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      Parapneumonic Empyema Deaths during Past Century, Utah

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          Abstract

          Vaccine strategies and antimicrobial drug stockpiling to control empyema will increase preparedness as we prepare for the next influenza pandemic.

          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.

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          1918 Influenza: the Mother of All Pandemics

          Jeffery K Taubenberger, David M. Morens (2006)
          The "Spanish" influenza pandemic of 1918–1919, which caused ≈50 million deaths worldwide, remains an ominous warning to public health. Many questions about its origins, its unusual epidemiologic features, and the basis of its pathogenicity remain unanswered. The public health implications of the pandemic therefore remain in doubt even as we now grapple with the feared emergence of a pandemic caused by H5N1 or other virus. However, new information about the 1918 virus is emerging, for example, sequencing of the entire genome from archival autopsy tissues. But, the viral genome alone is unlikely to provide answers to some critical questions. Understanding the 1918 pandemic and its implications for future pandemics requires careful experimentation and in-depth historical analysis.
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            Methicillin-resistant S. aureus infections among patients in the emergency department.

            Gregory J Moran, Anusha Krishnadasan, Rachel Gorwitz … (2006)
            Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly recognized in infections among persons in the community without established risk factors for MRSA. We enrolled adult patients with acute, purulent skin and soft-tissue infections presenting to 11 university-affiliated emergency departments during the month of August 2004. Cultures were obtained, and clinical information was collected. Available S. aureus isolates were characterized by antimicrobial-susceptibility testing, pulsed-field gel electrophoresis, and detection of toxin genes. On MRSA isolates, we performed typing of the staphylococcal cassette chromosome mec (SCCmec), the genetic element that carries the mecA gene encoding methicillin resistance. S. aureus was isolated from 320 of 422 patients with skin and soft-tissue infections (76 percent). The prevalence of MRSA was 59 percent overall and ranged from 15 to 74 percent. Pulsed-field type USA300 isolates accounted for 97 percent of MRSA isolates; 74 percent of these were a single strain (USA300-0114). SCCmec type IV and the Panton-Valentine leukocidin toxin gene were detected in 98 percent of MRSA isolates. Other toxin genes were detected rarely. Among the MRSA isolates, 95 percent were susceptible to clindamycin, 6 percent to erythromycin, 60 percent to fluoroquinolones, 100 percent to rifampin and trimethoprim-sulfamethoxazole, and 92 percent to tetracycline. Antibiotic therapy was not concordant with the results of susceptibility testing in 100 of 175 patients with MRSA infection who received antibiotics (57 percent). Among methicillin-susceptible S. aureus isolates, 31 percent were USA300 and 42 percent contained pvl genes. MRSA is the most common identifiable cause of skin and soft-tissue infections among patients presenting to emergency departments in 11 U.S. cities. When antimicrobial therapy is indicated for the treatment of skin and soft-tissue infections, clinicians should consider obtaining cultures and modifying empirical therapy to provide MRSA coverage. Copyright 2006 Massachusetts Medical Society.
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              Updating the accounts: global mortality of the 1918-1920 "Spanish" influenza pandemic.

              Juergen Mueller, Justin S. Hogg (2001)
              The influenza pandemic of 1918-20 is recognized as having generally taken place in three waves, starting in the northern spring and summer of 1918. This pattern of three waves, however, was not universal: in some locations influenza seems to have persisted into or returned in 1920. The recorded statistics of influenza morbidity and mortality are likely to be a significant understatement. Limitations of these data can include nonregistration, missing records, misdiagnosis, and nonmedical certification, and may also vary greatly between locations. Further research has seen the consistent upward revision of the estimated global mortality of the pandemic, which a 1920s calculation put in the vicinity of 21.5 million. A 1991 paper revised the mortality as being in the range 24.7-39.3 million. This paper suggests that it was of the order of 50 million. However, it must be acknowledged that even this vast figure may be substantially lower than the real toll, perhaps as much as 100 percent understated.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): January 2009
                Volume: 15
                Issue: 1
                Pages: 44-48
                Affiliations
                [1]University of Utah School of Medicine, Salt Lake City, Utah, USA
                Author notes
                Address for correspondence: Jeffrey M. Bender, University of Utah, Division of Pediatric Infectious Diseases, Department of Pediatrics, 30 N 1900 E, Salt Lake City, UT 84132, USA; email: jeffrey.bender@ 123456hsc.utah.edu
                Article
                Publisher ID: 08-0618
                DOI: 10.3201/eid1501.080618
                PMC ID: 2660697
                PubMed ID: 19116048
                SO-VID: a7355a30-0331-433d-9c22-9e21ca6235f9
                History
                Categories
                Subject: Historical Review

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: historical review,utah population database,methicillin resistant staphylococcus aureus,streptococcus pneumoniae,spanish flu,complicated pneumonia,vaccine
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: historical review, utah population database, methicillin resistant staphylococcus aureus, streptococcus pneumoniae, spanish flu, complicated pneumonia, vaccine

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