ABSTRACT
Respiratory syncytial virus (RSV) is associated with considerable morbidity and mortality among older adults (aged ≥60 years) and adults with certain chronic conditions in the United States (US). Despite this burden, no previous studies have assessed the knowledge, attitudes, and perceptions (KAP) of RSV among these populations. This study evaluates RSV-related KAP among US adults at increased risk of severe RSV infection. A cross-sectional, web-based survey was administered from May to June 2022 to better understand respiratory infection- and RSV-related KAP among US adults who are at risk of severe RSV infection. The survey included ≥200 adults in each of 4 subgroups: adults aged 60–89 years, and adults aged 18–59 years with ≥1 chronic cardiovascular condition, chronic pulmonary condition, or diabetes mellitus. Survey responses were analyzed descriptively overall and by subgroup, with exploratory logistic regression modeling used to evaluate characteristics associated with RSV awareness and concern. Among the 827 survey respondents, only 43.3% had ever heard of RSV (n = 358/827). The study identified key knowledge gaps (e.g. bacterial vs. viral nature of respiratory infections, RSV seasonality, common RSV symptoms, extent to which RSV causes respiratory infections in specific patient populations). Although 33.7% of RSV-aware adults (n = 120/356) reported being worried/very worried about RSV, 67.3% (n = 241/358) rarely consider RSV as a potential cause of their cold/flu-like symptoms. Results from this study highlight important knowledge gaps related to RSV, perceived risk, and severity of RSV. Findings can be used to support the development of tailored education efforts to support RSV prevention.
Plain Language Summary
What is the context?
Respiratory syncytial virus (RSV) is a common cause of illness among older adults (60 years and older) and adults with certain chronic conditions in the United States (US), with some adults experiencing severe RSV outcomes such as hospitalization or death.
Despite this considerable burden, the awareness of RSV among these at-risk populations has never been studied until now.
What is new?
We assessed RSV-related knowledge, attitudes, and perceptions among US adults at increased risk of severe RSV infection (adults aged 60–89 years and adults aged 18–59 years with ≥1 chronic cardiovascular condition, chronic pulmonary condition, or diabetes).
Among older and at-risk adults, 43.3% had ever heard of RSV, with a lower awareness in the older adult subgroup.
Among adults at increased risk of severe RSV who are aware of RSV, less than 35% consider themselves to be knowledgeable about RSV and 16–19% were unable to assess their perceived risk of contracting RSV or potential severity of RSV should they contract it.
Knowledge gaps specific to RSV include the viral nature of RSV, its seasonality, symptoms, extent to which it causes respiratory infections in specific patient populations, the difficulty distinguishing RSV from other respiratory infections based on symptoms alone, and the limited testing for RSV in routine clinical practice.
What is the impact?
Two RSV vaccines were recently approved in the US and are recommended for the prevention of RSV among adults aged 60 years and older with shared clinical decision making.
Results from this study reveal limited awareness of RSV among adults in the US at increased risk of severe RSV and knowledge gaps among those aware of RSV.
These findings can be used by healthcare providers initiating shared clinical decision-making conversations with their patients aged 60 years and older who are eligible for RSV vaccination, as well as to tailor RSV disease awareness educational interventions to healthcare providers and patients.
