Meningitis Vaccine Delivery Strategies and Their Health Impact in Africa: A Scoping Review to Inform the Introduction of New Vaccines

Abstract

Introduction

Vaccination has played a pivotal role in mitigating the burden of meningitis in the African meningitis belt. However, outbreaks have continued due to the emergence of new serogroups, and logistical barriers. This scoping review synthesizes published evidence on health impact of meningitis vaccine delivery strategies to guide policy and programmatic decision-making and maximize the impact of the new meningitis vaccines.

Methods

The review followed PRISMA extension for scoping reviews. Eligible studies published between 2004 and 2024 in English or with an English translation examining the use of meningitis vaccines and delivery strategies across Africa were included. A systematic search of online databases was conducted using predefined search terms, and following screening of 1,026 articles, 20 were included in the review. Data on relevant themes were extracted into an excel spreadsheet and analyzed guided by PAGER framework.

Results

The review found limited real-world evidence on meningitis vaccine delivery strategies, with many studies relying on modelling approaches. Findings showed that routine infant immunization and campaign-based strategies have been used to deliver meningitis vaccines in Africa. Compared to routine vaccination, campaign-based strategies were shown to achieve high coverage rates (∼95%), high risk reduction (71%) and high decline in suspected cases (82%). However, routine immunization combined with an initial catch-up campaign was cost-effective, saving USD1.3 for every USD1 invested. The use of the Controlled Temperature Chain (CTC) system for Men A conjugate vaccines enhanced accessibility and cost-effectiveness, particularly for remote facilities lacking cold chain infrastructure. Integrated campaigns were more cost-effective than stand-alone campaigns. Combining campaigns with routine immunization resulted in significant reduction of disease burden, despite potential disruptions during mass vaccination campaigns.

Conclusions

Combining routine and campaign-based immunization strategies will enhance the impact of the new meningitis vaccines. There is need for more real-world implementation and cost-effectiveness research from Africa.

Introduction

Meningitis is a global public health challenge, causing about 250,000 deaths every year and serious complications and disabilities among survivors.^1,2 Its impact is felt the most in Africa, particularly within the “meningitis belt” where recurrent epidemics of meningococcal meningitis have caused substantial morbidity, mortality and social disruption. The extended meningitis belt of Africa spans 26 countries, from Ethiopia in the East and Senegal in the West. ² These countries typically experience seasonal outbreaks of meningitis every year, with major epidemics occurring every 5 to 12 years. Within the belt, countries like Nigeria, Niger, Burkina Faso, Chad and Mali are vulnerable and most frequently affected, with periodic localized and cross-border outbreaks and large-scale epidemics. ² Their vulnerability is due to the intersection of climactic risk, population dynamics, pathogen evolution and health system limitations.

Meningitis disproportionately affects children and young adults who account for most cases and deaths in the African meningitis belt. During large-scale epidemics, majority of meningitis cases occur in individuals aged 1 to 29 years, with children under 5 years bearing the highest case fatality rates and risk of long-term complications. During the 1996 epidemic in Nigeria, 84% of reported cases were in individuals under 20 years of age. ³ The recent meningitis epidemics in Nigeria during the 2023/2024 season significantly impacted children and adolescents. The country recorded 4,915 suspected cases and 361 deaths across 24 states and the Federal Capital Territory, and children aged 5 to 15 years accounted for the highest proportion of cases. ⁴ The high burden among young people has profound implications for individuals as well as for workforce productivity and long-term socioeconomic development in the region.

In response to the persistent threat posed by meningitis, African countries have implemented a range of vaccine delivery strategies, including mass vaccination campaigns, routine immunization integration, and targeted outbreak response mechanisms. Notably, the introduction of the meningococcal A conjugate vaccine (MenAfriVac) in 2010, through mass campaigns targeting individuals aged 1–29 years, led to a dramatic reduction in serogroup A meningitis across the region. ⁵ Evidence from Burkina Faso, Mali, Niger, and Chad showed near elimination of serogroup A disease following vaccination, with marked declines in carriage suggesting interruption of transmission and potential elimination of the serogroup A reservoir in the population. ⁶ This success galvanized efforts to expand meningitis vaccination beyond reactive campaigns toward integrated, sustainable immunization approaches. However, seasonal outbreaks of meningitis have persisted largely due to other serogroups – especially C, W and X.^7-12

