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The Anticipated Severity of a ‘‘1918-Like’’ Influenza Pandemic in Contemporary Populations: The Contribution of Antibacterial Interventions 1 2 3 Yu-Wen Chien *, Bruce R. Levin , Keith P. Klugman 1 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America, 2 Department of Biology, Emory University, Atlanta, Georgia, United States of America, 3 Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America Abstract Recent studies have shown that most of deaths in the 1918 influenza pandemic were caused by secondary bacterial infections, primarily pneumococcal pneumonia. Given the availability of antibiotics and pneumococcal vaccination, how will contemporary populations fare when they are next confronted with pandemic influenza due to a virus with the transmissibility and virulence of that of 1918? To address this question we use a mathematical model and computer simulations. Our model considers the epidemiology of both the influenza virus and pneumonia-causing bacteria and allows for co-infection by these two agents as well as antibiotic treatment, prophylaxis and pneumococcal vaccination. For our simulations we use influenza transmission and virulence parameters estimated from 1918 pandemic data. We explore the anticipated rates of secondary pneumococcal pneumonia and death in populations with different prevalence of pneumococcal carriage and contributions of antibiotic prophylaxis, treatment, and vaccination to these rates. Our analysis predicts that in countries with lower prevalence of pneumococcal carriage and access to antibiotics and pneumococcal