Background
Respiratory syncytial virus (RSV) infection develops each year in the United States (US) in 3–7% of healthy older adults (aged ≥65 years) and 4–10% of adults who are at increased risk of severe RSV.Citation1 RSV typically causes mild, cold-like symptoms but can be more severe in infants, older adults, adults with comorbidities (e.g., chronic cardiovascular and pulmonary conditions), and adults with weakened immune systems.Citation2–4 Adults who are at risk for severe RSV infection may experience more serious outcomes, such as pneumonia, exacerbation of underlying chronic conditions (e.g., asthma, chronic obstructive pulmonary disease [COPD], congestive heart failure [CHF]), hospitalization, and/or death.Citation3,Citation5 A recent population-based surveillance study conducted in the US found that more than half (54%) of the adults aged ≥60 years hospitalized with an RSV diagnosis between July 2022 and June 2023 were aged ≥75 years.Citation4 Authors also observed that the most frequent underlying medical conditions associated with RSV-hospitalization in adults aged ≥60 years were obesity, COPD, CHF, and diabetes mellitus. In comparison with influenza, results from recent studies suggest that RSV may be associated with more severe outcomes (e.g., longer hospital stays, increased rate of intensive care unit admission, increased rate of pneumonia, increased mortality at 1-year post-hospitalization).Citation6,Citation7 Among US adults aged 65 years and older, RSV is estimated to result in approximately 177,000 hospitalizations and 14,000 deaths each year.Citation1
Despite the burden of RSV among older adults and those with underlying comorbidities, little is known on the knowledge, attitudes, and perceptions of RSV among these groups. Previous research focused on the awareness of RSV and/or diagnostic practices related to RSV among healthcare providers (HCPs)Citation8,Citation9 or on maternal vaccination.Citation10,Citation11 For example, in a survey of primary care physicians, almost half of respondents (49%) indicated that they never or rarely cared for an adult with possible RSV infection, and most (61%) indicated that they do not conduct RSV testing because of the lack of RSV treatment.Citation9 Prior research examined patient knowledge and perceptions of antibiotic use and the causes and treatment of upper respiratory infections, and found that 48–70% of respondents incorrectly thought that antibiotics are required for the treatment of viral infections.Citation12,Citation13
While the coronavirus disease 2019 (COVID-19) pandemic increased public awareness of respiratory illnesses, the resulting nonpharmaceutical interventions (e.g., masking and social distancing) is hypothesized to have decreased population immunity to RSV, which may have contributed to recent surges in RSV hospitalizations.Citation14,Citation15 Incidentally, the loosening of restrictions in summer 2021 is thought to have led to a surge in RSV activity, mostly in children and young adults who may not have continued adhering to public health measures as much as older adults.Citation16 Understanding the knowledge and perceptions of RSV, and associated risks, is needed to inform disease awareness and education efforts for adults at increased risk of severe RSV.
The objectives of this study were to evaluate the knowledge, attitudes, and perceptions of respiratory infections and RSV, as well as respiratory infection-related care-seeking behaviors, among adults who are at increased risk of severe RSV infection in the US (adults aged 60 years and older and adults aged 18–59 years with chronic pulmonary conditions, chronic cardiovascular conditions, and/or diabetes mellitus).
Methods
Study design
A non-interventional, cross-sectional, web-based survey of US adults at increased risk of severe RSV infection was administered between May and June 2022 to evaluate respiratory infection- and RSV-related knowledge, attitudes, and perceptions among these adults (Supplementary Figure 1). Descriptive analyses were conducted, and exploratory logistic regression modeling was also conducted to identify participant characteristics associated with key dependent variables of interest, including awareness of RSV and worry about RSV. A sample size of 800 participants was deemed sufficient for a knowledge, attitudes, and perceptions survey with descriptive and exploratory analyses, and is aligned with similar studies about influenza.Citation17,Citation18
Participants
The study population of adults at increased risk of severe RSV infection was recruited from an online US patient panel. The survey included at least 200 adults in each of 4 subgroups: older adults aged 60–89 years and adults aged 18–59 years with ≥1 chronic cardiovascular condition, chronic pulmonary condition, or diabetes mellitus.
The eligibility criteria for the study were purposely designed with minimal selection criteria to recruit a general population (Supplementary File 1). To be eligible for the study, adults self-reported their age and relevant medical conditions in the screener. Participants were asked if they have ever been diagnosed with, and currently have specific health conditions of interest. Participants were required to live in the US, be able to read and speak English, and acknowledge online informed consent. Adults who were currently pregnant or who were an HCP were excluded from participation in this study.
