Boosting RSV Immunization Uptake in The Netherlands: (Expectant) Mothers and Healthcare Professionals’ Insights on Different Strategies
Abstract
1. Introduction
2. Methods
2.1. Study Population and Recruitment
2.2. Data Collection
2.3. Data Analysis
3. Results
3.1. RSV Awareness & Impact
3.2. RSV Protection & Vaccine Hesitancy
3.3. Timing of Neonatal Immunization
3.4. The Most Suitable Approach
3.5. Information
3.6. Influence
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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COREQ Domain | Item | Study Details |
---|---|---|
| Interviewers | 1st and 2nd author (LL and LH) with one of two research nurses (RN). |
Training and experience | Medical doctors and postdoctoral researchers at the Spaarne Hospital and one of two research nurses (working at the Spaarne Hospital). | |
Relationship with participants | No prior relationship established | |
| Participant groups | 21 expectant mothers (EMs) and 32 healthcare professionals (HCPs) |
Recruitment strategy | EMs: random selection and approach of participants of previous Uptake study [7] HCPs: via networks, associations, and direct outreach; aiming for disciplinary and regional diversity | |
Setting of interviews | Online | |
Interview guide | Semi-structured topic guide, see data collection and Table S2 | |
Data saturation | Participant recruitment continued until thematic saturation was reached, which occurred after the inclusion of 21 EMs and 32 HCPs. This was informally assessed during data collection; jointly evaluated by the research team | |
| Coding approach | Thematic analysis; coded by LL and LH; disagreements discussed and resolved |
Software used | MAXQDA Analytics Pro (version 24.4.1) | |
Participant quotations included | Yes, representative, anonymized quotes included to illustrate key themes, Table 4 |
Baseline Characteristics (Expect) Mothers, n = 21 | |
Age (Years) | 31 [24–31] |
Pregnant (n, %) | 9 (42.8) |
Gestational age (Weeks) | 34 [30–37] |
Recently given birth (n, %) | 12 (57.1) |
Newborn age (Weeks) | 8.5 [3.8–10.0] |
Multiparous women (n, %) | 10 (47.6) |
Opinion in Previous UPTAKE-Questionnaire Study, n (%) | |
Maternal vaccination: Yes Neonatal immunization: Yes | 9 (43) |
Maternal vaccination: Doubt, likely yes Neonatal immunization: Doubt, likely yes | 4 (19) |
Maternal vaccination: Doubt, likely yes Neonatal immunization: Doubt, likely no | 3 (14) |
Maternal vaccination: Doubt, likely no Neonatal immunization: Doubt, likely no | 2 (10) |
Maternal vaccination: No Neonatal immunization: Doubt, likely no | 2 (10) |
Maternal vaccination: No Neonatal immunization: No | 1 (5) |
Baseline Characteristics Healthcare Professionals, n = 32 | |
---|---|
Profession | |
General Practitioner | 5 (16) |
Pediatrician | 5 (16) |
Midwife | 6 (19) |
Obstetrician | 5 (16) |
Youth Healthcare Doctor | 5 (16) |
Youth Healthcare Nurse | 6 (19) |
Work area * | |
North | 2 (6) |
East | 5 (16) |
Central | 4 (13) |
South | 10 (31) |
West | 11 (34) |
Population ** | |
Urban | 9 (28) |
Provincial | 9 (28) |
Mixed | 14 (44) |
Quotations per Theme from Pregnant Women and New Mothers (PNMs) and Healthcare Professionals (HCPs) |
---|
RSV awareness and Impact |
PNMs |
Well, I think part of it comes from your direct environment, so I also think that I haven’t worried too much about RSV so far because no one I know has experienced a severe case with their child. (INT010) |
I have seen first-hand how quickly things can escalate, especially with a newborn, where it [RSV] can turn severe in an instant. (INT007) |
When our child had RSV, they [doctors] didn’t know where there was [hospital] space due to so many RSV cases [in the country]. At one point, we thought we might have to travel far for a spot. Luckily, after eight hours of waiting, a bed became available nearby, which was a huge relief. But as soon as our child was off the Airvo [respiratory support], it was like, “Okay, you’re going home, the next patient is coming in.” (INT002) |
For parents, having a child in the hospital is something that I think is often underestimated by others. Even though the chance of a child dying from it is small in The Netherlands, the impact on parents is huge. (INT019) |
HCPs |
RSV protection is such a no-brainer for me. But that’s easy to say from my role as a pediatrician, as I see all the sick children. I think people who are familiar with the situation won’t hesitate, but there are also many who don’t realize how seriously ill children can become—Ped5 (INT125) |
I think as a general practitioner, you also regularly experience that in November, you can’t admit any child because you know the hospital is completely full of [children with] respiratory infections.—GP5 (INT120) |
