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Sci Transl Med 26 June 2013:
Vol. 5, Issue 191, p. 191ra84
Sci. Transl. Med. DOI: 10.1126/scitranslmed.3005982
Research Article
Epidemiology
Identifying the Interaction Between Influenza and Pneumococcal Pneumonia Using Incidence Data
Sourya Shrestha1,2,*,
Betsy Foxman3,
Daniel M. Weinberger4,5,
Claudia Steiner6,
C?cile Viboud4 and
Pejman Rohani1,2,7
+ Author Affiliations
1Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA.
2Center for the Study of Complex Systems, University of Michigan, Ann Arbor, MI 48109, USA.
3Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA.
4Division of International Epidemiology and Population Studies, National Institutes of Health, Bethesda, MD 20892, USA.
5Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520, USA.
6Healthcare Cost and Utilization Project, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, MD 20850, USA.
7Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA.
↵*Corresponding author. E-mail: sourya@umich.edu
Abstract
The association between influenza virus and the bacterium Streptococcus pneumoniae (pneumococcus) has been proposed as a polymicrobial system, whereby transmission and pathogenicity of one pathogen (the bacterium) are affected by interactions with the other (the virus). However, studies focusing on different scales of resolution have painted an inconsistent picture: Individual-scale animal experiments have unequivocally demonstrated an association, whereas epidemiological support in human populations is, at best, inconclusive. We integrate weekly incidence reports and a mechanistic transmission model within a likelihood-based inference framework to characterize the nature, timing, and magnitude of this interaction. We find support for a strong but short-lived interaction, with influenza infection increasing susceptibility to pneumococcal pneumonia ~100-fold. We infer modest population-level impacts arising from strong processes at the level of an individual, thereby resolving the dichotomy in seemingly inconsistent observations across scales. An accurate characterization of the influenza-pneumococcal interaction can form a basis for more effective clinical care and public health measures for pneumococcal pneumonia.
Copyright ? 2013, American Association for the Advancement of Science
Citation: S. Shrestha, B. Foxman, D. M. Weinberger, C. Steiner, C. Viboud, P. Rohani, Identifying the Interaction Between Influenza and Pneumococcal Pneumonia Using Incidence Data. Sci. Transl. Med. 5, 191ra84 (2013).
Vol. 5, Issue 191, p. 191ra84
Sci. Transl. Med. DOI: 10.1126/scitranslmed.3005982
Research Article
Epidemiology
Identifying the Interaction Between Influenza and Pneumococcal Pneumonia Using Incidence Data
Sourya Shrestha1,2,*,
Betsy Foxman3,
Daniel M. Weinberger4,5,
Claudia Steiner6,
C?cile Viboud4 and
Pejman Rohani1,2,7
+ Author Affiliations
1Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA.
2Center for the Study of Complex Systems, University of Michigan, Ann Arbor, MI 48109, USA.
3Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA.
4Division of International Epidemiology and Population Studies, National Institutes of Health, Bethesda, MD 20892, USA.
5Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520, USA.
6Healthcare Cost and Utilization Project, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, MD 20850, USA.
7Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA.
↵*Corresponding author. E-mail: sourya@umich.edu
Abstract
The association between influenza virus and the bacterium Streptococcus pneumoniae (pneumococcus) has been proposed as a polymicrobial system, whereby transmission and pathogenicity of one pathogen (the bacterium) are affected by interactions with the other (the virus). However, studies focusing on different scales of resolution have painted an inconsistent picture: Individual-scale animal experiments have unequivocally demonstrated an association, whereas epidemiological support in human populations is, at best, inconclusive. We integrate weekly incidence reports and a mechanistic transmission model within a likelihood-based inference framework to characterize the nature, timing, and magnitude of this interaction. We find support for a strong but short-lived interaction, with influenza infection increasing susceptibility to pneumococcal pneumonia ~100-fold. We infer modest population-level impacts arising from strong processes at the level of an individual, thereby resolving the dichotomy in seemingly inconsistent observations across scales. An accurate characterization of the influenza-pneumococcal interaction can form a basis for more effective clinical care and public health measures for pneumococcal pneumonia.
Copyright ? 2013, American Association for the Advancement of Science
Citation: S. Shrestha, B. Foxman, D. M. Weinberger, C. Steiner, C. Viboud, P. Rohani, Identifying the Interaction Between Influenza and Pneumococcal Pneumonia Using Incidence Data. Sci. Transl. Med. 5, 191ra84 (2013).
