Implications of bacterial-viral interactions to present day pandemic preparedness – the Spanish flu revisited

Abstract number: S497

Klugman K.P.

It was recognised during the so-called Spanish influenza pandemic in 1918 that the majority of deaths due to the flu occurred more than 7 days after the onset of symptoms. In the overwhelming majority of cases of pandemic influenza, signs and symptoms resolved by day 6, but in a subgroup with significant mortality, illness worsened in the second week of illness. There is abundant evidence that most of the mortality during the pandemic was due to the combination of influenza plus bacterial super-infection. The most common bacterial cause of death was the pneumococcus, but nosocomial spread of group A streptococci was often lethal, as were staphylcocccal infections. Up to 50% of young soldiers' deaths due to influenza in 1918 were complicated by bacteraemia. While antibiotics were not available in 1918, it is naive to believe that antibiotics will reliably save individuals suffering from the cytokine storm of pandemic influenza and simultaneous bacteraemia. Prophylactic antibiotics should be considered, but as progression to pneumonia may be impossible to predict, the amount of antibiotic needed to be given will be considerable (to all those infected with influenza). An additional approach to reduce mortality is vaccination – vaccination against the pandemic influenza strain will be the first priority if such a vaccine is available. Vaccines are currently however available to prevent pneumococcal infection. Data from a randomised trial of pneumococcal conjugate vaccine (PCV) show that children immunised with PCV have 45% less hospitalisation for pneumonia due to endemic influenza. The 23 valent pneumococcal vaccine (23v) is highly protective against bacteraemia when given to healthy young adults. Widespread PCV administration to children including a booster dose in the second year of life is essential to ensure their protection plus the best chance of herd immunity to the PCV types in the older population. Healthcare workers, military personel and other first responders should receive the 23v vaccine when the pandemic threat level reaches level 5. Attempts should be made at that time to also strengthen existing recommendations to immunise at risk and elderly persons with the 23v vaccine. Pandemic influenza plans at present fail to recognise the potentially essential role of pneumococcal vaccine in the prevention of mortality from pandemic influenza.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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