Bacterial Pneumonia Caused Most Deaths in 1918 Influenza Pandemic

The majority of deaths during the influenza pandemic of 1918-1919 were not caused by the influenza virus acting alone, report researchers from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

Instead, most victims succumbed to bacterial pneumonia following influenza virus infection. The pneumonia was caused when bacteria that normally inhabit the nose and throat invaded the lungs along a pathway created when the virus destroyed the cells that line the bronchial tubes and lungs.

A future influenza pandemic may unfold in a similar manner, say the NIAID authors, whose paper in the Oct. 1 issue of The Journal of Infectious Diseases is now available online. Therefore, the authors conclude, comprehensive pandemic preparations should include not only efforts to produce new or improved influenza vaccines and antiviral drugs but also provisions to stockpile antibiotics and bacterial vaccines as well.

The work presents complementary lines of evidence from the fields of pathology and history of medicine to support this conclusion.

“The weight of evidence we examined from both historical and modern analyses of the 1918 influenza pandemic favors a scenario in which viral damage followed by bacterial pneumonia led to the vast majority of deaths,”

says co-author NIAID Director Anthony S. Fauci, M.D. (photo, top)

 “In essence, the virus landed the first blow while bacteria delivered the knockout punch.”

NIAID co-author and pathologist Jeffery Taubenberger, M.D., Ph.D., examined lung tissue samples from 58 soldiers who died of influenza at various U. S. military bases in 1918 and 1919. The samples, preserved in paraffin blocks, were re-cut and stained to allow microscopic evaluation. Examination revealed a spectrum of tissue damage “ranging from changes characteristic of the primary viral pneumonia and evidence of tissue repair to evidence of severe, acute, secondary bacterial pneumonia,” says Dr. Taubenberger.

In most cases, he adds, the predominant disease at the time of death appeared to have been bacterial pneumonia. There also was evidence that the virus destroyed the cells lining the bronchial tubes, including cells with protective hair-like projections, or cilia. This loss made other kinds of cells throughout the entire respiratory tract — including cells deep in the lungs — vulnerable to attack by bacteria that migrated down the newly created pathway from the nose and throat.

In a quest to obtain all scientific publications reporting on the pathology and bacteriology of the 1918-1919 influenza pandemic, Dr. Taubenberger and NIAID co-author David Morens, M.D., searched bibliography sources for papers in any language. They also reviewed scientific and medical journals published in English, French and German, and located all papers reporting on autopsies conducted on influenza victims.

From a pool of more than 2,000 publications that appeared between 1919 and 1929, the researchers identified 118 key autopsy series reports. In total, the autopsy series they reviewed represented 8,398 individual autopsies conducted in 15 countries.

The published reports “clearly and consistently implicated secondary bacterial pneumonia caused by common upper respiratory flora in most influenza fatalities,” says Dr. Morens. Pathologists of the time, he adds, were nearly unanimous in the conviction that deaths were not caused directly by the then-unidentified influenza virus, but rather resulted from severe secondary pneumonia caused by various bacteria.

Absent the secondary bacterial infections, many patients might have survived, experts at the time believed. Indeed, the availability of antibiotics during the other influenza pandemics of the 20th century, specifically those of 1957 and 1968, was probably a key factor in the lower number of worldwide deaths during those outbreaks, notes Dr. Morens.

The cause and timing of the next influenza pandemic cannot be predicted with certainty, the authors acknowledge, nor can the virulence of the pandemic influenza virus strain. However, it is possible that — as in 1918 — a similar pattern of viral damage followed by bacterial invasion could unfold, say the authors.

Preparations for diagnosing, treating and preventing bacterial pneumonia should be among highest priorities in influenza pandemic planning, they write. “We are encouraged by the fact that pandemic planners are already considering and implementing some of these actions,” says Dr. Fauci.

Visit http://www.PandemicFlu.gov for one-stop access to U.S. Government information on avian and pandemic flu.

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®

Reference

DM Morens et al. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: Implications for pandemic influenza preparedness. The Journal of Infectious Diseases DOI: 10.1086/591708 (2008).

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Comments (5)

  • Avatar

    Alan

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    That is very interesting. I have read that pneumonia was the cause of death rather than the virus and I think that is the same with Covid19, but there are both viral and bacteria pneumonia and so I assumed it was the viral version for which there isn’t a vaccination. However, there is a vaccination for bactrial pneumonia. Why don’t we hear more of this if it could prevent flu deaths and might prevent Covid deaths?

    Reply

  • Avatar

    NecktopPC

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    There is also this:

    The hypothesis presented herein is that aspirin contributed to the incidence and severity of viral pathology, bacterial infection, and death, because physicians of the day were unaware that the regimens (8.0–31.2 g per day) produce levels associated with hyperventilation and pulmonary edema in 33% and 3% of recipients, respectively.
    https://academic.oup.com/cid/article/49/9/1405/301441

    Reply

  • Avatar

    Doug Harrison

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    I have yet another view derived from recent experience. Up until five months ago i had endured a persistent cough for five or more years and had been told by my Dr that I would die with it because of the exact same symptoms described in this article. About six months ago there was an article promoting the use of a product called NAC or N Acytle Cisteine on this site. My son is an organic chemist and he tells me it is an amino acid. My only concern was that NAC also acted as a blood thinner and I was already taking one called Pradaxa as I had been diagnosed about 20 years ago with atrial fibrillation and it was to prevent the formation of clots in my heart. So I decided to exchange Pradaxa for NAC. My Dr was not best pleased and a few harsh words passed between us. In spite of his concerns the result has been an amazing transformation in my general well being and NO MORE COUGHING.
    This is not a recommendation but a lot of older people might benefit if the article was posted again and they could at least discuss it with their health adviser. From the bottom of my heart: Thank you PSI!!

    Reply

  • Avatar

    MattH

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    During the 2019 measles epidemic in Samoa it was bacterial pneumonia that killed the 81 mostly under 2 year olds. The international doctors had a balancing act of fighting the pneumonia with antibiotics and overwhelming the vulnerable young bodies with too much antibiotics.

    With CoVid 19 the blood clots in the lungs (thrombosis) appear to be a new symptom associated with influenza type diseases. One would question if it is both a viral pneumonia and bacterial pneumonia at play. Hence the azithromycin (antibiotic) in conjunction with zinc and hydroxychloroquine success if treatment is begun within 5 days of symptoms appearing.

    In New Zealand we have a sub species of Hectors Dolphins called Maui Dolphins which are being killed by Toxoplasmosis which is a parasitic infection that turns the dolphins liver to mush. (plasma)
    I mention this because the illness in relation to CoVid appears to turn the patients lungs to mush which is more than merely historical symptoms for bacterial pneumonia.

    Reply

    • Avatar

      Carbon Bigfoot

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      The blood clots you refer to are a result of EMF and more specifically 5G millimeter waves. Ground breaking research by Lea Pu is available on her website:
      https://lenasfabulousfrequencies.com/. The video on the lower right hand side of her main page is extremely informative. Don’t understand why this hasn’t gained traction. My son-in-law’s brother is a cardiologist/surgeon, based in Denver, who has experienced this phenomena first hand with his WuWHOFlu patients.

      Reply

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