The DOI matches its Crossref record; 78 of the 80 references it cites were found in a registry or an index; 22 of the 134 sources its claims cite were checked for support.
Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness
Open accessAbstract
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.
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Claims the paper makes
19 Not checked yet · 16 Own result · 14 Own interpretation · 11 Partly supported · 11 No full text of the sources · 5 No basis given · 3 Supported · 3 Supported so far · 3 Sources not found · 2 Own method · 1 Couldn’t confirm · accuracy not yet measured
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“In the 14 of 96 autopsy series that did not report the predominance of lung pneumopathogens [29, 36, 41-53], pneumopathogens accounted collectively for 37.4% of pneumonia deaths.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Bacteriologic studies in autopsy series during the 1918–1919 influenza pandemic
What the sources say
- Not checked — no full text of the sourcecites [29] Lucke B Wight T Kime E Pathologic anatomy and bacteriology of influenza: epidemic of autumn, 1918 Arch Intern Med 1919 24 154 237 source
- Not checked — no full text of the sourcecites [36] Roos C Notes on the bacteriology, and on the selective action of B. influenzae Pfeiffer J Immunol 1919 4 189 201 source
- Not checked — no full text of the sourcecites [41] Little TR Discussion on influenza Proc R Soc Med (Great Britain) 1918 12 36 41 PMC2067067 19980424 source
- Not matchedcites [42] Rucker JB Wenner JJ Friedländer bacillus, the causative factor in bronchopneumonia following influenza Proc Pathol Soc Philadelphia 1918 21 41 2
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [43] Rucker JB Wenner JJ Friedlander bacillus the causative factor in bronchopneumonia following influenza N Y Med J 1918 108 1066 9
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Supportedcites [44] Abrahams A Hallows N French H A further investigation into influenzo-pneumococcal and influenzo-streptococcal septicæmia: epidemic influenzal “pneumonia” of highly fatal type and its relation to “purulent bronchitis” Lancet 1919 1 1 11 source
The paper’s “Statistics: Incidence” passage says the authors examined over 400 autopsies but could not keep detailed records and made no attempt to give statistical details. This supports citing it as an autopsy series that did not report a quantitative predominance; the 37.4% figure is the citing authors’ collective calculation across 14 series, not a result attributed to this paper alone. (LLM, conf=0.85)
- Not checked — no full text of the sourcecites [45] Findlay GM Notes on the bacteriology of influenza epidemic in Lower Egypt Lancet 1919 1 1113 14 source
- Not matchedcites [46] Fiore G Contributo allo studio batteriologico dell’epidemia di influenza 1918 Riv Clin Pediatr (Firenze) 1919 17 281 303
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [47] Gibson HG Bowman FB MRC (Medical Research Council) The bacteriological flora of the respiratory tract in cases of influenza Special Report Series, No. 36. Studies of influenza in hospitals of the British Armies in France, 1918: part I. Abbeville Research Team 2 London His Majesty’s Stationery Office 1919 37 46
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [48] Medalia LS Influenza epidemic at Camp MacArthur: etiology, bacteriology, pathology, and specific therapy Boston Med Surg J 1919 180 323 30 source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 109 published autopsy series and 8398 autopsies are representative of influenza deaths during the 1918-1919 pandemic.
- Rests on an assumption: Postmortem lung culture results reflect bacteria that contributed to death rather than postmortem contamination or incidental colonization.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Between 1890 and 1950, most observers believed fatal influenza to be a polymicrobial infection in which an inciting agent of low pathogenicity (either a bacterium such as Bacillus influenzae or a “filter passing agent”—most of which have now been identified as viruses) acted synergistically with known pneumopathogenic bacteria [13, 14, 20, 33, 64-66].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Not matchedcites [13] Vaughan WT Influenza: an epidemiological study. Monograph series no. 1 Baltimore, Maryland American Journal of Hygiene 1921
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [14] Jordan EO Epidemic influenza: a survey Chicago, Illinois American Medical Association 1927
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [20] Opie EL Blake FG Rivers TM The pathology and bacteriology of pneumonia following influenza Chapter IV Opie EL Blake FG Small JC Rivers TM Epidemic respiratory disease. The pneumonias and other infections of the respiratory tract accompanying influenza and measles St Louis CV Mosby 1921 107 281
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [33] MacCallum WG Pathological anatomy of pneumonia associated with influenza; 23 plates Johns Hopkins Hosp Rep 1921 20 149 249
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [64] Leichtenstern O Mittheilungen über die Influenzaepidemie in Köln Dtsch Med Wochenschr 1890 16 212 5 320 1 388 9 485 6 509 11 642 3 665 6 936 40 957 8 source
- Partly supportedcites [65] Maxwell ES Ward TG Van Metre TE The relation of influenza virus and bacteria in the etiology of pneumonia J Clin Invest 1949 28 307 18 16695680 PMC439604 sourceExperimental — accuracy not yet measured
The opening section says that certain investigators viewed 1918 influenza as a primary viral illness followed by secondary bacterial pneumonia; the Discussion also describes mixed viral–bacterial infections. But the paper does not say that most observers held this view throughout 1890–1950, or establish a low-pathogenicity inciting agent as the historical consensus. Page numbers are unavailable in our copy. (LLM, conf=0.84)
- Not checked — no full text of the sourcecites [66] Taubenberger JK Hultin JV Morens DM Discovery and characterization of the 1918 pandemic influenza virus in historical context Antivir Ther 2007 12 581 91 17944266 PMC2391305 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“suggests that early and aggressive treatment, including antibiotics and intensive care, could save most patients [84, 85]”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Partly supportedcites [84] Memoli MJ Morens DM Taubenberger JK Pandemic and seasonal influenza: therapeutic challenges Drug Discov Today 2008 13 590 5 18598914 PMC2556034 sourceExperimental — accuracy not yet measured
The Introduction says treatment must account for influenza’s rapid progression and that therapies for secondary pneumonia are important. It also describes intensive-care needs, but does not say that early, aggressive treatment with antibiotics and intensive care could save most patients with severe influenza-associated pneumonia. (LLM, conf=0.83)
- Partly supportedcites [85] Brundage JF Interactions between influenza and bacterial respiratory pathogens: implications for pandemic preparedness Lancet Infect Dis 2006 6 303 12 16631551 PMC7106411 sourceExperimental — accuracy not yet measured
The ‘Interactions model: public health and clinical implications’ section says antibiotics may help prevent secondary bacterial infections and may be useful adjuncts to influenza countermeasures. It does not say that early treatment with antibiotics and intensive care could save most patients who already have severe influenza-associated pneumonia; its mention of intensive care concerns preparedness plans, not a demonstrated benefit. (LLM, conf=0.86)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The issue was addressed anew in the early 1930s when Shope published a series of experimental studies that involved the just-discovered swine influenza A virus: severe disease in an animal model resulted only when the virus and Hemophilus influenzae suis were administered together [67].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Supportedcites [67] Shope RE Swine influenza. III. Filtration experiments and etiology J Exp Med 1931 54 373 85 19869924 PMC2132000 source