To enhance meningitis control, efforts have intensified to expand vaccine protection beyond serogroup A. One major development is the WHO-prequalified Men5CV (also known as MenFive), a pentavalent conjugate vaccine that provides protection against serogroups A, C, W, X, and Y. ¹³ Men5CV was introduced in outbreak response campaigns in March 2024 in high-burden Nigerian states (for the first time globally), and Niger utilized the vaccine later that year during a meningitis outbreak. The rollout of Men5CV led to a remarkable decline in new infections in Jigawa State, Nigeria,^14,15 and cessation of new cases in vaccinated areas of Niamey, Niger. ¹⁶

While the introduction of the new meningitis vaccines represents a significant advancement in combating meningitis in Africa, several challenges could hinder its widespread access and integration into national immunization programs. Therefore, understanding the contextual and operational challenges to vaccine delivery becomes critical to sustaining disease control and achieving the goals of the World Health Organization’s roadmap for a meningitis-free world by 2030. ¹⁷

This review aims to synthesize existing evidence on the impact of meningitis vaccine delivery strategies and the challenges encountered in their implementation across African countries. By consolidating findings from diverse settings, the review seeks to inform policy and practice toward more effective, equitable, and sustainable meningitis prevention efforts in the region.

Methods

The aim of the review was to identify existing and emerging evidence from literature on implementation and impact of meningitis vaccine delivery strategies.

To achieve this, a scoping review was conducted following the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for conduct of scoping reviews (PRISMA-ScR).^18,19

This review explores the vaccine delivery strategies for meningitis vaccines used in the meningitis belt. The research questions were

• • What are the types and target groups of meningitis vaccines?

• • What strategies are used to deliver meningitis vaccines, including supply and storage systems?

• • How effective have these strategies been in terms of coverage, cost-effectiveness and reduction of disease burden?

The search for articles was performed in PubMed, HINARI, DOAJ and Google Scholar on the 16^th of December 2024 using specified search strategies. Search strategies were developed using a combination of keywords, Boolean operators and relevant truncations (Supplemental file 1). Some key words in the search queries are meningococcal, meningitis, MenAfrVac, MenA, MenACWY, MenB, vaccine, delivery, strategy, vaccination. Variations in search strategies were used across databases in order to optimize the search for each database by accommodating differences in indexing and search functionalities. Reference lists of identified studies were also searched for relevant articles.

Articles included in the review were from observational studies, randomized and non-randomized controlled trials, modelling studies, qualitative and mixed studies as well as review articles of any kind and editorials that described the use of any kind of meningitis vaccines and delivery strategies were included. The articles were written in English language (or had English language translation available) and were published from 2004 to 2024. This timeframe was selected to be able to cover key shifts in meningococcal vaccination policy and implementation in Africa including the pre- MenAfriVac era. Only articles from the African continent were considered eligible.

Inclusion Criteria

Studies were included if they examined delivery strategies of meningitis vaccines or reported outcomes related to coverage, cost-effectiveness or disease burden and was done in Africa.

Exclusion Criteria

Studies that were not focused on meningococcal vaccination, focused on only immunogenicity of meningitis vaccines, or did not report on delivery strategy or outcomes were excluded. Studies not conducted in Africa and articles in non-English languages without translation were excluded. Articles that were not freely available or could not be accessed through HINARI or using CE’s University of York research fellowship account were excluded.

The rationale for these criteria was to ensure the articles were relevant to the objectives of the review. The focus on studies conducted in Africa allows for context-specific insights within the meningitis belt. Members of the review team were English speakers, which made restriction to English-language publications a consideration for feasibility.

Selection of articles was guided by PRISMA-ScR guidelines (Figure 1). ¹⁸ Screening of articles was done independently by two review authors (CE and OE) in two phases. In the first phase, the titles and abstracts of the studies were screened to identify whether they met our eligibility criteria. Articles which were not eligible according to our eligibility criteria were screened out. The second phase involved the review of the full text of articles which passed the initial screening phase. At this stage, articles that were irrelevant to our objectives or did not meet our inclusion criteria were further excluded. Conflicting decisions on the selection of any study were resolved by discussions and consensus among the two review authors and a final tie-break decision by a third review author (CM) where necessary. The quality grading of studies was not used as a criterion for selection. Hence, the studies were not assessed for quality.

Figure 1.

PRISMA-ScR flowchart showing the selection of studies in the review

A data extraction form was created on Microsoft Excel to extract relevant data from the articles. The authors, year of publication, country of study, study design, meningitis vaccine type, vaccine delivery strategies and findings on impact and cost-effectiveness of vaccine delivery strategies were extracted. Data extraction was deductive. Themes were predefined based on the research questions. The data extraction form had a column for additional findings where reviewers could input any finding that did not fit into the predefined themes. Additional findings noted from each paper were extracted into this column.

Two review authors (CE and OE) independently extracted data from the studies into the form. This was double-checked by a third review author (CM). Previously reviewed studies were not systematically revisited when new themes emerged. However, discussions were held to ensure consistency in how themes were applied across studies.

The PAGER framework was applied to synthesize and present key findings systematically. The framework facilitated the identification of Patterns across studies, such as common delivery strategies like mass campaigns and routine immunization. It also helped to highlight Advances, including the introduction of multivalent vaccines like Men5CV. Gaps were identified in areas such as vaccine access, integration into national programs, and community engagement. Evidence for practice was drawn from successful country-level implementations, while Research recommendations pointed to the need for more implementation research.

Results

The articles included in the review are briefly described in the supplementary file (Supplemental file 2). Most of the articles (19 out of 20) were published after 2010. Eighteen of the articles were from studies in West Africa (Burkina Faso, Mali, Niger, Ghana, Senegal, Gambia, Northern Benin, Togo, Nigeria, and Sierra Leone).

Various types of meningitis vaccines were reported in the articles including, conjugate vaccines such as meningococcal serogroup A polysaccharide-tetanus toxoid conjugate vaccine – PsA-TT (brand name – MenAfriVac), pneumococcal conjugate vaccine 13-valent – PCV13; and polysaccharide vaccines such as quadrivalent meningococcal polysaccharide vaccine (PsACWY), pneumococcal polysaccharide vaccine (PPSV23).^20-39 Meningococcal vaccines used in Africa primarily target serogroups A, C, W, X, and Y, with MenAfriVac targeting serogroup A and newer vaccines such as the multivalent conjugate vaccine (Men5CV) providing broader coverage across multiple serogroups. However, this review did not identify any relevant article on health impact or cost of delivery strategies for Men5CV. The target population in majority of the articles were 1 – 29-year-olds. Infants were targeted in a few of the articles.

This review identified four strategies that have been widely used singly or in combination for meningitis vaccination in Africa. These strategies can be broadly classified into routinized and campaign-based strategies. The routinized strategy is routine infant vaccination while the campaign-based strategies are introductory mass vaccination campaigns, catch-up campaigns, and reactive vaccination campaigns. Operational definitions of the strategies are highlighted in table 1, as they were described in the respective studies.

Table 1.

Operational Definitions of Vaccine Delivery Strategies That Have Been Employed for Meningitis Vaccines in Africa

Strategy	Delivery channel	Target population	Operational use
Routine infant vaccination	Facility-based	Infants (9-12 months)	Routine
Introductory mass vaccination campaign	Facility-based	1 – 29-year-olds	New vaccines
Reactive vaccination campaign	Mass gatherings	1 – 29-year-olds	Outbreaks
Catch-up campaign	Facility-based	Unvaccinated children	Missed opportunities

Routine infant vaccination was reported in three articles.^20-22 It was described as a facility-based strategy aimed at continuous vaccination of infants of 9–12 months within the national programme on immunization. The defined age intervals for infants allow for the routine strategic administration of vaccines at appropriate timepoints. Introductory/mass vaccination campaign has been employed as a discrete facility-based event to administer meningitis vaccines to individuals aged 1–29 during the introduction of new meningitis vaccines.^5,22-25

Reactive vaccination campaign has been reportedly used in response to and following meningitis outbreaks.^21,26-28 Vaccines were delivered through mass gatherings to age cohorts of 1–29 who did not receive the vaccine routinely as infants.^21,26-28 Reactive campaigns were reported in the literature to be implemented approximately two weeks after outbreaks exceeded a weekly epidemic response threshold of 10 suspected meningitis cases per 100,000. Catch-up campaign was reportedly used to reach an unvaccinated birth cohort or children born after the initial introductory campaign.^20,29 It was also used to reach infants who had not been introduced to routine vaccination.^20,29

As shown in table 2, the effectiveness of vaccine delivery strategies (in terms of coverage rates and reduction of disease burden) varied across the different approaches. Introductory mass vaccination campaign with PsA-TT (MenAfriVac) in Burkina Faso in 2010 achieved exceptionally high national coverage rate of 95%, resulting to a 71% decline in risk of meningitis one year after the campaign. ³⁰ In the WHO’s report on immunization and vaccines related implementation research it is predicted that at 95% vaccination coverage rate with MenAfriVac, meningitis A can be controlled for up to 15 years, assuming 10 years of vaccine-induced protection. ³¹

Table 2.

