Acceptance and preference between respiratory syncytial virus vaccination during pregnancy and infant monoclonal antibody among pregnant and postpartum persons in Canada

BACKGROUND: Vaccination during pregnancy and infant monoclonal antibodies (mAb) were recently approved to prevent respiratory syncytial virus (RSV) disease in infants. Our study aims to describe self-reported attitudes and preferences between vaccination during pregnancy and infant mAb for this indication. METHODS: From September 2023-March 2024, we completed a web-based, cross-sectional survey within the COVERED national prospective cohort study. Individuals who became pregnant in 2023 and were ≥ 19 years of age were included. We assessed demographics and general vaccination attitudes within and outside pregnancy, as well as attitudes toward newly licensed RSV products (i.e., vaccine during pregnancy, infant mAb), that were not yet available. Univariate and multivariate analysis was completed to identify predictors of accepting RSV immunization during pregnancy. RESULTS: A total of 723 participants completed the RSV survey module, of which 50.3 % (n = 364) were currently pregnant. Among all participants, 79 % (n = 568) would accept at least one of the RSV immunization strategies; 77 % (n = 559) would accept RSV vaccination during pregnancy and 55 % (n = 396) would accept infant mAb. Vaccination during pregnancy was preferred by 79 % (n = 567) of participants, infant mAb were preferred by 4.4 % (n = 32), and 14 % (n = 98) indicated no preference. Participants rated Tdap vaccination as the highest priority (51 %) followed by RSV (17 %), COVID-19 (14 %), hepatitis B (11 %), and influenza (7 %). Predictors of accepting RSV vaccine during pregnancy included acceptance of Tdap and COVID-19 vaccines during pregnancy (p < 0.001 and p = 0.006, respectively) and ranking RSV as a high priority among pregnancy vaccines (p = 0.006). CONCLUSION: In this national survey, more than two thirds of participants would accept the RSV vaccine while more than half would accept mAb. If given a choice, the vast majority preferred vaccination during pregnancy over mAb. These preferences should be considered when drafting policies and could influence cost-utility analyses.