BACKGROUND: Respiratory syncytial virus (RSV) is a common respiratory virus that often results in mild, cold-like symptoms in adults but can lead to severe disease in certain groups (e.g., older adults and those with comorbidities). The 2023-2024 RSV season marked the first season that RSV vaccines were available in the United States (US) for use among adults aged ≥ 60 years. Specifically, in May 2023, the US Food and Drug Administration (FDA) approved the adjuvanted RSVPreF3 vaccine1, and the RSVpreF vaccine2 for use in this age group. In June 2023, these vaccines were recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) using shared clinical decision-making (SCDM)3. With this type of recommendation, healthcare professionals (HCPs) and patients should discuss RSV vaccination to jointly decide whether patients should receive the vaccine. Given the recent availability of RSV vaccines for use in older adults and potential challenges in implementing SCDM vaccine recommendations4, the objective of this study was to evaluate US HCP knowledge, attitudes, and practices (KAP) regarding RSV disease and vaccination.
METHODS: A cross-sectional, web-based survey of HCPs was conducted in November 2023. HCPs were recruited from an online panel of HCPs, with the study targeting a sample size of approximately 600 HCPs (including 150 primary care physicians [PCPs], 150 specialist physicians, 150 nurse practitioners [NPs]/physician assistants [PAs], and 150 pharmacists). Specialist physicians included pulmonologists, cardiologists, and endocrinologists, with approximately 50 physicians in each category targeted for study inclusion. HCPs were required to live in the US, work ≥ 21 hours weekly in direct patient care, provide care for patients aged ≥ 50 years, and be in their current profession for ≥ 2 years. PCP, specialist physician, and NP/PA HCPs were excluded if they worked primarily in an inpatient setting or spent most of their time in emergency care or a surgical setting. Pharmacist HCPs were excluded if they worked primarily in a mail-order, hospital-based, or specialty pharmacy. Survey questions focused on HCP knowledge of RSV disease and vaccines in older adults, RSV-related attitudes and perceptions (e.g., related to RSV risk, SCDM vaccine recommendations), RSV vaccination practices in adults aged ≥ 60 years during the first season of vaccine availability, and perceived barriers and facilitators to RSV older adult vaccination. Descriptive analyses were conducted on survey responses for the overall HCP sample and stratified by HCP type.
RESULTS AND CONCLUSION: The survey was completed by 603 HCPs, including 148 PCPs, 151 specialist physicians, 150 NPs/PAs, and 154 pharmacists. Although most HCPs (63.0%) reported being very familiar with RSV disease in older adults, several knowledge gaps were identified. As an example, at the time of data collection, 24.9% of HCPs did not know that older adult RSV vaccines were FDA-approved with an ACIP recommendation. Despite recognizing the benefit of having these vaccines available and recommended, protecting older adults against RSV was ranked lower priority than several other respiratory infections. In the previous 3 months, 33.5% of HCPs did not recommend, prescribe, or administer an RSV vaccine to any patients aged ≥ 60 years. In an average week, HCPs estimated that they initiate SCDM conversations with 27.0% of patients aged ≥ 60 years. These conversations are more often initiated by HCPs/other healthcare team members versus patients. Many HCPs (39.3%) are worried that they are not initiating SCDM conversations with all older adult patients who are at increased risk of severe RSV disease and 38.5% agreed that SCDM recommendations may result in health disparities. Nearly half of HCPs (48.3%) felt that recommendations should be changed to age-based recommendations. Survey results describe RSV disease- and vaccine-related KAP among US HCPs, including initial insights into older adult RSV vaccination practices during the first season of vaccine availability. Findings can be used to inform HCP and patient education efforts aimed at ensuring equitable access to RSV vaccines among older adults.
