A Study of a Type I Pneumococcus Epidemic at the State Hospital at Worcester, Mass

Smillie, Wilson G.; Warnock, G. H.; White, Harold J.

doi:10.2105/ajph.28.3.293

Cited by 79 publications

(26 citation statements)

References 5 publications

(4 reference statements)

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“…Other similar data (11,12) indicate that localized epidemics of pneumococcus pneumonia have been associated with outbreaks of clinical influenza.…”

mentioning

confidence: 58%

The Relation of Influenza Virus and Bacteria in the Etiology of Pneumonia 12

Maxwell¹,

Ward²,

Metre³

1949

J. Clin. Invest.

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Evidence is accumulating that influenza virus plays a role in the etiology of certain pneumonias generally considered to be primarily bacterial in origin. The earliest recorded observations (1, 2) describe influenza as a mild self-limited disease of the upper respiratory tract which progressed occasionally in certain individuals to produce more serious symptoms involving the pulmonary tissue. Soon after the discovery of bacteria, clinicians (3) pointed out that pneumonia caused by streptococci, staphylococci and pneumococci often followed symptoms of influenza.During the pandemic of 1918 influenza was frequently complicated by bacterial pneumonia. Certain investigators (4, 5) believed that the primary disease was of unknown virus etiology and that the pulmonary involvement was a manifestation of the secondary invasion of the respiratory tissues by pathogenic organisms.Epidemiological data (6-10) show a significant increase in pneumonia deaths accompanying and following epidemics of clinical influenza. Other similar data (11,12) indicate that localized epidemics of pneumococcus pneumonia have been associated with outbreaks of clinical influenza.Laboratory evidence (13-22) on clinical cases of bacterial pneumonia in man and experiments on laboratory animals (23-28) during the past decade have further supported these observations.The studies reported herein show that there was a simultaneous infection with pneumococci and influenza virus in about one-half of the human cases of lobar pneumonia studied during an influenza epidemic. Such mixed infections were also observed during interepidemic periods.

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“…Other similar data (11,12) indicate that localized epidemics of pneumococcus pneumonia have been associated with outbreaks of clinical influenza.…”

mentioning

confidence: 58%

The Relation of Influenza Virus and Bacteria in the Etiology of Pneumonia 12

Maxwell¹,

Ward²,

Metre³

1949

J. Clin. Invest.

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“…Streptococcus pneumoniae is commonly carried in the nasopharynges of healthy children and adults; however, a characteristic epidemiological feature of serotype 1 is that it is very rarely found among healthy carriers, even in locations where serotype 1 frequently causes invasive disease (11,14,18,21,27). The fact that serotype 1 is among the most common causes of invasive disease in many parts of the world, although it is rarely carried by either adults or children, and the ability of serotype 1 to cause outbreaks suggest that this serotype has an unusually high attack rate.…”

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confidence: 99%

Geographic Distribution and Clonal Diversity of Streptococcus pneumoniae Serotype 1 Isolates

2003

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Serotype 1 pneumococci are a major cause of serious disease and have been associated with outbreaks but are rarely carried. The high attack rate and lack of coverage of this serotype by the heptavalent conjugate vaccine prompted the characterization of a geographically diverse collection of 166 serotype 1 isolates from recent cases of invasive disease. The isolates were resolved by multilocus sequence typing into 16 clones, which clustered into three major lineages with very different geographic distributions. Lineage A isolates were exclusively from Europe and North America, lineage B isolates were predominantly from Africa and Israel, and lineage C isolates were mainly from Chile. There was no clear association between the presence of individual clones within a country and the prevalence of serotype 1 disease.

