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Bacterial adherence to virus-infected respiratory tract cells may be one of the several mechanisms whereby virus predisposes to bacterial pneumonia. To evaluate the effect of influenza virus infection on pneumococcus adhesion, 39 mice were infected with PR8/A influenza virus. The adherence of radiolabeled pneumococcus to mice tracheal cells was determined 2, 4, and 6 days after viral inoculation. The pneumococcal adhesion to infected tracheas was significantly enhanced on Day 6 (p less than 0.001). Scanning and transmission electron microscopy revealed that by the fourth and sixth days after virus inoculation, the ciliated and the secretory cells of the tracheal epithelium had desquamated and the mucosa were coated with a continuous layer of basal cells. In a few cases, a desquamation of the basal layer was observed and the exposed basement membrane appeared as a pole of attraction for bacteria. Pneumococci were never seen attached to control tracheas. In contrast, they were observed adhered to the microvilli of the basal cells and, to a greater extent, to the exposed basement membrane.

The isolation of influenza virus 80 years ago in 1933 very quickly led to the development of the first generation of live-attenuated vaccines. The first inactivated influenza vaccine was monovalent (influenza A). In 1942, a bivalent vaccine was produced after the discovery of influenza B. It was later discovered that influenza viruses mutated leading to antigenic changes. Since 1973, the WHO has issued annual recommendations for the composition of the influenza vaccine based on results from surveillance systems that identify currently circulating strains. In 1978, the first trivalent vaccine included two influenza A strains and one influenza B strain. Currently, there are two influenza B lineages circulating; in the latest WHO recommendations, it is suggested that a second B strain could be added to give a quadrivalent vaccine. The history of influenza vaccine and the associated technology shows how the vaccine has evolved to match the evolution of influenza viruses.

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