Stop the spread

Many articles have been written in the past on the dangers of pneumococcal infections and the vital need for vaccination against this deadly disease.

In this issue, attention is once again focused on the severity of this disease through the story of a patient, Rachel Anne, aged six, who became infected with pneumonia caused by the bacterium Streptococcus pneumoniae. Her infection was made worse by her underlying asthmatic condition.

Although Rachel's health has now been restored to normal because of the quick action of her family in getting her diagnosed and treated appropriately, her fight against pneumonia should be shared with all.

Before delving into little Rachel's story, here's some useful information about the disease.

Pneumococcal diseases are the leading cause of serious illnesses in children and adults worldwide. More children die from pneumococcal infections than AIDS, malaria and tuberculosis combined. In fact, a million children around the world die every year from pneumococcal diseases, and every two minutes, an Asian child dies from the infection.

Pneumococcus is commonly found in the nose and throat of children and adults and is highly contagious. The bacteria can spread when you cough or sneeze or come into contact with respiratory secretions. Symptoms of the pneumococcal infection are very similar to the common cold or fever, making early detection difficult.

If these bacteria enter the bloodstream, it is called bacteraemia (blood infection). Bacteremia may not lead to symptoms, and can resolve without treatment, or it may produce fever and other symptoms of the infection.

In some cases, bacteremia may lead to septic shock, a potentially life-threatening condition.

If the bacteria attacks the lining of the brain, this is known as meningitis. This particular pneumococcal infection has the worst consequences. Children, especially those younger than five, are at high risk of either dying or suffering from brain damage as a result of the infection.

Meningitis can also cause lifelong blindness or deafness.

Symptoms of meningitis include headaches, vomiting, seizures, high fever, and in worst-case scenarios, falling into a coma.

When pneumococcal bacteria attack the lungs, you could get pneumonia. The fatality rate from this infection is quite high, between 5-7 per cent. Symptoms of pneumonia include sudden high fever, chills, chest pains and difficulty breathing.

Pneumococci can also cause otitis media, an infection of the middle ear, and sinusitis, an inflammation of the sinuses. If the disease causes otitis media, the eardrums will swell and lead to extreme pain, as well as fever and sleep disturbances.

Recent studies by the Mayo Clinic in the US have shown that asthma patients have a six times increased risk of contracting invasive pneumococcal disease.

Deaths of children below the age of five years due to this disease can be prevented if parents are aware of the threat of pneumococcal disease and have their children vaccinated early.

Let us now delve into little Rachel's story of her fight against the pneumococcal disease.

Rachel's encounter

Rachel's encounter

At the tender age of three years, Rachel was diagnosed with asthma, and since then, she has been on asthma medication, including nebulised medicines. At the age of six years, whilst at a day care centre, she contracted a slight cough and cold from two other children at the centre, who were also down with the cold.

When taken to a clinic, the consulting doctor diagnosed her with a normal cough and cold. After five days however, her cough did not improve, but instead got much worse, with complaints of chest pains, shortness of breath, wheezing and high fever.

Not wanting to waste any more precious time, the family took Rachel to a consultant paediatrician at a nearby hospital. They complained to the paediatrician that their daughter's asthma did not improve with medicines from their regular GP.

After a thorough examination, the paediatrician concluded that Rachel had indeed contracted pneumonia, and that her asthma symptoms had contributed to her breathing difficulties, but it was now made worse by the infection in her lungs.

Rachel was admitted into hospital for a chest x-ray, close observation, and was started on a course of intravenous antibiotics. Due to the quick action of Rachel's family in bringing her to the hospital for a second opinion, Rachel escaped developing various severe complications of pneumococcal pneumonia - which may include a pleural effusion (a collection of fluid that forms in the space that surrounds the lung), empyema (the effusion becomes a collection of pus) and lung abscess).

Prevention is vital

The best way to protect your family against pneumococcal diseases is through vaccination. According to the World Health Organization (WHO), pneumococcal infections are the leading cause of death from a vaccine-preventable disease.

The pneumococcus is the number one cause of pneumonia deaths. More than 50 per cent of pneumonia deaths are due to the pneumococcus. Infants and young children are at a high risk of deadly infections and published studies on pneumococcal infections have shown that morbidity and mortality are highest among children below two years of age.

The WHO, in 2007, declared: "Recognising the heavy burden of pneumococcal disease in children and the safety and efficacy of Pneumococcal Conjugate Vaccine (PCV) in this age group, WHO considers the inclusion of this vaccine in National Immunisation Programs (NIP) as a priority".

Vaccination against invasive pneumococcal disease (IPD) is a pivotal life-saving strategy and reduces morbidity because it may prevent children from ever being infected, it reduces the transmission of the bacteria in the community, thus reducing IPD in the other age groups (herd immunity), and it reduces the need for antibiotics, resulting in lower rates of resistant bacteria.

Global immunisation statistics in 2008 showed that only 7 per cent of children have been immunised with the PCV, and most of these were in the developed countries. A large proportion of our children under five years especially, in the under-developed world, is still very much exposed to the scourge of invasive pneumococcal disease.

To date, about 50 countries have incorporated the PCV in their NIP. In Asia, only Singapore, Macau and Hong Kong have included PCV in their NIP.

Since the arrival of the PCV to Malaysia in October 2005, only a meagre 10 per cent of our birth cohorts (about 450,000 births per year) have been vaccinated against the pneumococcus, and virtually all of these were in the private health sector. The vaccine is not available to the 70-80 per cent of Malaysian children who attend the government health centres for their scheduled immunisations since the PCV is not in the nation's NIP.

The Malaysian Paediatric Association (MPA) and her various local and international partners in child health have been advocating for global action to prevent, protect against and effectively treat IPD. Together with ASAP (Asian Strategic Alliance for Pneumococcal disease prevention, the MPA has been at the forefront in the advocacy for the inclusion of PCV in the NIP of countries in the Asia Pacific region, including Malaysia.

Recently, during the annual event, World Pneumonia Day (WPD) which fell on November 12, 2011, another call was made to address and to raise awareness about the increasing toll of pneumonia on children, which the WHO and UNICEF appropriately labelled as the "forgotten killer of children". This is timely too, as this year's event will focus on the theme "Fight Pneumonia. Save a Child".

With better awareness and support from the public, the inclusion of the PCV in our NIP should very soon become a reality. Meanwhile, PCV can still be obtained from private hospitals and private paediatric practices.

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