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To the Editor: Dr Hoberman and colleagues¹ concluded that influenza vaccine did not reduce the occurrence of acute otitis media (AOM) in children. Unfortunately, the low incidence of influenza in their cohorts limits the conclusions from the study.

The authors' primary end point—the number of children with at least 1 episode of AOM—may miss a clinically significant effect of vaccination. For example, if during a given period unvaccinated children would experience 2 episodes of AOM and the vaccinees only 1 episode, this would constitute a 50% reduction in AOM in the vaccine group. Thus, it could have been expected that there would have been no difference between groups in this end point.

Furthermore, the authors provided only combined 2-year data for many outcomes. However, influenza was virtually absent in the second year and thus we question the validity of these variables. It would have been more helpful, for instance, if . . . [Full Text of this Article]

Terho Heikkinen, MD, PhD
terho.heikkinen@utu.fi

Olli Ruuskanen, MD, PhD
Department of Pediatrics
Turku University Hospital
Turku, Finland

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