Every day, thousands of people around the world die from severe pneumonia from SARS-CoV-2 infection. However, in 2019, when we did not know this virus yet, about 2,5 million people worldwide died from pneumonia, including over 670. kids. Prof. Jacek Wysocki, a pediatrician and contagious doctor, tells what the symptoms of the disease are and why it is still so dangerous.
- Pneumonia can be the result of infection with viruses or bacteria
- The most common cause of pneumonia is pneumococcus. – Older people suffer worse – says prof. Jacek Wysocki
- It is worth knowing that the symptoms of the disease are different in children and in elderly people
- You can find more such stories on the TvoiLokony home page
Journalists for Health Association: Is pneumonia still a deadly disease?
Prof. Jacek Wysocki: Yes. Although the reality has changed over the last 50 years and we are able to heal more and more sick people, it is still a dangerous disease. It touches an organ essential for human life, which is responsible for the gas exchange in the body. If our lungs fail, there will be no oxygen in our blood. Hence, each of their ailments can have serious consequences for every human being.
How is it infected?
Pneumonia can be divided into two groups: viral and bacterial. Flu can be a typical example of a viral infection, because in a certain percentage of infections the inflammatory process does not end with the throat, trachea and larynx, but goes down to the lungs. In turn, the second type of infection occurs when human defense mechanisms are unable to resist bacteria. The most common are pneumococci that specifically attack the lungs.
Who gets the most frequent pneumococcal pneumonia?
The incidence curve resembles the letter “U”. We have a lot of cases in the group of children up to 5 years of age, among people in their prime there are fewer of them, while in people over 50 there are more and more of them, and over 65 the incidence is higher than that in children. Older people get worse. Taking into account all pneumococcal infections, not only pneumonia but also the so-called Invasive Pneumococcal Disease, when bacteria enter the bloodstream, has a mortality rate of 5-10 percent in children, and up to 65 percent in people over 50 years of age. So these indicators are dramatic.
Are the symptoms of pneumonia in children and the elderly similar?
Partly. In the youngest children, the pathology of the respiratory system is not as pronounced as in the elderly. These children rarely cough, while they have fever, dyspnea and lung auscultation, they also breathe worse and the level of oxygen saturation in the blood is lower.
In older people we notice more pathologies of the respiratory system – these people also have a fever, but also cough, have weaker endurance, shortness of breath, tire quickly, blood oxygen saturation decreases and their condition worsens.
How is pneumonia treated?
In the case of viral pneumonia, our possibilities are limited to symptomatic treatment, because we do not have specific drugs. The exception is the flu, because we have two medications (prescription) that inhibit the multiplication of the virus. When it comes to bacterial inflammation, we use antibiotics. First, however, we should know what bacteria caused the pneumonia. Determining it is not easy (blood culture, sputum test). In more than half of the cases, the etiology of the disease remains unknown, we can only guess it.
What other effects can pneumococcal infection have?
These bacteria can cause inflammation confined to the lungs themselves, but they can also cause invasive pneumococcal disease. Then they penetrate the blood, and with it to other organs, which can cause, among others meningitis. Invasive pneumococcal disease is much more severe than pneumococcal pneumonia, and its course and prognosis are much more severe. It attacks especially children up to 5 years of age, but it is also very dangerous for the elderly.
Another dangerous bacterium is also Haemophilus influenzae type B (HiB). What do we know about her?
It is a common bacterium and often causes inflammation of the throat, middle ear and sinuses. Type b is especially dangerous for young children because it causes sepsis and severe meningitis. Even 20 years ago, children recovering from this disease were not fully functional: they had hydrocephalus, epilepsy, deafness, etc. The change came with the advent of the vaccine. Widespread immunization of infants began in Poland in 2007 and today we have virtually no meningitis and septicemia caused by Hib. There are only a few cases a year among children. This is one of the strongest evidence that vaccines are effective.
Does RSV remain a threat to children’s respiratory system?
The RSV virus (respiratory syncytial virus) is especially dangerous for premature babies. It happens that due to breathing difficulties they end up in intensive care units, where we fight to keep them alive. There is no effective vaccine against this virus yet. Antibodies, on the other hand, play a significant role. When given to children, they protect them from RSV for a month. In many countries, including Poland, a program is implemented whereby premature babies are given them every month during the first fall-winter season of their lives. This method is less convenient than vaccination, but it is also effective.
So if there are vaccines against pneumococci and HiB bacteria, are they worth using?
Of course. Pneumococcal vaccines were included in the calendar of compulsory, i.e. free, vaccinations in January 2017, i.e. relatively recently. The current observations show that there are fewer and fewer pneumococcal infections, but a more complete picture of the situation will be provided only by the analysis of studies conducted over a longer period of time.
Adults can also be vaccinated against pneumococci (for a fee).
Are RSV and Coronavirus Similar?
Only because they both attack the respiratory system. However, they are completely different. RSV viruses primarily attack among humans, while coronaviruses do not. Certain types occur in humans, giving rise to mild colds, but SARS-Cov-2 is a classic example of a virus infiltrating us and spreading among animals. So it is something new for us. We have no immunity against it, not even cross-immunity, to related viruses. We are defenseless: no medicine, no vaccine. We have no tools other than a mask, disinfection and distancing.
Should the vaccination schedule be followed in the event of a pandemic?
Vaccination against infectious diseases should not be stopped. The point is that the serious situation related to the coronavirus should not be overlapped by other epidemics, such as influenza or mass pneumococcal infections, because the health service will not be able to cope with it. This is the main reason why influenza and pneumococcal vaccination are encouraged. With symptoms such as cough and fever, the family doctor, based on teleport advice, is not able to determine whether he is dealing with the flu or the coronavirus. That is why we want as few people as possible with such symptoms, and this is what we can get through vaccination.
When are pneumococcal and influenza vaccinations given?
We start vaccinating against pneumococci in children in the second month of life, when they are 2 weeks old. In the first year of life, they receive 6-2 doses (depending on the preparation), and in the second year of life – one. Early use of these vaccines is important because pneumococci pose a great risk to the youngest children – babies and toddlers.
In contrast, flu vaccines can be used in children from 6 months of age.
The motto of this year’s World Pneumonia Day celebration (November 12) is “Fight pneumonia, protect your child”. There is what to fight for?
It is, and it’s not just about the kids. Invasive pneumococcal disease is called the disease of grandparents and grandchildren because it is especially dangerous in these age groups. Mass vaccinations of children around the world have shown that they have a positive effect on the health of the older generation, because vaccinated children no longer infect their grandparents.
It is worth remembering that many local governments buy vaccines for their citizens and you can find out if such a program is being implemented in our area.
Pediatrician, infectious diseases specialist, head of the Chair and Department of Health Prevention at the Faculty of Health Sciences, Medical University of Karol Marcinkowski in Poznań, deputy chairman of the Polish Society of Wakcynology
Authorized press interview prepared by the Journalists for Health Association in connection with the World Pneumonia Day and the XXIV edition of the Quo Vadis Medicina? Fri “Dangerous pneumonia in the time of the coronavirus pandemic”, November 2020.
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