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The Efficacy of Live Attenuated Influenza Vaccine Against Influenza-associated Acute Otitis Media in Children

Block, Stan L. MD*; Heikkinen, Terho MD, PhD; Toback, Seth L. MD; Zheng, Wei MS; Ambrose, Christopher S. MD

The Pediatric Infectious Disease Journal: March 2011 - Volume 30 - Issue 3 - p 203-207
doi: 10.1097/INF.0b013e3181faac7c
Original Studies

Background: Acute otitis media (AOM) is a frequent complication of influenza in young children. Influenza vaccination is known to protect against AOM by preventing influenza illness. We sought to determine the efficacy of the live attenuated influenza vaccine (LAIV) against influenza-associated AOM compared with placebo and trivalent inactivated influenza vaccine (TIV). LAIV is approved for eligible children aged ≥2 years in the United States and in several other countries.

Methods: AOM incidence data from 6 randomized, double-blind, placebo-controlled trials and 2 randomized, double-blind, TIV-controlled trials in children 6 to 83 months of age were pooled and analyzed.

Results: A total of 290 cases of AOM were identified in 24,046 study subjects. LAIV efficacy against influenza-associated AOM was 85.0% (95% confidence interval [CI], 78.3%–89.8%) compared with placebo and 54.0% (95% CI, 27.0%–71.7%) compared with TIV. Efficacy trended higher in those ≥24 months of age compared with those aged 6 to 23 months. In placebo-controlled trials, among children who acquired influenza despite vaccination, AOM was diagnosed in 10.3% of LAIV recipients and 16.8% of placebo recipients, representing a 38.2% (95% CI, 11.0%–58.2%) relative reduction in the development of AOM. In TIV-controlled studies, among subjects with breakthrough influenza illness, the proportions of LAIV and TIV recipients who developed AOM were similar.

Conclusions: Children receiving LAIV had a high level of protection against influenza-associated AOM when compared with placebo or TIV. This was most evident in children older than 2 years, for whom LAIV is indicated. LAIV recipients who contracted breakthrough influenza illness despite vaccination developed AOM at a significantly lower rate than did unvaccinated children who developed influenza.


From *Kentucky Pediatric and Adult Research, Bardstown, KY; †The Department of Pediatrics, Turku University Hospital, Turku, Finland; and ‡MedImmune, Gaithersburg, MD.

Accepted for publication September 2, 2010.

Supported by MedImmune. Supported (grant/research support) by MedImmune (to S.L.B.).

T.H. has served as a consultant for MedImmune. S.L.T., W.Z., and C.S.A. are employees of MedImmune. Data were analyzed by Mr. Zheng and Dr. Toback of MedImmune. The analysis was reviewed in detail and approved by all authors. The first draft was written jointly by Dr. Block (Introduction and Discussion) and Dr. Toback (Methods and Results). All authors revised and approved subsequent drafts, including the final, submitted draft. As stated in the disclosures, although the studies were sponsored by MedImmune, Dr. Block and Dr. Heikkinen were not compensated for their work on the manuscript.

Address for correspondence: Stan L. Block, MD, Kentucky Pediatric and Adult Research, 201 South 5th St, Suites 102 & 104, Bardstown, KY 40004. E-mail:

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© 2011 Lippincott Williams & Wilkins, Inc.