Coverage Rates or Estimates and Impact of Meningitis Vaccine Delivery Strategies on Meningitis Disease Burden

Strategy	Coverage rates or estimates	Impact on meningitis disease burden	Year & source
Introductory mass vaccination with PsA-TT	95.9% in Burkina Faso	71% decline in meningitis disease risk after one year	2010 30
	>90% in nine African meningitis belt countries	​	2017 5
Routine infant vaccination	Varies by country <40% in Guinea to 87.3% in Burkina Faso	Sustained reduction in disease incidence	2021 32
Reactive vaccination campaign	104.6% administrative coverage	82% decline in suspected cases	2021 28
Catch-up campaign	Assumed 80%	Rapid reduction in disease incidence (<1 case per 10,000)	2013 34

For routine infant immunization, there are wide variations in reported coverage rates by country. The study by Bender et al., which modelled meningitis vaccine coverage rates in twelve countries with completed routine immunization rollouts, reported estimates of 87.3% in Burkina Faso, over 60% in Côte d'Ivoire, Eritrea, the Gambia, Ghana, Mali, Niger, and Sudan, and between 40% and 60% in Central African Republic, Chad and Nigeria, and below 40% in Guinea. ³²

Latt et al reported on the impact of reactive vaccination with ACWY following an outbreak of meningitis in Banalia, DRC from October 9–16, 2021. The campaign achieved 104.6% administrative coverage and was associated with a significant reduction in meningitis cases, with an 82% decline in suspected cases (IRR = 0.18; 95% CI: 0.02–0.80; p = 0.041). ²⁸ A study that modelled the impact of reactive vaccination campaigns with PCV13 in the African meningitis belt estimated that 10-20% of cases could have been averted in previous meningitis outbreaks in Ghana, Chad and Burkina Faso. ²⁶

In the review by Miller and Shahab, findings from a modelling study estimated 71% sustained coverage and 59% reduction in cases resulting from preventative vaccination campaign. ³³ The modelling study suggested that preventive vaccination strategies could be more cost-effective than reactive campaigns under specific assumptions. These included scenarios in which vaccination coverage in reactive campaigns remained below 94% and where delays occurred between outbreak onset and response implementation. These values were derived from modelling assumptions and sensitivity analyses rather than empirical estimates of vaccination coverage or effectiveness during reactive campaigns. The review however underscores how delays in outbreak detection and response mobilization may limit the potential impact of reactive vaccination strategies. ³³

None of the articles in the review reported actual coverage rates for catch-up campaigns. However, a modelling study assumed a coverage rate of 80%. ²²

Findings from the review on cost-effectiveness of the various meningitis vaccine delivery strategies are presented in Table 3. Few studies reported costs and cost-effectiveness of vaccine delivery strategies.^27,33,35-38 An economic evaluation of meningitis vaccine delivery strategies in Burkina Faso found that routine immunization was more cost-effective than reactive strategies with an incremental cost-effectiveness ratio of USD 50 per Quality-Adjusted Life Year (QALY). Baring initial investment in introductory and catch-up campaigns, every investment of USD 1 in routine immunization resulted in savings of USD 1.3 ²⁷. The study concluded that combining routine immunization with an initial catch-up campaign is cost saving as it reduces direct and indirect medical costs. ²⁷ Introductory mass vaccination campaign was reported to cost USD 1.40 per person, and it was estimated that MenAfriVac achieved a cost per Disability Adjusted Life Year (DALY) averted of USD 96.36, confirming its cost-effectiveness. ²⁵ Reactive vaccination campaigns were estimated to cost around USD 240 per case prevented. ³³

Table 3.

