Pneumonia-The Greatest Toddler Murderer-Dr. Musa Mohd Nordin and Dr. Husna Musa | What You Think

November 12-Pneumonia kills an estimated 1.4 million children under the age of five each year. This is more than the total number of deaths from AIDS, malaria and tuberculosis. It accounts for 18% of all childhood deaths under the age of 5 worldwide. Every 20 seconds one child dies of pneumonia. Most of these pneumonia deaths occur in developing countries.

In Malaysia, the prevalence of pneumonia in children under the age of 5 is 28-39 percent. It is the fifth leading cause of death in Malaysian children, accounting for 3.8% of deaths under the age of 5 in 2006 and increasing to 5.1% in 2016.

Of the 2016 deaths from pneumonia under the age of 5, Orang Asli children were at greatest risk of death. Non-citizens, Bumiputera mackerel, and “other Malaysian” children were also at significantly higher risk of death from pneumonia.

This global tragedy is exacerbated by the universal finding that only one in five caregivers can recognize the dangerous signs of pneumonia. Pneumonia often mimics a common cold that begins with fever and cough, and parents may not be aware that the condition can be much more serious than the flu. And only one in five children with pneumonia was given antibiotics that actually saved their lives.

The World Health Organization (WHO) and UNICEF outlined the Global Action Plan for the Prevention and Management of Pneumonia in the 2008 GAPP document. In summary, this child’s survival strategy contained three important elements:

-Protection by hand washing, breastfeeding alone, improved nutrition, avoidance of indoor pollution (smoking, stove fire), reduction of risk factors (HIV, etc.).

-Treatment by improving access to health care and proper management in health care facilities.

-Prevention of pneumonia by immunizing the causative bacteria such as whooping cough, influenza, Haemophilus influenzae B (Hib), and Streptococcus pneumoniae.

Up to 1.2 million neonatal pneumonia deaths each year by 2015 after GAPP interventions for protection (breastfeeding), prevention (vaccination) and treatment (case management) in 68 countries with high child mortality rates There is a possibility that can be avoided, which greatly contributes to MDG4.

Prevention strategies with the “pneumonia vaccine” have been shown to significantly reduce the morbidity and mortality of pneumonia in children. Malaysia introduced whooping cough, measles, Hib and pneumococcal conjugate vaccine (PCV) into the Ministry of Health (MoH) and National Vaccination Program (NIP) in 1960, 1982, 2002 and 2020, respectively. .. Influenza vaccine is not included in NIP.

The Malaysian Children’s Association (MPA) and its partners have endorsed the inclusion of PCV, the latest “pneumonia vaccine” in NIP since 2005. This was included in the 2020 budget in the kickstart budget for RM60 by the Pakatan Harapan Government. a million. PCV prevents Streptococcus pneumoniae, the leading cause of death from pneumonia. Over 50% of deaths from pneumonia are due to Streptococcus pneumoniae.

Apart from pneumonia, Streptococcus pneumoniae is associated with other serious illnesses: meningitis (inflammation of the lining of the spine and brain), bacteremia (bacteria in the blood), and other less invasive but prevalence. Very burdensome in terms of the amount of illness-otitis media (inflammation of the middle ear) and sinusitis (infection of the sinus) that can cause otitis media. For every case of pneumococcal meningitis, there are probably 1,000 cases of pneumococcal otitis media each year. The following two cases show the extent of the disease caused by hemispheres.

Case 1: A 3-year-old girl with a 3-week history of coughing and a 6-day high fever. She did not respond to oral antibiotics and was referred to the hospital. On admission, she was feverish, breathing fast, and moaning. Her chest x-ray (CXR) showed pneumonia of the entire right lung with fluid collection. Pulmonary fluid was drained and Streptococcus pneumoniae grew. She needed respiratory assistance for 5 days in the intensive care unit (ICU) and oxygen for another 5 days. Her repeated CXR showed residual lung injury and she was hospitalized for a total of 4 weeks.

Case 2: The second case of a 5 month old girl wasn’t very lucky. She had a fever 36 hours before admission, was poorly fed, and vomited twice. She turned out to be sleepier. Both her blood and cerebrospinal fluid caused Streptococcus pneumoniae to grow. Despite ventilation in the ICU, intravenous administration of antibiotics, and close monitoring, she died of pneumococcal sepsis and meningitis within 10 hours.

Therefore, vaccination against invasive pneumococcal infection (IPD) is a crucial life-saving strategy that reduces morbidity for the following reasons:

-You can prevent your child from getting infected

-Reduces bacterial transmission within the community and reduces IPD in other age groups (herd immunity)

-Reduces the need for antibiotics and reduces the incidence of resistant strains

The pneumococcal vaccine, first introduced in the United States in 2000, has since been shown to be very effective in a wide variety of populations studied in the United States, American Indians, Gambia, and South Africa. The pneumococcal conjugate vaccine (PCV) was the first vaccine in 20 years to be vaccinated in a major randomized controlled clinical trial in Gambia that showed a significant reduction in infant mortality from all causes. Seven deaths were prevented for every 1000 children.

WHO in a 2007 opinion stated, “Recognizing the burden of pneumococcal infections in children and the safety and efficacy of PCV7 in this age group, WHO prioritizes the inclusion of this vaccine in national vaccination programs. I think it’s a matter. “

Since the arrival of PCV in Malaysia in October 2005, only about 15% of our birth cohort has been vaccinated against Streptococcus pneumoniae, and virtually all belong to the private health sector.

MPA, namely Datuk Dr Musa Mohd Nordin and Datuk Dr Zulkifli Ismail, are both co-founders of the Asian Strategic Alliance for the Prevention of Pneumococcal Infectious Diseases (ASAP), which has been at the forefront of advocating the inclusion of PCV in NIPs. is. Of Asia Pacific countries. MPA and ASAP were part of the World Union for Pediatric Pneumonia (GCCP), which was established in 2009 to advocate global action to prevent, effectively treat and prevent pneumonia.

World Pneumonia Day (WPD), the annual event of the World Pneumonia Eradication Union, held annually on November 12, discusses and raises awareness of the increasing sacrifice of pneumonia in children properly labeled by WHO and UNICEF. It was a call for. “Forgotten murderers of children”. Together, “Let’s fight pneumonia. And save the child.”

* Dr. Musa Mohd Nordin is an MPA treasurer and co-founder of ASAP, and Dr. Husna Musa is a pediatrician at the University of Putra, Malaysia.

** This is the author’s personal opinion and does not necessarily represent his view. Malay mail..