Gaps in knowledge about the vaccine coverage of immunocompromised children: a scoping review

Figures & data

Table 1. Frequency of study characteristics of included studies (N = 97).^a

Characteristics	Number of articles	% of articles
Year of Publication
2015–2020	50	52
2011–2014	27	28
2000–2010	18	19
<2000	2	2
Publication Type
Journal article	67	69
Abstract	30	31
Immunocompromising Condition
Cancer/stem cell transplant	24	25
Solid organ transplant	23	24
Sickle cell disease	21	22
HIV	12	12
Immunosuppressive therapy for a chronic condition	14	14
Splenectomy	4	4
Primary immunodeficiency	2	2
Unspecified	3	3
Age Range of Children
0–4 y	48	49
5–11 y	55	57
12–18 y	50	52
Not stated	29	30
Vaccine Type
Immunization guidelines/routine schedules	24	25
Measles- and/or mumps- and/or rubella-containing	29	30
Varicella	23	24
Diphtheria- and/or tetanus- and/or pertussis- and/or poliomyelitis- and/or Haemophilus influenzae type B- and/or hepatitis B-containing	36	37
Meningococcal	25	26
Pneumococcal	46	47
Rotavirus	2	2
Influenza	44	45
Human papillomavirus	19	20
Bacillus Calmette–Guérin	10	10
Hepatitis A	11	11
Typhoid fever	1	1
Yellow fever	1	1
Not stated	1	1
Timepoints of Vaccine Coverage Measurement^b
Pretreatment	20	30
Posttreatment	25	37
During treatment	21	31
Unspecified	6	9
Geographic Region
North America	48	49
Europe	33	34
Africa	6	6
Latin America/Caribbean	6	6
Oceania	3	3
Middle East	2	2
Income of Country
High-income	84	87
Upper-middle-income	10	10
Lower-middle-income	2	2
Low-income	4	4
Study Design
Cross-sectional	46	47
Retrospective cohort	19	20
Prospective cohort interventional	16	16
Prospective cohort observational	11	11
Case-control	4	4
Randomized controlled trial	1	1
Vaccine Coverage Data Source
Medical record/chart	25	26
Caregiver/parent questionnaire	18	19
Hospital unit questionnaire	1	1
Electronic medical record	5	5
Database or registry	7	7
Caregiver interview	1	1
Physician-obtained data	2	2
Mixed data sources	25	26
Not stated	13	13
Sample Size
<25	9	9
25–50	14	14
51–100	24	25
101–200	18	19
>200	28	29
Not stated	5	5
Comparison Group
Non-immunocompromised	24	25
Same immunocompromised condition	23	24
Different immunocompromised condition	3	3
No comparison group	50	52
Quality Score
High	34	35
Low	63	65

^aTotals may not equal 100% due to non-mutually exclusive categories.

^bFrequency calculated using the 67 studies relevant to this variable.

Figure 1. PRISMA flow diagram.

Table 2. Vaccine types and geographic regions.^a

Vaccine type	Geographic region
	North America	Europe	Oceania	Latin American and the Caribbean	Africa	Middle East
M/M/R-containing^b	n = 8	n = 11	n = 1	n = 4	n = 3	n = 2
Varicella	n = 8	n = 9	n = 3	n = 2	n = 0	n = 0
D/T/P/Polio/Hib/Hep B-containing^c	n = 14	n = 13	n = 1	n = 2	n = 4	n = 2
Meningococcal	n = 12	n = 11	n = 0	n = 1	n = 1	n = 0
Pneumococcal	n = 22	n = 17	n = 1	n = 3	n = 3	n = 0
Rotavirus	n = 1	n = 1	n = 0	n = 0	n = 0	n = 0
Influenza	n = 17	n = 24	n = 1	n = 1	n = 1	n = 0
HPV^d	n = 12	n = 7	n = 0	n = 0	n = 0	n = 0
BCG^e	n = 0	n = 3	n = 0	n = 2	n = 3	n = 2
Hepatitis A	n = 7	n = 3	n = 0	n = 1	n = 0	n = 0
Typhoid fever	n = 0	n = 0	n = 0	n = 0	n = 1	n = 0
Yellow fever	n = 0	n = 0	n = 0	n = 0	n = 1	n = 0

^aThe darker colored cells indicate areas that were more commonly studied.

^bMeasles- and/or mumps- and/or rubella-containing.

^cDiphtheria- and/or tetanus- and/or pertussis- and/or poliomyelitis- and/or Haemophilus influenzae type B- and/or hepatitis B-containing.

^dHuman papillomavirus.

^eBacillus Calmette–Guérin.

