*The medical condition & its public health implications Created by Sarah Versackas Summer 2012
* * An acute infection with inflammation of the respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli of the lung(s). Watch this video for further description:
*• Pneumonia remains the leading killer of children under five years of age worldwide, totaling 1.8 million of the estimated 9 million deaths in 2007 in that age group (WHO, 2010).• The incidence of pneumonia in children under five years of age is estimated at 0.29 episodes per child-year in developing countries, compared to 0.05 in developed countries (WHO, 2010).• That adds up to 156 million new episodes each year worldwide, where 151 million of those are in developing countries (WHO, 2010).
*• Childhood mortality due to pneumonia is strongly linked to malnutrition, poverty, and inadequate access to health care.• More than 98% of deaths due to pneumonia in children occur in developing countries (WHO, 2010).• Bacterial infections contribute disproportionately to pneumonia mortality in developing countries. Even though bacterial infections cause less than %50 of pneumonia cases, they cause nearly 70% of deaths due to pneumonia (WHO, 2010).
*A little more information * In the U.S., around 3 million cases of pneumonia are reported annually. One-third of those cases occur in people over 65 years old. * About 4 out of every 100 children in the country develop pneumonia every year. About 60,000 people die as a result of the condition. * People with weakened immune systems or who breathe in chemicals are at greater risk of developing pneumonia or dying from it (i.e. adults 65+, infants, farm or constructions worker, people living where there is high air pollution). * Some medical conditions increase risk for pneumonia (i.e. diabetes, emphysema, heart disease, HIV/AIDS, sickle-cell disease)
Pneumonia can develop from over 30 different causes (Mayo Clinic staff, 2012). * Those can be classified into 5 infectious agents: bacteria fungus foreign matter/chemical virus mycoplasmas *
Name of Organism TypePneumoniaMycoplasma Mycoplasma pneumonia Bacteria-likeHospital-acquired MRSA (Methicillin Resistant Bacterial Staphylococcus aureus)Aspiration Foreign matter Often happens when vomit while unconscious or trouble swallowing & food goes in lungViral Influenza, parainfluenza, Viral adenovirus, rhinovirus, herpes simplex, respiratory syncytial, hantavirus, or CMVCommunity- Streptococcus pneumoniae, Usually bacterial staphylococcus aureus,acquired Haemophilus influenzae Klebsiella pneumoniae, Moraxella catarrhalis or a fungi or parasiteLegionella Legionella pneumophila BacterialChlamydia Chlamydophila pneumoniae Bacterial *
* Watch how the body has difficulty exchanging oxygen & CO2 due to the pus lining the alveoli in the lungs:
How Mayo Clinic describes Pneumonia: “Most pneumonia occurs when a breakdown in your bodys natural defenses allowsgerms to invade and multiply within your lungs. To destroy the attacking organisms, whiteblood cells rapidly accumulate. Along with bacteria, they fill the air sacs within your lungs(alveoli). Breathing may be labored as air sacs become inflamed and filled with fluid. Aclassic sign of pneumonia is a cough that produces thick, blood-tinged or yellowish-greenishsputum” (Mayo Clinic staff, 2012).
* -Chest pain -Nausea GI Muscle -Headache -Vomiting upset pain/aches -Fatigue -Diarrhea -Confusion -Tachycardia -Diaphoretic Shortness -Tachypnea Fever -Shaking chills of breath -Rales & rhonchi breath sounds -White chest x-ray -High WBC count Abnorma l -Discolored -Acidotic ABG Labs/test Cough mucous -Positive blood, urine -Sore throat or sputum culture s
*If the causative agent is bacterial… If no improvement Broad- in around 3 spectrum days, a Rest, hydration, p antibiotics are culture/sensitivity ain given (i.e. test can identify medication, cough azithromycin the bacteria. suppressant, antip or Then a new yretics can all amoxicillin). antibiotic can be help. tried.
If the causative agent is viral… Tamiflu and Relenza are Rest, hydration Varicella the two most popular , pain pneumonia, whi antivirals to treat medication, co ch is rare can influenze, which can ugh be treated withlead to pneumonia. This suppressant, an antiviral will only decrease the d antipyretics medication. duration not cure it. can all help.
