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Ebola vaccines are safe and effective in children, providing strong protection and lasting immunity, supporting their use in pediatric vaccination programs.
Ebola virus disease is a life-threatening infection with high fatality rates, particularly impacting children. Although vaccines have shown strong protection in adults, their safety and immune response in children remain less understood. This systematic review and meta-analysis led by Marianna Zarro et al. analyzed the immunogenicity and safety of Ebola vaccines in pediatric populations, generating evidence to guide immunization strategies and boost preparedness for future outbreaks.
A set of PRISMA guidelines was used to evaluate Phase IIb–IV trials and post-marketing studies on Ebola vaccines in children, published up to March 2025. Comprehensive searches were performed across major databases, including PubMed, SCOPUS, Web of Science, ClinicalTrials.gov, ISRCTN, EUCTR, CTIS, and PACTR, to identify studies comparing vaccination with no vaccine or alternative vaccines in children under 18 years. Primary outcomes included immunogenicity, estimated by seroconversion, and safety assessed via serious adverse events (SAEs).
Data from the full-text studies were independently extracted by two evaluators, with a third evaluator settling any differences. The team then performed pooled proportion analyses and direct comparisons between vaccines, including subgroup analyses based on vaccine type. The analysis included 7 datasets with 1,10,258 children (50.7% female). After the first dose, pooled seroconversion was 89%, rising to 96% after full vaccination and slightly declining to 91% at 1 year.
Head-to-head comparisons confirmed strong immune responses, with no major differences between single- and two-dose regimens. SAEs were rare (1%) and mostly unrelated to vaccination. Overall, Ebola vaccines were safe and highly immunogenic in children, providing both strong short-term protection and lasting immunity, supporting their use in pediatric programs. The findings emphasize the importance of including children in Ebola vaccination campaigns and tailoring immunization strategies according to vaccine type and outbreak context.
THE LANCET
Immunogenicity and Safety of Ebola Vaccines in Children: A Systematic Review and Meta-Analysis
Marianna Zarro et al.
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