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No temporal association between influenza outbreaks and invasive pneumococcal infections
  1. Andre Michael Toschke1,2,
  2. Stephan Arenz1,
  3. Rüdiger von Kries1,
  4. Wolfram Puppe3,
  5. Josef A I Weigl3,
  6. Michael Höhle4,
  7. Ulrich Heininger5
  1. 1
    Institute for Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians University Munich, Munich, Germany
  2. 2
    Division of Health and Social Care Research, King’s College London, London, UK
  3. 3
    Pediatric Infectious Diseases, University Children’s Hospital Kiel, Kiel, Germany
  4. 4
    Department of Statistics, Ludwig-Maximilians University Munich, Munich, Germany
  5. 5
    Division of Pediatric Infectious Diseases, University Children’s Hospital Basel, Basel, Switzerland
  1. Professor Ulrich Heininger, University Children’s Hospital Basel, PO Box 4005, Basel, Switzerland; Ulrich.Heininger{at}


Objective: To assess whether the influenza peak in populations precedes the annual peak for invasive pneumococcal infections (IPI) in winter.

Design: Ecological study. Active surveillance data on influenza A and IPI in children up to 16 years of age collected from 1997 to 2003 were analysed.

Setting: Paediatric hospitals in Germany.

Patients: Children under 16 years of age.

Results: In all years under study, the influenza A season did not appear to affect the IPI season (p = 0.49). Specifically, the influenza peak never preceded the IPI peak.

Conclusion: On a population level there was no indication that the annual influenza epidemic triggered the winter increase in the IPI rate or the peak of the IPI distribution in children.

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  • Competing interests: Rüdiger von Kries is conducting a surveillance study on invasive pneumococcal infections in children in Germany funded by the manufacturer of a 7-valent pneumococcal vaccine, Prevenar (Wyeth) and – on a few occasions – has accepted honoraria for lectures given at meetings sponsored by Wyeth. Ulrich Heininger is a member of the Prevenar Advisory Board of Wyeth/Switzerland.

  • Funding: The surveillance of invasive pneumococcal infections in children in Germany was supported by Wyeth Pharma Germany, Münster and by a grant (FKZ 01KI0213) for (Pediatric Infectious Diseases Network on Acute Respiratory Tract Infections) awarded by the Bundesministerium für Forschung (BMBF).

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