Strengthening the technical capacity at country-level to make informed policy decisions on new vaccine introduction: lessons learned by PAHO's ProVac Initiative.

Rotavirus, pneumococcal conjugate and HPV vaccines have the potential to make substantial gains in health, specifically in reducing child mortality and improving women's health. Decisions regarding new vaccine introduction should be grounded in a broad evidence base that reflects national conditions. In this paper, we describe the Pan American Health Organization ProVac Initiative's experience in strengthening national decision making regarding new vaccine introduction through five sets of activities: (1) strengthening infrastructure for decision making; (2) developing tools for economic analyses and providing training to national multidisciplinary teams; (3) collecting data, conducting analysis, and gathering a framework of evidence; (4) advocating for evidence-based decisions; and (5) effectively planning for new vaccine introduction when evidence supports it. Key lessons learned regarding the role of multidisciplinary country teams, provision of direct technical support, development of tools, and provision of distance and in-person training are highlighted

Strengthening the technical capacity at country-level to make informed policy decisions on new vaccine introduction: lessons learned by PAHO's ProVac Initiative.

Rotavirus, pneumococcal conjugate and HPV vaccines have the potential to make substantial gains in health, specifically in reducing child mortality and improving women's health. Decisions regarding new vaccine introduction should be grounded in a broad evidence base that reflects national conditions. In this paper, we describe the Pan American Health Organization ProVac Initiative's experience in strengthening national decision making regarding new vaccine introduction through five sets of activities: (1) strengthening infrastructure for decision making; (2) developing tools for economic analyses and providing training to national multidisciplinary teams; (3) collecting data, conducting analysis, and gathering a framework of evidence; (4) advocating for evidence-based decisions; and (5) effectively planning for new vaccine introduction when evidence supports it. Key lessons learned regarding the role of multidisciplinary country teams, provision of direct technical support, development of tools, and provision of distance and in-person training are highlighted

Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review

<div><p>Background</p><p>Several Latin American and Caribbean (LAC) countries have introduced pneumococcal conjugate vaccine (PCV-10 or PCV-13) in their routine national immunization programs.</p><p>Objectives</p><p>We aimed to summarize the evidence of PCV impact and effectiveness in children under 5 years old in the LAC Region.</p><p>Methods</p><p>We conducted a systematic review of the literature on impact or effectiveness of PCVs on deaths or hospitalizations due to invasive pneumococcal disease (IPD), pneumonia, meningitis and sepsis. We searched Medline, WoS, Lilacs, Scopus, Central and gray literature published in any language from 2009 to January 2016. We included studies addressing the outcomes of interest in children in the target age group, and with the following designs: randomized trials, cohort or case-control, interrupted time series with at least three data points before and after the intervention, and before-after studies. Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Descriptive analysis of the effectiveness measurements and sensitivity analysis were conducted. Effectiveness is reported as 1-OR or 1-RR for case control or cohort/clinical trials, and as percent change of disease incidence rates for before-after studies.</p><p>Results</p><p>We identified 1,085 citations, 892 from databases and 193 from other sources. Of these, 22 were further analyzed. Studies were from Brazil, Chile, Uruguay, Argentina, Peru and Nicaragua. Effectiveness ranged from 8.8–37.8% for hospitalizations due to X-ray confirmed pneumonia, 7.4–20.6% for clinical pneumonia, and 13.3–87.7% for meningitis hospitalizations, and 56–83.3% for IPD hospitalization, varying by age, outcome definition, type of vaccine and study design.</p><p>Conclusions</p><p>Available evidence to date indicates significant impact of both PCV-10 and PCV-13 in the outcomes studied, with no evidence of the superiority of one vaccine over the other on pneumonia, IPD or meningitis hospitalization reduction in children under 5 years old.</p></div

Characteristics of studies reviewed with invasive pneumococcal disease as endpoint.

<p>Characteristics of studies reviewed with invasive pneumococcal disease as endpoint.</p

Summary of characteristics from 22 included studies.

<p>Summary of characteristics from 22 included studies.</p

Flowchart: process of study selection.

<p>Flowchart: process of study selection.</p

Characteristics of studies reviewed with pneumococcal meningitis as endpoint.

<p>Characteristics of studies reviewed with pneumococcal meningitis as endpoint.</p

Vaccine effectiveness (%, 95% confidence interval*) against invasive bacterial disease, by vaccine, group of age, vaccine serotypes and all serotypes, and hospitalization or death.

<p>*Study by Valenzuela et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0166736#pone.0166736.ref045" target="_blank">45</a>] did not report confidence interval and was not plotted. Countries: BRA (Brazil); URU (Uruguay).</p