Seasonality of invasive pneumococcal disease: Temporal relation to documented influenza and respiratory syncytial viral circulation

Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
The American Journal of Medicine (Impact Factor: 5). 04/2005; 118(3):285-91. DOI: 10.1016/j.amjmed.2004.09.016
Source: PubMed


Seasonal fluctuation in the incidence of invasive pneumococcal disease has been attributed to winter virus exposure (e.g., influenza and respiratory syncytial virus [RSV]). Evidence of a direct correlation of invasive pneumococcal disease with laboratory-confirmed virus seasons, however, is limited. Using two prospective surveillance networks, the temporal relation between invasive pneumococcal disease and isolation of circulating winter viruses was explored.
Episodes of invasive pneumococcal disease in five Tennessee counties were collected prospectively from January 1995 through June 2002. Virus seasons were defined using prospective laboratory-based surveillance. Correlation between weekly identification of invasive pneumococcal disease and laboratory isolation of RSV and influenza, as well as comparisons of the frequencies of invasive pneumococcal disease episodes during viral and nonviral seasons were determined.
A total of 4147 invasive pneumococcal disease episodes were identified. Weekly frequency of invasive pneumococcal disease correlated directly with the weekly frequency of isolation of RSV (r = 0.56, P <0.001) and influenza (r= 0.40, P <0.001). The average weekly frequency of invasive pneumococcal disease during RSV and influenza seasons was higher than during the nonviral seasons (P <0.001 for each year).
Weekly episodes of invasive pneumococcal disease correlated temporally with laboratory-confirmed weekly isolation of RSV and influenza, and the incidence of invasive pneumococcal disease was increased when these viruses were circulating in the community.

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Available from: Tina V Hartert, Aug 14, 2014
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    • "Pneumococcal pneumonia occurred preferentially during autumn or winter. This phenomenon has already been described in non-critically ill patients, with a clear link to external temperature [49] and concomitant respiratory viral infections [50]. Here we report for the first time this seasonality in ICU pneumococcal CAP. "
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    ABSTRACT: Introduction Community-acquired pneumonia (CAP) account for a high proportion of ICU admissions, with Streptococcus pneumoniae being the main pathogen responsible for these infections. However, little is known on the clinical features and outcomes of ICU patients with pneumococcal pneumonia. The aims of this study were to provide epidemiological data and to determine risk factors of mortality in patients admitted to ICU for severe S. pneumoniae CAP. Methods We performed a retrospective review of two prospectively-acquired multicentre ICU databases (2001-2008). Patients admitted for management of severe pneumococcal CAP were enrolled if they met the 2001 American Thoracic Society criteria for severe pneumonia, had life-threatening organ failure and had a positive microbiological sample for S. pneumoniae. Patients with bronchitis, aspiration pneumonia or with non-pulmonary pneumococcal infections were excluded. Results Two hundred and twenty two patients were included, with a median SAPS II score reaching 47 [36-64]. Acute respiratory failure (n = 154) and septic shock (n = 54) were their most frequent causes of ICU admission. Septic shock occurred in 170 patients (77%) and mechanical ventilation was required in 186 patients (84%); renal replacement therapy was initiated in 70 patients (32%). Bacteraemia was diagnosed in 101 patients. The prevalence of S. pneumoniae strains with decreased susceptibility to penicillin was 39.7%. Although antibiotherapy was adequate in 92.3% of cases, hospital mortality reached 28.8%. In multivariate analysis, independent risk factors for mortality were age (OR 1.05 (95% CI: 1.02-1.08)), male sex (OR 2.83 (95% CI: 1.16-6.91)) and renal replacement therapy (OR 3.78 (95% CI: 1.71-8.36)). Co-morbidities, macrolide administration, concomitant bacteremia or penicillin susceptibility did not influence outcome. Conclusions In ICU, mortality of pneumococcal CAP remains high despite adequate antimicrobial treatment. Baseline demographic data and renal replacement therapy have a major impact on adverse outcome.
    Critical care (London, England) 08/2012; 16(4):R155. DOI:10.1186/cc11471 · 4.48 Impact Factor
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    • "Environmental conditions may have also impacted on IPD rates through the progressive warming of colder months. IPD is a well-described winter disease associated with the colder months of the year in the Northern hemisphere [49], [50], [51]. In SSA, IPD is associated with the dry season, which also tends to coincide with the colder months [52]. "
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    PLoS ONE 03/2011; 6(3):e17765. DOI:10.1371/journal.pone.0017765 · 3.23 Impact Factor
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    • "The incidence of invasive pneumococcal disease closely correlates with the influenza season [19], and pneumococcal vaccination not only results in an overall reduced number of pneumonia cases, it also leads to markedly reduced cases of virus-associated pneumonia [20]. Although secondary bacterial pneumonia has been described for other respiratory viruses as well, the morbidity and mortality is much lower than observed for influenza [21,22]. "
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    ABSTRACT: Seasonal and pandemic influenza are frequently complicated by bacterial infections, causing additional hospitalization and mortality. Secondary bacterial respiratory infection can be subdivided into combined viral/bacterial pneumonia and post-influenza pneumonia, which differ in their pathogenesis. During combined viral/bacterial infection, the virus, the bacterium and the host interact with each other. Post-influenza pneumonia may, at least in part, be due to resolution of inflammation caused by the primary viral infection. These mechanisms restore tissue homeostasis but greatly impair the host response against unrelated bacterial pathogens. In this review we summarize the underlying mechanisms leading to combined viral/bacterial infection or post-influenza pneumonia and highlight important considerations for effective treatment of bacterial pneumonia during and shortly after influenza.
    Critical care (London, England) 04/2010; 14(2):219. DOI:10.1186/cc8893 · 4.48 Impact Factor
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