Knowledge, attitudes, and practices of pediatricians in Crete, Greece, regarding RSV immunization: a cross-sectional study

Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory tract infections in early infancy, and the recent introduction of two novel immunoprophylaxis tools-maternal vaccination with the RSVpreF vaccine and infant protection with the long-acting monoclonal antibody nirsevimab-represents a major advancement in RSV prevention. The successful implementation of these strategies depends heavily on pediatricians' awareness, confidence, and readiness to integrate them into routine clinical practice. Evidence from Southern Europe remains limited. This cross-sectional study assessed the knowledge, attitudes, and practices of pediatricians in Crete, Greece, regarding RSV infection and emerging prevention tools. A structured electronic questionnaire was distributed between April and July 2025 to all board-certified pediatricians and pediatric residents registered with the regional medical associations. Among 169 respondents (mean age 46 ± 12.5 years; 83.4% women), overall knowledge was high, with a mean score of 89.6 ± 10.0. Knowledge gaps were concentrated in areas related to newly introduced immunoprophylaxis tools, including awareness of RSV monoclonal antibody availability for infants, updated recommendations covering infants up to 6 months, and distinctions between palivizumab and nirsevimab. Attitudes toward vaccination were overwhelmingly positive: nearly all participants expressed strong vaccine confidence and adherence to national immunization guidelines. Most pediatricians (78.6%) felt adequately informed about RSV. These findings suggest that pediatricians in Crete possess a strong foundation for integrating new RSV prevention strategies, although targeted educational initiatives-particularly regarding nirsevimab-will be essential to ensure consistent and equitable implementation. The results provide timely insights to support national planning and optimize the rollout of RSV immunoprophylaxis in Greece and comparable settings. What is Known: • RSV is a leading cause of severe respiratory disease in early infancy. • New prevention tools (RSVpreF, nirsevimab) are being introduced into national programs. • Pediatricians' knowledge and confidence strongly influence vaccine uptake. What is New: • Greek pediatricians show high overall RSV knowledge and strong vaccine confidence. • Specific gaps exist regarding nirsevimab and distinctions between immunoprophylaxis tools. • Findings highlight targeted education needs during early implementation of RSV prevention.