Participants aged 18–89 years were placed in one of the following subgroups: adults aged 60–89 years; adults aged 18–59 years with a chronic cardiovascular condition; adults aged 18–59 years with a chronic pulmonary condition, or adults aged 18–59 years with type 1 or type 2 diabetes mellitus.
Variables
In the web-based survey, eligible adults were first asked questions about their knowledge, attitudes, and perceptions of respiratory infections in general, as well as their vaccination history. RSV-aware participants were also asked a series of questions related to their knowledge, attitudes, and perceptions of RSV. Finally, all participants were asked to report their demographic characteristics (Supplementary Figure 1). The part of the questionnaire about knowledge, attitudes, and perceptions of respiratory infections and RSV comprised 23 questions.
Data sources/measurement
Survey recruitment was managed by Global Perspectives using an online panel network that includes individuals who have agreed to take part in online questionnaires related to healthcare. Participants who completed the questionnaire were compensated with cash or reward points.
Participants were provided a link to complete the survey and could stop the questionnaire and resume upon revisiting the link at a later time in order to complete the questionnaire. However, participants were not able to go back and change answers to previous questions. This restriction minimized the likelihood of participants searching for answers via the internet or other sources or being influenced by answers to subsequent questions.
Data collection remained open for 3 weeks from May 27–June 18, 2022. Once the target sample size of 200 respondents in each subgroup was achieved, the database was locked, and the questionnaire links were deactivated. All participants with surveys in progress before the target sample was achieved were allowed to finish their surveys (i.e., subgroups could have sample sizes that ended up with more than 200 respondents as a result).
The final data set was deidentified using numeric participant code identifiers. Study results are presented as aggregate analyses that omit subject identification. This study complied with all applicable laws regarding subject privacy. The RTI Office of Research Protection determined that this study met the criteria for exemption from institutional review board (IRB) review on April 27, 2022.
Statistical methods
Questionnaire response data were analyzed descriptively. The denominator for percentages was based on the total number of participants who had an opportunity to answer the question. Results were presented by risk group and for all participants combined. Participants aged 18–59 years were able to contribute data to more than one category if they had multiple chronic conditions of interest.
Exploratory logistic regression modeling was conducted to better understand the relationship between participant characteristics and key dependent variables of interest, including awareness of RSV and worry about RSV. Logistic regression models were first used to assess associations between each of the dependent variables of interest and each independent variable of interest separately. Backwards selection was used for the final multivariable models to include independent variables meeting a prespecified stay criterion (p < 0.1). Race/ethnicity, gender identity, presence of ≥1 chronic cardiovascular condition, presence of ≥1 chronic pulmonary condition, presence of diabetes mellitus, and age were included in both regression models prior to model selection, regardless of whether they met the prespecified stay criterion.
Results
Participant characteristics
A total of 10,127 individuals were sent invitations to participate in the survey. Of the 991 participants who accessed the survey link, 102 were not eligible, 44 were over quota, and 18 did not provide consent. The final sample included 827 survey respondents: 224 were aged 60–89 years, 200 were aged 18–59 years with a chronic cardiovascular condition, 347 were aged 18–59 years with a chronic pulmonary condition, and 308 were aged 18–59 years with diabetes mellitus (). A total of 603 respondents (72.9%) were aged 18–59 years, with most of these respondents (n = 387/603, 64.2%) contributing data to only one of the subgroups of interest (chronic cardiovascular condition, chronic pulmonary condition, or diabetes mellitus); 180 respondents aged 18–59 years (29.9%) contributed data to two of the subgroups and the remaining 36 respondents aged 18–59 years (6.0%) contributed data to all three subgroups. Among the 827 respondents in the final sample, the mean age was 49.0 years (standard deviation, 15.6 years) and most respondents self-identified as female (n = 523/827, 63.2%) and White (n = 660/827, 79.8%). Respondents most frequently reported living in the South census region (n = 347/827, 42.0%) and in suburban areas (n = 370/827, 44.7%) ().