Costs and Cost-Effectiveness of Meningitis Vaccine Delivery Strategies

Strategy	Cost per person vaccinated	Cost-effectiveness	Notes
Introductory mass vaccination campaign	∼USD 1.40. 25	USD 96.36 per DALY averted. 25	High coverage; significant disease reduction.
Routine infant immunization	Varies	USD 50 per QALY. 27	More cost-effective than reactive strategies.
Reactive vaccination campaign	Varies	∼USD 240 per case prevented. 33	Less effective due to delays
Integrated campaigns	USD 0.34. 36	Operational cost savings of USD 0.062. 37	Efficient resource utilization

Two studies reported that integrating MenA vaccination into yellow fever and measles campaigns, respectively, was more cost-effective than the stand-alone yellow fever or measles campaigns.^36,37 A saving of at least USD 1.2 million in financial resources was made by integrating meningitis A vaccine delivery with a yellow fever campaign, amounting to USD 0.17 per dose delivered. ³⁶ When including opportunity costs, the economic cost saving was estimated at USD 0.34 per dose delivered. ³⁶ The second study found that there was optimization of resources, improved efficiency and cost reductions for vaccination personnel, implementation materials, supplies and team transportation, and pen markers; leading to lower costs per children during integrated MenA and measles campaign. ³⁷ The costs per child for vaccination personnel was higher in the measles stand-alone strategy (USD 0.172) than in the measles-MenA integrated approach (USD 0.110). However, the cost per child of waste management in the integrated strategy was 2.41 times higher than stand-alone. ³⁷

A study conducted during a meningitis A mass vaccination campaign in Chad evaluated the economic benefits of using a controlled temperature chain instead of a traditional cold chain for vaccine storage and transport. ³⁹ Findings showed that cold chain logistics cost USD 0.24 per person vaccinated, while a modelled controlled temperature approach could reduce these costs by 50% to USD 0.12 per person, indicating substantial potential cost savings from more flexible vaccine storage strategies. ³⁹ In another study, the average logistics costs per dose were estimated at USD 0.026±0.032 for facilities using controlled temperature chain (CTC) and USD 0.029±0.054 for facilities using the full cold chain system approach, but the two estimates were not statistically different. ³⁸ However, if the facilities without refrigerators had not used a CTC but had received daily deliveries of vaccines, the average cost per dose would have increased to USD 0.063 (range USD 0.007 to 0.33), with larger logistics cost increases occurring for facilities that were far from districts. ³⁸ This suggests that the CTC approach is more cost-effective for remote facilities with no cold chain infrastructure.

Discussion

This scoping review has synthesized available evidence on coverage, health impact and cost-effectiveness of meningitis vaccine delivery strategies in the African meningitis belt, majorly from West Africa. Findings highlight variations in meningitis vaccination coverage and cost-effectiveness of delivery strategies from observed data and modelled estimates. Findings suggest that introductory mass vaccination campaigns are highly impactful and cost-effective strategies for reducing meningitis burden in Africa, and that integration with routine immunisation programmes and/or periodic catch-up campaigns over time will ensure sustained population immunity. While current evidence remains insufficient to determine whether one delivery strategy is consistently superior across different contexts, the effectiveness of both approaches is closely linked to the strength of underlying health system and logistical capacities.

Findings show that introductory mass vaccination campaigns have consistently achieved the highest coverage rates and demonstrated high short-term cost-effectiveness. Their high coverage and rapid deployment played a pivotal role in the near elimination of Neisseria meningitidis serogroup A epidemics in vaccinated populations. Countries such as Burkina Faso, Mali, and Niger reported national coverage exceeding 90% during their initial MenAfriVac campaigns targeting individuals aged 1–29 years. ⁵ The ICER of less than USD150 per DALY averted is well below the commonly used thresholds for cost-effectiveness in low-income countries. ⁴⁰ Hence, rendering this strategy highly cost-effective. However, this strategy is inherently time-bound and does not protect new birth cohorts unless followed by routine or catch-up immunization efforts.

