Abstract

Purpose Nirsevimab and the maternal vaccination in pregnancy are newly introduced prevention strategies against respiratory syncytial virus (RSV). This study evaluated pediatricians’ knowledge, attitudes, and barriers to RSV immunization in Italy and Cyprus/Greece, where nirsevimab had not yet been implemented, and in Spain, where it was introduced in 2023/2024.

Methods A survey was distributed to pediatricians across Spain, Italy, and Cyprus/Greece in July-August/2024. Occupational characteristics, and knowledge, attitudes and practices toward palivizumab, nirsevimab, and the maternal vaccine were collected. Of 578 respondents (response rate=19.3%), 50% were from Spain, 40% from Italy, and 10% from Cyprus/Greece. As 90% of responses came from Spain and Italy, the main analysis focused on these two countries. Descriptive and univariate analyses (Chi-square or Fisher’s exact tests) were conducted.

Results Respondents included pediatricians from community (51.7%), tertiary (30.4%), and primary/secondary care (17.9%) settings. Pediatricians were generally aware of RSV risk factors, without differences across countries. However, 245 (55.9%) and 375 (86.0%) participants reported average-to-low knowledge of nirsevimab and the maternal vaccine, respectively, with differences across countries (p=0.002). Despite limited knowledge, 311 (85.9%) pediatricians were willing to administer nirsevimab, and 319 (92.2%) supported its use for all infants. Nirsevimab administration’s barriers, including unfamiliarity and logistical challenges, were cited by 69 (20.0%) pediatricians. Regarding immunization preferences, 165 (47.4%) pediatricians were very likely to support the maternal vaccine over nirsevimab.

Conclusions While pediatricians support RSV immunization, knowledge gaps and logistical barriers may hinder early-stage implementation. Optimizing education on RSV immunization will be crucial to improve uptake and prevention strategies.

What’s Known on This Subject There is limited evidence regarding pediatricians’ attitudes and knowledge of nirsevimab and maternal RSV vaccination during pregnancy.

What This Study Adds This multi-country survey evaluates pediatricians’ knowledge, attitudes, and barriers to RSV immunization in Italy and Cyprus/Greece, where nirsevimab had not yet been implemented, and in Spain, where it was introduced in 2023/2024.

Competing Interest Statement

IRC has received speaking fees from MSD, GSK, Sanofi, Moderna and Pfizer; scholarships/research grants from Sanofi Pasteur, MSD, Novartis and Pfizer; consulting fees for Pfizer, MSD, Sanofi; and has participated as a subinvestigator in clinical trials of vaccines from Ablynx, Abbot, Seqirus, Sanofi Pasteur MSD, Sanofi Pasteur, Cubist, Wyeth, Merck, Pfizer, Roche, Regeneron, Jansen, Medimmune, Novavax, Novartis and GSK. IRC belongs to the Board of Directors of the CAV-AEP. AS-A has received funding from Sanofi, Pfizer and MSD for lectures and grants. ALV has received research grants from MSD and funding from Angelini Pharma for lectures and advisory boards. SKM has received funding from GSK, Pfizer, and Sanofi Pasteur for lectures and ad hoc advisory boards. The other authors have indicated that they have neither potential conflicts of interest nor financial relationships relevant to the article to disclose.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

As part of a broader research initiative conducted in Canada, this study was submitted to and approved by the Hospital for Sick Children s Research Ethics Board (REB # 1000081077), with protocol acknowledgment in Cyprus and Greece. Due to anonymity, ethics approval wasn t needed in Spain and Italy. Participation was voluntary, with implied consent upon survey completion.

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Yes

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Yes

AbbreviationsRSVRespiratory Syncytial VirusEMAEuropean Medicines AgencyFDAU.S. Food and Drug AdministrationREDCapResearch Electronic Data CaptureSMDStandardized Mean Difference