By Henrylito D. Tacio
Despite being easily preventable and treatable, pneumonia is still the world’s leading infectious killer of children under the age of 5, according to the Geneva-based World Health Organization (WHO).
Pneumonia claims one child every 39 seconds, deplores the Stop Pneumonia Organization.
“Pneumonia is the single biggest infectious killer of adults and children – claiming the lives of 2.5 million, including 672,000 children, in 2019,” the organization reports in its website, stoppneumonia.org.
In 2015, the United Nations health agency said the Philippines was among the 15 countries that make up 75% of the world’s childhood pneumonia cases. In 2016, pneumonia was listed as the third biggest killer in the country – just behind ischemic heart disease and cancer. In 2017, pneumonia caused approximately 57.2 thousand deaths.
Since 2009, the international community marked every year on November 12 as World Pneumonia Day. This year’s celebration is doubly worrisome as coronavirus disease 2019 (COVID-19) “is dramatically increasing pneumonia deaths from the global pandemic and other causes.”
“COVID-19 could add 1.9 million to the death toll this year,” stoppneumonia.org warns. “This could increase ‘all-cause’ pneumonia deaths by more than 75%. No other infection causes this burden of death.”
In addition, disruptions to healthcare services are estimated to cause up another 2.3 million child deaths – 35% from pneumonia and newborn sepsis.
“We are calling on governments and other stakeholders to ensure that the massive effort to control the pandemic contributes to reducing ‘all-cause’ respiratory infections and deaths among both children and adults for the long term,” the organization urges.
Pneumonia is actually an infection of the lungs that involves the small air sacs (alveoli) and the tissues around them. But then, pneumonia isn’t a single illness but many different ones, each caused by a different microscopic organism.
“Pneumonia tends to be more serious for children under the age of five, adults over the age of 65, people with certain conditions, or organ or blood and marrow stem cell transplant procedures,” the US National Heart, Lung, and Blood Institute (NHLBI) says.
Lifestyle habits, like smoking cigarettes and drinking too much alcohol, can also raise a person’s chances of getting pneumonia. “Smoking damages your body’s natural defenses against the bacteria and viruses that cause pneumonia,” the Mayo Clinic says.
The WHO says pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are: Streptococcus pneumoniae (the most common cause of bacterial pneumonia in children), Haemophilus influenzae type B or Hib (the second most common cause of bacterial pneumonia), and respiratory syncytial virus (the most common viral cause of pneumonia).
“In infants infected with human immunodeficiency virus (HIV), Pneumocystis jiroveci is one of the most common causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants,” the United Nations health agency states.
In healthy adults, two types of influenza virus – called types A and B – cause pneumonia. The chickenpox virus can also cause pneumonia in adults. In elderly people, viral pneumonia is likely to be caused by influenza, parainfluenza, or respiratory syncytial virus.
There are three types of fungi that commonly cause pneumonia: Histoplasma capsulatum, which causes histoplasmosis; Coccidioides immitis, which causes coccidioidomycosis; and Blastomyces dermatitidis, which causes blastomycosis. Most people who become infected have only minor symptoms and don’t know that they’re infected. Some become gravely ill.
There are so-called “atypical pneumonias,” which are pneumonias caused by organisms other than the typical bacteria, viruses, or fungi. The most common causes are Mycoplasma pneumoniae and Chlamydia pneumoniae. Both bacteria-like organisms are the most common cause of pneumonia in people ages 5 to 35. Mycoplasma epidemics reportedly occur in confined groups such as students, military personnel, and families.
Pneumonia can be spread in a number of ways. “The viruses and bacteria, commonly found in a child’s nose or throat, can infect the lungs if they are inhaled,” the WHO states. “They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth.”
“(Pneumonia) is a tough disease to diagnose,” says Dr. Marie Budev, a pulmonologist and the medical director of the lung transplant program at the Cleveland Clinic in Ohio. “Age makes a big difference, as well as a person’s immune system… and, of course, the symptoms themselves.”
“The signs and symptoms of pneumonia may vary from mild to severe, depending on factors such as the type of germ causing the infection, and your age and overall health,” the Mayo Clinic says. “Mild signs and symptoms often are similar to those of a cold or flu, but they last longer.”
The Mayo Clinic says the signs and symptoms of pneumonia may include: chest pain when you breathe or cough; confusion or changes in mental awareness (in adults age 65 and older); cough, which may produce phlegm; fatigue; fever, sweating and shaking chills; lower than normal body temperature (in adults older than age 65 and people with weak immune systems); nausea, vomiting or diarrhea; and shortness of breath.
“Newborns and infants may not show any sign of the infection,” the Mayo Clinic says. “Or they may vomit, have a fever and cough, appear restless or tired and without energy, or have difficulty breathing and eating.”
Pneumonia is generally treated with antibiotics. “The antibiotic of choice is amoxicillin dispersible tablets,” the WHO says. “Most cases of pneumonia require oral antibiotics, which are often prescribed at a health center. These cases can also be diagnosed and treated with inexpensive oral antibiotics at the community level by trained community health workers.”
Hospitalization is recommended only for severe cases of pneumonia.
An ounce of prevention is better than a pound of cure, so goes a saying. “Preventing pneumonia in children is an essential component of a strategy to reduce child mortality,” the WHO says. “Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.”
In 2013, the Department of Health introduced the Pneumococcal Conjugate Vaccine as an addition to its free basic immunization program for children in the health centers across the country.
“Non-immunization is one of the definite risk factors that makes any child more vulnerable to pneumonia,” said Dr. Salvacion Gatchalian, past president of the Pediatric Infectious Disease Society of the Philippines. – ###