People with signs/symptoms of pneumonia *Older than 65 or cannot care for him or herself.Have co-existing chronic health problems (i.e. COPD, heart failure,asthma, diabetes, kidney failure, or liver disease).Have unrelieved chest pain or cannot cough effectively to clearlungs. Pain medicine and/or supplemental oxygen may aid in this.Are not able to keep food/fluids down, and need intravenoushydration or nutrition. May need electrolyte replacement too.Are being treated outpatient, but are not getting better.
*These are not all FDA approved. Patients should discuss which alternativetherapies are safe with their primary physician, especially if they are undergoingother forms of treatment. Therapy Reasoning Zinc Strengthens immune system, reduces lung inflammation & obstruction of the airways. Vitamin A & C Strengthens immune system to fight infection. Pleurisy root Native American herbal remedy to fight infections. Traditional Chinese medicine Studies have shown combined acupuncture & herbs (xie bai san & banxia houpo tang) to relieve s/s. Coughing, deep breathing, To loosen phlegm and help it drain from massage, postural draining, lungs. physical therapy Other herbal preparations Examples such as barberry root bark, Oregon grape root, cayenne pepper, or garlic have all been thought to have anti- bacterial properties
• Education about pneumonia, good nutrition, regular exercise, dangers of tobacco.• Regular exams & screening tests to monitor risk factors for illness.• Immunization against pneumonia.• Controlling potential hazards at home (i.e. reduce mold, clean house).• Control work hazards (i.e. wash hands, avoid inhaling harmful substances, good ventilation).• Prevention of low birth weight & breastfeeding education.
• Counsel people to take daily vitamins & minerals, and answer any other dietary questions.• Recommend regular exams and screening tests in people with known risk factors for pneumonia (i.e. elderly, children under 5, smokers, people with COPD or HIV).• Encourage post-op and physically challenged patients to stay active and cough/deep breathe to prevent pneumonia.• Provide modified diet, such as thickened liquids to people with risk of aspiration.
• COPD or HIV management programs, with a portion focusing on preventing infections such as pneumonia.• Case management for patients who repeatedly get pneumonia.• Patient support groups for high risk patients.
* There are numerous public health issues that arise due to theserious health condition pneumonia. This article describes a studythe use of a pneumonia vaccine, specifically a “9-valent PnCV todefine different end points of vaccine efficacy and the preventableburden of pneumococcal pneumonia in 39,836 children who wererandomized in double-blind, placebo-controlled trial in South Africa”(Cutland, Klugman, Kuwanda, & Madhi, 2005).
The article described the need for The study came to the conclusion the study, showing that the that the burden prevented by Privacy was burden of pneumonia prevented vaccination is best evaluated maintained for by vaccination was difficult to using outcome measures with high test subjects. determine. sensitivity, such as a clinical diagnosis. The PnCV proved to be A standard examinationrelevant in improving the The study was form was completed that quality of life for the randomized in a captured clinical signs &children infected with HIV double-blind trial. symptoms of lowerwho received the vaccine. respiratory tract infection. *
Majority of children The increase in WHO- w/pneumonia in study defined mildwould have been treated pneumonia was Pneumonia evident only when all can be a The study did not outside of the hospital directly determine the where there was no children were complex included in condition to HIV status of the surveillance. children at study entry, analysis, irrespective diagnose, of presence of treat, & which would have wheezing in clinical therefore increased the precision exam. study. of the vaccine impact.Since a placebo was used,the overall incidence of C- LRTI hospitalization forHIV-infected children was 6.4-fold greater than The results cannot necessarily beuninfected children. This generalized because health care Only trends toward fewer may have been unethical services (i.e. oxygen, antibiotics) episodes requiring to withhold prevention were readily available for this mechanical ventilation methods for these study. That is not the case in many support & fewer deaths in subjects (Cutland et al, other developing countries or rural HIV-uninfected children 2005). areas of S. Africa were observed. *
• Pneumonia is the 8th leading cause of death in Iowa, with around 1,000 deaths per year.• The number of deaths in Iowa from all respiratory diseases has almost doubled since 1979—due to COPD, pneumonia, influenza, & bronchial infections. *
* Respiratory conditions, including pneumonia, asthma, & chronic COPD were the 4th leading cause of hospitalization in 2006.* Pneumonia accounted for 45% of those hospitalizations, compared to the next highest condition of COPD at 17%. Then 50% of those cases of pneumonia were found in people aged 75+.* The rate of hospitalized pneumonia cases in Iowa was at 45.1 per 10,000 in 2006.