Every year, we [the hospital in general] have huge issues with RSV admissions, and this can even lead to admission stops in our gynaecology department. This, in turn, affects neonatology and our overall admission capacity, which means we are able to handle fewer patients. So, what I have encountered is that there is a real need for prevention due to these logistical challenges.—Obs4 (INT119) |
I have many people in my practice who start asking themselves: Could they [my child] have the RS virus? They are very concerned about it.—GP2 (INT114) |
RSV protection & Vaccine Hesitancy |
PNMs |
With all the knowledge and research we have now, it is amazing that we have come this far. I think we should consider ourselves fortunate that it [vaccines] exists, that it is offered to us, and that its value is widely recognized. (INT016) |
Well, I think it is especially important to explain what kind of diseases these [in vaccines] are and what kind of impact they can have. Because nowadays, when I hear people talk, you know, ‘measles’ or whatever, they just think, ‘Well, that is not a big deal.’ I think, that is all fine, but that is because it is so rare now. These diseases are being really underestimated, and people only see the dangers of the vaccine, not the disease itself. (INT015) |
The fuss around the COVID vaccinations made me more sceptical. Before that, I was less doubtful about vaccines. I got all my vaccinations as a child, so I just went along with it, it is just something you do. But during COVID, I also heard about strange side effects from vaccines. And now, it is about your baby, right? (INT006) |
I think it is unfortunate that the vaccination rate is declining. On the other hand, I also think it might be a good thing if day-care centres are allowed to say, ‘If we have too many unvaccinated children, we can refuse them’. (INT009) |
HCPs |
I do think there is definitely support for it [RSV vaccination], because, you know, it always shows up in the local media here as well, that the hospital is once again struggling because of RSV admissions.—Obs4 (INT119) |
I don’t think it is wise for healthcare providers to decide to do things a certain way, but the option should remain open for parents to make their own choices.—MW3 (INT111) |
General doubt about vaccination has been somewhat fueled by the COVID pandemic. That is actually the largest group, and just at a time when everyone is starting to rethink vaccinations, we are introducing all these new vaccines.—Obs3 (INT112) |
A combination of options would allow parents to make a choice, but it also gives them a second chance. That’s how I would see it.—YHCD1 (INT101) |
The Most Suitable Approach |
PNMs |
This is really based on the fact that I want to give my child as few shots as possible while still providing full protection. Well, of course, you want what is best, right? If it is better to vaccinate your child, then that is the way to go. But if it is not necessary, then I’d rather take the shots myself. (INT012) |
I think it [vaccinating a newborn] is just a bit emotional, it is simply not pleasant to give a shot to a very young baby, even though I know it is not truly traumatic. But if I can take it instead and it still provides the protection my baby needs, then I just feel like that is a little less invasive, I believe. (INT020) |
I think, yes, the shot itself isn’t pleasant for the child. They might be bothered by it for a moment, but I believe they quickly forget about it afterward. (INT017) |
If the vaccine is only effective for a certain period, then I’d probably choose to have it administered during the season when the virus is most present, when I feel my child needs that protection the most. (INT015) |
HCPs |
If, of course, there is the option of a vaccination for pregnant women, I think parents would be more likely to go for that than having their newborn receive an injection during the postpartum period.—MW2 (INT110) |
I notice some resistance to vaccination during pregnancy, so I think, on a national level, you’d be more likely to get support for an immunization for neonates, to be included in the overall vaccination program.—Obs3 (INT112) |
I think the easiest to implement would be to vaccinate the babies, and I say that because it is easier to adapt to changes in peaks, like we experienced a few years ago when we suddenly had a peak in the summer due to COVID.—Ped5 (INT125) |
Because I also notice that people often think, ‘If I can protect the baby by doing this, and then the baby doesn’t even need to be vaccinated until later…’ That is often the turning point where I see people change their minds if they are still unsure.—MW4 (INT113) |
Timing of Neonatal Immunization |
PNMs |
