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Financial and other disclosures provided by the authors are available with the full text of this letter at NEJM.org. Parsons DW, Jones S, Zhang X, et al. An integrated genomic 1. analysis of human glioblastoma multiforme. Science 2008;321: 1807-12. Yan H, Parsons DW, Jin G, et al. 2. IDH1 and IDH2 mutations in gliomas. N Engl J Med 2009;360:765-73. Mardis ER, Ding L, Dooling DJ, et al. Recurring mutations 3. found by sequencing an acute myeloid leukemia genome. N Engl J Med 2009;361:1058-66. Campbell PJ, Baxter EJ, Beer PA, et al. Mutation of JAK2 in 4. the myeloproliferative disorders: timing, clonality studies, cytogenetic associations, and role in leukemic transformation. Blood 2006;108:3548-55. Beer PA, Jones AV, Bench AJ, et al. Clonal diversity in the 5. myeloproliferative neoplasms: independent origins of genetically distinct clones. Br J Haematol 2009;144:904-8.

S. pneumoniae and H. influenzae are the 2 most common pathogens producing otitis media in Costa Rican children. An increase in the number of H. influenzae and M. catarrhalis was observed in recent years. Penicillin-nonsusceptible S. pneumoniae isolates were more commonly observed during the rainy season, in which increased morbidity with respiratory pathogens is observed.

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The serotype distribution of S. pneumoniae causing pediatric OM in Costa Rica is similar to those reported from developed countries. The current heptavalent pneumococcal conjugate vaccine covers 74% of OM episodes in Costa Rican children.