1. Dr. George Nelson Public health doctor specializing in respiratory disease Centers for Disease Control and Prevention Pneumococcal Pneumonia and Pandemic H1N1 Emerging Infectious Diseases National Center for Emerging and Zoonotic Infectious Diseases Emerging Infectious Diseases June 2012 Based on the article Invasive Pneumococcal Disease and Pandemic (H1N1) 2009, Denver, Colorado, USA George E. Nelson, Kenneth A. Gershman, David L. Swerdlow, Bernard W. Beall, and Matthew R. Moore

2. What is pneumonia?  Pneumonia  Infection of the lungs.  Alveoli (air sacs of lungs) fill with fluid and pus, making breathing more difficult.  Pneumococcal pneumonia  Caused by bacteria called pneumococcus (Streptococcus pneumoniae).  Can also be caused by other bacteria, viruses, fungi, parasites.

3. How is pneumonia spread?  Most cases of pneumonia are spread person-to-person by coughing out of tiny droplets.  Some pathogens can live in nose and throat without causing disease.  But when inhaled into lungs, they can cause pneumonia.  While many people are exposed to pneumococcus, usually only those with underlying health issues develop pneumonia.

4. Who is at higher risk for pneumonia?  People with some medical conditions are at higher risk for pneumonia, including: heart disease, lung disease, diabetes, etc.  Smoking also increases risk of developing pneumonia.

5. What is invasive pneumococcal disease?  Occurs when pneumococcus gets into part of the body normally free of bacteria.  Pneumococcus in blood = bacteremia.  Pneumococcus in spinal fluid = meningitis.  People with bacteremia and meningitis can become very sick, disabled, and in 10-15% of adult cases they die.

6. What is the relationship between flu and pneumonia?  During flu pandemics before 2009, up to 1 in 3 flu victims developed pneumonia.  2009 H1N1 flu pandemic  Study found more than 3 times the number of cases of invasive pneumococcal disease than expected during the month that the flu peaked in Denver.  Up to 62% of the cases of pneumococcal pneumonia may have been associated with pandemic H1N1.

7. What vaccines will help protect you from pneumonia?  In the United States, there are several vaccines available for preventing pneumonia:  2 pneumococcal vaccines  vaccines against Haemophilus influenzae type b (Hib), whooping cough, chickenpox, measles, and flu  Adults should check with their doctors – they may need vaccines or boosters to vaccinations that they got as children.

8. Recommended public health strategies  Raise awareness  Let patients and healthcare providers know about the relationship between flu and pneumococcal pneumonia.  Alert people to look for complications of bacterial pneumonia after flu infection.  Advocate for vaccination  Especially with flu and pneumococcal vaccines.

9. For more information please contact, Emerging Infectious Diseases Journal, Centers for Disease Control and Prevention 1600 Clifton Road NE, Mailstop D61, Atlanta, GA 30333, USA Telephone: 1-404-639-1960/Fax: 1-404-639-1954 E-mail: eideditor@cdc.gov Web: http://www.cdc.gov/eid/ The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases Emerging Infectious Diseases Thank you to all authors George E. Nelson, Kenneth A. Gershman, David L. Swerdlow, Bernard W. Beall, and Matthew R. Moore