In the discussion (pp. 381–382), Shope reports that swine given the filtrable agent alone developed a mild disease, those given H. influenzae suis alone showed no illness, and those given both developed typical swine influenza. The experimental results (around p. 378) also describe exceptionally severe disease in two animals given the mixture. (LLM, conf=0.92)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“its pathogenic mechanisms may be atypical because the virus is poorly adapted to humans [88]”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Partly supportedcites [88] Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus: update on avian influenza A (H5N1) virus infection in humans N Engl J Med 2008 358 261 73 18199865 sourceExperimental — accuracy not yet measured
The Viral Factors section (p. 4) says H5N1 does not readily infect humans and that mutations found in some human isolates appear insufficient for efficient human-to-human transmission. The Viral Replication section (p. 4) describes where the virus replicates, but the paper does not say its pathogenic mechanisms are atypical because it is poorly adapted to humans. (LLM, conf=0.83)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
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In the paper
“The spread of bacteria such as methicillin-resistant Staphylococcus aureus and highly pathogenic clones of Streptococcus pyogenes pose more general risks [86].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Partly supportedcites [86] Rothberg MB Haessler SD Brown RB Complications of viral influenza Am J Med 2008 121 258 64 18374680 PMC7172971 sourceExperimental — accuracy not yet measured
The Secondary Bacterial Pneumonia section reports severe influenza-associated pneumonia due to methicillin-resistant Staphylococcus aureus, supporting a risk from that bacterium. It does not describe its spread, or the spread of highly pathogenic Streptococcus pyogenes clones; the Pulmonary Complications with Unusual Pathogens section mentions only β-hemolytic streptococci as a cause of secondary pneumonia. Page numbers were not available in our copy. (LLM, conf=0.84)
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
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In the paper
“These materials, sent during the pandemic from various United States military bases to the National Tissue Repository of the Armed Forces Institute of Pathology [8-10], represent all known influenza cases from this collection for which lung tissue is available.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > METHODS > Examination of tissue specimens from 1918–1919 influenza fatalities
What the sources say
- Not checked — no full text of the sourcecites [8] Taubenberger JK Reid AH Krafft AE Bijwaard KE Fanning TG Initial genetic characterization of the 1918 “Spanish” influenza virus Science 1997 275 1793 6 9065404 source
- Partly supportedcites [9] Reid AH Fanning TG Hultin JV Taubenberger JK Origin and evolution of the 1918 “Spanish” influenza virus hemagglutinin gene Proc Natl Acad Sci U S A 1999 96 1651 6 9990079 PMC15547 sourceExperimental — accuracy not yet measured
In Materials and Methods (Case Selection; page unavailable), the paper describes examining archival tissues and records from 74 victims in the Armed Forces Institute of Pathology files. It does not identify 58 autopsy materials or say they represent all known cases in the collection with available lung tissue. (LLM, conf=0.83)
- Not checked — no full text of the sourcecites [10] Taubenberger JK Morens DM The pathology of influenza virus infections Annu Rev Pathol Mech Dis 2008 3 499 522 PMC2504709 18039138 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 58 autopsy specimens available from the National Tissue Repository are representative of 1918-1919 influenza fatalities.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > Abstract > Results
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 109 published autopsy series and 8398 autopsies are representative of influenza deaths during the 1918-1919 pandemic.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Bacteria were commonly observed in the sections, often in massive numbers.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Histologic examination of lung tissue from 1918 victims
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The 58 autopsy specimens available from the National Tissue Repository are representative of 1918-1919 influenza fatalities.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“in cases for which a single lung pathogen was recovered from culture, the anatomical-pathological type of the pneumonia usually corresponded to what was expected.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Published pathologic and/or bacteriologic findings from the 1918–1919 influenza pandemic
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Probably not a substantial claim. 16
- It may state two separate claims as one. 30
- The quote only partly states this claim. 4
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“The pandemic caused a “W-shaped” age-specific mortality curve, which exhibited peaks in infancy, between about 20–40 years of age, and in elderly individuals [3, 21].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Background epidemiologic data on influenza mortality rates in 1918–1919
What the sources say
- Not checked — no full text of the sourcecites [3] Morens DM Fauci AS The 1918 influenza pandemic: insights for the 21st century J Infect Dis 2007 195 1018 28 17330793 source
- Supportedcites [21] Taubenberger JK Morens DM 1918 influenza: the mother of all pandemics Emerg Infect Dis 2006 12 15 22 16494711 PMC3291398 source
The passage labeled Abstract describes the 1918 pandemic’s age-specific death rates as a W-shaped curve: peaks in the very young and very old, plus a third peak at approximately ages 20–40. The Figure 2 caption identifies the plotted mortality curve as being for the 1918 pandemic year. (LLM, conf=0.95)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The viruses that caused the 1957 and 1968 pandemics were descendants of the 1918 virus in which 3 (the 1957 virus) or 2 (the 1968 virus) new avian gene segments had been acquired by reassortment [21].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Pathologic and bacteriologic information obtained from later pandemic and seasonal influenza cases
What the sources say
- Partly supportedcites [21] Taubenberger JK Morens DM 1918 influenza: the mother of all pandemics Emerg Infect Dis 2006 12 15 22 16494711 PMC3291398 sourceExperimental — accuracy not yet measured
The passage headed “What Was the Animal Host Origin of the Pandemic Virus?” says the 1957 and 1968 viruses arose by reassortment between an avian virus and the previously circulating human H1N1 strain; another passage describes the reassorted pandemic viruses as descendants of the 1918 virus. Our copy does not give the claimed counts of three new avian gene segments in 1957 and two in 1968. (LLM, conf=0.88)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Staphylococcus aureus, a relatively minor cause of the 1918 fatalities, was predominant in the culture results from 1957–1958 [21, 57-61], and negative lung tissue cultures were more common, possibly as a result of the widespread administration of antibiotics [57, 58, 61].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Pathologic and bacteriologic information obtained from later pandemic and seasonal influenza cases
What the sources say
- Could not verifycites [21] Taubenberger JK Morens DM 1918 influenza: the mother of all pandemics Emerg Infect Dis 2006 12 15 22 16494711 PMC3291398 sourceExperimental — accuracy not yet measured