Table 1. Summary of demographic characteristics.
Knowledge about respiratory infections and RSV
Among the survey respondents, 43.3% (n = 358/827) had previously heard of RSV. Fewer than 1 in 3 adults aged 60–89 years were aware of RSV (n = 72/224, 32.1%), although awareness was higher among adults aged 18–59 years with diabetes mellitus (n = 126/308; 40.9%), a chronic cardiovascular condition (n = 103/200, 51.5%), or a chronic pulmonary condition (n = 192/347, 55.3%) (). Awareness of RSV was lower than most of the other respiratory infections included in the survey, except for human metapneumovirus (18.9% [n = 156/827] had previously heard of human metapneumovirus). A total of 96 respondents (11.6%) were aware of all six respiratory infections included in the survey. Among survey respondents aware of RSV, only 7.3% (n = 26/357) reported being previously diagnosed with RSV by an HCP.
Figure 1. Awareness of respiratory diseases in the study sample.
Although 74.2% (n = 614/827) of respondents considered themselves knowledgeable about respiratory infections (), only 34.6% (n = 124/358) of those aware of RSV reported being knowledgeable about it (). The older adult cohort was the least confident in their knowledge about RSV with 18.1% (n = 13/72) considering themselves knowledgeable (versus adults aged 18–59 years with diabetes mellitus [n = 61/126, 48.5%], a chronic cardiovascular condition [n = 39/103, 37.9%], or a chronic pulmonary condition [n = 68/192, 35.4%]).
Figure 2. Self-reported and assessed knowledge of respiratory diseases (a) and RSV (b).
Among all respondents who answered 5 true/false questions on respiratory infection, 61.0% (n = 504/826) answered 3 or more of the questions correctly. In contrast, 12.9% (n = 46/356) of RSV-aware respondents who answered 5 true/false questions on RSV answered 3 or more of the questions correctly ().
Responses to the true/false questions reveal knowledge gaps related to the nature of respiratory infections and the frequency of occurrence of lower respiratory tract infections in the US (), and knowledge gaps about the viral nature of RSV, that RSV is typically seasonal, and RSV frequency of occurrence and clinical practice (i.e., the inability to distinguish RSV based on symptoms and limited testing for RSV) ().
Among those who had heard of RSV, 25.1% (n = 90/358) were unable to identify any common symptoms of RSV.
Other key results related to participants’ knowledge and awareness of RSV and other respiratory infections are presented in Supplemental Tables 1 and 4.
Attitudes about respiratory infections and RSV
About half of respondents were worried/very worried about pneumonia, bronchitis, hospitalization, or death due to RSV or other respiratory infections. Among respondents aware of RSV, 33.7% (n = 120/356) reported that they worry about it (vs. 57.6% [n = 200/347] for COVID-19, 45.2% [n = 148/327] for pneumococcal disease, 42.3% [n = 142/336] for influenza, 29.5% [n = 90/305] for pertussis, and 19.3% [n = 69/358] for the common cold [among respondents who were aware of each of these other respiratory conditions]). Most respondents with asthma (n = 219/313; 70.0%) or COPD (n = 68/85; 80.0%) were worried/very worried about more severe asthma and COPD symptoms, respectively, that can be triggered by RSV or other respiratory infections. Fewer than 1 in 3 respondents were worried/very worried about congestive heart failure resulting from RSV or other respiratory infections (n = 264/825; 32.0%).
Only 2.5% of respondents (n = 21/827) reported that they do not take any steps to prevent respiratory infections; among those taking steps to prevent illness, washing hands often was most frequently reported (n = 677/827; 81.9%). Additionally, most RSV-aware adults know how to prevent the spread of RSV: 76.7% (n = 254/358) correctly identified all 6 proposed ways of preventing the spread RSV.
