News Release: Research , School of Public Health

Dec. 23,  2009

Vaccinating Against Bacterial Infections May Reduce Flu-Related Pneumonia Deaths

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Vaccination against bacterial infections such as those that cause pneumonia may reduce deaths from influenza-related pneumonia, says Emory University public health researcher Keith Klugman, MD, PhD.

In a special letter in the Dec. 24 issue of The New England Journal of Medicine (NEJM), Klugman reviewed studies that reported on culture samples taken from adults diagnosed with pneumonia during the 1918 U.S. flu pandemic as well as adults who didn't have pneumonia. The cultures showed that patients with influenza-associated pneumonia more commonly had bacteria in their blood cultures.

Bacterial infections, in particular pneumococcal disease, can follow a viral illness such as flu and cause secondary infections that worsen flu symptoms and increase flu-related death risk, says Klugman. These types of bacterial infections were a major cause of influenza-associated pneumonia and death among military personnel and civilians during the 1918 flu pandemic, Klugman notes in the NEJM letter.

Historical data from the 1918 flu pandemic suggest that vaccinating against pneumonia and other bacterial infections as well as antibiotic therapy may reduce flu-related pneumonia deaths. A recent report by the Centers for Disease Control and Prevention (CDC) showed that 29 percent of patients who died in 2009 from H1N1 influenza had evidence of pneumococcal or other bacterial infections in their lungs.

"The U.S.'s current vaccination program includes vaccinations against bacterial infections such as pneumonia, but not all those eligible get these vaccines," says Klugman, William H. Foege Professor of Global Health, Emory's Rollins School of Public Health. "Vaccination against pneumococcal pneumonia should be given prior to the next wave of pandemic or seasonal influenza, and patients infected with influenza who are very severely ill, or who have not recovered within three to four days of the start of their illness should seek medical care, as antibiotic therapy to treat secondary bacterial infection may be lifesaving at that time."

The full text of the special letter can be found at

In addition to Klugman, letter authors included Yu-Wen Chien, MD, MSPH, of Emory University and David Morens, MD, of the National Institute of Allergy and Infectious Diseases.


The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service.

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