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The Bradford-Hill criteria and evidence of association between influenza vaccination and ischaemic heart disease
  1. C Raina MacIntyre,
  2. Anita Elizabeth Heywood
  1. School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Professor C Raina MacIntyre, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia; r.macintyre{at}

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The Authors’ reply: In their letter, Rogawski et al 1 have misinterpreted our data.2 They state “However, because the authors control for infection in the regression model that includes vaccination, they report an effect of vaccination independent of influenza infection. Therefore, the estimated vaccine effect is not mediated by influenza.” We would like to clarify that the independent effect of vaccination as described in our paper refers to an epidemiological, not a biological effect. That is, after adjustment, vaccination remains independently predictive and is not confounded by the known confounders which were adjusted. In the paper we make the point that the study had far greater statistical power to examine vaccination as a predictor of acute myocardial infarction (AMI), with 276 vaccinated subjects, than it did for influenza infection, which was a rarer event (15 cases in total with a fourfold rise in antibody or positive nucleic acid testing (NAT)). As stated in the paper, this is the most likely explanation for why vaccination but not infection significantly predicted …

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  • Contributors Both authors contributed to the writing of this letter of response.

  • Competing interests The original study to which this letter refers was an investigator driven study funded by GSK.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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