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. 2025 Apr 1;8(4):e252841.
doi: 10.1001/jamanetworkopen.2025.2841.

Patient- and Community-Level Characteristics Associated With Respiratory Syncytial Virus Vaccination

Diya Surie  1 , Katharine A Yuengling  1 , Basmah Safdar  2 , Adit A Ginde  3 , Ithan D Peltan  4   5 , Samuel M Brown  4   5 , Manjusha Gaglani  6   7   8 , Shekhar Ghamande  6   8 , Robert L Gottlieb  7   9 , Cristie Columbus  7   10 , Nicholas M Mohr  11 , Kevin W Gibbs  12 , David N Hager  13 , Mary O'Rourke  14 , Michelle N Gong  15 , Amira Mohamed  15 , Nicholas J Johnson  16 , Jay S Steingrub  17 , Akram Khan  18 , Abhijit Duggal  19 , Jennifer G Wilson  20 , Nida Qadir  21 , Steven Y Chang  21 , Christopher Mallow  22 , Laurence W Busse  23 , Jamie Felzer  23 , Jennie H Kwon  24 , Matthew C Exline  25 , Ivana A Vaughn  26 , Mayur Ramesh  27 , Adam S Lauring  28   29 , Emily T Martin  30 , Jarrod M Mosier  31 , Estelle S Harris  32 , Adrienne Baughman  33 , Sydney A Swan  34 , Cassandra A Johnson  34 , Paul W Blair  35 , Nathaniel M Lewis  36 , Sascha Ellington  36 , Rachel E Rutkowski  1 , Yuwei Zhu  34 , Wesley H Self  33   35 , Fatimah S Dawood  1 ; Investigating Respiratory Viruses in the Acutely Ill (IVY) Network
Affiliations

Patient- and Community-Level Characteristics Associated With Respiratory Syncytial Virus Vaccination

Diya Surie et al. JAMA Netw Open. .

Abstract

Importance: In 2023, the first respiratory syncytial virus (RSV) vaccines were recommended for US adults 60 years or older, but few data are available about which patients were most likely to receive vaccine to inform future RSV vaccine outreach efforts.

Objective: To assess patient- and community-level characteristics associated with RSV vaccine receipt and patient knowledge and attitudes related to RSV disease and RSV vaccines.

Design, setting, and participants: During the first season of RSV vaccine use from October 1, 2023, to April 30, 2024, adults 60 years or older hospitalized with RSV-negative acute respiratory illness were enrolled in this cross-sectional study from 26 hospitals in 20 US states. Sociodemographic and clinical data were abstracted from health records, and structured interviews were conducted for knowledge and attitudes about RSV disease and RSV vaccines.

Exposures: Age, sex, race and ethnicity, pulmonary disease, immunocompromised status, long-term care facility residence, medical insurance, social vulnerability index (SVI), and educational level.

Main outcomes and measures: The exposures were identified a priori as possible factors associated with RSV vaccine receipt and were entered into a modified Poisson regression model accounting for state clustering, to assess for association with RSV vaccine receipt. Knowledge and attitudes were summarized with frequencies and proportions.

Results: Among 6746 hospitalized adults 60 years or older, median age was 73 (IQR, 66-80) years and 3451 (51.2%) were female. Among the 6599 patients with self-reported race and ethnicity, 699 (10.6%) were Hispanic, 1288 (19.5%) were non-Hispanic Black, 4299 (65.1%) were non-Hispanic White, and 313 (4.7%) were other race or ethnicity. There were 700 RSV-vaccinated (10.4%) and 6046 unvaccinated (89.6%) adults. Among 3219 unvaccinated adults who responded to RSV knowledge questions, 1519 (47.2%) had not heard of RSV or were unsure; 2525 of 3218 (78.5%) were unsure if they were eligible for RSV vaccine or thought they were not. In adjusted analyses, characteristics associated with RSV vaccination were being 75 years or older (adjusted risk ratio [ARR], 1.23; 95% CI, 1.10-1.38, P < .001), being male (ARR, 1.15; 95% CI, 1.01-1.30; P = .04), and having pulmonary disease (ARR, 1.39; 95% CI, 1.16-1.67; P < .001), immunocompromised status (ARR, 1.30; 95% CI, 1.14-1.48; P < .001), low (ARR, 1.47; 95% CI, 1.18-1.83, P < .001) or moderate (ARR, 1.47; 95% CI, 1.21-1.79; P < .001) SVI, and educational level consisting of 4 or more years of college (ARR, 2.91; 95% CI, 2.14-3.96; P < .001), at least some college or technical training (ARR, 1.85; 95% CI, 1.35-2.53; P < .001), or grade 12 education or General Educational Development (ARR, 1.44; 95% CI, 1.03-2.00; P = .03). RSV vaccination was less likely among residents of long-term care facilities, patients with Medicaid coverage, and uninsured patients.

