MANILA, Philippines – At the Philippine General Hospital where he serves, pulmonologist Dr. Joel Santiaguel reveals that up to an astounding 80 percent of patients in the ICU are critically infected with pneumonia or have diseases complicated by pneumonia.
In fact, one sad characterization of the ailment is that it is usually the final disease that sends people to the end of their lives.
“Pneumonia has always been among the top diseases in terms of illness and death in any country, not only in the Philippines but worldwide,” says Santiaguel.
“It is consistently among the top five leading causes of morbidity and mortality yearly so that would easily translate to around a million deaths in a year worldwide,” he adds.
Unfortunately, many people, regardless of their economic standing, do not give much thought to the disease even when warning signs appear (cough, chest pains, lingering fever or fatigue, difficulty of breathing, etc.). They only become alarmed when a dire diagnosis is made, usually when pneumonia has already reached an advanced or severe stage.
“Some of them develop respiratory failure and may actually die because of the infection,” says Santiaguel.
In community-acquired pneumonia, the most commonly occurring bacteria causing infection is Streptococcus pneumoniae.
Santiaguel points out that “a lot of people are carriers” of the bacteria, and that the carriers are of two types: a patient with pneumococcal-disease, and someone who is “sipunin/ubuhin,” (usually children) whose upper airways are colonized by pneumococcal bacteria but who has already become immune to or is no longer affected by the disease.
Infected persons release contaminated droplets into the air that are inhaled by susceptible members of the community. Those at risk, because of weaker or weakened immune system, include children and the elderly, and those with chronic medical conditions like hypertension, heart condition, pulmonary diseases like asthma and COPD, diabetes, kidney failure, cancer, and HIV/AIDS.
Streptococcus pneumoniae can travel through and infect passages in the body like the ears and throat, compromise the blood, and invade organs, including the lungs and brain.
Pneumonia not a natural consequence of aging
In his 11 years as lung disease specialist, Santiaguel has witnessed many heart-rending episodes of pneumonia-stricken grandmothers having difficulty breathing. The general mindset is that “part ng natural course ng pagtanda ang magkasakit.”
But the truth is pneumonia can happen at any age. With proper antibiotic management, doctors are able to pull patients out of danger, “but especially in elderly and sickly patients, out of 10, only four usually survive.”
According to Santiaguel, one of the problems during treatment is that there are now resistant strains of pneumonia bacteria due to misuse and overuse of antibiotics.
Another issue is the high cost of medication and hospitalization which represents a heavy burden on the family. In high-end hospitals, just a week in ICU can set back a family’s finances by a million pesos; in a regular hospital, around P200,000 to 300,000 will be spent for intensive care.
Tragic yet avoidable
Pneumonia is the world’s leading cause of vaccine-preventable deaths in all age groups worldwide, according to 2003 data from the World Health Organization.
Aside from pneumonia, Streptococcus pneumoniae can cause other disorders such as tonsillitis, sinusitis, otitis media (ear infection known as “luga” which is prevalent among children), and meningitis (inflammation of the brain and spinal cord membranes).
“Kaya ina-advice din naming magpa-vaccinate kasi hindi lang laban sa pneumonia mapoprotektahan,” Santiaguel says.
The pneumonia vaccine protects against 23 of the most prevalent and invasive serotypes of Streptococcus pneumoniae. Vaccination can reduce by half the number of deaths caused by pneumonia.
A preventive measure for children (two years and above), elderly, and kids and adults with compromised immune system, the vaccine costs so much less compared to the brutal expense of treatment. Only a single dose is needed to effectively protect for at least five years, after which another immunization session is recommended.
Why vaccination is important
When very few people are safeguarded against Streptococcus pneumoniae, the bacteria spread easily in the community. But if more members in an area become immunized against the disease, vaccinated people can serve as a sort of barrier against the spread of disease, benefiting non-vaccinated individuals.
This concept of herd immunity is applicable within the smallest social unit where diseases are so commonly shared, which is the household. “We’re happy to note that people have now begun to bring their family members to the clinics to get pneumonia vaccination,” reports Santiaguel.
Similar to flu, pneumonia has seasonal peaks associated with rainy season diseases that weaken the immune system. However, people need to remember that Streptococcus pneumoniae “is just there lurking, waiting for a chance when your resistance weakens. It’s there year-long,” Santiaguel alerts the public.
“You just have to protect the population so they don’t become susceptible to pneumonia,” he adds.