The paper discusses 1918 influenza mortality and complicated respiratory infections (Abstract; no page given), but the passages found do not identify Staphylococcus aureus as a relatively minor cause of 1918 deaths. Searches for Staphylococcus aureus, 1957–1958 culture results, negative lung cultures, and antibiotics found no passage addressing those claims. (LLM, conf=0.76)
- Not checked — no full text of the sourcecites [57] Mark DD The pathology of 1957 (Asian) influenza Am Rev Tuberc Pulmon Dis 1959 79 440 9 13650115 source
- Not checked — no full text of the sourcecites [58] Robertson L Caley JP Moore J Importance of Staphylococcus aureus in pneumonia in the 1957 epidemic of influenza A Lancet 1958 2 233 6 13564806 source
- Partly supportedcites [59] Louria DB Blumenfeld HL Ellis JT Kilbourne ED Rogers DE Studies on influenza in the pandemic of 1957–1958. II. Pulmonary complications of influenza J Clin Invest 1959 38 213 65 13620784 PMC444127 sourceExperimental — accuracy not yet measured
The Discussion (page unavailable) says bacteria were almost invariably isolated from fatal 1918–19 cases and that S. aureus was the associated pathogen in a majority of the fatal influenza pneumonias it discusses from later years. It does not establish that staphylococci were a relatively minor cause of 1918 fatalities. More importantly, its section on primary influenza virus pneumonia argues that antibiotics were unlikely to have made the culture-negative lungs in its cases sterile, contrary to the proposed explanation. (LLM, conf=0.86)
- Partly supportedcites [60] Oswald NC Shooter RA Curwen MP Pneumonia complicating Asian influenza Br Med J 1958 2 1305 11 13596593 PMC2027396 sourceExperimental — accuracy not yet measured
The Pleural Effusion discussion reports that Staphylococcus aureus was common in pathological series of 1957 influenza deaths, supporting its prominence in those results. The paper does not establish that it was a minor cause of 1918 fatalities or that negative lung-tissue cultures were more common in 1957–1958 because of antibiotics; its discussion of antibiotic use does not link it to negative cultures. (LLM, conf=0.85)
- Not checked — no full text of the sourcecites [61] Oseasohn R Adelson L Kaji M Clinicopathologic study of thirty-three fatal cases of Asian influenza N Engl J Med 1959 260 509 18 13632920 source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Bacillus influenzae tended to appear early in symptomatic influenza in association with diffuse bronchitis and/or bronchiolitis, sometimes infiltrating the bronchiolar submucosa [35]; it caused seroconversion [56] and was then typically replaced by other secondary organisms.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Bacteriologic studies in autopsy series during the 1918–1919 influenza pandemic
What the sources say
- Not matchedcites [35] Reckford FFD Acute alveolar and interstitial emphysema in influenza bronchopneumonia Pennsylvania Med J 1920 23 379 87
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Partly supportedcites [56] Wollstein M Pfeiffer’s bacillus and influenza: a serological study J Exp Med 1919 30 555 68 19868377 PMC2126671 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Bacillus influenzae largely corresponds to modern Hemophilus influenzae.
- Not matched
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“in one study of approximately 9000 subjects who were followed from clinical presentation with influenza to resolution or autopsy [40], researchers obtained, with sterile technique, cultures of either pneumococci or streptococci from 164 of 167 lung tissue samples.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Bacteriologic studies in autopsy series during the 1918–1919 influenza pandemic
What the sources say
- Partly supportedcites [40] Hirsch EF McKinney M An epidemic of pneumococcus bronchopneumonia J Infect Dis 1919 24 594 617 sourceExperimental — accuracy not yet measured
The Introduction (p. 594) reports 9,037 hospital admissions during the epidemic, and the postmortem investigation plan (approximately p. 596) calls for culturing exudates from consolidated lung tissue. The passages in our copy do not establish that all patients were followed to resolution or autopsy, or report 164 positive cultures among 167 lung samples with no negative results. (LLM, conf=0.86)
plainn = 167- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In rhesus monkeys, human influenza viruses given intranasally were not pathogenic, but could be made so by nasopharyngeal instillation of otherwise nonpathogenic bacteria [69].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Supportedcites [69] Wilson HE Saslaw S Doan CA Woolpert OC Schwab JL Reactions of monkeys to experimental mixed influenza and Streptococcus infections. An analysis of the relative roles of humoral and cellular immunity, with the description of an intercurrent nephritic syndrome J Exp Med 1947 85 199 215 19871608 PMC2135694 source
The Discussion (p. 211) says normal rhesus monkeys remained relatively asymptomatic after intranasal administration of influenza A virus or group C streptococci alone. It then reports (p. 213) that serious infection occurred more often when streptococci were given after influenza virus: five of eleven monkeys became ill, and two developed fatal septicemia. (LLM, conf=0.88)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“As reviewed recently by McCullers [75], a body of experimental research during the last 3 decades has identified possible mechanisms by which coinfection with the influenza virus and bacteria might affect pathogenicity. These include viral neuraminidase (NA)–induced exposure of bacterial adherence receptors; bacterial NA-induced upregulation of influenza infection; interleukin 10–induced suscept”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Partly supportedcites [75] McCullers JA Insights into the interaction between influenza virus and pneumococcus Clin Microbiol Rev 2006 19 571 82 16847087 PMC1539103 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Partly supportedcites [76] van der Sluijs KF Nijhuis M Levels JHM Influenza-induced expression of indoleamine 2,3-dioxygenase enhances interleukin-10 production and bacterial outgrowth during secondary pneumococcal pneumonia J Infect Dis 2006 193 214 22 16362885 sourceExperimental — accuracy not yet measured
The introduction (p. 1) says excessive IL-10 was critically involved in bacterial outgrowth during postinfluenza pneumococcal pneumonia in mice; the Discussion (p. 6) also reports that neutralizing IL-10 reduced bacterial loads. The paper does not establish the claimed neuraminidase mechanisms or IL-10-induced susceptibility to staphylococci, although it mentions staphylococci as a cause of postinfluenza pneumonia. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [77] Navarini AA Recher M Lang KS Increased susceptibility to bacterial superinfection as a consequence of innate antiviral responses Proc Natl Acad Sci U S A 2006 103 15535 9 17030789 PMC1622858 source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“The 1968 influenza pandemic was mild, and autopsy studies were uncommon [21].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Could not verifycites [21] Taubenberger JK Morens DM 1918 influenza: the mother of all pandemics Emerg Infect Dis 2006 12 15 22 16494711 PMC3291398 sourceExperimental — accuracy not yet measured
Our copy discusses archival autopsy materials from 1918 (Abstract, page unavailable), but does not address how common autopsy studies were during the 1968 pandemic. Searches for 1968, autopsy studies, and related terms found no passage supporting that point. (LLM, conf=0.75)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Could not verify
Every source the paper cites for this claim was checked and supports it.
