title: Severe pneumococcal pneumonia in previously healthy children: the role of preceding influenza infection.
abstract: An outbreak of severe pneumococcal pneumonia among children occurred in Iowa from November 1995 through January 1996. An associated outbreak of influenza disease was predominantly caused by influenza A (H1N1) for the first time since 1989. We conducted a case-control study to determine whether preceding influenza infection was directly associated with pneumococcal illness. We identified 13 children with severe pneumococcal pneumonia. Patients were more likely than control subjects to report experiencing an influenza-like illness in the 7-28 days preceding admission (matched odds ratio [OR], 12.4; 95% confidence interval [CI], 1.7-306). Likewise, family members of patients were more likely than those of control subjects to report experiencing an influenza-like illness in the 28 days preceding their admission date (OR, 2.6; 95% CI, 1.0-6. 3). Patients were more likely than control subjects to have a positive influenza A (H1N1) convalescent serology (matched OR, 3.7; 95% CI, 1.0-18.1). This study provides direct and indirect evidence that influenza infection led to severe pneumococcal pneumonia among these children. Prevention of pneumococcal disease should be included among the potential benefits of influenza vaccination.
authors.affiliation: Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. klobrien@jhsph.edu
authors.forename: K L
authors.initials: KL
authors.lastname: O'Brien
authors.forename: M I
authors.initials: MI
authors.lastname: Walters
authors.forename: J
authors.initials: J
authors.lastname: Sellman
authors.forename: P
authors.initials: P
authors.lastname: Quinlisk
authors.forename: H
authors.initials: H
authors.lastname: Regnery
authors.forename: B
authors.initials: B
authors.lastname: Schwartz
authors.forename: S F
authors.initials: SF
authors.lastname: Dowell
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D009980:Influenza A virus / Q000276:immunology; D007251:Influenza, Human / Q000150:complications*; D007484:Iowa / Q000453:epidemiology; D008297:Male; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification
chemical_list: D000914:Antibodies, Viral