In conjunction with World Pneumonia Day today, Aznim Ruhana Md Yusup talks to a mother and a paediatrician about the fatal infection.
PNEUMONIA happens when lungs are infected, causing small sacs called alveoli inside the organ to be filled with pus and fluid instead of air in a healthy person. This makes breathing difficult and limits oxygen intake.
Anyone can get pneumonia. While it is treatable and preventable, it remains deadly.
Those with a weaker immune system such as very young children and older adults are especially vulnerable. Individuals with a healthy immune system can usually fight off the infection successfully.
In Malaysia, pneumonia is second on the Department of Statistics’s report on principal causes of death for 2018, after coronary heart disease. It is the main cause of death for children aged zero to 14 last year, with 234 deaths. From that figure, 170 are below 5.
Globally, the World Health Organisation calls pneumonia the single largest infectious cause of death for children under 5, with more than 808,000 pneumonia deaths worldwide in 2017.
HOSPITAL STAY
Such figures are enough to make any parent worry. For Noradlina Rosemi, her concerns are founded when one of her 4-year-old twin sons, Rex Zayd Muttaqin, was diagnosed with pneumonia recently.
“He started with a cough and fever that didn’t settle even after we gave him over-the-counter medicine. As a pharmacist, I know that this could be serious, so we went for an emergency check-up. He ended up being hospitalised for 10 days,” says the 33-year-old.
It brought back memories when her other son Rumi Zane Muttaqin came down with pneumonia as a baby. It was before the twins had their pneumococcal vaccines and Rumi Zane was also warded for 10 days.
“He was far weaker than his brother had been recently,” says Noradlina. “I understand that Rex Zayd had atypical pneumonia caused by mycoplasma infection. There’s no vaccine for this particular bacterium but I can see the difference. Rex would’ve been a lot worse if he was never vaccinated,” she says.
According to WebMD, pneumonia from mycoplasma infection is also called walking pneumonia because it is usually quite mild. But there’s still the danger of infection because the bacteria spread through coughs and sneezes.
“I sometimes see this but parents really should not go out with their sick children. It could worsen the child’s condition or infect other people. I also worry that they may not tell the caregiver (at daycare) the full extent of their child’s condition and endanger other children,” she says.
CARE PACKAGE
For young children particularly, coughs are only one of the warning signs for pneumonia.
“Other suggestive symptoms include rapid or laboured breathing and flaring of the nostrils, which warrants a visit to the doctor,” says Gleneagles Kuala Lumpur paediatric consultant Dr Patrick Chan.
The condition may worsen to the point where the lips and nails turn blue due to the lack of oxygen. The child may even be drowsy and cannot be roused. By now, it is imperative that they are sent to the hospital immediately.
But there are also less specific symptoms of pneumonia, such as fever, lethargy, shivers and poor appetite.
Babies may be fretful and irritable. A visit to the doctor’s, who will listen to their heartbeat and see their chest X-ray, will usually confirm the diagnosis. Further tests will determine the cause of the disease, whether it’s a virus or bacteria.
“It’s important to identify the causative organism as it will determine the treatment. Children with bacterial pneumonia will be prescribed with antibiotics for seven to 10 days and there should be improvement within 48 hours of starting the course,” says Dr Chan.
The good news is, not all pneumonia cases require hospitalisation like twins Rex Zayd and Rumi Zane.
Children with mild pneumonia can be treated as an outpatient, with their condition reviewed by the doctor periodically.
But those with more severe bacterial pneumonia will be warded for antibiotics treatment via an intravenous drip. Some children may require oxygen or extra fluids. Even more serious cases will see the young patient needing life support or be placed in paediatric intensive care.
There is no specific treatment for viral pneumonia but certain measures and medication such as paracetamol may be prescribed to control the child’s symptoms until the virus runs its course.
“In any case, cough suppresants should be avoided as coughing is necessary to clear the excessive secretions caused by the infection,” says Dr Chan.
“Other than that, let the child rest and keep them hydrated and fed with water, milk, soups and snacks. Make them comfortable . Older children may prefer sleeping propped up on a few pillows rather than laying down flat,” he adds.
Meanwhile, complications that arise from pneumonia such as hypoxia or sepsis can be fatal.
Hypoxia or respiratory failure happens when alveoli in the infected lungs are not supplying enough oxygen to the blood stream. Sepsis or bacteremia is when bacteria from the infected lungs spread into the blood stream, causing blood pressure to fall and kidneys to fail.
In some cases, pus that builds up in the alveoli can cause lung abscess. Pus can also accumulate in the pleural layers between the lungs and chest wall, causing pleural effusion.
Considering that anyone can get pneumonia, it helps to take action to minimise the risk of infection. This includes practising good hygiene, eating well and avoiding exposure to cigarette smoke. Breast feeding helps too as it strengthens the baby’s immune system.
“Make sure the child is up to date with vaccination,” adds Dr Chan. “The ones that can reduce the risk include pneumococcal, pertussis or DTaP, measles and influenza vaccines.”
VACCINES FOR ALL
Speaking of vaccination, Dr Chan welcomes the government’s announcement in Budget 2020 that allocates RM60 million to the Health Ministry to administer pneumococcal vaccines to all children starting next year.
“It’s been available in private practice for some time. I’m not privy to how or which of the pneumococcal vaccines that the Health Ministry will implement, but it is timely and a step in the right direction.
“The vaccine is important because children go to kindergarten or nurseries at a much younger age nowadays, so there’s a higher exposure to things that cause pneumonia. The government also wants more women in the workforce. With that, more children will be in daycare, further increasing that exposure risk,” says Dr Chan.
Pneumococcal vaccines provide protection against certain strains of the streptococcus pneumoniae bacteria, which cause many illnesses, including pneumonia. The different types of vaccines protect against a number of bacterium strains.
Meanwhile, prices vary but a dose of pneumococcal vaccine at private hospitals reportedly can cost between RM200 and RM300.
Vaccination plans also differ but in general, several doses are required every few months after birth and so a full course can be costly.
That said, Dr Chan believes that free pneumococcal vaccine for the population will undoubtedly show its benefits in the long run.
“When you save a 70-year-old, you maybe add 10 years of life. If you save a 5-year-old, you potentially add 85 years of life and decades of productivity to the country. So any preventable measures for children has a greater long-term effectiveness than any adult disease prevention programmes,” he says.