Abstract Background Respiratory syncytial virus (RSV) causes severe respiratory illness among older adults, leading to significant morbidity, mortality, and healthcare burden. Although new RSV vaccines are now available, little is known about how consistently vaccination guidelines are followed in nursing homes, where awareness, ordering, and administration barriers may limit uptake. We conducted this study to better understand the real-world implementation of RSV vaccination among Veterans residing in nursing homes. Our threefold goal was to assess adherence to guideline recommendations, characterize patterns of vaccine ordering and administration, and compare vaccination rates before and after implementation of an RSV vaccination awareness program. Methods We enrolled veterans admitted to the South Texas Veterans Health Care System contracted nursing homes. The observation period was from August 1, 2023, through September 30, 2025, and was divided into a pre-evaluation period (August 1, 2023-December 31, 2024) and a post-evaluation period (January 1-September 30, 2025), following the launch of an RSV vaccination awareness program on January 1, 2025. We included all Veterans admitted during this timeframe, with no exclusion criteria applied. Patients were stratified by RSV vaccine refusal status. The primary outcomes were the presence of an RSV vaccination order and successful vaccine administration. RSV vaccination rates between pre- and post-awareness periods were compared using Chi-square goodness-of-fit test. Results We analyzed data from 29 nursing homes including 315 Veterans. Nineteen percent (n = 61) refused RSV vaccination. The cohort was predominantly male, representing 91% (n = 287), with a mean (SD) age of 78 (±9.5) years. Among the 81% (n = 254) of patients who did not refuse vaccination, 19% (n = 47) had an active RSV vaccination order, and nearly all, 98% (n = 46), received the vaccine. Additionally, 7% (n = 15) of patients without an active order were vaccinated. Overall, 19% (n = 61) of all nursing home patients received the RSV vaccine. Among eligible patients (n = 254), RSV vaccination rates increased from 13.9% (n = 23) in the pre-awareness period to 43.7% (n = 38) in the post-awareness period. Monthly vaccination rates increased from 1.35 to 4.22 vaccinations per month (rate ratio: 3.12, 95% CI: 1.86-5.24, p 0.0001). Conclusion RSV vaccination rates increased significantly following implementation of the awareness program. However, more than half of eligible patients remain unvaccinated, indicating the need for multi-level interventions beyond awareness to improve coverage. This abstract is funded by: none
Ali et al. (Fri,) studied this question.