Systematic Review of Active Safety Surveillance of Vaccines and Medicines in Low- and Middle-Income Countries

Abstract

Background: Functional active safety surveillance is essential for post-authorization assessment and life-cycle safety evidence generation of vaccines and medicines. Data collected through active surveillance methods are routinely used for post-approval surveillance of novel vaccines and medicines. Implementing these methods in low- and middle-income countries remains challenging.

Objective: This systematic review identified and assessed existing active safety surveillance in low- and middle-income countries, including key features, strengths, and limitations.

Methods: A search of EMBASE and PubMed Google Scholar databases was conducted. The protocol was registered with PROSPERO and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Findings were synthesized narratively and categorized by surveillance systems characteristics.

Results: Of 13,027 records identified, 423 publications met inclusion criteria. Articles spanned 96 low- and middle-income countries, with India (96), China (57), Brazil (30), Iran (26), Ethiopia (21), Indonesia (20), Uganda (18), Kenya (17), and Ghana (16), most represented. The majority focused on vaccines (211). A total of 127 articles utilized mobile technologies for follow-up, online data collection, and/or adverse event reporting. Fifteen percent of vaccine surveillance systems described in articles demonstrated flexibility to incorporate new vaccines, 34% reported multi-sectoral collaborations, and 10% involved multiple countries. Gaps identified include small sample sizes, lack of sustainability, limited flexible surveillance, staffing challenges, and limited use of standard case definitions and digital technologies.

Conclusions: Active safety surveillance in low- and middle-income countries has made progress but still faces challenges. The capture and management of safety data through harmonized digital tools that promote consistency in recording and reporting and cross-country collaborations are crucial in further strengthening active safety surveillance in low- and middle-income countries.