses showed statistical significance when comparing RSV administration in both groups to newborn medication administration and gestational age, and between maternal RSV immunization and maternal age < 30 years old, insurance type, and religion.

Conclusion(s): Our study shows disparities in RSV immunization based on race for mothers and infants. It reflects similar associations with other perinatal practices such as vitamin K refusals seen in other literature. However, we did not observe all disparities seen in the outpatient setting, suggesting that inpatient immunization administration can play an important role in decreasing health disparities.

Table 1. Maternal and Newborn RSV Immunization Rates by Race/Ethnicity
P-value calculated based on Pearson chi-square test of independent samples.

Table 2. Maternal and Newborn RSV Immunization Rates Based on Language
P-value calculated based on Pearson chi-square test of independent samples.

Table 3. Secondary Analyses
P-value calculated based on Pearson chi-square test of independent samples.