BACKGROUND: Measles is a leading cause of death among children globally. Nationwide non-selective campaigns together with routine immunization have sharply reduced measles cases and deaths in many low- and middle-income countries (LMICs). However, since 2018, vaccine funders (especially Gavi) are urging countries to consider targeted and selective measles-rubella campaigns. In 2021, Senegal conducted a nationwide selective campaign, with a door-to-door census to identify un- and under-vaccinated children needing a measles-rubella vaccine, followed by a vaccination campaign three weeks later. An evaluation of the selective campaign in Senegal and a scoping review on targeted and selective campaigns were conducted to assess if the evidence supports use of these strategies.
METHODS: For the scoping review, publications relevant to LMICs were sourced from key word searches on PubMed and Embase, and through consultation with measles-rubella experts, who also advised on data extraction and synthesis. To evaluate Senegal’s campaign, census and vaccination data were reviewed and 56 key informants were interviewed across national, regional, district, and health facility levels to understand campaign outcomes, barriers, and facilitators. The RE-AIM framework was used to interpret the findings. The scoping review and evaluation findings were presented during a World Health Organization (WHO) consultation in March 2023.
OUTCOMES: The scoping review found insufficient published evidence on the relative benefits of targeted and selective campaigns and no evidence-based guidance to consider them. The review proposed definitions for “tailored”, “targeted”, and “selective” campaigns; consensus was reached on the definitions during the WHO consultation. The evaluation in Senegal revealed that only 23% of the estimated 913,445 un- and under-vaccinated children were identified during the census. Several respondents recommended against using a selective campaign in the future due to difficulties with conducting a complete door-to-door census, misallocation of resources for the vaccination campaign based on an incomplete census, and challenges with vaccinating all identified children in a mobile population.
CONCLUSION: The selective measles-rubella campaign in Senegal was unsuccessful in vaccinating most un- and under-vaccinated children and suggested that these approaches may not succeed in countries with limited operational capacity and weak information systems. The evaluation and scoping review findings informed WHO’s decision to develop interim guidance on targeted and selective campaigns in 2023. / 2025-07-25T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/46499 |
| Date | 26 July 2023 |
| Creators | Bhatnagar, Barkha |
| Contributors | Hamer, Davidson H. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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