Too much for the lungs

PHOTO: Too much for the lungs

THE influenza A(H1N1) pandemic first broke out in mid-April 2009, with a surge of cases that subsequently quietened down for a period of time. However, the recent re-emergence of the disease at the end of the first quarter this year could mean that the second wave is already in its infancy.

Though the current situation is nowhere near as serious as the situation back in 2009, the public is advised to continue taking precautions and remain vigilant to prevent infection and complication from the disease.

Pneumococcus - complicating influenza A(H1N1) recovery

Though most A(H1N1) cases have been mild, with many of those affected usually recovering, there have also been more severe cases with complications that can prove to be fatal. Statistics from the Centers for Disease Control and Prevention (CDC) in the US show that the more severe cases of influenza are made worse by secondary bacterial infections, particularly by Streptococcus pneumoniae.

Streptococcus pneumoniae causes pneumococcal disease, which is very contagious and can easily be spread from person to person through respiratory droplets that are expelled via coughing, sneezing, or close contact. Since the pneumococcal bacteria are common inhabitants of the respiratory tract, almost anyone can get pneumococcal disease.

However, the risk is higher in the young, the elderly, as well as those who suffer from certain types of health problems, such as A(H1N1), and those who have weakened immune systems.

The most common complication observed in A(H1N1) cases is pneumonia, an infection of the lungs. In fact, it was noted that during each of the influenza pandemics worldwide, secondary bacterial pneumonia was a frequent cause of illness and death.

This is because influenza predisposes individuals to developing pneumonia by weakening the lung's defenses, allowing bacteria like S. pneumonia to infiltrate and infect lung tissues. Similarly, the disease can also infiltrate the blood and the fluids surrounding the brain, causing bacteraemia and meningitis.

Influenza and children

Without medical help, it may be difficult to detect influenza in very young children, as they may not complain of the common influenza symptoms like fever, sore throat, and breathing difficulties. Thus, as parents, it is important to take note of various changes consistent with the onset of influenza in children. Bring your child to the doctor immediately should he exhibit any of these symptoms:

  • Fever, cough and runny nose
  • Tiredness, lethargy, mild fever, poor appetite, diarrhoea, and/or vomiting
  • Has severe trouble with breathing
  • Has bluish skin colour/lips
  • Has fits/seizures
  • Is unresponsive and difficult to wake up from sleep
  • Dehydrated (in infants, no wet diaper for 12 hours)

Some children, especially those younger than the age of two, have a weak immune system, and are at higher risk for developing severe forms of influenza and contracting a secondary bacterial infection.


Pneumococcal infections develop quickly, within one to three days, and delayed treatment may lead to more severe complications and adverse effects such as hearing loss, paralysis, brain damage, coma, and even death.

Pneumococcal disease is usually diagnosed by taking samples of the child's blood, sputum, or spinal fluid for cultures. Depending on how severe an infection is, the child is treated through different methods using antibiotics. Mild infections are treated with oral antibiotics as outpatients, while more severe ones would require hospitalisation and antibiotics given intravenously.

Penicillin is the common antibiotic used to treat the disease. However, recent studies show that more and more pneumococcal strains are becoming resistant to penicillin as well as other commonly used antibiotics. This complicates treatment and may result in the use of new, more expensive alternative antibiotics. These complications lead to prolonged hospital stays with higher medical costs, and higher incidences of mortality.

The way ahead for the battle against invasive pneumococcal disease is to prevent it. With the availability and easy access to pneumococcal vaccines nowadays, there should be no excuses for not immunising your child against IPD.

Prevention is better than cure

Pneumococcal disease is one of the leading causes of vaccine-preventable deaths and coupled with influenza A(H1N1), the disease may prove fatal.

Thus, to prevent such complications from developing, the CDC recommends the public to obtain a yearly seasonal flu vaccine as the first defence against the common seasonal influenza. Vaccines to protect against the A(H1N1) influenza are now available and children aged between six months and 10 years are given priority, as they are more vulnerable.

Additionally, pneumococcal vaccines are also recommended by the CDC to reduce illness and death resulting from secondary pneumococcal infections, especially among children below the age of five years.

For children, the pneumococcal conjugate vaccine (PCV7) protects against seven serotypes of pneumococcal strains while the newer pneumococcal non-typeable haemophilus influenzae protein d conjugate vaccine (PHiD-CV) protects against 10 serotypes of pneumococcal strains.

Vaccine benefits

Although influenza, specifically A(H1N1), is not making the headlines these days, it still remains a very large part of humanity, and as with most illnesses, young children are the most susceptible. Parents should play their role in ensuring their child receives the best and is well taken care of during the high-risk periods and through all other times as well.

Vaccinate your child before it is too late. Pay close attention to pneumococcal vaccination as well as vaccines against other bacterial infections (eg Haemophilus influenza b) to prevent secondary bacterial superinfections that may complicate influenza A(H1N1).

Datuk Dr Musa Mohd. Nordin is a consultant paediatrician and neonatologist. This article is courtesy of the Malaysian Paediatric Association's Positive Parenting Childhood Immunisation Campaign that is supported by an educational grant from GlaxoSmithKline. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care.