Leads:

• Juan Diaz Quinones, MD, Vice Chair, Operations and Integration, Obstetrics and Gynecology and Women’s Health
• Joshua Cohen, MD, Generalist, Obstetrics and Gynecology
• Network Performance Group (NPG) members: Chelsea Chung, Rafael Ruiz, PhD, Kelsie E. Cowman, MPH
• Janette Nevers, NP, Nurse Lead, Obstetrics and Gynecology

The Montefiore Einstein Department of Obstetrics and Gynecology and Women’s Health has launched a quality improvement initiative to increase maternal respiratory syncytial virus (RSV) vaccination during the 2025 to 2026 flu season. Previously, our vaccination rate was 38 percent in 2024 to 2025, consistent with national averages. This is much too low in our estimation due to the serious risk RSV poses to infants, especially in the first six months of life.

Maternal RSV vaccination protects both the mother and the newborn. By vaccinating pregnant patients, we decrease RSV-related morbidity and prevent infection in two patients, mother and baby. Because there is no licensed pediatric RSV vaccine, infant protection depends on maternal vaccination or the use of monoclonal antibodies.

Nearly half of infants who do not receive protection through maternal vaccination will contract RSV in the first two years of life. Many severe infections require hospitalization for oxygen and supportive care. In fact, one in five infants hospitalized with RSV require intensive care. During a typical flu season, more than 80 percent of neonatal intensive care unit admissions for upper respiratory tract infections are related to RSV.

The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommends seasonal maternal RSV vaccination. Post-implementation studies in countries such as Argentina and the United Kingdom demonstrate reduced symptom severity and lower RSV hospitalization rates following vaccination.

The national RSV vaccination rate during pregnancy in 2024 to 2025 was 38.5 percent. As of November 18, 2025, just eleven weeks into our program, our rate has reached 62 percent. This places us well above the national benchmark for the 2025 to 2026 season and reflects early success of a multi-pronged intervention strategy benefiting the community.

Intervention strategy components:

1. Education campaign
   • Ongoing training for nurses, advanced practice providers, residents, and attending physicians on RSV, the vaccine, American College of Obstetricians and Gynecologists guidance, and effective counseling strategies
2. Obstetric visit templates
   • Clinical prompts added to visits at 28 to 32 weeks and again at 32 to 36 weeks of pregnancy to ensure vaccine counseling and offering
3. Smart phrases
   • Standardized language created to guide provider-patient discussions, including timing, side effects, benefits, and next steps if vaccination is declined
4. Eligibility tracking
   • Weekly distribution of eligible patient lists by gestational age, with vaccine orders pre-placed by nursing staff to prompt provider offering
5. Monitoring and feedback
   • Biweekly dashboard reviews of vaccination rates by site, with targeted outreach to locations showing lower uptake
6. Leadership engagement
   • Biweekly meetings with operations, nursing, and administrative leadership to review performance data, address barriers, and reinforce guideline-aligned practices
7. Documentation
   • Use of the electronic medical record to communicate maternal vaccination status to pediatric teams, enabling appropriate monoclonal antibody decisions

Our efforts align closely with the ACOG Practice Advisory on maternal RSV vaccination, which recommends the following:

• A single dose of Pfizer’s RSVpreF vaccine (Abrysvo) between 32 weeks and 36 weeks and 6 days of gestation during RSV season
• Administration of a monoclonal antibody to the infant after birth if maternal vaccination is declined
• Avoidance of routine use of both maternal vaccination and monoclonal antibody, except when infants are born within fourteen days of maternal vaccination
• Clear counseling on risks, benefits, safety, and potential side effects
• Co-administration with other maternal vaccines including COVID-19, influenza, and Tdap
• Clear documentation and communication to pediatric teams regarding infant protection needs

Early uptake reaching 62 percent demonstrates that strong provider recommendations, system-level reminders, and alignment with national professional guidance can significantly improve maternal RSV vaccine coverage. Continued workflow refinement, culturally and linguistically tailored education, and close monitoring will be essential to sustaining and exceeding this rate through the remainder of the season. Increased maternal and infant vaccination also contributes to reduced RSV transmission in the broader community.