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Sir—We thank Genton and D'Acremont [1] for their interest in our article. We agree with the authors that no data from a randomized controlled trial comparing the efficacy of the intranasal versus injectable vaccine are available. However, immunogenicity and safety data regarding the virosome-formulated subunit vaccine containing the heat-labile toxin of Escherichia coli were published before winter 2000 [2]. In addition, immunogenicity and safety data were available from Berna Biotech AG. It has been argued that the intranasal vaccine would induce secretory IgA antibodies (in addition to IgG antibodies) in the nasopharyngeal cavity, which are able to neutralize influenza viruses [3]. This may suggest a potentially higher efficacy [3], although a head-to-head randomized controlled trial of the injectable versus intranasal vaccine would be needed to verify this. In our study, patients who chose the intranasal vaccine were less likely to develop influenza-like symptoms [4]. However, this difference was not statistically significant because of a lack of power, because the number of patients who received the injectable vaccine was very low. In addition, the study was not designed to detect differences in effectiveness [4].

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