Methods and challenges for the health impact assessment of vaccination programs in Latin America

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"OBJECTIVE:To describe methods and challenges faced in the health impactassessment of vaccination programs, focusing on the pneumococcal conjugateand rotavirus vaccines in Latin America and the Caribbean.METHODS:For this narrative review, we searched for the terms “rotavirus”,“pneumococcal”, “conjugate vaccine”, “vaccination”, “program”, and“impact” in the databases Medline and LILACS. The search was extended tothe grey literature in Google Scholar. No limits were defined for publicationyear. Original articles on the health impact assessment of pneumococcaland rotavirus vaccination programs in Latin America and the Caribbean inEnglish, Spanish or Portuguese were included.RESULTS:We identified 207 articles. After removing duplicates andassessing eligibility, we reviewed 33 studies, 25 focusing on rotavirusand eight on pneumococcal vaccination programs. The most frequentstudies were ecological, with time series analysis or comparing pre- andpost-vaccination periods. The main data sources were: health informationsystems; population-, sentinel- or laboratory-based surveillance systems;statistics reports; and medical records from one or few health care services.Few studies used primary data. Hospitalization and death were the mainoutcomes assessed.CONCLUSIONS:Over the last years, a significant number of health impactassessments of pneumococcal and rotavirus vaccination programs havebeen conducted in Latin America and the Caribbean. These studies werecarried out few years after the programs were implemented, meet the basicmethodological requirements and suggest positive health impact. Futureassessments should consider methodological issues and challenges arisenin these first studies conducted in the region."