In the paper
“The 1968 influenza pandemic was mild, and autopsy studies were uncommon [21].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Supportedcites [21] Taubenberger JK Morens DM 1918 influenza: the mother of all pandemics Emerg Infect Dis 2006 12 15 22 16494711 PMC3291398 source
The paper identifies the 1968 pandemic virus as a descendant of the 1918 virus (Abstract, page unavailable) and says that all apparent descendants caused substantially milder human disease. This supports the quoted claim about 1968, although the paper expresses mildness relative to 1918. (LLM, conf=0.84)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“During the 1940s, additional studies in ferrets, mice, and rats established that the influenza virus in combination with any of several pneumopathic bacteria acted synergistically to produce either a higher incidence of disease, a higher death rate, or a shortened time to death [70-73]; these effects could be mitigated or eliminated if antibiotics were given shortly after establishment of combined”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Not matchedcites [70] Glover RE Spread of infection from the respiratory tract of the ferret. II. Association of influenza A virus and Streptococcus group C Br J Exp Pathol 1941 22 98 107
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [71] Schwab JL Blubaugh FC Woolpert OC The response of mice to the intranasal inoculation of mixtures of Streptococcus hemolyticus and influenza virus J Bacteriol 1941 41 59 60
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [72] Francis T Vicente de Torregrosa M Combined infection of mice with H. influenzae and influenza virus by the intranasal route J Infect Dis 1945 76 70 7 source
- Partly supportedcites [73] Harford CG Smith MR Wood WB Sulfonamide chemotherapy of combined infection with influenza virus and bacteria J Exp Med 1946 83 505 18 20983719 sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“in certain experimental animal models [e.g., 89], some strains have induced severe pathology that differs from the findings associated with circulating human influenza viruses (which, in these models, cause disease resembling self-limited seasonal influenza in humans [90])”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Supportedcites [89] Salomon R Franks J Govorkova EA The polymerase complex genes contribute to the high virulence of the human H5N1 influenza virus isolate A/Vietnam/1203/04 J Exp Med 2006 203 689 97 16533883 PMC2118237 source
The Results section (‘Model system for evaluation of pathogenicity in ferrets and mice’; page unavailable) reports severe lung, liver, and brain pathology in ferrets infected with the H5N1 strain VN1203. The paper also describes ordinary human influenza viruses as causing acute respiratory illness in ferrets. The more specific self-limited seasonal-influenza comparison is attached to citation [90], not this source. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [90] Reuman PD Keely S Schiff GM James N Assessment of signs of influenza illness in the ferret model J Virol Methods 1989 24 27 34 2760163 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The postmortem samples we examined from people who died of influenza during 1918–1919 uniformly exhibited severe changes indicative of bacterial pneumonia.”
- Also stated in: § Histologic examination of lung tissue from 1918 victims · hedged
“The examination of recut lung tissue sections from 1918–1919 influenza case material revealed, in virtually all cases, compelling histologic evidence of severe acute bacterial pneumonia, either as the predominant pathology or in conjunction with underlying pathologic features now believed to be associated with influenza virus infection [10, 24] (figure 1).”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > Abstract > Results
plainn = 58- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
- Rests on an assumption: The 58 autopsy specimens available from the National Tissue Repository are representative of 1918-1919 influenza fatalities.
- Also stated in: § Histologic examination of lung tissue from 1918 victims · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The majority of the cases examined demonstrated asynchronous histopathological changes, in which the various stages of development of the infectious process, from early bronchiolar changes to severe bacterial parenchymal destruction, were noted in focal areas.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Histologic examination of lung tissue from 1918 victims
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
- Rests on an assumption: The 58 autopsy specimens available from the National Tissue Repository are representative of 1918-1919 influenza fatalities.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of 2007 pneumococcal isolates, 874 (43.5%) were serotyped by agglutination. Type I was isolated from 124 (14.2%) of 874 subjects; type II from 163 (18.6%); type IIa from 26 (3.0%); type III from 184 (21.1%); and type IV, a category containing diverse and, at the time, untypeable organisms, from 377 (43.1%).”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Bacteriologic studies in autopsy series during the 1918–1919 influenza pandemic
plainn = 874- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The 109 published autopsy series and 8398 autopsies are representative of influenza deaths during the 1918-1919 pandemic.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Cultures of blood samples in 30 military and 12 civilian series, which examined a total of 1887 subjects (table 2), had positive results in 70.3% of cases and typically contained either pneumococci or streptococci in pure culture.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Bacteriologic studies in autopsy series during the 1918–1919 influenza pandemic
plainn = 1,887- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The 109 published autopsy series and 8398 autopsies are representative of influenza deaths during the 1918-1919 pandemic.
- Rests on an assumption: Postmortem lung culture results reflect bacteria that contributed to death rather than postmortem contamination or incidental colonization.
In the paper
“As was true for the 58 autopsy cases we reviewed (see above), published autopsies for victims of the 1918–1919 pandemic generally showed histopathological asynchrony [20].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Contemporary views of the natural history of severe influenza during the 1918–1919 influenza pandemic
What the sources say
- Not matchedcites [20] Opie EL Blake FG Rivers TM The pathology and bacteriology of pneumonia following influenza Chapter IV Opie EL Blake FG Small JC Rivers TM Epidemic respiratory disease. The pneumonias and other infections of the respiratory tract accompanying influenza and measles St Louis CV Mosby 1921 107 281
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelationaln = 58- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“(4) the predominance of bronchopneumonia and lobular pneumonia, as opposed to lobar pneumonia, consistent with diffuse predisposing bronchiolar damage [27-33].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Published pathologic and/or bacteriologic findings from the 1918–1919 influenza pandemic
What the sources say
- Not checked — no full text of the sourcecites [27] Goodpasture EW The significance of certain pulmonary lesions in relation to the etiology of influenza Am J Med Sci 1919 158 863 70 19680020 source
- Not checked yetcites [28] Klotz O Members of the Faculty of the School of Medicine, University of Pittsburgh The pathology of epidemic influenza Studies on epidemic influenza comprising clinical and laboratory investigations by Members of the Faculty of the School of Medicine, University of Pittsburgh Pittsburgh University of Pittsburgh 1919 207 294
- Not checked — no full text of the sourcecites [29] Lucke B Wight T Kime E Pathologic anatomy and bacteriology of influenza: epidemic of autumn, 1918 Arch Intern Med 1919 24 154 237 source
- Not matchedcites [30] MacCallum WG Pathology of epidemic pneumonia in camps and cantonments in 1918 Med Rec 1919 95 776 84
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked yetcites [31] Tobias JW Anatomía Patológica de la grippe pandémica Rev Med Univ Buenos Aires 1920 17 109 99
- Not matchedcites [32] Winternitz MC Wason IM McNamara FP The pathology of influenza New Haven Yale University Press 1920
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked yetcites [33] MacCallum WG Pathological anatomy of pneumonia associated with influenza; 23 plates Johns Hopkins Hosp Rep 1921 20 149 249
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The rest of the deaths were associated collectively with either culture of nonpneumopathogenic “other bacteria,” such as nonhemolytic and viridans streptococci, “green-producing streptococci” [54], probably largely corresponding to α-hemolytic streptococci, uncharacterized diplostreptococci, Micrococcus (Moraxella) catarrhalis, Bacillus (Escherichia) coli, Klebsiella species, and complex mixed b”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Bacteriologic studies in autopsy series during the 1918–1919 influenza pandemic
What the sources say
- Not checked — no full text of the sourcecites [54] Tunnicliff R Observations on green producing cocci of influenza J Infect Dis 1920 26 405 17 source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
- Rests on an assumption: The 109 published autopsy series and 8398 autopsies are representative of influenza deaths during the 1918-1919 pandemic.
