Acceptability and preferences regarding RSV immunisation during pregnancy: a cross-sectional study in diverse global settings.

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Background Respiratory syncytial virus (RSV) is the leading cause of severe lower respiratory tract infections in infants. Two effective preventive strategies exist: maternal RSV Prefusion F vaccination during pregnancy and child immunisation with monoclonal antibodies.Objectives To assess pregnant individuals' acceptance of, and preferences between, maternal RSV vaccination and infant monoclonal antibodies across diverse global settings after receiving standardized information on RSV risks and expected protective benefits.Study Design Cross-sectional study conducted between March 2024 and March 2025 among pregnant individuals recruited by convenience sampling in partner centres across eight countries (Brazil, Canada, Colombia, Spain, France, Italy, Luxembourg, and Switzerland). The primary outcome was acceptance of RSV vaccination during pregnancy, and the secondary outcome was preference between maternal RSV vaccination and infant Nirsevimab; associated factors were assessed using multivariable logistic regression, with country group included as a design-related adjustment variable.Results Among 887 participants, 675 (76.1%) reported accepting RSV vaccination during pregnancy: 96 (10.8%) were already vaccinated and 579 (65.3%) would have liked to receive it when available. Acceptance of the RSV vaccine during pregnancy differed across main study sites, ranging from 70.4% in Switzerland to 79.1% in Colombia. Factors independently associated with willingness to be vaccinated included having a child previously hospitalised in neonatal intensive care unit, uptake of other recommended vaccines during pregnancy, and perceiving a positive influence from health authorities. Most of participants (69.8%, 619/887) preferred maternal RSV vaccination over child immunisation with monoclonal antibody administration (14.5%, 129/887). Factors independently associated with vaccination preference included: having received other recommended vaccines during pregnancy, whereas history of pre-eclampsia or perception of foetal or obstetrical risk associated with this vaccine favoured preference for the monoclonal antibody. Additional motivations for preferring maternal RSV vaccination included: avoiding an extra injection for the newborn, perceived greater efficacy, and a preference for endogenous antibody-mediated protection.Conclusion This multinational study demonstrates high acceptance of maternal RSV vaccination and a predominant preference for this strategy over infant immunisation. These findings highlight the importance of tailored communication addressing pregnant individuals' concerns about safety and efficacy, alongside policies that align with parental vaccination preferences to facilitate effective implementation.