To the Editor: The randomized study by Dr Loeb and colleagues1 of communities receiving either inactivated influenza vaccine or hepatitis A vaccine supports school-based influenza immunization and adds credence to a nationwide Japanese study that concluded that 1 life was saved for every 420 children immunized against influenza.2 The study by Loeb et al showed protection of community members against clinical illness, confirmed by real-time reverse transcriptase–polymerase chain reaction assay, but failed to show protection against infection as determined by hemagglutination inhibition titers. The authors speculated that “[o]ne possible explanation for the lack of significant differences in serologic outcomes is that the influenza vaccination may have attenuated infection that . . . rendered it subclinical but without preventing infection.”
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