- Rests on an assumption: Postmortem lung culture results reflect bacteria that contributed to death rather than postmortem contamination or incidental colonization.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“(2) the frequency of pneumonia caused by both mixed pneumopathogens (particularly pneumococci and streptococci) and by other mixed upper respiratory–tract bacteria;”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Published pathologic and/or bacteriologic findings from the 1918–1919 influenza pandemic
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“(3) the aggressiveness of bacterial invasion of the lung, often resulting in “phenomenal” [30] numbers of bacteria and polymorphonuclear neutrophils, as well as extensive necrosis, vasculitis, and hemorrhage [20, 32, 33];”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Published pathologic and/or bacteriologic findings from the 1918–1919 influenza pandemic
What the sources say
- Not matchedcites [30] MacCallum WG Pathology of epidemic pneumonia in camps and cantonments in 1918 Med Rec 1919 95 776 84
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [20] Opie EL Blake FG Rivers TM The pathology and bacteriology of pneumonia following influenza Chapter IV Opie EL Blake FG Small JC Rivers TM Epidemic respiratory disease. The pneumonias and other infections of the respiratory tract accompanying influenza and measles St Louis CV Mosby 1921 107 281
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [32] Winternitz MC Wason IM McNamara FP The pathology of influenza New Haven Yale University Press 1920
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked yetcites [33] MacCallum WG Pathological anatomy of pneumonia associated with influenza; 23 plates Johns Hopkins Hosp Rep 1921 20 149 249
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These findings reflect rates of bacterial isolation similar to those of the series that reported the predominance of pneumopathogens (above and table 1), but with higher isolation rates for “other bacteria” offsetting the lower isolation rates for pneumococci, streptococci and staphylococci.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Bacteriologic studies in autopsy series during the 1918–1919 influenza pandemic
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The 109 published autopsy series and 8398 autopsies are representative of influenza deaths during the 1918-1919 pandemic.
- Rests on an assumption: Postmortem lung culture results reflect bacteria that contributed to death rather than postmortem contamination or incidental colonization.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Cultures of pleural or empyema fluid, reported in 23 military and 12 civilian series examining a total of 1245 subjects (table 2), revealed either streptococci or pneumococci as the most commonly recovered organism in all but 7 series: in 4 series mixed pneumopathogens predominated, and in 3 series Staphylococcus aureus predominated.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Bacteriologic studies in autopsy series during the 1918–1919 influenza pandemic
plainn = 1,245- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The 109 published autopsy series and 8398 autopsies are representative of influenza deaths during the 1918-1919 pandemic.
- Rests on an assumption: Postmortem lung culture results reflect bacteria that contributed to death rather than postmortem contamination or incidental colonization.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“From more than 2000 such publications, we carefully examined the 1539 reports that contained human pathologic and/or bacteriologic findings”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > METHODS > Pathology and bacteriology research records from the 1918–1919 influenza pandemic
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“109 of which provided useful bacteriologic information derived from 173 autopsy series. These series reported 8398 individual autopsy investigations undertaken in 15 countries”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > METHODS > Pathology and bacteriology research records from the 1918–1919 influenza pandemic
plainn = 8,398- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Rests on an assumption: The 109 published autopsy series and 8398 autopsies are representative of influenza deaths during the 1918-1919 pandemic.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“96 postmortem lung tissue culture series, 42 blood culture series, and 35 pleural fluid culture series.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > METHODS > Pathology and bacteriology research records from the 1918–1919 influenza pandemic
plainn = 8,398- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Rests on an assumption: The 109 published autopsy series and 8398 autopsies are representative of influenza deaths during the 1918-1919 pandemic.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“cases have tended to occur in elderly individuals, who rarely undergo autopsy.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The 1918 pandemic and subsequent pandemics differed with respect to the spectrum and extent of secondary bacterial pneumonia (e.g., the switch in prevalence during the antibiotic era to predominantly staphylococcal secondary pneumonia, as opposed to streptococcal, pneumococcal, and mixed secondary pneumonia; and the greatly decreased involvement of Bacillus [Hemophilus] influenzae)”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Influenza pandemic preparedness strategies in the United States [2] assume 3 levels of potential severity corresponding to the 20th century pandemics of H1N1 “Spanish flu” (1918–1919), H2N2 “Asian flu” (1957–1958), and H3N2 “Hong Kong flu” (1968–1969)”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > Abstract > Conclusions
What the sources say
- Not checked yetcites [2] United States Department of Health and Human Services (HHS) HHS pandemic influenza plan Washington, DC US Government Printing Office 2005 Available at: http://www.hhs.gov/pandemicflu/plan/pdf/HHSPandemicInfluenzaPlan.pdf 16 June 2008
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Extrapolation from 1918–1919 pandemic data to the current population and age profile has led United States government officials to plan for more than 1.9 million excess deaths during a severe pandemic [2].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > Abstract > Conclusions
What the sources say
- Not checked yetcites [2] United States Department of Health and Human Services (HHS) HHS pandemic influenza plan Washington, DC US Government Printing Office 2005 Available at: http://www.hhs.gov/pandemicflu/plan/pdf/HHSPandemicInfluenzaPlan.pdf 16 June 2008
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The increased fatality rate in the 3 high-risk age groups was predominantly due to the increased frequency of bronchopneumonia, not to increased incidence of influenza or an increased bronchopneumonia case-fatality rate [19].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Background epidemiologic data on influenza mortality rates in 1918–1919
What the sources say
- Not checked — no full text of the sourcecites [19] Collins SD Age and sex incidence of influenza and pneumonia morbidity and mortality in the epidemic of 1928–29 with comparative data for the epidemic of 1918–19 Public Health Rep 1931 46 1909 37 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Primary “panbronchitis” [35] was thought to reflect rapidly spreading epithelial cytolytic infection of the entire bronchial tree [32, 35, 36]; this was thought to have led to the secondary spread of enormous numbers of bacteria along the denuded bronchial epithelium to every part of the bronchial tree, following which focal bronchiolar infections broke through into the lung parenchyma.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Contemporary views of the natural history of severe influenza during the 1918–1919 influenza pandemic
What the sources say
- Not matchedcites [35] Reckford FFD Acute alveolar and interstitial emphysema in influenza bronchopneumonia Pennsylvania Med J 1920 23 379 87
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [32] Winternitz MC Wason IM McNamara FP The pathology of influenza New Haven Yale University Press 1920
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [36] Roos C Notes on the bacteriology, and on the selective action of B. influenzae Pfeiffer J Immunol 1919 4 189 201 source
hedgeddirect- Asserted: fails — The authors may not put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“Among the ≥60% of individuals who survived such severe pneumonia, severe chronic pulmonary damage was apparently uncommon [37, 38].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Contemporary views of the natural history of severe influenza during the 1918–1919 influenza pandemic
What the sources say
- Not checked — no full text of the sourcecites [37] Wynn WH Chronic influenzal fibrosis of the lungs Lancet 1927 2 964 7 source