Table 3. Vaccine types and study designs.^a

	Study design
Vaccine type	Retrospective cohort	Prospective cohort: interventional	Prospective cohort: observational	Cross-sectional	Case-control	Randomized controlled trial
M/M/R- containing^b	n = 7	n = 2	n = 2	n = 17	n = 1	n = 0
Varicella	n = 5	n = 2	n = 1	n = 14	n = 1	n = 0
D/T/P/Polio/Hib/Hep B-containing^c	n = 10	n = 1	n = 3	n = 21	n = 1	n = 0
Meningococcal	n = 7	n = 1	n = 1	n = 13	n = 2	n = 1
Pneumococcal	n = 14	n = 5	n = 3	n = 21	n = 3	n = 0
Rotavirus	n = 2	n = 0	n = 0	n = 0	n = 0	n = 0
Influenza	n = 6	n = 12	n = 4	n = 21	n = 1	n = 1
HPV^d	n = 5	n = 1	n = 0	n = 12	n = 1	n = 0
BCG^e	n = 2	n = 0	n = 2	n = 6	n = 0	n = 0
Hepatitis A	n = 4	n = 2	n = 0	n = 4	n = 1	n = 0
Typhoid fever	n = 1	n = 0	n = 0	n = 0	n = 0	n = 0
Yellow fever	n = 1	n = 0	n = 0	n = 0	n = 0	n = 0

^aThe darker colored cells indicate areas that were more commonly studied.

^bMeasles- and/or mumps- and/or rubella-containing.

^cDiphtheria- and/or tetanus- and/or pertussis- and/or poliomyelitis- and/or Haemophilus influenzae type B- and/or hepatitis B-containing.

^dHuman papillomavirus.

^eBacillus Calmette–Guérin.

Table 4. Vaccine types and data sources.^a

	Data Source
Vaccine type	Medical record/chart	Electronic medical record	Database/registry	Caregiver/patient questionnaire	Hospital unit questionnaire	Caregiver interview	Physician-obtained	Mixed	Unspecified
M/M/R-containing^b	n = 14	n = 2	n = 0	n = 3	n = 0	n = 0	n = 0	n = 7	n = 3
Varicella	n = 11	n = 2	n = 0	n = 1	n = 0	n = 0	n = 0	n = 7	n = 2
D/T/P/Polio/Hib/Hep B-containing^c	n = 12	n = 3	n = 1	n = 3	n = 0	n = 1	n = 1	n = 11	n = 3
Meningococcal	n = 8	n = 3	n = 1	n = 2	n = 0	n = 0	n = 1	n = 7	n = 2
Pneumococcal	n = 17	n = 3	n = 3	n = 5	n = 1	n = 0	n = 2	n = 13	n = 3
Rotavirus	n = 0	n = 0	n = 0	n = 1	n = 0	n = 0	n = 0	n = 0	n = 1
Influenza	n = 5	n = 4	n = 4	n = 9	n = 1	n = 0	n = 1	n = 13	n = 6
HPV^d	n = 3	n = 2	n = 1	n = 7	n = 0	n = 0	n = 0	n = 5	n = 1
BCG^e	n = 2	n = 1	n = 0	n = 2	n = 0	n = 1	n = 0	n = 3	n = 1
Hepatitis A	n = 3	n = 2	n = 0	n = 0	n = 0	n = 0	n = 1	n = 4	n = 1
Typhoid fever	n = 1	n = 0	n = 0	n = 0	n = 0	n = 0	n = 0	n = 0	n = 0
Yellow fever	n = 1	n = 0	n = 0	n = 0	n = 0	n = 0	n = 0	n = 0	n = 0

^aThe darker colored cells indicate areas that were more commonly studied.

^bMeasles- and/or mumps- and/or rubella-containing.

^cDiphtheria- and/or tetanus- and/or pertussis- and/or poliomyelitis- and/or Haemophilus influenzae type B- and/or hepatitis B-containing.

^dHuman papillomavirus.

^eBacillus Calmette–Guérin.

