MONTREAL — U.S. plans for an influenza virus pandemic should include a strong recommendation for bacterial pneumonia vaccination, as this measure has been shown to reduce influenza mortality by up to 50%, said Dr. Keith Klugman.
“Among the 18 fundamental points in the U.S. pandemic plan, there is little mention of bacterial vaccines. I believe their role is significant and has not been considered up until now,” he said at an international conference on community-acquired pneumonia.
Although the influenza virus alone can be fatal, the risk of death is greater with secondary pneumococcal infection, said Dr. Klugman, professor of infectious diseases and the William H. Foege Chair of Global Health at Emory University, Atlanta.
“The combination of bacterial superinfection and influenza is highly fatal. It's a huge problem, and it's not a small part of influenza mortality and morbidity,” he said in an interview.
Evidence that pneumococcal infection played a major role in the 1918 influenza pandemic “is substantial, but seems to have been forgotten,” Dr. Klugman recently wrote in a letter to the editor (Science 2007;316:49–50), citing historical evidence of culturable pneumococci in the blood of at least half of the survivors and victims of influenza in two studies (Br. Med. J. 1919;1:3–5; JAMA 1918;71;1735).
And a randomized, controlled trial by Dr. Klugman and his colleagues has shown that, in children, vaccination against the pneumococcal bacteria results in a 31% decrease in pneumonias associated with respiratory viruses (Nat. Med. 2004;10:811–3).
“Because of the vaccine, they are not getting the superinfection that brings them to the hospital,” he said at the meeting, which was sponsored by the International Society of Chemotherapy. “I think that people have known for years that there can be bacterial superinfections with influenza, but they just didn't realize how common they were and how much of a role they play.”