A historical review
Abstract
Bacterial pneumonia with empyema is a serious complication of influenza and commonly resulted in death during the 1918 influenza pandemic. We hypothesize that deaths caused by parapneumonic empyema are increasing in Utah once again despite advances in critical care and the availability of antimicrobial drugs and new vaccines.
In this study, we analyzed the historical relationship between deaths caused by empyema and influenza pandemics by using 100 years of data from Utah. Deaths caused by empyema have indeed increased from 2000?2004 when compared with the historic low death rates of 1950?1975. Vaccine strategies and antimicrobial drug stockpiling to control empyema will be important as we prepare for the next influenza pandemic.
Snips from the long discussion:
* Pneumonia, especially due to S. pneumoniae, is thought to be a major contributor to the excess deaths seen during the 1918 influenza pandemic.
* We noted a statistically significant increase in the number of empyema deaths in Utah at the turn of the 21st century (2000?2004) when compared with the mid-20th century (1950?1975).
* We speculate that increased mortality rates from empyema are caused by changes in the organisms that cause pneumonia and empyema worldwide.
* Changes in circulating serotypes of S. pneumoniae have been reported from many regions worldwide. These changes may play a role in the increase in deaths caused by empyema.
* These strategies (to prevent and treat influenza complications) might include broadening recommendations for existing or enhanced pneumococcal vaccines that cover serotypes associated with empyema, such as 1, 3, and 19A.
* Determining who should be vaccinated with these pneumococcal vaccines during an influenza pandemic would have to be done on the basis of risk and the availability of vaccines. Further, the stockpiling of antimicrobial drugs active against CA-MRSA and other resistant pathogens may also be needed. * Currently, the US Department of Health and Human Services Pandemic Influenza Plan from 2005 does not specifically account for secondary bacterial infections or the need for bacterial vaccines.
However, the Infectious Diseases Society of America called for improved antibacterial agents and vaccines as a key need in pandemic influenza preparedness. Our data provide support for this concept. Extending the range of conjugate pneumococcal vaccines to include the serotypes now commonly associated with empyema and encouraging broader use of the polysaccharide vaccine may help lessen the effects of S. pneumoniae infection on a pandemic.
If high vaccination rates cannot be routinely achieved, stockpiles of pneumococcal vaccine might be needed. Antimicrobial drug stockpiling, particularly agents with activity against MRSA, should be included in the discussion of antiviral drug stockpiling as well. Further, because the treatment for empyema frequently requires drainage either through chest tubes or surgical procedures, planning for these healthcare resources should also be considered.
http://www.cdc.gov/eid/content/15/1/44.htm#figure
Abstract
Bacterial pneumonia with empyema is a serious complication of influenza and commonly resulted in death during the 1918 influenza pandemic. We hypothesize that deaths caused by parapneumonic empyema are increasing in Utah once again despite advances in critical care and the availability of antimicrobial drugs and new vaccines.
In this study, we analyzed the historical relationship between deaths caused by empyema and influenza pandemics by using 100 years of data from Utah. Deaths caused by empyema have indeed increased from 2000?2004 when compared with the historic low death rates of 1950?1975. Vaccine strategies and antimicrobial drug stockpiling to control empyema will be important as we prepare for the next influenza pandemic.
Snips from the long discussion:
* Pneumonia, especially due to S. pneumoniae, is thought to be a major contributor to the excess deaths seen during the 1918 influenza pandemic.
* We noted a statistically significant increase in the number of empyema deaths in Utah at the turn of the 21st century (2000?2004) when compared with the mid-20th century (1950?1975).
* We speculate that increased mortality rates from empyema are caused by changes in the organisms that cause pneumonia and empyema worldwide.
* Changes in circulating serotypes of S. pneumoniae have been reported from many regions worldwide. These changes may play a role in the increase in deaths caused by empyema.
* These strategies (to prevent and treat influenza complications) might include broadening recommendations for existing or enhanced pneumococcal vaccines that cover serotypes associated with empyema, such as 1, 3, and 19A.
* Determining who should be vaccinated with these pneumococcal vaccines during an influenza pandemic would have to be done on the basis of risk and the availability of vaccines. Further, the stockpiling of antimicrobial drugs active against CA-MRSA and other resistant pathogens may also be needed. * Currently, the US Department of Health and Human Services Pandemic Influenza Plan from 2005 does not specifically account for secondary bacterial infections or the need for bacterial vaccines.
However, the Infectious Diseases Society of America called for improved antibacterial agents and vaccines as a key need in pandemic influenza preparedness. Our data provide support for this concept. Extending the range of conjugate pneumococcal vaccines to include the serotypes now commonly associated with empyema and encouraging broader use of the polysaccharide vaccine may help lessen the effects of S. pneumoniae infection on a pandemic.
If high vaccination rates cannot be routinely achieved, stockpiles of pneumococcal vaccine might be needed. Antimicrobial drug stockpiling, particularly agents with activity against MRSA, should be included in the discussion of antiviral drug stockpiling as well. Further, because the treatment for empyema frequently requires drainage either through chest tubes or surgical procedures, planning for these healthcare resources should also be considered.
http://www.cdc.gov/eid/content/15/1/44.htm#figure