Lessons from a decade of adult vaccine rollout in low- and middle-income countries: a scoping review

Figures & data

Figure 1. PRISMA flow diagram.

This PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram illustrates the study identification and selection process for this review. The initial database search identified 22,529 studies. Following the removal of duplicate records, screening, and eligibility assessment, 25 studies were ultimately included in the review.

Table 1. Brief overview of included study characteristics (n = 25).

Reference	Author	Publication year	Country	Vaccine of focus	Vaccination campaign type	Target population included
[1]	Burchett et al.	2014	Mali	MenA^a	Routine and campaign/mass	18 years and older
[2]	Otieno et al.	2021	Kenya	TTV^b	Routine	Pregnant females
[3]	Abubakar et al.	2015	South Sudan	OCV^c	Emergency/outbreak	Internally displaced persons (IDPs)
[4]	Khan et al.	2019	Bangladesh	OCV	Campaign/mass and catch-up	High-risk individuals in defined vaccine clusters, excluding pregnant women
[5]	Amani et al.	2022	Cameroon	OCV	Reactive mass vaccination	One year and older including pregnant females
[6]	Poncin et al.	2018	Zambia	OCV	Reactive mass vaccination	All individuals older than one year who lived in one of the 10 townships of Lusaka that, in March 2016, were considered high-risk for cholera
[7]	Fleming et al.	2019	Malawi	TTV	Routine and mass	18 years and older; pregnant females
[8]	Bwire et al.	2020	Uganda	OCV	Emergency/outbreak	Persons older than year of age living in the OCV targeted area at the time of the vaccination campaign
[9]	Poncin et al.	2022	Zimbabwe	TCV	Emergency/outbreak	Adults aged 16–45 years in one suburb with high past attack rates of typhoid
[10]	Lubogo et al.	2020	Somalia	OCV	Emergency/outbreak	Persons older than one year of age living in 11 high-risk districts
[11]	Kar et al.	2014	India	OCV	Campaign/mass	Persons older than one year of age
[12]	Mounier-Jack et al.	2014	Mali	MenA	Campaign/mass	All people 1–29 years old
[13]	Ciglenecki et al.	2013	Guinea	OCV	Reactive mass vaccination	Coastal and island populations older than one year of age in 3 districts of Guinea
[14]	Parker et al.	2017	South Sudan	OCV	Emergency/outbreak	Neighborhoods with evidence of significant transmission just prior to the campaign and vulnerable groups at higher risk of cholera including IDPs, prisoners and health care workers. Close contacts of confirmed cases were also prioritized
[15]	Khan et al.	2019	Bangladesh	OCV	Campaign/mass	Participants with high risk for cholera and low socioeconomic conditions older than 1 year of age and not pregnant
[16]	Heyerdahl et al.	2017	Malawi	OCV	Reactive mass vaccination	Fishermen living in floating islands (‘Zimboweras’) and population living in villages within 2 km radius of Lake Chilwa, Malawi
[17]	Grandesso et al.	2018	Malawi	OCV	Reactive mass vaccination	Fishermen living in floating islands (‘Zimboweras’) and population living in villages within 2 km radius of Lake Chilwa, Malawi
[18]	Sharp et al.	2020	Haiti	OCV	Emergency/outbreak	All individuals older than 1 year of age living in selected households in 16 Communes in Haiti
[19]	Porta et al.	2014	South Sudan	OCV	Campaign/mass	IDPs older than 1 year of age, in four refugee camps: Jamam, Doro, Batil and Gendrassa, and the host population in Maban County, South Sudan
[20]	Uddin et al.	2014	Bangladesh	OCV	Campaign/mass	Population living in Mirpur area of Dhaka with high cholera incidence aged older than 1 year.
[21]	Ngwa et al.	2020	Nigeria	OCV	Reactive mass vaccination	Internally displaced persons (IDPs) aged 1 year and above excluding pregnant persons living in 6 high-risk local government areas (LGAs)
[22]	Msyamboza et al.	2016	Malawi	OCV	Reactive mass vaccination	Individuals aged one year or more living in 19 camps of people internally displaced by floods and their surrounding communities in Nsanje district, Malawi
[23]	Elias Chitio et al.	2022	Mozambique	OCV	Reactive mass vaccination	Individuals aged one year or more living in Cuamba district, Mozambique with frequent cholera outbreaks
[24]	Amani et al.	2021	Cameroon	OCV	Reactive mass vaccination	One year and older including pregnant females
[25]	Anikene et al.	2016	Nigeria	EBOV^d	Pre-campaign	Healthcare workers

^aMenA- Meningitis A vaccines.

^bTTV- tetanus toxoid vaccines.

^cOCV- oral cholera vaccines.

^dEBOV- Ebola virus vaccines.

Table 2. Overview of stakeholders involved in policy-making and preparatory activities.

References	Country	Vaccine evaluated	Key stakeholders engaged as reported by studies
[19]	Kenya	Maternal Tdap/tetanus vaccine	Government: The Kenya National Immunization Technical Advisory Group (KENITAG), which is composed of senior members of the relevant medical specialties, experts from universities Personnel from the Ministry of Health (MoH) National and county governments Community representatives: Communities and opinion leaders Lobby groups that would influence public opinion Healthcare: Health providers
[20]	South Sudan	Oral cholera vaccine	Government: South Sudan Ministry of Health (MoH) International organizations: World Health Organization (WHO) Médecins Sans Frontières (MSF) Medair International Organization for Migration International Medical Corps United Nations Children’s Fund (UNICEF)
[21]	Bangladesh	Oral cholera vaccine	Government: Ministry and government representatives City Corporation officials Ward councilors International organizations: Non-governmental organizations (NGOs) World Health Organization (WHO) UNICEF Community representatives: Community representatives Field workers and volunteers
[22]	Cameroon	Oral cholera vaccine	Government: Ministry of Public Health International organizations: World Health Organization (WHO) Community representatives: Community and religious leaders Media personnel
[9]	Mali	Meningococcal vaccine	Government: EPI officials Ministry of Health officials Regional and district level officials Communication and Civil Society: National Communication Agency for Health Centre for Vaccine Development Health facility staff Civil society
[27]	Somalia	Oral cholera vaccine	Government: Federal Ministry of Health Health and security officials International organizations: World Health Organization (WHO) Community representatives: Local community elders Local NGOs Healthcare: WaSH partners
[28]	India	Oral cholera vaccine	Community representatives: Local leaders Community members Healthcare: Volunteer health workers

Table 3. Innovative strategies for adult vaccination uptake.

Key strategies Extending vaccination campaign hours Extending campaign to non-working days/weekends Choosing a convenient time for the campaign, accounting for holidays and climate season Setting up vaccination sites in convenient and communal locations frequented by adults (i.e. religious buildings, markets, trading centers, and public social gathering spots) Utilizing former known immunization venues Conducting education campaigns to address misconceptions Using a combination of vaccination delivery strategies (fixed, mobile, workplace, door-to-door) Second dose self-administration for oral vaccines Utilizing technology such as geo-spatial mapping to identify favorable venues before and during campaigns

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Figure 2. Key lessons learned for new adult vaccines.

This figure summarizes the key lessons and recommendations derived from the review of 25 studies on the factors influencing the availability, accessibility, and acceptability of new vaccines for adults in Low- and Middle-Income Countries (LMICs).

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