Table 5. Vaccine types and sample sizes.^a

	Sample size
Vaccine type	<25	25–50	51–100	101–200	>200	Not stated
M/M/R-containing^b	n = 3	n = 8	n = 9	n = 2	n = 7	n = 0
Varicella	n = 2	n = 6	n = 9	n = 1	n = 5	n = 0
D/T/P/Polio/Hib/Hep B—containing^c	n = 2	n = 8	n = 10	n = 5	n = 9	n = 1
Meningococcal	n = 2	n = 6	n = 6	n = 2	n = 7	n = 1
Pneumococcal	n = 5	n = 8	n = 11	n = 11	n = 9	n = 1
Rotavirus	n = 0	n = 1	n = 0	n = 0	n = 1	n = 0
Influenza	n = 4	n = 6	n = 11	n = 8	n = 12	n = 3
HPV^d	n = 2	n = 3	n = 3	n = 2	n = 8	n = 1
BCG^e	n = 0	n = 3	n = 3	n = 1	n = 3	n = 0
Hepatitis A	n = 2	n = 1	n = 5	n = 0	n = 2	n = 1
Typhoid fever	n = 0	n = 0	n = 1	n = 0	n = 0	n = 0
Yellow fever	n = 0	n = 0	n = 1	n = 0	n = 0	n = 0

^aThe darker colored cells indicate areas that were more commonly studied.

^bMeasles- and/or mumps- and/or rubella-containing.

^cDiphtheria- and/or tetanus- and/or pertussis- and/or poliomyelitis- and/or Haemophilus influenzae type B- and/or hepatitis B-containing.

^dHuman papillomavirus.

^eBacillus Calmette–Guérin.

Table 6. Immunocompromising conditions and vaccine Types.^a

	Vaccine type
Immunocompromising condition	M/M/R- containing^b	Varicella	D/T/P/Polio/Hib/Hep B-containing^c	Meningococcal	Pneumococcal	Rotavirus	Influenza	HPV^d	BCG^e	Hepatitis A	Typhoid fever	Yellow fever
Cancer/Stem Cell Transplant	n = 5	n = 5	n = 5	n = 2	n = 2	n = 0	n = 11	n = 9	n = 0	n = 2	n = 0	n = 0
Solid Organ Transplant	n = 13	n = 12	n = 13	n = 7	n = 14	n = 1	n = 8	n = 5	n = 5	n = 6	n = 0	n = 0
Sickle Cell Disease	n = 2	n = 1	n = 5	n = 7	n = 16	n = 0	n = 10	n = 0	n = 1	n = 3	n = 1	n = 1
HIV	n = 5	n = 1	n = 7	n = 2	n = 2	n = 0	n = 6	n = 2	n = 4	n = 0	n = 0	n = 0
Other Immunosuppressive Therapy	n = 3	n = 3	n = 3	n = 4	n = 7	n = 1	n = 9	n = 3	n = 0	n = 0	n = 0	n = 0
Splenectomy	n = 0	n = 0	n = 3	n = 3	n = 4	n = 0	n = 1	n = 0	n = 0	n = 0	n = 0	n = 0
Primary Immunodeficiency	n = 1	n = 1	n = 0	n = 0	n = 1	n = 0	n = 1	n = 0	n = 0	n = 0	n = 0	n = 0
Unspecified	n = 0	n = 0	n = 0	n = 0	n = 0	n = 0	n = 3	n = 0	n = 0	n = 0	n = 0	n = 0

^aThe darker colored cells indicate areas that were more commonly studied.

^bMeasles- and/or mumps- and/or rubella-containing.

^cDiphtheria- and/or tetanus- and/or pertussis- and/or poliomyelitis- and/or Haemophilus influenzae type B- and/or hepatitis - containing.

^dHuman papillomavirus..

^eBacillus Calmette–Guérin.