I don’t know if I’d be too eager in the first week. If it is a strong recommendation, I’d think, well, there must be a good reason for it. But if not, then I might hesitate as well. (INT008) |
I think in those first days, you are already on a rollercoaster, just trying to process everything. The maternity nurse is still around, the midwife is checking in, and there is the newborn screening in the first week. If another thing were added on top of that, I think I would have found it quite overwhelming during my postpartum week. But then again, you just go through with it anyway. (INT006) |
Maybe at the same time as the heel prick screening, since you are already dealing with procedures. The baby is crying anyway, but at least that is done at home. (INT010) |
HCPs |
I don’t think there is any woman who is particularly eager to have her child injected so soon after giving birth—MW3 (INT111) |
We are not against the RSV vaccine or injection, but the timing and organization of its administration present a significant challenge.—YHCD5/YHCN6 (INT 130/131) |
I can imagine that the role at the health center also include home visits in the second week, where they weigh and measure the baby. I can see that if it [neonatal immunization] becomes a standard procedure, like when we do a heel prick, a hearing test, and offer vaccination, there could be a lot of support for it. Especially if it is not framed as a vaccine but rather as a kind of medicine that prevents the child from getting sick.—GP5 (INT120) |
Information |
PNMs |
In my opinion, we received little information [about vaccination during and after pregnancy]. But I think that was also partly because we always very quickly and firmly stated, ‘Yes, we’re just getting all the vaccinations’. (INT018) |
Of course, it [information on vaccination] should be accessible through the government, but I would like more information. I want the option to dive deeper, not just feel like the benefits are being heavily pushed. You know, understanding both sides: what happens if you do it, but also what if you don’t? That would allow for a better choice. (INT004) |
For the 22-week vaccination, I only received a leaflet from a midwife. She did say, ‘Make sure to read this carefully, it is very important.’ But it was because I asked more questions that I learned more about it. There are plenty of people who see a leaflet, think ‘Oh, okay, I’ll read it,’ and then eventually it ends up in the trash. (INT021) |
I think a physical conversation would always work best for me, especially if it is with a midwife, a maternity care provider, or someone from the youth health clinic, someone I trust. (INT015) |
I think part of it comes from your immediate surroundings. I haven’t really worried about RSV because no one in my environment has had serious issues with it with their child. (INT010) |
HCPs |
You really need to provide judgment-free counseling, of course. But we all know that is not something we always manage to do.—MW2 (INT102) |
You are constantly engaging with each other [pregnant women and midwife], feeling each other out, and learning to communicate. So I think information about RSV protection is most easily shared within that bond of trust—MW3 (INT111) |
Providing information through infographics has proven to be very useful.—Ped2 (INT106) |
I think influencers have more impact than doctors nowadays, but I don’t rule out the possibility that doctors can also have an impact.—Ped5 (INT125) |
Our goal is never to convince people. Our goal is to provide proper information.—YHCD2 (INT102) |
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Share and Cite
van Leeuwen, L.; Harteveld, L.; Smit, L.; Vollebregt, K.; Bogaert, D.; van Houten, M. Boosting RSV Immunization Uptake in The Netherlands: (Expectant) Mothers and Healthcare Professionals’ Insights on Different Strategies. Vaccines 2025, 13, 1051. https://doi.org/10.3390/vaccines13101051
van Leeuwen L, Harteveld L, Smit L, Vollebregt K, Bogaert D, van Houten M. Boosting RSV Immunization Uptake in The Netherlands: (Expectant) Mothers and Healthcare Professionals’ Insights on Different Strategies. Vaccines. 2025; 13(10):1051. https://doi.org/10.3390/vaccines13101051
Chicago/Turabian Stylevan Leeuwen, Lisanne, Lisette Harteveld, Lucy Smit, Karlijn Vollebregt, Debby Bogaert, and Marlies van Houten. 2025. "Boosting RSV Immunization Uptake in The Netherlands: (Expectant) Mothers and Healthcare Professionals’ Insights on Different Strategies" Vaccines 13, no. 10: 1051. https://doi.org/10.3390/vaccines13101051
APA Stylevan Leeuwen, L., Harteveld, L., Smit, L., Vollebregt, K., Bogaert, D., & van Houten, M. (2025). Boosting RSV Immunization Uptake in The Netherlands: (Expectant) Mothers and Healthcare Professionals’ Insights on Different Strategies. Vaccines, 13(10), 1051. https://doi.org/10.3390/vaccines13101051