Routine infant immunization has shown more variable outcomes. While some countries have successfully integrated MenA into their EPI schedules, maintaining coverage rates above 80%, others have struggled. ³² Nigeria, for instance, has reported routine coverage rates between 40–60% in recent years, with even lower rates in hard-to-reach regions. ³² Although generally less expensive per capita than campaigns due to leveraging existing service infrastructure, routine infant immunization presents more variable cost-effectiveness. In countries with high coverage, such as Burkina Faso, routine delivery has maintained population immunity at relatively low cost. ²⁷ However, in countries with weaker routine immunization systems the lower uptake reduces effectiveness, diminishing its overall cost-efficiency. Factors contributing to variabilities in coverage and cost-effectiveness include differences in health system strength, vaccine supply consistency, caregiver awareness, and health worker capacity. Hence, although routine immunization guarantees more sustainable protection, it requires robust and reliable service delivery infrastructure to be effective. ⁴¹

Catch-up campaigns, implemented to reach birth cohorts missed by either the mass campaign or routine immunization, have demonstrated moderate to high coverage when well-executed. These campaigns help bridge immunity gaps but may face logistical challenges and compete with other health priorities, especially in settings with limited resources. This review did not identify any studies that reported the cost and cost-effectiveness of catch-up campaigns for meningitis vaccine in Africa. However, catch-up campaigns that integrated measles and MenA vaccination demonstrated moderate cost-effectiveness compared with standalone measles vaccination campaigns. ³⁷

Reactive vaccination campaigns, typically deployed during outbreaks, are able to achieve high coverage rates. ²⁸ However, they typically incur higher costs per case averted due to the urgency of response and coordination challenges. Although millions of people can be vaccinated in a short timeframe, reactive campaigns are constrained by the need for rapid detection, confirmation, and resource mobilization.^25,26,33 Additionally, reactive campaigns often begin after substantial transmission has already occurred, limiting their immediate impact on reducing incidence and mortality.^25,26,33 This can also result in continued transmission before adequate population level immunity is achieved. While reactive strategies are vital for outbreak containment, they are generally less cost-effective as a primary strategy, and they should not replace preventive vaccination strategies.

The findings of this review also highlight important evidence gaps regarding the effectiveness, implementation outcomes, and cost-effectiveness of different meningitis vaccination delivery strategies across diverse African contexts. The introduction of the pentavalent Men5CV vaccine, which protects against five major serogroups, is expected to improve cost-effectiveness across strategies by expanding protection in a single dose. Although more expensive per dose than MenAfriVac, early modeling suggests it may offer better long-term value, especially if used in settings where non-A serogroup outbreaks are increasing. ⁴² There is a need for further research and more standardized reporting of vaccination strategies and outcomes to strengthen comparative learning and inform context-specific decisions for meningitis vaccines, including Men5CV.

This review has some limitations, and the findings should be interpreted in the light of these considerations. The review included only English-language publications in selected databases, which may have excluded relevant studies from other settings. In addition, the absence of quality appraisal limits the ability to assess the strength and reliability of the included evidence. Finally, the predominance of studies from West Africa may restrict the generalizability of the findings to the wider African meningitis belt.

Conclusions

In conclusion, this review highlights that coverage, impact and cost-effectiveness of meningitis vaccine is strategy- and context-dependent. No single strategy is universally optimal; the evidence suggests that different approaches are more suitable under specific conditions. Mass vaccination campaigns are particularly suited for rapid control in high-burden or epidemic settings, while routine immunization helps sustain long-term population immunity. Catch-up campaigns are useful in settings transitioning to routine immunization as they close the immunity gap between vaccinated and unvaccinated populations, while reactive campaigns remain important for outbreak response.

As more countries begin to roll-out the new pentavalent Men5CV, a combination of routine and campaign-based vaccine delivery strategy that is context-appropriate offers the most optimal pathway for meningitis control. In resource-constrained settings, the use of CTC can enhance delivery efficiency and maximize the economic and public health benefits of vaccination. Continuous monitoring and evaluation of coverage rates across strategies are crucial to inform adaptive policy and program design.

Appendix.

List of Abbreviations

CTC

Controlled Temperature Chain

DALY

Disability-Adjusted Life Year

ICER

Incremental Cost-Effectiveness Ratio

Men5CV

Multivalent conjugate vaccine

PCV13

Pneumococcal conjugate vaccine 13-valent

PPSV23

Pneumococcal polysaccharide vaccine

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PsACWY

Quadrivalent meningococcal polysaccharide vaccine

PsA-TT

Meningococcal serogroup A polysaccharide-tetanus toxoid conjugate vaccine

QALY

Quality-Adjusted Life Year.

ORCID iD

Chinyere Mbachu https://orcid.org/0000-0003-3936-6184

Data Availability Statement

All data generated or analyzed during this study are included in this published article.*