Table 7. Complete vaccine coverage, by immunocompromising condition.^a

Study	Complete vaccine coverage by immunocompromising condition and vaccine type, %(n)
	As per guideline^b	M/M/R- containing^c	Varicella	D/T/P/Polio/Hib/Hep B-containing^d	Meningococcal	Pneumococcal	Rotavirus	Influenza	HPV^e	BCG^f	Hepatitis A
Cancer/Stem Cell Transplant
Pretreatment	81.3 (48)^Citation50	93.2 (55)^Citation50	64.4 (38)^Citation50	96.6 (57)^Citation50
Undergoing/posttreatment	6 (14);^Citation55 9.8 (5);^Citation44 9 (9);^Citation56 30–40;^gCitation57 44.9 (40);^Citation58 47.5 (28);^Citation50 88 (30)^Citation59	2.1 (5);^Citation55 35.3 (18);^Citation44 40 (36);^Citation58 81.1–90.9 (18–20)^Citation60	2.5 (6);^Citation55 13 (6);^Citation61 15 (13);^Citation58 21.4 (11)^Citation44	0–0.4 (0–1);^Citation55 12–54 (11–48);^Citation58 21.6–54.9 (11–28)^Citation44	1.3 (3);^Citation55 39 (35);^Citation58 47.5 (24)^Citation44	1.7–5.5 (4–13);^Citation55 17.6–21.6 (9–11)^Citation44		3.4 (8);^Citation55 20.5 (42)^g;^Citation51 25.8 (36);^Citation62 39.2 (20);^Citation44 40 ^g;^Citation63 54.8 (263)^g;^Citation64 66.1–70.3 (184–267)^g;^Citation53 74.9 (140)^g;^Citation65 87.1 (122)^Citation41	0 (0);^Citation55 12.6–25.5 (30–66);^Citation66 13.5 (133);^Citation67 18.3 (42);^Citation68 20.9 (72);^Citation69 27.3 (14)^Citation44	0 (0);^Citation44 2.5 (6)^Citation55
Unspecified time point								6.3–33.3 (1–6)^pCitation45
Solid Organ Transplant
Pre-transplant	8.7 (14);^Citation70 27.6 (24);^Citation71 29 (5);^Citation72 32 (13)^j;^Citation73 33 (6);^Citation74 47 (14);^Citation54 80;^g,hCitation46 86.4 (57)^Citation75	28–36 ^l;^Citation76 44 (11)^g;^Citation77 55.5 (50);^Citation78 57.4 (54);^Citation79 58 (58);^Citation80 60 (18);^Citation54 71.7–93.5 (33–43);^Citation81 75 (31)^j;^Citation73 75 ^k;^Citation71 82.1–84.9 (206–213);^Citation70 89;^Citation82 100 ^g,hCitation46	0 (0)^g;^Citation77 17.9–36.3 ^l;^Citation76 10.8 (5);^Citation81 20 (6);^Citation54 37.2 (35);^Citation79 58 (24)^j;^Citation73 58.9 (119);^Citation70 62 ^k;^Citation71 88;^Citation82 100 ^g,hCitation46	14–43 (6–19)^g;^Citation77 15–84 ^l;^Citation76 50–84;^Citation82 57.2–87.8 (52–59);^Citation78 58–85 (68–85);^Citation80 63.0–97.8 (29–45);^iCitation81 70–75^k;^Citation71 70.5–88.6 (177–202);^Citation70 73–100;^g,hCitation46 71–89 (29–36)^j;^Citation73 92 (59);^Citation83 100 (30)^Citation54	0 ^l;^Citation76 11 (5)^j;^Citation73 33 (10);^Citation54 47.9 (81);^Citation70 75–100;^g,hCitation46 94^51	0 (0)^g;^Citation77 0–6 ^l;^Citation76 0–100;^g,hCitation46 10.8 (5);^Citation81 30–44 ^k;^Citation71 39 (16)^j;^Citation73 42.0 (73);^Citation70 63^51; 73 (22);^Citation54 84 (54)^Citation83	50 (21)^jCitation73	23 (7);^Citation54 72 (46);^Citation83 100 ^g,hCitation46	27.3 (9);^Citation70 65^k;^Citation71 90^Citation82	97 (97);^Citation80 97.8 (88);^Citation78 100 (46);^Citation81 100 (13)^Citation70	8 (2)^g;^Citation77 42 (17)^j;^Citation73 50–100;^g,hCitation46 54^kCitation71 68;^Citation82 91 (29)^Citation83
Post-transplant		76.0–100 (35–46)^Citation81	10.8 (5)^Citation81	50.0–97.8 (23–45)^iCitation81		10.8 (5);^Citation81 15 (9);^jCitation42 44 (40)^Citation84		57.1 (8);^Citation85 67 (125);^Citation43 77 (45)^jCitation42		100 (46)^Citation81
Unspecified/Combined time point		80 (27)^mCitation86	100 ^mCitation86	45–71 (15–24)^mCitation86	82 (28)^mCitation86	25 (9)^mCitation86		33.3 (5);^Citation87 35.3 (77);^Citation88 55–59 (6–13)^mCitation86	12.5^mCitation86	80 (27)^mCitation86
Sickle Cell Disease
	19.5 (16);^Citation89 46.2 (48);^Citation52 69.8 (44);^Citation90 85 (17)^Citation91	20–100 ^g;^Citation92 92.3 (96)^Citation52	49 (27)^kCitation90	37–100 ^g;^Citation92 56 (14);^Citation93 84.6–91.3 (88–95)^Citation52	25–77;°^Citation94 47.5 (29) ^k;^Citation90 56 ^g;^Citation92 56 (14);^Citation93 59 (115);^Citation47 60 (19);^Citation95 86.8–90.2°^Citation96	0 (0);^Citation97 0–23 ^g;^Citation92 8–48 (5–30) ^k;^Citation90 25;^gCitation98 40–73°;^Citation48 44.7–72.5°;^Citation47 47.4 (768)^n;^Citation99 52.7–64.3°^Citation100; 54.8 (57);^Citation52 53–60;°^Citation94 56 (14);^Citation93 80;^gCitation101 73.3–96.8 (23–30);^Citation95 85 (17);^Citation91 88 (23);^Citation97 91.0–94.8 (286–271);^Citation102 97.5^Citation103		0 (0);^Citation97 8 (2);^Citation93 17 (11)^k;^Citation90 26;^gCitation101 45 ^g;^Citation104 50 (10);^Citation91 52 (56);^oCitation94 60;^Citation103 63.7 (205);^Citation105 90 (26)^Citation97		100 ^gCitation92	15 (3);^Citation91 25 (16)^kCitation90
HIV
	38 (12);^Citation106 68 (61)^Citation107	32 (6);^Citation108 67.0 (32);^Citation109 68.1 (258);^Citation110 70.1 (96);^Citation111 87.1 (165)^Citation112	15^kCitation108	7.0 (8);^Citation109 26.9–42.9°;^Citation49 43.5–74.5;°^Citation110 55.5–80.3 (76–110);^Citation111 68 (21);^Citation106 74 (14);^Citation108 91.4–97.9 (174–186)^Citation112	30.2–38.6°;^Citation49 68 (13)^Citation108	25 (10);^kCitation42 50^kCitation108		10–40;^pCitation45 48 (15);^Citation106 69.4 (25);^Citation113 72 (29);^kCitation42 82 (28)^Citation114	40; ^kCitation108 56(17)^Citation106	52 (16)^Citation106 ; 70.4 (273);^Citation110 100 (190);^Citation112 100 (257)^Citation109
Immunosuppressive Therapy for a Chronic Condition
	10.4 (25);^Citation115 18 (9);^Citation116 49 (26);^Citation117 98 (118)^Citation118	86 (43);^Citation116 89.3 (384);^Citation119 92 (300)^Citation120	18.4 (79);^Citation119 31–66;°^Citation116 74 (87)^Citation120	67–86;°^Citation116 81.9–99.3 (352–427);^Citation119 89 (290)^Citation120	9.4 (5);^Citation117 13–76;°^Citation116 23.5 (101)^Citation119	0–20 ^g;^Citation121 3.7–94.3 (4–100);^Citation122 7.0 (11);^gCitation123 7.8 (38);^Citation124 18.6 (80);^Citation119 26.4 (14);^Citation117 30 (36);^Citation118 42 (21)^Citation116	1.9 (8)^Citation119	1.7 (1);^Citation117 7.8 (38);^Citation124 26.7 (4);^Citation85 46 (41);^Citation87 57.1 (8);^Citation85 62.9 (202);^Citation88 74 (89);^Citation118 78–80;^gCitation125 84.3 (130)^Citation123	5.9 (22)^Citation119
Splenectomy
				37.5 (3)^g;^Citation126 41 (37)^Citation127	31.3 (5)^g;^Citation126 51 (46)^Citation127	44.4 (8)^g;^Citation126 72 (65);^Citation127 100 (4)^Citation128		18.8 (3)^Citation1g 01
Primary Immunodeficiency
		77–82°^Citation129	66 ^oCitation129			31–40°^Citation129		10–36.4^pCitation45
Unspecified Immunocompromising Condition
								3.9 (2,115);^Citation130 45.5–48.1^p;^Citation131 61.3 (434, 377)^Citation132

