Influenza and Pneumonia: Monthly Essentials January 2017

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The 3 essential studies on Influenza and Pneumonia this month, selected from 322 peer-reviewed studies

1. Meta-analysis of 6 randomized controlled trials involving 5000 children aged 2-59 mo. Zinc supplementation reduced pneumonia incidence by 13% and prevalence by 41%. See our essential synopsis of the article from Cochrane Database Syst Rev below.

2. Cohort study involving 200,000 children. No association between maternal influenza infection or vaccination during pregnancy and autism spectrum disorder. See our essential synopsis of the article from JAMA Pediatr below.

3. Several guidelines recommend adding either macrolide or fluoroquinolone to beta-lactam for severe community-acquired pneumonia, but there are few data on which combination is best. Meta-analysis of 3,800 patients suggests beta-lactam plus macrolide is superior to beta-lactam plus fluoroquinolone. See our essential synopsis of the article from J Korean Med Sci below.


See December's Monthly Essentials on Influenza»
See December's Monthly Essentials on Pneumonia»
See yesterday's Monthly Essentials on Gastrointestinal Diseases»


Pediatric pneumonia prevention with zinc: updated Cochrane review

Source:  Cochrane Database Syst Rev

  • Zinc supplementation in children was significantly associated with reduced incidence and prevalence of pneumonia.

Key results

  • 6 randomized controlled trials (RCTs).
  • 5193 participants.
  • No new studies since last update.
  • Previous conclusions are unchanged.
  • Administration of zinc supplementation showed a statistically significant effect on reducing pneumonia incidence by 13% (risk ratio [RR], 0.87) and reducing pneumonia prevalence by 41% (RR, 0.59).
  • Studies that used clinical definitions of age-specific fast-breathing, with or without lower chest indrawing did not exhibit effect from zinc supplementation on reducing pneumonia (RR, 0.95).
  • Studies that applied case definition for pneumonia based on chest examination or chest radiograph exhibited significant effect from zinc supplementation on reducing incidence of pneumonia by 21% (RR, 0.79).

Study design

  • Updated review from 2010.
  • Systematic review and meta-analysis of RCTs evaluating zinc supplementation for the prevention of pneumonia in children aged from 2 to 59 mo.
  • Funding: None.

Why this matters

  • Children, particularly those from low-income countries who have inadequate intake of zinc-containing food (mainly foods of animal origin) should receive supplements to address deficiency.

View Abstract


Influenza infection and vaccination in pregnancy: what is the autism risk?

Source: JAMA Pediatr


  • Maternal influenza infection during pregnancy was not associated with increased autism spectrum disorder (ASD) risk.

Key results

  • 196,929 children.
  • During pregnancy, 23% exposed to maternal influenza vaccination, 0.7% to maternal influenza.
  • ASD diagnosed in 1.6%.
  • After controlling for maternal and child covariates, no association between ASD and maternal influenza infection or vaccination was seen at any time during pregnancy.
  • First trimester influenza vaccination was associated with a slightly increased risk for ASD (adjusted HR, 1.20; P=.01); however, the association was insignificant after statistical correction for multiple comparisons.

Study design

  • Cohort study.
  • Children born at Kaiser Permanente Northern California (2000-2010).
  • Medical record data on maternal influenza infection and influenza vaccination during pregnancy and covariates.
  • Outcome of ASD in offspring over median follow-up of 8.3 y.
  • Funding: Kaiser Foundation Research Institute Community Benefit.

Why this matters

  • Many recent epidemiologic studies report an increased risk for ASD in association with maternal infections and fever during pregnancy.

View Abstract


Community-acquired pneumonia: what combination therapy for severe disease?

SourceJ Korean Med Sci


  • Beta-lactam plus macrolide (BL-M) therapy may be superior to beta-lactam plus fluoroquinolone (BL-F) therapy among patients with severe community-acquired pneumonia (CAP). 

Key results

  • 7 observational studies, 1 randomized controlled trial.
  • 3873 patients (2273 received BL-M, 1600 received BL-F).
  • Overall mortality rates 19.4% with BL-M vs 26.8% with BL-F.
  • Compared with BL-F, BL-M associated with significantly reduced overall mortality (OR, 0.68; P=.02...