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© 2018 Wolters Kluwer Health, Inc. All rights reserved. www.pidj.com | e353 Important New Resource for Clinicians Giving Expert Witness Testimony on Vaccines respectively), but up to 57% afterward. Only 9% of all VT-OM episodes prevented occurred during the early acute otitis media period. We fully agree that in large-scale vaccination programs, the effectiveness against VT disease approaches 100% as the indirect effect develops. However, even with full eradication of vaccine serotypes, the projected reduction in “early VT-OM” would be only 13% of all VT-OM episodes. Nevertheless, the FinOM trial long-term findings, on which the hypothesis is partly based on, were observed in an era of no PCV vaccination program and no indirect impact. Their third fundamental problem with the hypothesis is that it fails to consider replacement in full. With the minor reduction in VT-OM, replacement by pneumococcal non-VTs and other bacterial species reduces the net reduction. There was no reduction in overall OM during the first 6 months of life in the FinOM trial. Finally, an optimal study design to test the hypothesis would be a randomized trial with PCVs with different vaccination schedules; we have performed this in the Finnish Invasive Pneumococcal disease trial. The long-term vaccine effectiveness estimates against OM outcomes were similar, whether the vaccinations were started before 7 months of age (median, 14 weeks) or later (unpublished). In conclusion, the roles of VT-OM and especially the impact of early OM have been exaggerated in the hypothesis. Science goes forward by developing and testing hypotheses, the current one in question is very interesting, but it needs to be rejected based on the data. Early OM is an indicator, not cause, of OM recurrence, and PCVs offer long-term effectiveness against VT otitis. Arto A. Palmu, MD, PhD Mika Lahdenkari Department of Public Health Solutions National Institute for Health and Welfare Helsinki, Finland