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Efficacy of whole-cell killed bacterial vaccines in preventing pneumonia and death during the 1918 influenza pandemic Chien YW; Klugman KP; Morens DMJ Infect Dis 2010[Dec]; 202 (11): 1639-48BACKGROUND: Most deaths in the 1918 influenza pandemic were caused by secondary bacterial pneumonia. METHODS: We performed a systematic review and reanalysis of studies of bacterial vaccine efficacy (VE) in preventing pneumonia and mortality among patients with influenza during the 1918 pandemic. RESULTS: A meta-analysis of 6 civilian studies of mixed killed bacterial vaccines containing pneumococci identified significant heterogeneity among studies and estimated VE at 34% (95% confidence interval [CI], 19%-47%) in preventing pneumonia and 42% (95% CI, 18%-59%) in reducing case fatality rates among patients with influenza, using random-effects models. Using fixed-effect models, the pooled VE from 3 military studies was 59% (95% CI, 43%-70%) for pneumonia and 70% (95% CI, 50%-82%) for case fatality. Military studies showed less heterogeneity and may provide more accurate results than civilian studies, given the potential biases in the included studies. Findings of 1 military study using hemolytic streptococci also suggested that there was significant protection. CONCLUSIONS: Despite significant methodological problems, the systematic biases in these studies do not exclude the possibilities that whole-cell inactivated pneumococcal vaccines may confer cross-protection to multiple pneumococcal serotypes and that bacterial vaccines may play a role in preventing influenza-associated pneumonia.|Bacterial Vaccines/*history/standards[MESH]|History, 20th Century[MESH]|Humans[MESH]|Influenza, Human/complications/epidemiology/*history[MESH]|Military Medicine/history[MESH]|Mortality/history[MESH]|Pandemics/history[MESH]|Pneumonia, Bacterial/*history/prevention & control[MESH]|Regression Analysis[MESH] |
