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We thank Drs Klinkenberg and Blohm for their contribution, which points out the high risk for cases of influenza with lethal outcomes in children with chronic comorbidities and which rightly underlines the need of annual flu vaccination in children. In order to achieve the high vaccination rate that is required to protect pediatric risk groups, we also make the case for a general recommendation for vaccinating children. However, we think that our colleagues’ explanations of the protective effect of the flu vaccines are based on a misinterpretation. The morbidity rates of 4.2% (attenuated live vaccine) and 8.1% (conventional vaccine) relate to the respective total cohort of vaccinated persons, of whom 10–30% contract influenza every year. Morbidity rates of unvaccinated comparator cohorts were not included in the studies analyzed in the meta-analysis (1). In our study, we did not go into detail about the effectiveness of the attenuated live vaccine compared with placebo, for reasons of space. Depending on the degree of match between the vaccine viruses and circulating wild viruses, this is 78–83% (1). Unfortunately, this vaccine cannot be used in children younger than 2 years because of its side effect profile. As conventional vaccines are at best of moderate effectiveness in this age group, in order to protect these children high immunization rates among contacts should be aimed for, which may result in herd immunity (2).

DOI: 10.3238/arztebl.2014.0150b

Prof. Dr. med. Peter Wutzler

Universitätsklinikum Jena

Institut für Virologie und
Antivirale Therapie

peter.wutzler@med.uni-jena.de

Conflict of interest statement
Prof. Wutzler has received payment for serving on advisory boards for AstraZeneca and Sanofi Pasteur as well as lecture honoraria from AstraZeneca, GSK, and Novartis.

1.
Ambrose CS, Wu X, Knuf M, Wutzler P. The efficacy of intranasal live attenuated influenza vaccine in children 2 through 17 years of age: a meta-analysis of 8 randomized controlled studies. Vaccine 2012; 30: 886–92.
2.
Glezen WP: Universal influenza vaccination and live attenuated influenza vaccination of children. Pediatr Infect Dis J 2008; 27: 104–9.
3.
Wutzler P, Hardt R, Knuf M, Wahle K: Targeted vaccine selection in influenza vaccination. Dtsch Arztebl Int 2013; 110(47): 793–8 VOLLTEXT
1.Ambrose CS, Wu X, Knuf M, Wutzler P. The efficacy of intranasal live attenuated influenza vaccine in children 2 through 17 years of age: a meta-analysis of 8 randomized controlled studies. Vaccine 2012; 30: 886–92.
2.Glezen WP: Universal influenza vaccination and live attenuated influenza vaccination of children. Pediatr Infect Dis J 2008; 27: 104–9.
3.Wutzler P, Hardt R, Knuf M, Wahle K: Targeted vaccine selection in influenza vaccination. Dtsch Arztebl Int 2013; 110(47): 793–8 VOLLTEXT

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