title: Methods and challenges for the health impact assessment of vaccination programs in Latin America.
abstract: OBJECTIVE
  To describe methods and challenges faced in the health impact assessment of vaccination programs, focusing on the pneumococcal conjugate and 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 to the grey literature in Google Scholar. No limits were defined for publication year. Original articles on the health impact assessment of pneumococcal and rotavirus vaccination programs in Latin America and the Caribbean in English, Spanish or Portuguese were included.
  
  
  RESULTS
  We identified 207 articles. After removing duplicates and assessing eligibility, we reviewed 33 studies, 25 focusing on rotavirus and eight on pneumococcal vaccination programs. The most frequent studies were ecological, with time series analysis or comparing pre- and post-vaccination periods. The main data sources were: health information systems; 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 main outcomes assessed.
  
  
  CONCLUSIONS
  Over the last years, a significant number of health impact assessments of pneumococcal and rotavirus vaccination programs have been conducted in Latin America and the Caribbean. These studies were carried out few years after the programs were implemented, meet the basic methodological requirements and suggest positive health impact. Future assessments should consider methodological issues and challenges arisen in these first studies conducted in the region.
authors.affiliation: Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Ana Marli Christovam
authors.initials: AM
authors.lastname: Sartori
authors.affiliation: Departamento de Medicina Social, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil.
authors.forename: Andréia de Fátima
authors.initials: Ade F
authors.lastname: Nascimento
authors.affiliation: Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Tânia Yuka
authors.initials: TY
authors.lastname: Yuba
authors.affiliation: Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Patrícia Coelho de
authors.initials: PC
authors.lastname: Soárez
authors.affiliation: Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Hillegonda Maria Dutilh
authors.initials: HM
authors.lastname: Novaes
mesh_terms: D017691:Caribbean Region; D062489:Health Impact Assessment; D006801:Humans; D017589:Immunization Programs; D007843:Latin America; D022242:Pneumococcal Vaccines; D022243:Rotavirus Vaccines; D014611:Vaccination
chemical_list: D022242:Pneumococcal Vaccines; D022243:Rotavirus Vaccines