Respiratory syncytial virus (RSV) is a common respiratory virus that can cause severe breathing complications in babies, especially those younger than 6 months old. While many adults recover quickly from RSV with mild symptoms similar to a cold, infants often face a much greater risk of hospitalization due to their developing immune systems and smaller airways. One hundred to 300 children aged less than 5 years die of RSV each year.
In the fall of 2023, a new maternal RSV vaccine became available to protect infants from this life-threatening illness. Health experts recommend vaccination at 32 to 36 weeks’ gestation so antibodies can pass from mother to baby before birth. These antibodies should reduce severe infant RSV infections and decrease infant hospital admissions during peak RSV season.
Preparing for another RSV season
In the fall of 2023, Dallas health care providers prepared for what experts predicted would be another difficult RSV season. Health care professionals hoped that the maternal RSV vaccination could ease pressure on health care systems while protecting vulnerable newborns.
However, vaccination rates among pregnant women in Dallas varied widely throughout the 2023–2024 RSV season. Several sociodemographic factors influenced which mothers received the RSV vaccine.
At a public health clinic in Dallas County, obstetricians were eager to discuss the new maternal RSV vaccine with their patients. They also anticipated limitations in vaccinating patients.
“We aim to prioritize offering the maternal RSV vaccine to all eligible pregnant patients. However, accessibility is an issue,” a Dallas obstetrician said. “First, there is a national shortage. Second, patients on public insurance can only be vaccinated at federally reimbursed locations.”
Previous studies on maternal immunizations have described disparities in maternal vaccination rates among racial/ethnic groups due to vaccine acceptance and not due to availability.
In our study, published in Public Health Reports, we aimed to identify factors that influenced maternal RSV vaccination rates during the 2023–2024 season in Dallas. We also aimed to determine if the maternal RSV vaccine lowered infant hospitalization rates.
Health insurance type affects vaccination rates
Having private health care insurance increased the likelihood that a mother received the maternal RSV vaccine. In our study, women with private health insurance (37%) were more likely to be vaccinated than women with public (2%) or no health insurance (12%).
A Dallas nurse practitioner said, “Without private health insurance, women face cost-related barriers to accessing and paying for the maternal RSV vaccine.”
Public health officials recognized that economic inequality contributed to lower vaccination rates in certain Dallas communities, particularly among uninsured and underinsured populations.
Race and ethnicity affect vaccination status
In the 2023–2024 RSV season in Dallas, non-Hispanic Black women (6%) and Hispanic women (15%) were vaccinated at lower rates compared with non-Hispanic white (39%) and non-Hispanic Asian women (35%). Many non-Hispanic Black women and Hispanic women in Dallas either had no health insurance or received public health insurance. The disparity in insurance coverage shows how race, ethnicity, and health insurance coverage are interrelated.
Other societal factors affecting maternal vaccination rates
In our study, we also demonstrated that maternal RSV vaccination rates were lowest in women aged less than 30 years, who had a history of smoking or drug exposure, were multiparous, and who exclusively breastfed. Many studies have previously shown that young maternal age, maternal criminal history, and maternal history of psychiatric and substance use disorders increase the risk for RSV-related hospital admission in children. Thus, given our findings, it is crucial to target these sociodemographic groups for RSV prophylaxis.
Breastfeeding and maternal vaccination decrease infant RSV illness
Almost 3% of newborns born to mothers who did not receive the maternal RSV vaccine were hospitalized due to RSV. In our study, none of the babies whose mothers received the maternal RSV vaccine were hospitalized. We determined the vaccine effectiveness of the maternal RSV vaccine to be 100%.
However, vaccination alone does not eliminate RSV hospitalizations entirely. Preventive measures such as handwashing, avoiding sick contacts, timely pediatric care, and breastfeeding support remain essential components of infant protection.
Our study confirmed that exclusive breastfeeding was protective against severe RSV illness in infants. Breast milk is widely known to protect infants because it contains antibodies that help the infant’s immune system.
Conclusion
The 2023–2024 RSV season in Dallas, Texas, demonstrated both the promise and the challenges of maternal RSV vaccination. The maternal RSV vaccine provides an important opportunity to reduce severe illness and hospitalization among vulnerable infants, especially during the earliest months after birth. Yet many mothers faced barriers that influenced whether they received the vaccine.
Looking forward, public health leaders in Dallas should aim to expand maternal vaccination awareness and strengthen partnerships between hospitals, clinics, and local communities. Our goal remains clear: protecting infants before they ever face their first RSV season.
This story is part of Science X Dialog, where researchers can report findings from their published research articles. Visit this page for information about Science X Dialog and how to participate.
More information
Nicole A. Bailey et al, Factors Affecting Maternal Respiratory Syncytial Virus Vaccination and the Impact on Infant Hospitalization During the 2023–2024 Season in Dallas, Texas, Public Health Reports (2026). DOI: 10.1177/00333549261434117
Key medical concepts
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