It is a fact of life that we cannot escape those tiny miniscule creatures called viruses and bacteria. There are billions of them mutating and multiplying out there that our bodies cannot possibly develop natural immunity to all the diseases they cause. Doctors and scientists are continuously studying and experimenting to develop new medicines and vaccines to fight them.
For infants and young children whose immune systems are still developing and the elderly and sick whose immune systems are compromised, viral and bacterial infections can cause serious health complications and even be fatal!
In tropical countries like Malaysia, viral and bacterial diseases are endemic all year round.
Influenza and Pneumococcal Disease
Influenza and pneumococcal disease are two prevalent vaccine preventable diseases in Malaysia, indeed the world over.
Influenza is caused by different types of influenza viruses. Currently, the virus types A, B and C are circulating among humans. Type C is rare so currently, vaccines only contain viruses of influenza type A and B.
Pneumococcal disease is an infection caused by a type of bacteria called Streptococcus pneumoniae. There are more than 90 serotypes of these bacteria but about 15 of these are responsible for most of the disease.
Pneumococcal disease is the leading cause of vaccinepreventable deaths in children causing around 11% of all deaths in children aged 1-59 months. The World Health Organisation (WHO) estimates that up to 1 million children under 5 years of age die each year due to pneumococcal diseases.
Pneumococcal disease is classified into non-invasive and invasive infections. The non-invasive infection causes otitis media (ear infection) and sinusitis (infection of the sinus) while the invasive infection leads to pneumonia (lung infection), bacteraemia (blood infection) and meningitis (infection of the meninges – the protective layer covering the brain and spinal cord).
While heart disease and stroke account for the first and second leading cause of deaths in Malaysia, influenza and pneumonia take third place. In 2011, influenza and pneumonia caused 9417 deaths or 9.2% of total deaths in the country. These diseases are not to be taken lightly!
Signs and Symptoms
It is easy to mistake the signs and symptoms of an influenza (flu) attack as a common cold. With the common cold, the usual symptoms are sneezing and a stuffy nose. With influenza, the symptoms are more severe and come on suddenly with high fever, chills, headache, muscle aches, sore throat, cough, runny nose, dizziness, loss of appetite, tiredness, nausea or vomiting, weakness, ear pain, and diarrhoea.
Most of these symptoms will disappear after a week or two but it is important to seek treatment early for the symptoms especially in infants and young children, the elderly and people with other illnesses to prevent complications arising.
In pneumococcal diseases, the signs and symptoms are as follows:
- Otitis Media – ear ache, fever, irritability, and possible hearing loss if the ear drum is punctured.
- Pneumonia – rapid or difficult breathing and chest pain, chills, cough and fever.
- Bacteraemia – high fever and irritability, respiratory tract infection may or may not be present.
- Meningitis – fever, severe headache, nausea, vomiting, diarrhoea, stiff neck, sensitivity to light, seizures and in severe cases, coma.
Causes and Consequences
Influenza is spread when an infected person coughs or sneezes into the air and is breathed in by another person. It is also spread by contact with hands infected by the virus. Transmission can be lessened when infected persons cough or sneeze into a tissue and wash their hands regularly.
Influenza epidemics occur yearly and can result in hospitalisation and deaths. According to the World Health Organisation (WHO), worldwide these annual influenza epidemics cause three to five million severe cases of illness and 250,000 to 500,000 deaths, especially among those over 65 years of age.
Like influenza, pneumococcal disease is highly contagious and spread by droplets from coughing, sneezing or close contact. It has been reported that influenza infections can make people more
susceptible to pneumococcal diseases. Most people infected with the S. pneumoniae bacteria begin by having respiratory complaints which is later diagnosed as community acquired pneumonia.
Treatment and Prevention
Blood or sputum cultures and nasal swabs will be tested to determine which virus or bacterium is present before treatment is prescribed. Severe cases of influenza are treated with anti-viral medications while antibiotics usually penicillin is used to treat pneumococcal diseases. However, there are concerns that resistance to anti-virals and antibiotics is limiting the effectiveness of the treatment. A 2011 study in Malaysia reported penicillin resistance to be as high as 31.78%. Resistance to a whole range of antibiotics such as tetracycline, erythromycin, cephalosporins, ciprofloxacin and vancomycin is also increasing.
The best course of action against both influenza and pneumococcal disease is vaccination. There are safe and effective vaccines available to prevent or minimise the effects of viral and bacterial infections. Vaccination is especially important for infants and young children from ages 6 months to 2 years, and adults above 50 years and in the high risk groups.
According to the WHO, among healthy adults, influenza vaccination can prevent 70% to 90% of influenza-specific illness and among the elderly, the vaccine reduces severe illnesses and complications by up to 60%, and deaths by 80%.
The pneumococcal vaccine first introduced in the USA in 2000, has since been shown to be highly efficatious in a wide variety of populations studied in the USA, Europe, Gambia and South Africa. The pneumococcal conjugate vaccine (PCV) is the first vaccine in 20 years to show a significant reduction in child deaths, where in a study in Gambia, 7 deaths were prevented for every 1000 children. Evidently, vaccination should be the first line of defence!