Respondents reported that they would seek medical care for new or worsening symptoms of shortness of breath or difficulty breathing (78.6%, n = 650/827), fever (64.4%, n = 533/827), wheezing (60.1%, n = 497/827), and cough (52.5%, n = 434/827), but fewer than half (44.7%, n = 370/827) would seek care within 0–4 days of the onset of respiratory infection symptoms.
A total of 89.8% (n = 743/827) reported that it would be important/very important to know the cause of their infection, particularly to understand whether they are contagious and need to isolate themselves (72.6%, n = 539/742), to understand how to prevent future exposure or infection (71.7%, n = 532/742), to help discuss treatment options with their doctor (71.4%, n = 530/742), or to gain insight into their recovery time (65.6%, n = 487/742).
Other key results related to respondents’ attitude toward RSV and other respiratory infections are presented in Supplemental Tables 2 and 5.
Perceptions about respiratory infections and RSV
Although most RSV-aware adults agreed that RSV is a major cause of respiratory infections in specific adult populations (), 67.3% (n = 241/358) rarely considered RSV as a potential cause of their cold/flu-like symptoms.
Figure 3. Perceived RSV risk groups and severity. (a) perceived groups at risk for RSV; (b) perceived severity of RSV relative to other respiratory diseases.
When asked to rate their agreement with the statement that RSV is a major cause of respiratory infections in certain groups, approximately 1 in 4 respondents aware of RSV did not know whether this was the case for their own subgroup. Specifically, 25% (n = 18/72) of adults over 60 years, 26.2% (n = 27/103) of adults with a chronic cardiovascular condition, 28.1% (n = 54/192) of adults with a chronic pulmonary condition, and 14.3% (n = 18/126) of adults with diabetes mellitus did not know whether RSV is a major cause of respiratory infections for people within their respective subgroups. Among respondents aware of RSV, 15.9% (n = 57/358) did not know their risk of getting RSV when asked to rate their risk of contracting several infectious diseases, and 19.0% (n = 68/358) of overall respondents – and 33.3% (n = 24/72) of adults aged 60–89 years – did not know about the expected severity of RSV if they contract the disease.
Respondents generally perceived RSV as high risk/severe; most respondents aware of RSV perceived it to be at least as severe as several other respiratory infections ().
38.3% (n = 137/358) of respondents were unsure about their risk of RSV-related hospitalizations compared to influenza and 43.6% (n = 156/358) were unsure about their risk of RSV-related death compared to influenza. This varied by subgroup, with more than half of adults aged 60–89 years unsure about their risk of RSV-related hospitalizations (52.8%, n = 38/72) and death (59.7%, n = 43/72) compared to influenza.
Other key results related to perceptions of RSV and other respiratory infections are presented in Supplemental Tables 3 and 6.
Predictors of RSV awareness and worry about RSV
Significant predictors of RSV awareness included awareness of other respiratory infections (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.89–2.72), having a child or children in the household (OR, 1.92; 95% CI, 1.30–2.83), geographic region (Midwest vs. South, OR, 1.53; 95% CI, 1.00–2.34), and knowledge of respiratory infections (OR, 1.27; 95% CI, 1.09–1.47) (). Male gender identity was significantly associated with a lower likelihood of RSV awareness (male vs. female, OR, 0.53; 95% CI, 0.37–0.75).
Figure 4. Predictors of awareness of RSV (a) and worry about RSV (b).
Only awareness of symptoms of RSV (OR, 2.26; 95% CI, 1.12–4.54), perceived severity of RSV (OR, 1.58; 95% CI, 1.34–1.86), and perceived risk of RSV (OR, 1.39; 95% CI, 1.22–1.58) were significant predictors of being worried about RSV ().
