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The 1918–1919 influenza pandemic caused an estimated 675,000 excess deaths in the U.S. As we prepare for the next pandemic, we need to understand whether these deaths were caused by primary viral infection or secondary bacterial infection. To investigate this issue, researchers from the NIH reexamined postmortem samples from 58 people who died of influenza during the 1918–1919 pandemic and reviewed pathologic and bacteriologic information, from 109 published autopsy series, on 8398 persons who died during the pandemic.
Microscopic examination of recut lung tissue sections from pandemic victims revealed evidence of severe acute bacterial pneumonia in almost all cases. The autopsy literature from the time of the pandemic demonstrated a consens…