Dr. George Nelson is a public health doctor at the Centers for Disease Control and Prevention who specializes in respiratory disease. The document discusses pneumococcal pneumonia and its relationship to the H1N1 flu pandemic. It finds that during the peak of the 2009 H1N1 flu pandemic in Denver, there were more than three times the expected number of cases of invasive pneumococcal disease, and up to 62% of pneumococcal pneumonia cases may have been associated with the H1N1 virus. The document recommends raising awareness of the relationship between flu and bacterial pneumonia and advocating for flu and pneumococcal vaccines to help prevent pneumonia.

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