Pregnant Women Favor Maternal RSV Vaccine Over Infant Antibody Shot

A survey study published in JAMA Network Open found that pregnant women and parents of young children generally prefer maternal respiratory syncytial virus (RSV) vaccination over infant RSV antibody shot administration as a means of protecting infants against RSV-associated hospitalization. The 2 concurrent national cross-sectional surveys, fielded in April 2024 among 174 pregnant women and 1765 parents of children aged 0 to 5 years, found that only about half of participants reported positive intentions toward either immunization option, underscoring a persistent gap between product availability and uptake.¹

Preferences Lean Toward Maternal Vaccination

Among pregnant women eligible for vaccination, 55.5% reported positive intention toward maternal RSV vaccination, and 55.7% intended to have their child receive the RSV antibody shot if eligible. Parents of young children reported a slightly higher positive intention toward the antibody shot, at 59.8%, including 10.0% who had already immunized their child with it.¹

When asked directly about their preference between the 2 products, more participants favored maternal vaccination (parents, 48.3%; pregnant women, 58.2%) than the infant antibody shot (parents, 9.4%; pregnant women, 6.2%).¹

Two RSV immunization products have been available in the United States since 2023, which include a maternal vaccine administered at 32 to 36 weeks' gestation and a long-acting monoclonal antibody for infants younger than 8 months whose mothers were not vaccinated during pregnancy. There is no preferential recommendation between the 2 options, and families may choose either depending on eligibility and availability, with an additional monoclonal antibody product recommended for use in June 2025.¹

The preference for maternal vaccination observed in the survey aligns with separate research suggesting maternal immunization may offer longer-duration infant protection than monoclonal antibodies. A narrative review published in the Journal of Mother and Child found that maternal RSV vaccination provides protection for up to the child's first 6 months of life, compared with the narrower window covered by monoclonal antibodies such as palivizumab.²

Information Gaps Drive Hesitancy

Among pregnant women with negative or unsure intentions toward the RSV vaccine, the top reasons cited were not knowing enough about RSV or the vaccine to make a decision (50.4%), worry about vaccine safety for their child (38.6%), and worry about safety for themselves (33.0%). Parents reporting negative or unsure intentions toward the antibody shot most often cited worry about long-term safety (40.0%) and insufficient information (38.6%).¹

A strong health care practitioner recommendation shifted some participants toward acceptance: 35.8% of hesitant pregnant women said they would probably or definitely receive the maternal vaccine following such a recommendation, and 27.0% of hesitant parents said the same about the antibody shot for their child.¹

Still, most hesitant participants, ranging from 64.2% to 73.0% depending on the product and group, said they would not accept immunization even with a strong recommendation. Study authors concluded that a "multipronged communication strategy," including strengthened practitioner recommendations, is needed to address information and safety concerns among eligible families.¹

An Immunization Landscape in Flux

The survey's findings on persistent coverage gaps arrive at an unusually disrupted 2026 RSV season. National test positivity peaked at 9.1% in late February 2026, well above the 6.1% observed at the same point the previous year, with cases continuing into the spring before declining by May.³

"Respiratory syncytial virus season typically starts in the fall and peaks in the winter," Gretchen Garofoli, PharmD, BCACP, clinical professor in the School of Pharmacy at West Virginia University, said. "Cases also started later this season, which could be the reason that the peak occurred later, and cases continued later than expected."³

Pharmacists counseling families on RSV immunization are also contending with a fractured guidance environment. In January 2026, the AAP released an updated childhood and adolescent immunization schedule that, for the first time, explicitly diverged from the CDC recommendations, following a series of federal changes to vaccine policy.⁴

"For now, unfortunately, we have to ignore everything about vaccines that is coming from our federal government," Sean O'Leary, MD, MPH, chair of the AAP's Committee on Infectious Diseases, said.⁴

What This Means for Pharmacists

Together, these developments point to a widening gap between the information families need to make RSV immunization decisions and what they currently have, at a moment when official guidance itself is becoming harder to follow. Pharmacists are well positioned to help close that gap by addressing safety questions directly, explaining the distinctions between maternal vaccination and infant antibody shots, and reinforcing a clear practitioner recommendation, which survey data suggest can shift some hesitant patients toward acceptance.¹

As the study authors noted, continued uncertainty around vaccination decision-making, particularly during pregnancy, reinforces the need for consistent, proactive counseling at every point of contact with eligible families.¹

REFERENCES

1. Porter RM, Campos I, Shoaib M, et al. Respiratory syncytial virus immunization intention during pregnancy and infancy. JAMA Netw Open. 2026;9(7):e2625117. doi:10.1001/jamanetworkopen.2026.25117

2. Nowosielski B. Maternal RSV vaccine shows improved protection among infants. Drug Topics. August 18, 2025. Accessed July 28, 2026. https://www.drugtopics.com/view/maternal-rsv-vaccine-shows-improved-protection-among-infants

3. Gallagher A. Unusual RSV rates increased in early 2026, decreasing in May. Drug Topics. May 8, 2026. Accessed July 28, 2026. https://www.drugtopics.com/view/unusual-rsv-rates-increased-in-early-2026-decreasing-in-may

4. Nowosielski B. AAP releases updated childhood vaccine schedule amid recent HHS overhaul. Drug Topics. January 28, 2026. Accessed July 28, 2026. https://www.drugtopics.com/view/aap-releases-updated-childhood-vaccine-schedule-amid-recent-hhs-overhaul