395 - Infant Immunity Unveiled: The Interplay of RSV Protection and Social Risk in Academic Primary Care Centers
Saturday, April 25, 2026
3:30pm - 5:45pm ET
Publication Number: 2384.395
Mary Burkhardt, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Melissa E. Day, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Anne K. Jackson, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Qing Duan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Emily Gehring, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Francis Real, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Andrew F. Beck, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
Associate Division Director, Primary Care Cincinnati Children's Hospital Medical Center Cincinnati, Ohio, United States
Background: Respiratory syncytial virus (RSV) is a leading cause of infant morbidity in the U.S., disproportionately affecting Black, Hispanic, and publicly insured infants. Nirsevimab, a monoclonal antibody recommended for RSV prevention, could promote more equitable outcomes, but might also widen gaps if not implemented thoughtfully. Objective: To examine the association between RSV immunity and social risk in infants during the first two seasons of immunization availability (2023–24 and 2024–25). Design/Methods: We conducted a retrospective study at three primary care practices serving a predominantly Black, non-Hispanic, publicly insured population. Nirsevimab was offered during both seasons. Data were extracted from electronic health records, including demographics, RSV immunity status (defined as infant receipt of nirsevimab or maternal receipt of RSV vaccination during pregnancy), and social risk screening results. Primary exposures included race, ethnicity, insurance type, social risk presence, and a community material deprivation index based on geocoded home address. Chi-squared tests assessed associations between these factors and RSV immunity. Results: A total of 1,653 and 1,692 infants (49.0% female, 65.0% Black, 11.3% Hispanic; 82.7% publicly insured) were eligible for RSV protection during the 2023-24 season and 2024-25 season, respectively. Demographic characteristics among eligible infants varied across the two years (Table 1). The percentage of immune infants increased significantly from 47.7% in 2023-24 to 60.5% in 2024-25 (p < 0.001). In the 2024-25 season, the average age of infant immunization was earlier (46 days vs. 54 days; p=0.022) and more mothers received RSV vaccine (6.3% vs. 1.6%; p< 0.001). Table 2 denotes differences in demographic and social risk measures, based on immune status. Black, non-Hispanic patients were less likely to be immune, but insurance status was not significantly associated. Patients with immunity to RSV were more likely to have a positive social risk screener across the two seasons (53.8% vs. 46.2%, p=0.018 in 2023-24 and 63.4% vs 36.6%, p=0.007 in 2024-25) and were more likely to endorse food insecurity in the 2024-25 season (67.3% vs 32.7%, p=0.006).
Conclusion(s): Uptake of nirsevimab in infants and mothers receiving RSV vaccine increased between the 2023-24 and 2024-25 RSV seasons. Race and ethnicity were associated with uptake, but not insurance type. Positive social risk was linked to increased RSV protection, suggesting that novel RSV therapeutics might be a tool for promoting equitable outcomes.
