Pneumococcal Disease Killing Our Children

Pneumococcal disease will strike close to one million children worldwide - but there are ways to reduce the toll



WHEN FOUR-YEAR-OLD DARRYL HENG had a runny nose and fever one evening in March 1999, his father Heng Soo Yeow wasn't too concerned. Kids get the sniffles, thought the Singaporean civil servant before taking Darryl that evening to the family doctor, who prescribed the usual flue medication.



When Darryl's condition did not improve two days later, Heng took him to see the doctor again. Darryl was given antibiotics, but he broke out in rashes over the next few days due to an allergic reaction to the drugs. A blood test at a clinic didn't reveal anything unusual either.



When Darryl became breathless one evening, Heng took him to the National University Hospital where X-rays showed he had pneumonia. Doctors explain that Darryl's condition was further complicated by a collection of puts outside of the lung. Darryl spent 21 days in the intensive care and was hooked up to more than 13 drips. He needed morphine for the pain. Just 28 days after the first flu-like symptoms appeared, Darryl died of complications from pneumococcal disease.



Darryl is just one of thousands of children in our region stricken by pneumococcal (pronounced NEU-mo-KOK-al) disease, a group of illnesses that includes pneumonia (lung infection), meningitis (infection of the brain covering), bacteremia (blood infection), otitis media (inflammation of the middle ear) and sinusitis (inflamation of the sinus).



At a World Health Organization (WHO) meeting in Kuala Lumpur in March 2006, it was reported more than 700,000 children die globally each year from complications related to pneumococcal disease. In developing countries, pneumococcal meningitis kills or disables up to three quarters of children who become infected.Despite being such a serious concern, Associate Professor Daniel Goh, President of the Singapore Pediatric Society, says less than 20 per cent of parents in Asia are aware of this deadly disease. "We need to help parents caregivers understand the importance of disease prevention through immunisation," says Professor Goh.


Pneumococcal Disease is caused by the Streptococcus (S.) pneumoniae bug, also known as pneumococcus. It commonly lives in the nose or throat, and enters the blood stream to cause several types of severe invasive pneumococcal disease such as that seen in Darryl. The spread of pneumococcus from the nasal passage to the upper and lower respiratory tract also results in non-invasive conditions such as middle ear infection and sinusitis which, if left untreated, can lead to hearing loss, learning disabilities, speech impediment, paralysis and even death in children.



There are 90 different strains of the bug. Of these, about 20 strains are associated with more than 80 per cent of invasive pneumococcal disease occuring in all age groups globally; the 13 most common strains cause at least 75 per cent of invasive disease in children. WHO warns that there is a serious and rapidly growing problem worldwide of strains becoming multidrug resistant. In Asia, at least three of the seven serious strains are multidrug resistant.



At any one time, medical experts estimate that 10 per cent of adults and up to 90 per cent of young children carry the germs harmlessly in their respiractory tract. But during an outbreak, for reasons scientists cannot fully explain, the disease is spread from both healthy carriers and patients to other people.



"The bacteria is transmitted through air droplets from one person to another usually by sneezing, coughing, or close contact," says Professor Lulu Bravo, vice chancellor for research at University of the Phillipines and executive director of the National Institute of Health.



Although serious pneumococcal infections occur throughout life, young children and the ederly are most at risk. Infants under two years old are particularly susceptible because they have less-developed immune systems and are more likely to have physical contact with others. According to Prefessor Goh, of the children diagnosed with pneumococcal disease in Singapore each year, as many as 25 per cent may develop complications or suffer some permanent disability, and up to six per cent may die.



IN JULY 2006, two-year-old Becky Lee came down with the flu, so her mother Leona took her to a paediatrician in Singapore. When Becky still hadn't recovered after two weeks and instead developed a fever of 40 degrees, Leona took her back to the paediatrician, who ordered an X-ray of her lungs. The  X-ray showed a buildup of phlegm - symptomatic of bronchitis - but the paediatrician ruled out pneumonia and prescribed another round of antibiotics for bronchitis. Becky seemed better the following day but her fever returned that evening. This time, Leona decided to rush her to KK Women's and Children's Hospital.
A CT scan eventually revealed that Becky has excess fluid in the membrane covering her left lung. The surgeons recommended keyhole surgery to drain the fluid.


