Disparities in Access to RSV Prophylaxis Among Children in the U.S.

In a recent study published in the journal Pediatrics on July 17, 2025, researchers examined the accessibility of nirsevimab, a monoclonal antibody for respiratory syncytial virus (RSV) prophylaxis, highlighting significant disparities among eligible children. Despite the adequate availability of this preventive treatment, data revealed that only approximately one-third of eligible children born outside the typical RSV season received nirsevimab, raising concerns about social and demographic factors influencing healthcare access.

The study, led by Mahaa M. Ahmed, MS, from Clinical Futures at Children’s Hospital of Philadelphia, assessed a total of 7,208 children younger than eight months who were born between April and September 2023 and had at least one primary care visit within the first 14 days of life. The research encompassed practices across Pennsylvania and New Jersey, all of which had nirsevimab readily available. The findings indicated that the uptake of nirsevimab ranged significantly, from 20% to 65% across different practices.

According to the study, factors such as older age, Black race, and reliance on public insurance were linked with lower rates of nirsevimab administration. Specifically, 53.1% of the children who received nirsevimab were White, and 64.4% had private insurance. The data also suggested that children with low birth weight had higher odds of receiving the treatment, contrasting with older children who faced reduced odds of administration (adjusted odds ratio of 0.60 for each additional month of age).

Dr. Sarah Johnson, a pediatric health policy expert at Johns Hopkins University, emphasized that these findings underline the importance of understanding the social determinants of health that contribute to such disparities. “The identification of sociodemographic factors associated with receipt of nirsevimab emphasizes the necessity of examining the drivers of these disparities to inform interventions designed to ensure more equitable uptake,” Dr. Johnson stated.

The research highlights systemic issues within the healthcare system, particularly the barriers faced by minority populations and those with public insurance. Children who were Black had significantly lower odds of receiving nirsevimab compared to their White counterparts (adjusted odds ratio of 0.53), and those living in low-opportunity areas also faced reduced access (adjusted odds ratio of 0.70).

Despite its critical role in preventing severe RSV infections, the limited uptake of nirsevimab points to broader issues within pediatric healthcare access. According to the Centers for Disease Control and Prevention (CDC), RSV remains a leading cause of hospitalization in infants and young children, making equitable access to prophylaxis essential.

The authors of the study concluded that understanding these disparities is crucial for developing effective public health strategies aimed at improving RSV prophylaxis uptake among vulnerable populations. However, they acknowledged that their findings may not be generalizable, as the data represented a specific care network, and did not capture family preferences or clinician-patient interactions regarding nirsevimab.

Looking forward, the researchers call for targeted interventions to address these inequities, emphasizing that all children should have equal access to preventive measures against RSV. The study received support from the Infectious Diseases Society of America’s Grants for Emerging Researchers/Clinicians Mentorship program, and the Pediatric Infectious Diseases Society’s Supporting Research and Promoting Pediatric ID program. As pediatric healthcare continues to evolve, addressing such disparities will be paramount to ensure the well-being of all children across the United States.