CORRESPONDENCE
Vaccine for Prevention of Influenza in Children
N Engl J Med 2014; 370:1167-1168March 20, 2014DOI: 10.1056/NEJMc1400874
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To the Editor:
Jain et al. (Dec. 26 issue)1 claim that a quadrivalent influenza vaccine (QIV) is efficacious in preventing influenza in children, although their efficacy data are similar to those obtained with the use of the traditional trivalent influenza vaccine (TIV).2 What additional benefit does QIV offer over TIV? Why did they randomly assign patients to receive QIV or hepatitis A vaccine rather than QIV or TIV? We do not think that developing vaccines simply on the basis of including the hemagglutinin antigens of “best guess” A and B strains is sufficient for the global prevention of influenza because it does not avoid the risk of a mismatch between the influenza A strains selected for the vaccine and those actually circulating during the influenza season,3 nor does it reduce the delay in the availability of pandemic vaccines.4 Cross-reactive human B-cell and T-cell epitopes between influenza A and B strains have been identified recently in humans.5 Would it not be more appropriate to consider new strategies on the basis of conserved vaccine targets as a means of providing global protection against influenza?
Susanna Esposito, M.D.
Università degli Studi di Milano, Milan, Italy
susanna.esposito@unimi.it
Nicola Principi, M.D.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy