Words Hannah May-Lee Wong

World Pneumonia Day falls on the 12th of November every year. In November 2018, Immunise4Life hosted an educational programme to raise awareness on the importance of vaccination as prevention against pneumonia.

Consultant paediatrician Datuk Dr Zulkifli describes pneumonia as a serious lung disease whereby the alveoli in the lungs become filled with fluid or pus, which would cause difficulty in breathing. “Pneumonia is an infection that affects the parenchymal (the functional) part of the lungs. It affects the little globules at the end of the respiratory tract called the alveoli. When there is infection, inflammation occurs and when that happens, the cells swell up causing fluid build-up. Fluid in the lungs will hamper the transfer of oxygen from the air that we breathe to the capillaries around the alveoli, and this causes difficulty in breathing,” he explains. Common signs and symptoms of pneumonia include cough, difficulty breathing, rapid heartbeat, fever, shivers and chest pain.1

Public health physician, Dr Aminah adds that pneumonia is spread through air-borne droplets emitted by infected people when they cough or sneeze.

MORE THAN THE DISEASE

Other than suffering an infection, it is not uncommon for those struck with pneumonia to spend weeks at the hospital. Not only do parents have to deal with sky high medical bills, if a child gets pneumonia, his or her parents would have to take time off work. Furthermore, if the child is admitted to the ICU (intensive care unit), he also runs the risk of getting another infection from spending time at the ICU.

The cost of the vaccine depends on where you go to get it. On average, it is RM250 to RM300 per dose, and a child (depending on age) will need up to four doses. “In total, the vaccines would have cost just above RM1000 for four doses that a child typically needs. It is the most effective way of preventing pneumonia.” Dr Zulkifli adds, “When the vaccine was introduced in Malaysia in 2007, 3% of the birth cohort were vaccinated. The good news is that numbers have been increasing. Now 15% to 18% of children are vaccinated.”

WHO IS AT RISK?

Dr Zulkifli explains that anybody is prone to get infected if they are exposed to a high enough dose of bacteria or virus. That said, there are a few groups of people who are more susceptible to contracting pneumonia, namely:

• Those who have underlying medical conditions like having congenital or acquired immunodeficiency, sickle cell disease, pulmonary disease, chronic heart disease, chronic renal disease, diabetes and more.
• Children younger than the age of two and the elderly older than 65.
• Certain ethnic groups are more predisposed to getting pneumonia. These include Asian, Black, Hispanic and Native American people.
• Children who are looked after outside home (at a nursery or day care) for at least four hours a week and are in the presence of at least two children other than siblings.

WHAT CAUSES PNEUMONIA?

“Pneumonia is mostly caused by viruses. The common ones are: influenza virus, respiratory syncytial virus (RSV), measles virus and chicken pox virus. Bacterial causes include Streptococcus pneumoniae and Haemophilus influenzae type B (Hib). But in terms of pneumonia-associated mortality (death) rates, the numbers are higher with those cases caused by bacteria. This means, vaccines against pneumococcus is important,” Dr Zulkifli explains.

“Across the world, most deaths associated with pneumonia occur in the Southeast Asian region (where Malaysia is) and Western Pacific Region. But you’ll find that deaths caused by pneumonia has been decreasing from the year 2015.” Dr Zulkifli continues, “Compared with other Asian countries such as Indonesia, the death toll in Malaysia is low. This is not because we don’t see a lot of cases of pneumonia. Malaysia has been seeing good survival rates due to the health seeking behaviour of Malaysians and the good accessibility of health centres across Malaysia, from where patients can be referred to a tertiary health centre.”

Pneumonia is a health issue not to be taken lightly. It is the third leading cause of death among children under five in Malaysia, just behind deaths cause by delivery complications and congenital malformation.

HOW CAN WE PREVENT PNEUMONIA?

“Exclusive breast feeding for the first six months would give some protection to the child. Taking care of the environment where the child spends time is important too,” says Dr Zulkifli. Haze, indoor pollution and indoor smoking aggravate pneumonia.

He adds, “The practice of hand washing with soap and water prevents spread of disease. If possible, limit your child’s exposure to other children. This doesn’t mean your child should not play with other children. But be careful and watch who they play with. Make sure they play with kids who do not have a cough or running nose. Adequate nutrition is also important to ensure good health of a child.”

Vaccines are among the most effective means of preventing disease, disabilities and death in infants and children. Measles, pertussis and invasive Hib disease for example, had a reduction of 99-100% after vaccinations for those diseases were introduced.

Dr Zulkifli explains, “the pneumococcal vaccine is now being used in 142 countries in the world. In the US, when the vaccine was introduced in the year 2000, there was a 94% reduction of contracting pneumonia in children under 5 who received the vaccine. At the same time, what was not expected was that there was a 65% reduction of invasive pneumococcal disease in the elderly (older than 65 years) who were not vaccinated. This is the indirect effect of vaccination known as herd immunity. When you vaccinate the children, the elderly get protected because there are less circulating bacteria around.”

HOW DOES PNEUMONIA AFFECT YOUNG CHILDREN UNDER FIVE?

Younger children are particularly more vulnerable to complications of pneumonia. Paediatrician Dr Hishamshah remarks: “Treating pneumonia in young children can be complex. The disease can progress rapidly, and patients may require oxygen, intravenous therapy to deliver strong antibiotics and possibly surgery to drain their lungs. If lungs failure occurs, we will need to put them on a ventilator machine to enable them to breathe.”

He adds, “A small percentage may end up with chronic lung disease, which requires long term management and may impact quality of life down the road. The impact and burden not only falls on the child who is infected with pneumonia, it affects the parents and the hospital where the child is admitted. All of this can be prevented.”

THE TYPES OF VACCINATIONS AVAILABLE

There are conjugate and polysaccharide type vaccines for pneumonia. The polysaccharide vaccines will protect a person from 23 types of pneumococcal bacteria, while the conjugate will cover 10 or 13 serotypes. The conjugate vaccines can be given to children less than two years of age, while the polysaccharide is suitable for those older than two years old.

Dr Zulkifli adds “The polysaccharide vaccine will not prevent carriage, which means you may still carry the bacteria in your nasopharynx and you can transmit it. Whereas the conjugate vaccine does prevent carriage, which is why we see that indirect effect in the elderly when the children are vaccinated.” He continues, “The pneumococcal conjugate vaccine (PCV) confers life-long protection from the Streptococcus pneumoniae bacterium, which is the leading cause of severe pneumonia in children under five years old, accounting for one-third of deaths due to pneumonia, globally.”

Dr Aminah says the Hib, MMR and DTaP vaccines are already part of Malaysia’s National Immunisation Programme and are free of charge for infants. These vaccines protect against Hib, measles and pertussis. However, she encourages parents to talk to their doctors and consider vaccinating their children against influenza, chicken pox and pneumococcus. These would optimize their protection against vaccine-preventable pneumonia. HT

Reference: www.nhs.uk/conditions/pneumonia/

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