Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness

By D. Morens, J. Taubenberger, A. Fauci. Journal of Infectious Diseases, 2008

1,615 citations recorded by the source corpus.

Background 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. Methods 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. Results 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. Conclusions 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.

Subfields: Epidemiology, Pulmonary and Respiratory Medicine

View Paper: https://www.semanticscholar.org/paper/ba1be4d133fe4c5ddd7d4a2ee6bb6b74f7713c0f

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Epidemiology

1. J. Kash
2. M. Otto
3. J. Taubenberger

Citations in the corpus

• The Airway Epithelium: Soldier in the Fight against Respiratory Viruses (2011, background): “The majority of deaths during the 1918 to 1919 flu pandemic were due to bacterial pneumonia (185).”
• Disordered Microbial Communities in Asthmatic Airways (2010, background): “Significantly, death in the 1918–1919, 1957 and 1968 influenza pandemics resulted most commonly from secondary bacterial pneumonia caused by organisms presumed to be previously present in the respiratory tract [10,11].”
• Pathogenicity and virulence of Staphylococcus aureus (2021, background): “aureus secondary infection is often the ultimate cause for death [38,39].”
• Guidelines for the management of adult lower respiratory tract infections - Full version (2011, neutral): “aureus remains an unusual primary cause of CAP [213], although it is an important cause of pneumonia and death following influenza [214].”
• Influenza Virus Evolution, Host Adaptation and Pandemic Formation (2010, background): “The high mortality associated with the 1918 virus appears to have been a result of bacterial pneumonia, but the co-pathogenic mechanisms responsible for such fatal bacterial diseases remain unknown (Morens et al., 2008).”