Deaths from Bacterial Pneumonia during 1918–19 Influenza Pandemic
Open accessAbstract
Deaths during the 1918-19 influenza pandemic have been attributed to a hypervirulent influenza strain. Hence, preparations for the next pandemic focus almost exclusively on vaccine prevention and antiviral treatment for infections with a novel influenza strain. However, we hypothesize that infections with the pandemic strain generally caused self-limited (rarely fatal) illnesses that enabled colonizing strains of bacteria to produce highly lethal pneumonias. This sequential-infection hypothesis is consistent with characteristics of the 1918-19 pandemic, contemporaneous expert opinion, and current knowledge regarding the pathophysiologic effects of influenza viruses and their interactions with respiratory bacteria. This hypothesis suggests opportunities for prevention and treatment during the next pandemic (e.g., with bacterial vaccines and antimicrobial drugs), particularly if a pandemic strain-specific vaccine is unavailable or inaccessible to isolated, crowded, or medically underserved populations.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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?
During the 1918 pandemic, bacterial pneumonia was a major cause of morbidity and mortality.
“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 [11]
Much shorter times from onset to death have been recorded in pandemic periods.
“although much shorter times from onset to death have been recorded in pandemic periods”
From Bacterial and viral infections associated with influenza (2013) · cites this paper as [12]
Experts support the sequential infection hypothesis that bacteria were secondary invaders to pulmonary tissues weakened by the influenza virus.
“Experts now support the sequential infection hypothesis and believe that bacteria were secondary invaders to pulmonary tissues weakened by the influenza virus.”
From Bacterial and viral infections associated with influenza (2013) · cites this paper as [12]
The fatal outcome of influenza pneumonia was determined partly by virally depressed local and general pulmonary resistance and partly by the virulence and nature of the invading bacteria.
“The fatal outcome of influenza pneumonia was therefore determined partly by virally depressed local and general pulmonary resistance and partly by the virulence and nature of the invading bacteria.”
From Bacterial and viral infections associated with influenza (2013) · cites this paper as [12]
Streptococcus pneumoniae is the dominant pathogen involved in the synergistic process of co/secondary bacterial infection with influenza, followed mainly by Staphylococcus aureus and Haemophilus influenzae.
“Streptococcus pneumoniae continues to be the dominant pathogen involved in this synergistic process7 followed mainly by Staphylococcus aureus 5 and Haemophilus influenzae.12, 18”
From Bacterial and viral infections associated with influenza (2013) · cites this paper as [12]
This matches the previously established boundaries for maximum synergism in the secondary bacterial infection model, which parallel the typical order and timing of infections in humans.
“This matches the previously established boundaries for maximum synergism in the secondary bacterial infection model (33), which parallel the typical order and timing of infections in humans (34).”
From Depletion of alveolar macrophages during influenza infection facilitates bacterial superinfections (2013) · cites this paper as [34]
A majority of 1918 pandemic deaths were due to secondary S. pneumoniae infection.
“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 Brundage and Shanks, 2008
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 34 · Cited by 384
Research works printed but not linked: 2
- [5]Opie EL, Blake FG, Small JC, Rivers TM. Epidemic respiratory disease. St. Louis: C.V. Mosby Co.; 1921.
- [16]Britten RH. The incidence of epidemic influenza, 1918–19. Public Health Rep. 1932;47:303–39 [cited 2008 May 30]. Available from http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1996206&blobtype=pdf
- Authors
- Brundage, J. F., & Shanks, G. D.
- Affiliations
- Armed Forces Health Surveillance Center (US)
- Australian Defence Force Malaria and Infectious Disease Institute (AU)
- Corresponding author
- Brundage, John F.
- ORCID
- Shanks, G. Dennis
- Venue
- Emerging Infectious Diseases
- Published
- 2008-08
- Volume
- 14
- Issue
- 8
- Pages
- 1193-1199
- ISSN
- 1080-6040 (ISSN-L)
- 1080-6059
- PMC
- PMC2600384
- OpenAlex
- W2133743596
- Cited by
- 384
- References
- 34
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 7 · 2023: 17 · 2022: 21 · 2021: 23 · 2020: 31 · 2019: 17 · 2018: 20 · 2017: 15 · 2016: 16 · 2015: 13 · 2014: 12 · 2013: 26 · 2012: 27
- FWCI
- 30.93
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Emerging infectious diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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
- bacterial pneumonia, 1918 influenza pandemic, influenza-associated deaths, bacterial vaccines, antimicrobial therapy, pandemic preparedness, medically underserved populations
- MeSH terms
- Disease Outbreaks, Humans, Influenza, Human, Orthomyxoviridae, Virulence, Pneumonia, Bacterial, History, 20th Century
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.
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 ›
Are you an author, or do you see a problem with this page? Request a review
