A paradigm for the control of influenza.

Received 21 July 2010; accepted 21 July 2010; electronically published 28 October 2010. Potential conflicts of interest: none reported. Financial support: none reported. Reprints or correspondence: Dr Edward Lewin, 2730C Prosperity Ave, Fairfax, VA 22031 ([email protected]). The Journal of Infectious Diseases 2010;202(11):1619– 1622 2010 by the Infectious Diseases Society of America. All rights reserved. 0022-1899/2010/20211-0001$15.00 DOI: 10.1086/657090 In this issue of the Journal, Glezen et al [1] have produced the latest in a series of descriptions of an innovative approach to the control of influenza [2–10]. Dr Glezen and colleagues at Baylor College of Medicine have long been advocates of the concept that the epidemiology of influenza is the most important element in the control of this disease [11, 12]. The study by Glezen and colleagues investigates the effectiveness of immunizing 47.5% of elementary-school children 5–11 years old in 25 public schools and 3 parochial schools in which 1 dose of live attenuated influenza vaccine (LAIV) was administered (intervention group), relative to a comparable community in which vaccine (LAIV or trivalent inactivated vaccine [TIV]) was administered in an offprotocol manner. A significant degree of herd protection (reduction in the number of medically attended acute respiratory illness [MAARI]) was seen in all age groups except 12–17-year-olds, with risk ratios for all age groups 118 years old being lower even than that for the target group of 5– 11-year-olds. This occurred despite there being an excess of persons 175 years old in the intervention community. Furthermore, LAIV was 1.7 times more effective in the prevention of proven influenza virus infection in the target group than among those who received TIV and was 6 times more effective than among those who did not receive vaccine.