Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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
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.
Heikkinen T, Ruuskanen O. Effectiveness of Influenza Vaccine to Prevent Acute Otitis Media. JAMA. 2004;291(6):692-694. doi:10.1001/jama.291.6.692-c