Conclusions and relevance: In this cross-sectional study of hospitalized adults, knowledge of RSV disease and RSV vaccine eligibility was low. Older adults and those with certain medical conditions were more likely to have received vaccine, suggesting appropriate prioritization, but sociodemographic differences in vaccine uptake occurred.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Peltan reported receiving grant support from Bluejay Diagnostics Inc and Novartis AG outside the submitted work. Dr Brown reported having a patent for an airway device with royalties paid from ReddyPort and Company. Dr Gaglani reported receiving grant support from the Centers for Disease Control and Prevention (CDC) US Flu Vaccine Effectiveness Network and CDC-Westat Virtual SARS-CoV-2, Influenza, and Other Respiratory Viruses Network study outside the submitted work. Dr Gottlieb reported receiving research fees to institution and consulting and advisory board fees from AbbVie Inc, AstraZeneca, Eli Lilly and Company, and Gilead Sciences Inc, honoraria and gift-in-kind of medication to institution from Gilead Sciences Inc, research fees to institution and consulting and national coordinating investigator fees from Johnson & Johnson, research fees to institution and speaker fees from Pfizer Inc, and personal fees from Invivyd Inc outside the submitted work. Dr Hager reported receiving grant support from the National Institutes of Health (NIH) via Vanderbilt University Medical Center subcontract outside the submitted work. Dr Gong reported receiving grant support from the NIH and scientific advisory board fees from Regeneron Pharmaceuticals Inc, Novartis AG, and Koninklijke Philips NV outside the submitted work. Dr Mohamed reported receiving grant support from the Agency for Health Care Research and Quality and consulting fees from Baxter International Inc outside the submitted work. Dr N.J. Johnson reported receiving grant support from the NIH, American Heart Association, and Department of Defense and advisory board fees from NeurOptics Inc outside the submitted work. Dr Khan reported receiving grant support from Jazz Pharmaceuticals plc, 4DMedical, Roche, Dompé Farmaceutici, Direct Biologics LLC, and Eli Lilly and Company outside the submitted work. Dr Duggal reported receiving grant support from the NIH outside the submitted work. Dr Exline reported having a patent pending for Breath Detection of Viral Illness from The Ohio State University. Dr Vaughn reported receiving grant support from the CDC subcontract via University of Michigan, eMaxHealth via Henry Ford Health, Lilly USA via Henry Ford Health, and Evidera via Henry Ford Health outside the submitted work. Dr Ramesh reported advisory board fees from Moderna Inc and Pfizer Inc and consulting fees from AstraZeneca outside the submitted work. Dr Lauring reported receiving personal fees from Roche for a clinical trial outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flow Diagram
RSV indicates respiratory syncytial virus. aComponents of exclusion are not mutually exclusive.
Figure 2.
Figure 2.. Knowledge of Respiratory Syncytial Virus (RSV) Disease Among Adults 60 Years or Older Hospitalized With RSV-Negative Acute Respiratory Illness
A, A total of 3694 adults responded to the question. B, Of 6046 unvaccinated adults, 3070 responded. GED indicates General Educational Development. C, Of 6046 unvaccinated adults, 2804 with information available responded. The social vulnerability index (SVI) is a measure of the potential negative effects on communities caused by external stresses on human health and is based on inputs from 16 US census variables. Higher SVI values correspond to communities with higher social vulnerability; 0 to 0.39 indicated a low SVI; 0.40 to 0.59, moderate SVI; and 0.60 to 1.00, high SVI. Error bars indicate Clopper-Pearson 95% CI. aWe used χ2 test with Rao-Scott adjustment for within-state clustering to compare the proportions of vaccinated vs unvaccinated patients who reported knowledge of RSV disease. Participants with “no” or “unsure” responses were combined for statistical comparisons.
Figure 3.
Figure 3.. Knowledge of Respiratory Syncytial Virus (RSV) Vaccine Eligibility Among Adults 60 Years or Older Hospitalized With RSV-Negative Acute Respiratory Illness
A, A total of 3693 adults responded to the question. B, Of 6046 unvaccinated adults, 3069 responded. GED indicates General Educational Development. C, Of 6046 unvaccinated adults, 2803 with information available responded. The social vulnerability index (SVI) is a measure of the potential negative effects on communities caused by external stresses on human health and is based on inputs from 16 US census variables. Higher SVI values correspond to communities with higher social vulnerability; 0 to 0.39 indicated a low SVI; 0.40 to 0.59, moderate SVI; and 0.60 to 1.00, high SVI. Error bars indicate Clopper-Pearson 95% CI. aWe used χ2 test with Rao-Scott adjustment for within-state clustering to compare the proportions of vaccinated vs unvaccinated patients who reported knowledge of RSV vaccine eligibility. Participants with “no” or “unsure” responses were combined for statistical comparisons.
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