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Author Notes:

E-mail: yuwen32@gmail.com

Conceived and designed the experiments: YC BRL KPK.

Performed the experiments: YC.

Analyzed the data: YC BRL KPK.

Wrote the paper: YC BRL KPK.

Wrote, modified and debugged the Berkeley Madonna program: YC BRL.

Provided biological and epidemiological input: YC BRL KPK.

Performed the simulations: YC.

KPK has received research funding unrelated to the current paper from Pfizer Vaccines and has consulted for Pfizer Vaccines, Merck, GSK and Sanofi-Aventis.

This does not alter the authors adherence to all the PLoS ONE policies on sharing data and materials. YC and BRL report no conflict of interest.

Subjects:

Research Funding:

No current external funding sources for this study.

Keywords:

  • Science & Technology
  • Multidisciplinary Sciences
  • Science & Technology - Other Topics
  • MULTIDISCIPLINARY SCIENCES
  • COMMUNITY-ACQUIRED PNEUMONIA
  • STREPTOCOCCUS-PNEUMONIAE
  • NASOPHARYNGEAL CARRIAGE
  • PNEUMOCOCCAL PNEUMONIA
  • STAPHYLOCOCCUS-AUREUS
  • RESISTANT PNEUMOCOCCI
  • BACTERIAL PNEUMONIA
  • IMMUNE-RESPONSE
  • LOBAR PNEUMONIA
  • HOST IMMUNE

The Anticipated Severity of a "1918-Like" Influenza Pandemic in Contemporary Populations: The Contribution of Antibacterial Interventions

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Journal Title:

PLoS ONE

Volume:

Volume 7, Number 1

Publisher:

, Pages e29219-e29219

Type of Work:

Article | Final Publisher PDF

Abstract:

Recent studies have shown that most of deaths in the 1918 influenza pandemic were caused by secondary bacterial infections, primarily pneumococcal pneumonia. Given the availability of antibiotics and pneumococcal vaccination, how will contemporary populations fare when they are next confronted with pandemic influenza due to a virus with the transmissibility and virulence of that of 1918? To address this question we use a mathematical model and computer simulations. Our model considers the epidemiology of both the influenza virus and pneumonia-causing bacteria and allows for co-infection by these two agents as well as antibiotic treatment, prophylaxis and pneumococcal vaccination. For our simulations we use influenza transmission and virulence parameters estimated from 1918 pandemic data. We explore the anticipated rates of secondary pneumococcal pneumonia and death in populations with different prevalence of pneumococcal carriage and contributions of antibiotic prophylaxis, treatment, and vaccination to these rates. Our analysis predicts that in countries with lower prevalence of pneumococcal carriage and access to antibiotics and pneumococcal conjugate vaccines, there would substantially fewer deaths due to pneumonia in contemporary populations confronted with a 1918-like virus than that observed in the 1918. Our results also predict that if the pneumococcal carriage prevalence is less than 40%, the positive effects of antibiotic prophylaxis and treatment would be manifest primarily at of level of individuals. These antibiotic interventions would have little effect on the incidence of pneumonia in the population at large. We conclude with the recommendation that pandemic preparedness plans should consider co-infection with and the prevalence of carriage of pneumococci and other bacteria responsible for pneumonia. While antibiotics and vaccines will certainly reduce the rate of individual mortality, the factor contributing most to the relatively lower anticipated lethality of a pandemic with a 1918-like influenza virus in contemporary population is the lower prevalence of pneumococcal carriage.

Copyright information:

© 2012 Chien et al.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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