Pediatricians’ attitudes and knowledge of RSV immunization products: A multi-country cross-sectional survey

Objective: 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.