BACKGROUND: With the recent postlicensure identification of an increased risk of 
intussusception with rotavirus vaccine, the 14 Latin American countries 
currently using rotavirus vaccine must now weigh the health benefits versus 
risks to assess whether to continue vaccination. To inform policy 
considerations, we estimated excess intussusception cases and mortality 
potentially caused by rotavirus vaccine for each of the 14 countries and 
compared these estimates to hospitalizations and deaths expected to be averted 
through vaccination.
METHODS: We used regional rotavirus disease burden and rotavirus vaccine 
efficacy data, global natural intussusception and regional rotavirus 
vaccine-related risk estimates, and country-specific diphtheria, tetanus, and 
pertussus vaccination coverage rates to estimate rotavirus vaccine coverage 
rates. We performed a probabilistic sensitivity analysis to account for 
uncertainty in these parameters.
RESULTS: For an aggregate hypothetical birth cohort of 9.5 million infants in 
these 14 countries, rotavirus vaccine would annually prevent 144 746 (90% 
confidence interval [CI], 128 821-156 707) hospitalizations and 4124 deaths (90% 
CI, 3740-4239) due to rotavirus in their first 5 years of life but could cause 
an additional 172 hospitalizations (90% CI, 126-293) and 10 deaths (90% CI, 
6-17) due to intussusception, yielding benefit-risk ratios for hospitalization 
and death of 841:1 (90% CI, 479:1 to 1142:1) and 395:1 (90% CI, 207:1 to 526:1), 
respectively. In an uncertainty analysis using 10 000 simulations of our 
probabilistic parameters, in comparing rotavirus disease averted to 
intussusception events caused, the hospitalization ratio was never below 100:1, 
and our death ratio fell below 100:1 only once.
CONCLUSIONS: The health benefits of vaccination far outweigh the short-term 
risks and support continued rotavirus vaccination in Latin America.