- Not matchedcites [38] Nuzum JW Pilot I Stangl FH Bonar BE Pandemic influenza and pneumonia in a large civil hospital J Am Med 1918 71 1562 5 12100
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It is noteworthy that pneumococcal typing antisera were unavailable in 11 of these 14 studies, and that many of the cultured “other” bacteria were reported as “gram-positive diplococci,” “streptococci,” or “diplostreptococci” (data not shown), consistent with the possibility that in this early era of bacterial typing, some of the unidentified organisms in the culture may have been pneumopathogens.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Bacteriologic studies in autopsy series during the 1918–1919 influenza pandemic
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The data are consistent with a natural history in which the virus, highly cytopathic to bronchial and bronchiolar epithelial cells, extends rapidly and diffusely down the respiratory tree, damages the epithelium sufficiently to break down the mucociliary barrier to bacterial spread”
- Also stated in: § DISCUSSION · hedged
“and if able to gain access to the distal respiratory tree—perhaps on the basis of receptor affinity [80]—creates both a direct pathway for secondary bacterial spread and an environment (cell necrosis and proteinaceous edema fluid) favorable to bacterial growth.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Not checked — no full text of the sourcecites [80] Stevens J Blixt O Glaser L Glycan microarray analysis of the hemagglutinins from modern and pandemic influenza viruses reveals different receptor specificities J Mol Biol 2006 355 1143 55 16343533 source
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- Also stated in: § DISCUSSION · hedged
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In the paper
“we searched major bibliographic sources [e.g., 11–17] for papers in all languages and tables of contents of major journals in English, German, and French; in addition, we searched all of the papers we identified for additional citations.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > METHODS > Pathology and bacteriology research records from the 1918–1919 influenza pandemic
What the sources say
- Not matchedcites [11] Billings JS Fletcher R Garrison FH Index Medicus 18 Series II Washington, DC Government Printing Office 1903–1920
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [12] Library of the Surgeon General’s Office, United States Army Index-catalogue of the Library of the Surgeon-General’s Office, United States Army. Authors and Subjects 10 Series III Washington, DC US Government Printing Office 1918–1932
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [13] Vaughan WT Influenza: an epidemiological study. Monograph series no. 1 Baltimore, Maryland American Journal of Hygiene 1921
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [14] Jordan EO Epidemic influenza: a survey Chicago, Illinois American Medical Association 1927
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [15] Thomson D Thomson R Annals of the Pickett-Thomson Research Laboratory Volume X. Influenza (Part II) With special reference to the complications and sequellæ, bacteriology of influenzal pneumonia, pathology, epidemiological data, prevention and treatment London Baillière, Tindall & Cox 1934 source
- Not checked — no full text of the sourcecites [16] Phillips H Killingray D The Spanish Influenza Pandemic of 1918–19. New Perspectives London Routledge 2003 source
- Not matchedcites [17] Byerly CR Fever of War: the influenza epidemic in the U. S. Army during World War I New York New York University Press 2005
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
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In the paper
“A priori, we stratified data by military and civilian populations (see Discussion), and by the quality of lung tissue culture results, considering to be of “higher quality” the 68 autopsy series with lung tissue culture results that reported, for all autopsies, both the presence and absence of negative culture results and the bacterial components of mixed culture results.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > METHODS > Pathology and bacteriology research records from the 1918–1919 influenza pandemic
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“If, as some fear, a future pandemic is caused by a derivative of the current highly pathogenic avian H5N1 virus, lessons from previous pandemics may not be strictly applicable.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“Because few autopsy reports and, to our knowledge, no autopsy series addressed conditions other than predominantly pulmonary complications, nonpulmonary causes of death are not considered here.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > RESULTS > Background epidemiologic data on influenza mortality rates in 1918–1919
hedgeddirect- Asserted: passes — The authors put it forward as true.
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In the paper
“These might include the use of antibiotics and antiviral agents, the rate of influenza vaccination and bacterial vaccination, and demographic and social factors.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The viral etiology of and timing of the next influenza pandemic cannot be predicted [87].”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > DISCUSSION
What the sources say
- Not checked — no full text of the sourcecites [87] Taubenberger JK Morens DM Fauci AS The next influenza pandemic: can it be predicted? JAMA 2007 297 2025 27 17488968 PMC2504708 source
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper relies on this without support.
The 58 autopsy specimens available from the National Tissue Repository are representative of 1918-1919 influenza fatalities.
“These materials, sent during the pandemic from various United States military bases to the National Tissue Repository of the Armed Forces Institute of Pathology [8-10], represent all known influenza cases from this collection for which lung tissue is available.”
The paper relies on this without support.
The 109 published autopsy series and 8398 autopsies are representative of influenza deaths during the 1918-1919 pandemic.
“These series reported 8398 individual autopsy investigations undertaken in 15 countries”
The paper relies on this without support.
Postmortem lung culture results reflect bacteria that contributed to death rather than postmortem contamination or incidental colonization.
“Negative lung culture results were uncommon in the 96 identified military and civilian autopsy series, which examined 5266 subjects (4.2% of results overall) (table 1; full bibliographic list available at http://www3.niaid.nih.gov/topics/Flu/1918/bibliography.htm).”
The paper relies on this without support.
Bacillus influenzae largely corresponds to modern Hemophilus influenzae.
“Bacillus influenzae (largely corresponding to the modern Hemophilus influenzae)”
The paper relies on this without support.
The prevalent upper respiratory tract bacteria in a future pandemic will be capable of causing severe secondary bacterial pneumonia when influenza virus damages the respiratory epithelium.
“precipitating severe disease associated with prevalent colonizing bacteria.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“The “Spanish flu” of 1918 was the most severe influenza pandemic on record, 95% of the mortality due to bacterial infection (Morens et al., 2008).”
From Oral Microbiome and SARS-CoV-2: Beware of Lung Co-infection (2020) · cites this paper as Morens et al., 2008
In the citing paper
“Epidemiological data indicated that bacterial complications further increased morbidity and mortality of influenza infection.”
From Oral Microbiome and SARS-CoV-2: Beware of Lung Co-infection (2020) · cites this paper as Morens et al., 2008
In the citing paper
“Lung tissue samples from the 1918 influenza pandemic suggest that the majority of the estimated 20–60 million deaths were from bacterial infections rather than from direct effects of the virus.3”
From The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. (2016) · cites this paper as [3]
In the citing paper
“During the 1918 pandemic, bacterial pneumonia was a major cause of morbidity and mortality, as shown by studies at the time as well as retrospective study of pathology specimens [10, 11].”
From The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. (2018) · cites this paper as [10]
In the citing paper
“Morens et al. reviewed autopsy data from 58 lung tissue samples collected during the 1918 influenza pandemic and histologic evidence of severe bacterial pneumonia was found in almost all samples [10].”
From The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. (2018) · cites this paper as [10]
In the citing paper
“This showed that more than 92% of autopsy lung cultures were positive for at least one bacterium [10].”