Iowa has the 9th highest percentage of seniors aged 60+ compared to other U.S. states, which is 20.8% of its total population (Iowa Department on Aging, 2011). Iowa has the 11th highest number of elderly who annually suffer from pneumonia compared to other states (Gorina, Hines, Kelly, & Lubitz, 2008).The age-adjusted influenza/pneumonia death rate in the state of Iowa is158.8 per 100,000 population aged 65+ (Gorina et al., 2008).
1. Promote vaccination for high-risk groups, especially elderly aged 65+.2. Educate the public about pneumonia and its related complications, with a focus on educating staff in long-term care facilities.3. Educate the public about how a healthy diet, not smoking, regular exercise, and hygiene such as hand-washing can prevent pneumonia.4. Work to reduce hospital-acquired pneumonia in hospital settings, promoting hand-washing and clean technique.
* * Pneumonia is an acute infection in the lungs that can lead to more serious complications if not treated. * It is a public health concern as many people die from it every year; especially those facing malnutrition, poverty, and lack of access to care. * It is a preventable condition, if the correct precautions are taken (i.e. give immunizations to high risk people, healthy diet & exercise, not smoking, etc.).
ResourcesBritish Thoracic Society (2004). BTS Guidelines For the Management of Community-Acquired Pneumonia in Adults – 2004 Update.London: BTS.Centers for Disease and Control Prevention, (2012). Vaccines and Preventable Diseases: Pneumonococcal Disease In-Short.Immunizations. Retrieved from http://www.cdc.gov/vaccines/vpd-vac/pneumo/in-short-both.htm.Cutland, C., Klugman, K., Kuwanda, L., & Madhi, S., (2005). The Impact of a 9-Valent Pneumococcal Conjugate Vaccine on the PublicHealth Burden of Pneumonia in HIV-Infected and –Uninfected Children. Clinical Infectious Diseases, 40, 1511 – 1518.Gorina, Y., Hines, Z., Kelly, T., & Lubitz, J., (2008). Trends in Influenza and Pneumonia Among Older Persons in the United States.U.S. Department of Health & Human Services: Centers for Disease Control and Prevention National Center for Health Statistics.Retreived from http://www.cdc.gov/nchs/data/ahcd/agingtrends/08influenza.pdf.Healthy.net, (2012). Pneumonia: Alternative treatments for pneumonia. What Doctors Don’t Tell You, 15 (11). Retrieved fromhttp://www.healthy.net/scr/article.aspx?Id=3168.Institute for Work and Health, (2006), Primary, secondary, and tertiary prevention. At Work, 43. Retrieved fromhttp://www.iwh.on.ca/primary-secondary-and-tertiary-prevention.Iowa Department of Public Health, (2009). Healthy Iowan. Iowa Chronic Disease Reporthttp://www.idph.state.ia.us/apl/common/pdf/health_statistics/chronic_disease_report.pdf.Iowa Department on Aging, (2011). States Ranked by Age Group as % of Total Population: Population Estimates July 1, 2011.Retrieved fromhttp://www.aging.iowa.gov/Documents/Statistics/States%20Ranked%20by%20Age%20Group%20_2011%20Estimates.pdf.Mayo Clinic staff, (2012). Causes, Pneumonia. Retrieved fromhttp://www.mayoclinic.com/health/pneumonia/ds00135/dsection=causes.Swierzewski, S., (2007). Pneumonia Overview. Remedy’s Health Communities.com, Retrieved fromhttp://www.healthcommunities.com/pneumonia/overview-of-pneumonia.shtml.
Gorina, Y., Hines, Z., Kelly, T., & Lubitz, J., (2008). Trends in Influenza and Pneumonia Among Older Persons in the United States.U.S. Department of Health & Human Services: Centers for Disease Control and Prevention National Center for Health Statistics.World Health Organization, (2010). Treatment and Prevention of Pneumonia. Sixty-Third World Health Assembly: Provisional agendaitem 11.23. Retrieved from http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_26-en.pdf.