Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness
Identifieur interne : 000534 ( Pmc/Corpus ); précédent : 000533; suivant : 000535Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness
Auteurs : David M. Morens ; Jeffery K. Taubenberger ; Anthony S. FauciSource :
- The Journal of infectious diseases [ 0022-1899 ] ; 2008.
Abstract
Despite the availability of published data on 4 pandemics that have occurred over the past 120 years, there is little modern information on the causes of death associated with influenza pandemics.
We examined relevant information from the most recent influenza pandemic that occurred during the era prior to the use of antibiotics, the 1918–1919 “Spanish flu” pandemic. We examined lung tissue sections obtained during 58 autopsies and reviewed pathologic and bacteriologic data from 109 published autopsy series that described 8398 individual autopsy investigations.
The postmortem samples we examined from people who died of influenza during 1918–1919 uniformly exhibited severe changes indicative of bacterial pneumonia. Bacteriologic and histopathologic results from published autopsy series clearly and consistently implicated secondary bacterial pneumonia caused by common upper respiratory–tract bacteria in most influenza fatalities.
The majority of deaths in the 1918–1919 influenza pandemic likely resulted directly from secondary bacterial pneumonia caused by common upper respiratory–tract bacteria. Less substantial data from the subsequent 1957 and 1968 pandemics are consistent with these findings. If severe pandemic influenza is largely a problem of viral-bacterial copathogenesis, pandemic planning needs to go beyond addressing the viral cause alone (e.g., influenza vaccines and antiviral drugs). Prevention, diagnosis, prophylaxis, and treatment of secondary bacterial pneumonia, as well as stockpiling of antibiotics and bacterial vaccines, should also be high priorities for pandemic planning.
Url:
DOI: 10.1086/591708
PubMed: 18710327
PubMed Central: 2599911
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PMC:2599911Le document en format XML
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<author><name sortKey="Morens, David M" sort="Morens, David M" uniqKey="Morens D" first="David M." last="Morens">David M. Morens</name>
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<author><name sortKey="Taubenberger, Jeffery K" sort="Taubenberger, Jeffery K" uniqKey="Taubenberger J" first="Jeffery K." last="Taubenberger">Jeffery K. Taubenberger</name>
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<author><name sortKey="Fauci, Anthony S" sort="Fauci, Anthony S" uniqKey="Fauci A" first="Anthony S." last="Fauci">Anthony S. Fauci</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness</title>
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<series><title level="j">The Journal of infectious diseases</title>
<idno type="ISSN">0022-1899</idno>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P1">Despite the availability of published data on 4 pandemics that have occurred over the past 120 years, there is little modern information on the causes of death associated with influenza pandemics.</p>
</sec>
<sec sec-type="methods" id="S2"><title>Methods</title>
<p id="P2">We examined relevant information from the most recent influenza pandemic that occurred during the era prior to the use of antibiotics, the 1918–1919 “Spanish flu” pandemic. We examined lung tissue sections obtained during 58 autopsies and reviewed pathologic and bacteriologic data from 109 published autopsy series that described 8398 individual autopsy investigations.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">The postmortem samples we examined from people who died of influenza during 1918–1919 uniformly exhibited severe changes indicative of bacterial pneumonia. Bacteriologic and histopathologic results from published autopsy series clearly and consistently implicated secondary bacterial pneumonia caused by common upper respiratory–tract bacteria in most influenza fatalities.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">The majority of deaths in the 1918–1919 influenza pandemic likely resulted directly from secondary bacterial pneumonia caused by common upper respiratory–tract bacteria. Less substantial data from the subsequent 1957 and 1968 pandemics are consistent with these findings. If severe pandemic influenza is largely a problem of viral-bacterial copathogenesis, pandemic planning needs to go beyond addressing the viral cause alone (e.g., influenza vaccines and antiviral drugs). Prevention, diagnosis, prophylaxis, and treatment of secondary bacterial pneumonia, as well as stockpiling of antibiotics and bacterial vaccines, should also be high priorities for pandemic planning.</p>
</sec>
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<front><journal-meta><journal-id journal-id-type="nlm-journal-id">0413675</journal-id>
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<journal-id journal-id-type="nlm-ta">J Infect Dis</journal-id>
<journal-title>The Journal of infectious diseases</journal-title>
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<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
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<title-group><article-title>Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness</article-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Morens</surname>
<given-names>David M.</given-names>
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<contrib contrib-type="author"><name><surname>Taubenberger</surname>
<given-names>Jeffery K.</given-names>
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<contrib contrib-type="author"><name><surname>Fauci</surname>
<given-names>Anthony S.</given-names>
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<aff id="A1">National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland</aff>
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<author-notes><corresp id="FN1">Reprints or correspondence: David M. Morens, MD, Bldg. 31, Room 7A-10, 31 Center Dr., MSC 2520, National Institute of Allergy and Inectious Diseases, National Institutes of Health, Bethesda, MD 20892–2520 (<email>dmorens@niaid.nih.gov</email>
)</corresp>
<fn id="FN3" fn-type="conflict"><p>Potential conflicts of interest: none reported.</p>
</fn>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>28</day>
<month>10</month>
<year>2008</year>
</pub-date>
<pub-date pub-type="ppub"><day>1</day>
<month>10</month>
<year>2008</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>1</day>
<month>10</month>
<year>2009</year>
</pub-date>
<volume>198</volume>
<issue>7</issue>
<fpage>962</fpage>
<lpage>970</lpage>
<related-article journal-id-type="nlm-ta" journal-id="J Infect Dis" related-article-type="commentary" page="945" id="N0x1c34e00N0x28294f8" xlink:href="18710326" ext-link-type="pubmed" vol="198"></related-article>
<abstract><sec id="S1"><title>Background</title>
<p id="P1">Despite the availability of published data on 4 pandemics that have occurred over the past 120 years, there is little modern information on the causes of death associated with influenza pandemics.</p>
</sec>
<sec sec-type="methods" id="S2"><title>Methods</title>
<p id="P2">We examined relevant information from the most recent influenza pandemic that occurred during the era prior to the use of antibiotics, the 1918–1919 “Spanish flu” pandemic. We examined lung tissue sections obtained during 58 autopsies and reviewed pathologic and bacteriologic data from 109 published autopsy series that described 8398 individual autopsy investigations.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">The postmortem samples we examined from people who died of influenza during 1918–1919 uniformly exhibited severe changes indicative of bacterial pneumonia. Bacteriologic and histopathologic results from published autopsy series clearly and consistently implicated secondary bacterial pneumonia caused by common upper respiratory–tract bacteria in most influenza fatalities.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">The majority of deaths in the 1918–1919 influenza pandemic likely resulted directly from secondary bacterial pneumonia caused by common upper respiratory–tract bacteria. Less substantial data from the subsequent 1957 and 1968 pandemics are consistent with these findings. If severe pandemic influenza is largely a problem of viral-bacterial copathogenesis, pandemic planning needs to go beyond addressing the viral cause alone (e.g., influenza vaccines and antiviral drugs). Prevention, diagnosis, prophylaxis, and treatment of secondary bacterial pneumonia, as well as stockpiling of antibiotics and bacterial vaccines, should also be high priorities for pandemic planning.</p>
</sec>
</abstract>
<contract-num rid="PHS2">NIH0010150429</contract-num>
<contract-sponsor id="PHS2">NIH Intramural Employee : PHS</contract-sponsor>
</article-meta>
</front>
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