From The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. (2018) · cites this paper as [10]
In the citing paper
“the so-called “Spanish Flu” pandemic of H1N1 influenza A virus from 1918 to 1919 resulted in more than 50 million deaths, with many caused by bacterial super-infection leading to secondary pneumonia”
From Respiratory viral infection-induced microbiome alterations and secondary bacterial pneumonia. (2018) · cites this paper as [6]
In the citing paper
“Historical and contemporary descriptions of influenza pathology have characteristically focused, predominantly or exclusively, on disease caused by seasonal or pandemic influenza A viruses [2,3,[10][11][12][13][14][15].”
From Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection (2012) · cites this paper as [3]
In the citing paper
“The time from onset to death observed with fatal influenza B was more rapid than the duration of fatal illness described for pandemic 1918 A(H1N1), pandemic 1957 A(H2N2), pandemic 1968 A(H3N2), pandemic 2009 H1N1, and seasonal A(H3N2) viruses [3, 10-13, 4).”
From Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection (2012) · cites this paper as [3]
In the citing paper
“Analysis of lung tissue sections from fatal 1918 influenza case materials frequently revealed histopathologic findings consistent with acute bacterial pneumonia [3].”
From Streptococcus pneumoniae coinfection is correlated with the severity of H1N1 pandemic influenza (2009) · cites this paper as [3]
In the citing paper
“Secondary bacterial infections have been implicated in morbidity and mortality in H1N1 influenza [3].”
From Streptococcus pneumoniae coinfection is correlated with the severity of H1N1 pandemic influenza (2009) · cites this paper as [3]
In the citing paper
“Agents recovered by postmortem cultures of lung samples from 96 fatal 1918 influenza pandemic cases included S. pneumoniae (23.2%), S. haemolyticus (18.0%), S. aureus (7.7%) and H. influenzae (4.7%) [3].”
From Streptococcus pneumoniae coinfection is correlated with the severity of H1N1 pandemic influenza (2009) · cites this paper as [3]
In the citing paper
“Recent re‐analyses of post‐mortem lung cultures from 1918 showed evidence of bacterial infection in >90% of the specimens.”
From Bacterial and viral infections associated with influenza (2013) · cites this paper as [18]
In the citing paper
“The three influenza pandemics of the 20th century (1918 H1N1, 1957 H2N2 and 1968 H3N2) are all associated with secondary bacterial pneumonia.”
From Bacterial and viral infections associated with influenza (2013) · cites this paper as [18]
In the citing paper
“Certain bacterial pathogens have been commonly isolated from patients with secondary bacterial infections, such as Streptococcus pneumoniae, (4, 11, 12).”
From Depletion of alveolar macrophages during influenza infection facilitates bacterial superinfections (2013) · cites this paper as [4]
In the citing paper
“Primary human airway epithelial cells and cell lines derived from them have been shown to express 10 TLRs (TLR1 to -10) (188, 260), and TLR expression has been documented for human biopsy tissue (101).”
From The airway epithelium: soldier in the fight against respiratory viruses (2011) · cites this paper as [188]
In the citing paper
“Overall 95% of deaths were due to co/secondary bacterial pneumonia (Opie et al., 1921; Morens et al., 2008).”
From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Morens et al., 2008
In the citing paper
“A majority of those deaths due to secondary S. pneumoniae infection (Brundage and Shanks, 2008; Morens et al., 2008).”
From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Morens et al., 2008
In the citing paper
“pneumonia as a consequence of bacterial infection is estimated to have occurred in up to 95% of deaths during this pandemic (Morens et al., 2008).”
From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Morens et al., 2008
In the citing paper
“Additional post-mortems of lung tissue suggest that at least 90% of samples showed evidence of bacterial infection (Oxford et al., 2002; Morens et al., 2008; Chien et al., 2009).”
From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Morens et al., 2008
In the citing paper
“Post-mortem cultures show evidence of bacterial infection in up to 80% of all severe and fatal cases (Hers et al., 1958; Morens et al., 2008; Gill et al., 2010).”
From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Morens et al., 2008
In the citing paper
“For example, autopsies from the 1918 pandemic were reviewed and it was found that S. pneumoniae was the most common co-infector, followed by S hemolytic, S. aureus, and H. influenzae. ‘Other bacteria’ were also highlighted within which M. catarrhalis was grouped (Morens et al., 2008).”
From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Morens et al., 2008
In the citing paper
“It has been estimated that .95% of all fatal influenza cases during the 1918-1919 pandemic were complicated by to secondary bacterial pneumonia [2].”
From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [2]
In the citing paper
“This absence of the proinflammatory activity of PB1-F2 may explain why this pandemic has been milder and has featured many fewer secondary bacterial infections than the 1918 H1N1 pandemic [2].”
From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [2]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > Abstract > Methods
“reviewed pathologic and bacteriologic data from 109 published autopsy series that described 8398 individual autopsy investigations.”
§ Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness > METHODS > Pathology and bacteriology research records from the 1918–1919 influenza pandemic
“109 of which provided useful bacteriologic information derived from 173 autopsy series.”
Citations
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“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].”
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“This results in a tremendous economic burden because of increased hospitalizations, medical costs, and indirect costs during both pandemic and interpandemic influenza periods (4).”
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“Histological analyses of infected lung tissue indicates that bacterial superinfection resulting in secondary bacterial pneumonia was the predominant cause of death during the 1918 type A influenza virus pandemic and the more recent H1N1 pandemi”
BackgroundThe gut microbiota prime systemic antiviral immunity via the cGAS-STING-IFN-I axis
Erttmann, S. F., Swacha, P., Aung, K. M., Brindefalk, B., Jiang, H., Härtlová, A., Uhlin, B. E., Wai, S. N., & Gekara, N. O. (2022) · Immunity · doi:10.1016/j.immuni.2022.04.006 · Cited by 358
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“The oldest report of bacterial infections that occurred simultaneously or shortly after influenza is related to the 1918 Influenza pandemic, in which most deaths occurred as a result of co-infection with infectious bacteria.(35) Also, the H1N1 Influenza pandemic in 2009 was complicated by bacterial pneumonia in 4–33%…”
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“Recent re-examination of 58 re-cut lung specimens from autopsy samples showed that nearly all were fully consistent with bacterial pneumonia, either alone or superimposed on viral pneumonia.(11)”
BackgroundResultInfluentialInfluenza and Bacterial Superinfection: Illuminating the Immunologic Mechanisms of Disease
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“pneumoniae was the bacterial pathogen most commonly identified (1).”
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“Notably, the virus was clinically unremarkable in >95% of patients (2), and almost all fatalities were caused by secondary bacterial pneumonia (6, 7).”
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“As antibiotics were not available then, secondary bacterial pneumonia was a major cause of death among those infected with the virus [5].”