^aReported coverage for additional vaccines studied for sickle cell disease: typhoid fever, 26%;⁹¹ yellow fever, 100%.⁹¹ See supplemental material for more detail.

^bReported up-to-date as per referenced guidelines or infectious disease physician recommendations.

^cMeasles- and/or mumps- and/or rubella-containing; for studies that considered components of the vaccine separately, coverage is presented as a range.

^dDiphtheria- and/or tetanus- and/or pertussis- and/or poliomyelitis- and/or Haemophilus influenzae type B- and/or hepatitis B-containing; for studies that considered components of the vaccine separately, coverage is presented as a range.

^eHuman papillomavirus.

^fBacillus Calmette–Guérin.

^gVaccination coverage from study’s pre-intervention phase or intervention control group.

^hVaccine coverage reported as interquartile range.

ⁱHib coverage not included as only 1 child in study was eligible due to changing guidelines.

^jReports coverage at time of evaluation and at time of transplant. Evaluation coverage reported here.

^kCoverage numbers for individual vaccines estimated from figure.

^lGives coverage for different age at transplant, provided as range here.

^mBooster coverage.

ⁿOverall coverage reported here; authors also provide estimates by age range.

^oReported coverage as per age, unknown n.

^pRange represents vaccine coverage reporting on a range of years.

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