"The bacteria most frequently associated with secondary infections after influenza in 1918–1919 were the pneumopathogens Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus. Almost all of the tens of millions of deaths worldwide during the 1918 pandemic were associated with secondary bacterial infections, primarily with Gram-positive bacteria. Had it not been for secondary bacterial pneumonias caused by these and other pneumopathogens, the 1918 pandemic likely would have been associated with a far lower mortality. Increased susceptibility to secondary bacterial pneumonias in persons with influenza should be considered an intrinsic property of influenza virus pathogenicity, and this is likely to be the case for other pathogenic influenza viruses."
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Spanish flu
, also known as the Great Influenza epidemic or the 1918 influenza pandemic, was an exceptionally deadly global influenza pandemic caused by the H1N1 influenza A virus. The earliest documented case was March 1918 in Kansas, United States, with further cases recorded in France, Germany and the United Kingdom in April. Two years later, nearly a third of the global population, or an estimated 500 million people, had been infected in four successive waves. Estimates of deaths range from 17 million t
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