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“, 2008; Mossad, 2009; Murray and Chotirmall, 2015) and/or living with one or more chronic medical conditions [such as heart disease, obesity, asthma, chronic obstructive pulmonary disease (COPD), and/or diabetes mellitus] (Morens et al., 2008; Jain et al., 2009; La Ruche et al., 2009; Flint et al., 2010; Hulme et al.,…”
BackgroundInfluentialStreptococcus pneumoniae coinfection is correlated with the severity of H1N1 pandemic influenza
Palacios, G., Hornig, M., Cisterna, D., Savji, N., Bussetti, A. V., Kapoor, V., Hui, J., Tokarz, R., Briese, T., Baumeister, E., et al. (2009) · PLoS ONE · doi:10.1371/journal.pone.0008540 · Cited by 275
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“During 1918 and subsequent influenza pandemics, Streptococcus pneumoniae and other bacterial superinfections were common causes of mortality and morbidity.[3] Recent retrospective studies have suggested that aspergillosis and other fungal infections are under-recognized complications of severe influenza.”
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“[46] More recent evidence during the H1N1 virus pandemic points to a substantial impact of influenza on predisposition to invasive GAS infection.”
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“12, 18 Legionella pneumophila a less common bacterium was also found to be associated with influenza infection in the 2009 H1N1 pandemic.”
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“influenza cases where infection also involves the lower respiratory tract [56,57], as observed in infections with avian-origin H5N1 [58,59], and 1918 pandemic influenza strains [60,61].”
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The urgent need for metallo-β-lactamase inhibitors: an unattended global threat
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“This may distinguish the influenza A(H1N1)pdm09 virus from the 1918 H1N1 IAV, for which bacterial superinfection was determined to cause a majority of the deaths (104, 105), although this may more accurately reflect improved hygiene and standard of care.”
BackgroundIL-22 Is Essential for Lung Epithelial Repair following Influenza Infection
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Bacterial Coinfections in Coronavirus Disease 2019
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Pandemic influenza - including a risk assessment of H5N1
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“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 (48).”
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“The most common cause of death from complications of 1918 influenza virus was secondary bacterial pneumonia (26), but viral pneumonia also developed in many patients.”
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“90% of deaths during the 1918 influenza pandemic likely resulted from secondary pneumococcal pneumonia (4, 5).”
BackgroundProtection of Racial/Ethnic Minority Populations During an Influenza Pandemic
Hutchins, S. S., Fiscella, K. A., Levine, R. S., Ompad, D. C., & McDonald, M. (2009) · American Journal of Public Health · doi:10.2105/ajph.2009.161505 · Cited by 200
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“96 Moreover, evidence suggests that viral-bacterial coinfection may facilitate viral, and viral/bacterial airborne transmission 97 and may even increase case-fatality, a phenomenon noted as long ago as 1917.”
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“This can render a mild influenza infection severe or even fatal [1].”
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“Modern studies of patients who died in the 1918 influenza epidemic suggest that most of those deaths were, in fact, associated with secondary bacterial infection [76].”
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“The lethality came from secondary bacterial infections that caused severe pneumonias, particularly among pregnant women.(1,2) In addition, there are indications of long-term impairments in those exposed prenatally.”
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“The divergent results obtained by using Ifnar1 - / - mice and by exogenous addition of type I IFNs in viral infections serve as a good example to demonstrate the pleiotropic functions of the type I IFN family.”
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“Streptococcus was the most common pathogen and was responsible for over 50% of the deaths (27).”
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The 1918 influenza pandemic: 100 years of questions answered and unanswered
Taubenberger, J. K., Kash, J. C., & Morens, D. M. (2019) · Science Translational Medicine · doi:10.1126/scitranslmed.aau5485 · Cited by 209
“Whereas most sick persons had self-limiting influenza, indistinguishable from influenza as seen today, an unexpectedly high number went on to die of pneumonia (3).”
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Inflammation induced by influenza virus impairs human innate immune control of pneumococcus
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Animal models for the study of influenza pathogenesis and therapy
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“A recent paper concluded “that influenza A virus infection in conjunction with bacterial infection led to most of the deaths during the 1918–1919 pandemic” (Morens et al., 2008).”
The 1918 influenza pandemic: Lessons for 2009 and the future
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“The bronchial tree appeared to be the primary organ of involvement in severe 1918 influenza cases; when bacterial invaders in the nasopharynx gained access to the peripheral bronchial tree by direct extension along denuded bronchial epithelium, bronchopneumonia could then occur (18).”
BackgroundInfluentialSelf-citationThe Role of Viral, Host, and Secondary Bacterial Factors in Influenza Pathogenesis
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“pyogenes.(12,13) Thus, the increased susceptibility to the complication of secondary bacterial infections should be considered as an intrinsic virulence property of influenza viruses.”
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“pneumoniae [14].”
Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia
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“Pandemic A (H1N1) 1918–1919 10 (NR) 93 Streptococcus pneumoniae [3]”
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Viral infection in community-acquired pneumonia: a systematic review and meta-analysis
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Influenza virus primes mice for pneumonia from Staphylococcus aureus.
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“[2].”
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“The high mortality associated with staphylococcal pneumonia following influenza was first documented during the 1918 influenza pandemic in which many young, previously health individuals died of staphylococcal pneumonia, having previously recovered from influenza [227, 228].”
PB1-F2 Proteins from H5N1 and 20th Century Pandemic Influenza Viruses Cause Immunopathology
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“Indeed, although bacterial super-infections complicated more than 95% of all deaths during the 1918 pandemic [29], bacterial”
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“Similarly, some of the hosts that died during the devastating 1918 pandemic seem to have succumbed to a viral pneumonia (the majority likely died due to secondary bacterial pneumonia; Morens & Fauci 2007; Morens et al. 2008).”
Background
Metadata
- Authors
- Morens, D. M., Taubenberger, J. K., & Fauci, A. S.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Morens, David M.
- Venue
- The Journal of Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-10
- Volume
- 198
- Issue
- 7
- Pages
- 962-970
- ISSN
- 0022-1899 (ISSN-L)
- 1537-6613
- PMC
- PMC2599911
- OpenAlex
- W2167944937
- Cited by
- 1,625
- References
- 80
- Citations by year
- 2026: 42 · 2025: 65 · 2024: 69 · 2023: 101 · 2022: 132 · 2021: 165 · 2020: 139 · 2019: 64 · 2018: 74 · 2017: 70 · 2016: 70 · 2015: 83 · 2014: 66 · 2013: 89 · 2012: 87
- FWCI
- 76.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99 AI999999)
- National Institute of Allergy and Infectious Diseases
- U.S. National Library of Medicine
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Keywords
- pandemic influenza, bacterial pneumonia, secondary bacterial pneumonia, causes of death, upper respiratory tract bacteria, pandemic preparedness, bacterial vaccines, autopsy findings
- MeSH terms
- Autopsy, Disease Outbreaks, Humans, Influenza, Human, Lung, Time Factors, Pneumonia, Bacterial, Influenza A Virus, H5N1 Subtype
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-01, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-01 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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