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“…54 The 1937 serotype 1 pneumococcal pneumonia outbreak at the State Hospital in Worcester, Massachusetts, noted a carriage rate of almost 10%. 60 Hodges and MacLeod suggest reasons why serotype 1 and serotype 3 carriage rates varied so much in early carriage studies, particularly with regard to differences in the methodology for specimen processing as they compared several culture methods. 61 Interestingly, mouse inoculation (favoured by the early Rockefeller Institute studies) yielded higher recovery rates of serotype 1 and serotype 3 pneumococci than direct plating of throat swabs onto blood agar (similar to the contemporary WHO standard method 62 ).…”

Section: Carrier States Of Serotypes 1 Andmentioning

confidence: 99%

“…82,83 There was variable success with the prevention of Type I IPD; some vaccines demonstrated no antibody response and no benefit, while groups such as Smillie and colleagues demonstrated substantial benefit. 60 Often results using Type III polysaccharide were inconclusive. 82 It was recognised that production of high titres of antisera to Type III were only achieved 'irregularly and with great difficulty'.…”

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confidence: 99%

Observations regarding historical accounts of pneumococcal diseases due to serotypes 1 and 3

Inverarity

Diggle²

2010

JRCPE

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Observations regarding historical accounts of pneumococcal diseases due to serotypes 1 and 3 aBstract Surveillance of the serotypes causing invasive pneumococcal diseases in the UK has indicated increasing incidence of serotype 1-and serotype 3-related disease in recent years. The introduction of a pneumococcal conjugate vaccine to the paediatric vaccination schedule in 2006, which did not cover these serotypes, has been regarded as a contributing factor. Serotypes 1 and 3 were perhaps the most extensively studied pneumococcal serotypes in the early twentieth century when pneumococcal serotyping began. Such historical observations are pertinent to our understanding of contemporary disease manifestations for these serotypes as many parallels can be seen between their behaviour in the early twentieth century and the early twenty-first century. There are many relevant lessons to be learned from these pre-antibiotic era descriptions and the observations of our predecessors. 18,19 S. mucosus (renamed Pneumococcus mucosus) was described in 1917 as 'larger, rounder, and less lanceolate than other types of pneumococcus' and possessing 'a large distinct capsule '. 20 It grew on blood agar with colonies which were 'moist, mucoid, and confluent' and became known as the Type III pneumococcus. 20 This phenotypic description matches that which would be seen for contemporary serotype 3 isolates ( Figure 1). There is potential for misclassification when only the phenotypic appearances are used to classify serotype 3 as mucoid colonies can be observed in some other pneumococcal serotypes, albeit uncommonly. 21 It was not until 1934 that Type III could be distinguished serologically from phenotypically similar Type VIII. 22 So only after 1934 can it be concluded that the Type III pneumococcus is equivalent to the contemporary serotype 3 pneumococcus.In the absence of antibiotics and with growing success in the treatment of lobar pneumonia using type-specific horse or rabbit sera, 23 serotyping of disease-related isolates of pneumococci became important in order to use the correct antisera as therapy. Lobar pneumonia was a reportable illness and in the 1920s the prevalence of, and mortality associated with, the different serotypes of pneumococci responsible for lobar pneumonia and other invasive disease manifestations began to be documented in Britain. This continued throughout the 1930s.The discovery of sulphonamide and penicillin antibiotics (which no longer required a knowledge of serotype to determine appropriate treatment) resulted in a decline in interest in pneumococcal serotyping from the 1940s until the 1980s when it again became important to determine the composition of local pneumococcal populations as polysaccharide vaccines were being introduced. By this time (likely due to the success of its pharmacological treatment), lobar pneumonia was no longer a notifiable condition. Consequently serological surveillance switched to documenting instances of pneumococcal bacteraemia and meningitis to record IPD cases. This m...

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A Study of a Type I Pneumococcus Epidemic at the State Hospital at Worcester, Mass

Cited by 79 publications

References 5 publications

The Relation of Influenza Virus and Bacteria in the Etiology of Pneumonia 12

The Relation of Influenza Virus and Bacteria in the Etiology of Pneumonia 12

Geographic Distribution and Clonal Diversity of Streptococcus pneumoniae Serotype 1 Isolates

Observations regarding historical accounts of pneumococcal diseases due to serotypes 1 and 3

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