"WHEN the doctor said surgery was needed to save her drowning lung, I broke down," recalls Leona. After the surgery, Becky continued with antibiotics for two weeks to ensure the infection was completely eliminated. Although normal and healthy now, Becky is still traumatised by the experience.



The symptoms of pneumococcal disease vary by illness but almost always involve fever and oftentimes resemble the flu. Pneumonia symptoms can bring on sudden shaking, chills, cough and chest congestion, while meningitis causes neck stiffness, vomiting, a rash of red purple spots and the victim will rapidly sicken."It is very difficult in the early stages of infection from the common flu, so seeking medical treatment is important," says Dr. Lee Bee Wah, a consultant paeditrician at Mount Elizabeth Medical Centre in Singapore, Other dangerous telltale signs include refusing food and drink, persistent vomiting, fast or difficult breathing, lethargy or drowsiness.



"Never treat a common flu or fever lightly," says Darryl's father Heng. "See a paediatrician immediately if things do not improve. The doctors tried everything to save my son but we still lost him."



WHEN ROSHNI MAHTANI had flu symptoms over Christmas in 2005, she thought perhaps she had overstrained herself. But when her high fever persisted, her doctor ordered a blood test. By then the 24-year-old Singaporean freelance writer was unable to breathe and couldn't even hold up her head. Chest X-rays showed that she had penumococcal infection. She survived the infection. She survived the infection after two horrifying weeks in hospital.



Although less vulnerable to the disease, teens and adults like Roshni can be affected if they have lowered immunity or chronic respiratory problems, says Dr.Lee.



Some scientists suspect that an increase in cold and flu cases may boost an individual susceptibility and encourage the infection to take hold. Other factors like the environment (exposure to tobacco smoke, air and dust pollution, toxic elements or chemicals), malnutrition and even lack of breastfeeding can contribute to one's predisposition to disease. "These factors are related to the decrease in the body's defences or immune mechanisms and increases the risk to respiratory ailments and general susceptibility to infection and pneumococcal disease," says Professor Bravo.



Studies have also shown that the risk of pneumococcal disease is higher among people who live closely or in crowded conditions, like housing estates. "It is also prevalent in areas with poor hygiene and unsanitary living conditions," says Professor Bravo.


Easy Ways to Reduce the Impact


"THE BEST PREVENTION IS TO vaccinate against pneumococcal disease," advises Dr. Musa Mohd Nordin, consultant paediatrician and neonatologist at Damansara Specialist Hospital in Kuala Lumpur. Prevnar (PCV7) is the first and currently the only pneumococcal disease in infants and children under two.



Vaccination also provides "herd immunity" by protecting those in close contact with children, further reducing the spread of pneumococcal disease in the community.
A study in Britain showed quick access to to antibiotics reduced deaths by 40 per cent when the family doctors, on suspecting pneumococcal disease, administered antibiotics before sending the patient to the hospital. "It is essential for antibiotics before sending the patient to the hospital. "It is essential for antibiotics to be given as soon as there is recognition of the disease," says Professor Bravo.



Early identification of contacs can help contain in the infection. If you have had close contact with someone who has pneumococcal infection, check with your doctor immediately.



WHO and the Global Alliance for Vaccines and Immunization are providing the tehnical and financial assistance for supporting and sustaining effective pneumococcal surveillance especially in developing countries. The Pneumococcal Awareness Council of Experts (PACE) was recently established to raise awareness for the disease and advocate for its prevention through vaccination.



WHO considers pnemococcal vaccination a priority for inclusion in national childhood immunisation programmers. A WHO staff told Reader's Digest that at least 17 countries worldwide will take up their recommendation this year.



The Malaysian Paediatric Association launched an awareness campaign for pneumoccocal disease in April 2007. And in Singapore, the Pneumococal Awareness Campaign alerts parents to the fact that pneumococcal disease is a common infection that leads to devastating conditions. On a larger scale, WHO also recently recognised pneumococcal disease as the leading vaccine-preventable cause of death in children less than five years of age.



"We regret not sending Becky for the pneumococcal jab earlier. "This experience has caused us much anxiety," says Leong. "We often take things for granted, thinking it would never happen. When it does, it may be too late.VC55K4VE6NFZ

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