Discussion
Relatively limited knowledge of RSV was observed in a sample of 827 adults at increased risk of severe RSV who answered a survey in Spring 2022. Among the survey respondents, only 43.3% were aware of RSV and 12.9% of these RSV-aware respondents correctly answered 3 or more out of 5 true/false questions on RSV. About one in four respondents did not know whether RSV is a major cause of respiratory infections within their subgroup. Though most respondents aware of RSV understood its symptoms and severity, they seldom considered RSV as a potential cause of their flu-like symptoms.
Among survey respondents aware of RSV in our study, only 7.3% reported that they had previously been diagnosed with RSV by an HCP. This finding is in line with prior studies that have reported undertesting and underdiagnosis of RSV in clinical practice.Citation19,Citation20 A higher percentage previously diagnosed with RSV would have been expected if testing were more routinely conducted, although testing frequency may be increasing. For example, in a recent survey conducted among US adults in early 2023, 10% of respondents reported someone in their household was sick with RSV in the previous month.Citation21 Our study found that nearly 90% of respondents think it is important/very important to know the cause of their respiratory infection, supporting the need for increased RSV testing.
RSV disease burden is well established in children and, despite being an illness affecting individuals of all ages, RSV continues to be thought of as a childhood disease.Citation15,Citation22 Indeed, we found that participants who had children at home were nearly twice as likely to be aware of RSV compared to those who did not.
In a survey conducted among US adults in early 2023, 25% were very or somewhat worried that they will get seriously sick from RSV.Citation21 Adults with a weakened immune system were more likely to be worried about getting seriously sick from RSV or the flu than non-immunocompromised adults.Citation21 In our study, where all respondents were at risk, 33.7% of respondents aware of RSV reported being worried/very worried about it and only awareness of RSV symptoms and perceived severity and risk of RSV were significant predictors of being worried about RSV.
Most respondents of our survey reported taking steps to prevent respiratory infections, and most RSV-aware adults know how to prevent RSV from spreading. This could be because the COVID-19 pandemic has increased general knowledge about respiratory infectious disease prevention. However, despite this knowledge, a surge in RSV cases and pressure on local healthcare systems was observed post pandemic, possibly due to increases in socialization, reductions in the use of nonpharmaceutical interventions to prevent infection, and decreased population immunity following a prolonged period of minimal RSV exposure.Citation14,Citation15 In an online survey of US adults, 46% of respondents said the news of COVID-19, RSV, and the flu spreading during the 2022–2023 winter made them more likely to take at least one protective measure, including wearing a mask in public, avoiding large gatherings, traveling less, or avoiding dining indoors at restaurants.Citation21 This shift in behaviors is thought to have contributed to the decreased incidence of RSV observed in older adults after the COVID-19 pandemic.Citation16
In our study, 67.3% of respondents rarely consider RSV as a potential cause of their cold/flu-like symptoms. Similarly, in a 2017 survey of HCPs, 57% of the surveyed physicians reported they rarely consider RSV as a potential pathogen, and 73% view influenza as more severe than RSV.Citation9 In our sample, one third of RSV-aware respondents perceived influenza as more severe than RSV, while studies comparing RSV and influenza suggest that RSV may be associated with more severe outcomes.Citation6,Citation7
Our results show that about one in six adults at increased risk of severe RSV did not know their risk of contracting RSV and about one in five did not know the severity of RSV should they contract the disease. Responses to the true/false questions also reflect knowledge gaps related to RSV features and diagnosis. In a 2017 survey of HCPs, physicians reported little experience with RSV disease in adults, with 7–14% of physicians reporting not knowing about the importance of RSV as a pathogen in various patient groups.Citation9 In the 2017 survey, 86% of HCPs also felt they needed more information about RSV burden in older adults.Citation9 Results from the current study of adults at increased risk of severe RSV and previous surveys of HCPs highlight the need for education efforts about RSV severity and at-risk groups, both in the public and at the HCP level, as HCPs are a trusted source of information for their patients and would be well suited to discuss preventive options.
