Maternal RSV vaccine use lags despite benefits for infants

Clinical takeaway: Discuss RSV prevention during prenatal care, address safety concerns and access barriers, and plan timely maternal vaccination or infant antibody protection according to eligibility.

Infants face their greatest risk of severe RSV disease during the first months of life. Although maternal vaccination offers substantial protection, a new systematic review found that relatively few eligible pregnant patients received it during the first US vaccination season in 2023–2024.

Across 13 studies covering more than 1.3 million pregnancies, pooled maternal RSV vaccination coverage was 27.1% in the US during the 2023–2024 season. Coverage varied widely. Several studies linked lower vaccination rates to socioeconomic disadvantage, insurance differences, and reduced healthcare access. This estimate reflects maternal vaccination alone, rather than total infant protection through vaccination or antibody products.

Maternal vaccination was approximately 74% effective at preventing hospitalization for RSV-related lower respiratory tract infections during infants’ first six months of life when given at least 14 days before delivery.

Protection was lower with vaccination closer to birth, allowing less time for protective antibodies to cross the placenta. CDC recommends Abrysvo at 32–36 weeks’ gestation during September–January in most of the United States. Eligible infants born less than 14 days after maternal vaccination should receive an RSV antibody.

Real-world studies found no increased risk of preterm birth after maternal RSV vaccination, providing reassurance after clinical trials reported a small imbalance in preterm births between vaccine and placebo groups. Findings on hypertensive disorders of pregnancy were mixed, supporting continued safety monitoring.

“Efforts to increase uptake and reduce disparities will be essential to maximise the benefits of maternal RSV vaccination,” the study authors concluded.

Source: Balsells E, et al. (2026 Oct 7) Lancet Reg Health Eur. Real-world evidence on maternal RSV vaccination uptake, effectiveness, and safety: a systematic review and meta-analysis