Two RSV vaccines were recently approved by the Food and Drug Administration in May 2023 and are recommended by the Advisory Committee on Immunization Practices for the prevention of RSV lower respiratory tract disease among adults aged 60 years and older with shared clinical decision making. Given the lack of awareness of RSV among older adults in particular (with fewer than 1 in 3 older adults ever having heard of RSV), HCPs will play a critical role in initiating shared clinical decision-making conversations related to RSV prevention.
Limitations
The study includes several key limitations that should be noted. First, survey respondents were recruited through a panel and may not be representative of all adults who are at increased risk of severe RSV. Some populations are potentially over-represented in the final sample, which may limit the generalizability of our findings. Specifically, the knowledge, attitudes, and perceptions of those who participate in a panel and were included in our study may be different from those who were not included, resulting in potential selection bias. Moreover, the survey was only offered in English, resulting in the exclusion of non-English speakers, who may have different RSV- and respiratory infection-related knowledge, attitudes, and perceptions than those captured in the current study. Because participation in the survey was voluntary and responses were not corroborated with other data sources, there is also the potential for response bias. The survey aimed to limit respondent fatigue, with 23 questions focused on knowledge, attitudes, and perceptions of respiratory infections and RSV. Survey insights are limited to those that can be made from the included questionnaire items. As an example, the survey did not capture the sources of respondents’ medical knowledge, limiting insights about the most common channels for knowledge acquisition. Additional research is needed to understand the impact of potential interventions on improving disease awareness.
Some participants qualified for multiple groups due to a combination of conditions. Thus, caution should be taken when comparing groups aged 18–59 years with different medical conditions because independence cannot be assumed. Additionally, interpretation of the results should account for the timing of data collection, which occurred prior to recent surges in RSV-related hospitalizations in the US.Citation23 Recent news stories related to these increases in RSV cases among infants and older adults in the US may have increased RSV awareness since the end of the study.
Conclusions
Results from this study highlight important knowledge gaps related to RSV in adults at increased risk of severe RSV, as well as attitudes and perceptions (e.g., related to the perceived risk and severity of RSV). Findings from the study can be used by healthcare providers initiating shared clinical decision-making conversations with their patients aged 60 years and older who are eligible for RSV vaccination, as well as to tailor RSV disease awareness educational interventions to healthcare providers and patients.
Author contributions
Phil Schwab participated in the interpretation of study results and development of this manuscript. All other authors participated in the design, implementation, and/or analysis, as well as the interpretation of study results and the development of this manuscript. All authors had full access to the data and gave final approval before submission.
Ethics approval statement
All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The work described was carried out in accordance with the recommendations of the International Committee of Medical Journal Editors for conduct, reporting, editing, and publication of scholarly work in medical journals.
Sponsor’s role
GSK funded this study (GSK study identifier: 218693/HE-RSV-004 BOD) and was involved in all stages of study conduct, including analysis of the data. GSK also took in charge all costs associated with the development and publication of this manuscript.
Supplemental Material
Download PDF (1.2 MB)Acknowledgments
The authors would like to thank Audrey Colliou and Kajan Gnanasakthy for their study support. The authors would also like to thank Business & Decision Life Sciences Medical Communication Service Center for editorial assistance and manuscript coordination, on behalf of GSK. Amandine Radziejwoski, on behalf of GSK, provided writing support.
Disclosure statement
Elizabeth La and Sara Poston are employed by and hold shares in GSK. Lauriane Harrington is employed by GSK. Su Bunniran, Diana Garbinsky, Maria Reynolds, and Phil Schwab are employees of RTI Health Solutions, which received funding from GSK for the conduct of this study. Su Bunniran is part of the community advisory board of the University of Mississippi. All authors declare no other financial or non-financial relationships and activities and no other conflicts of interest.
Data availability statement
The model used in this study is proprietary property of GSK and is not able to be shared.
Supplementary data
Supplemental data for this article can be accessed on the publisher’s website at https://doi.org/10.1080/21645515.2024.2303796.
Additional information
Funding
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