World Pneumonia Day: How Does Air Pollution Make Matters Worse?

How has the pandemic impact immunisation programme? How do pneumococcal vaccines help?

On World Pneumonia Day, FIT speaks with Dr Madhu Gupta, Professor of Community Medicine, School of Public Health, PGIMER.

(Photo Courtesy: Edited by Arnica Kala/ The Quint)

Pneumonia kills one child every 39 seconds globally, and India had the second-highest number of deaths of children under the age of five in 2018 due to pneumonia, according to UNICEF.

Yet, what makes this tragic is that the disease is highly preventable, and we have public health tools and an immunisation programme geared towards tackling it. What progress has India made to prevent these deaths? What is the disease? And what ramifications has the coronavirus pandemic had on the immunisation programme?

On World Pneumonia Day, FIT speaks with Dr Madhu Gupta, Professor of Community Medicine, School of Public Health, PGIMER.

Pneumonia is basically an infection of the lungs, where there is swelling of the lung tissue and there can at times with collection of fluids and pus in the lungs, making breathing very difficult for the child. In more severe cases, it can turn fatal, says Dr Gupta.

It can be caused by various organisms, but the most common remains bacteria. Streptococcus pneumoniae is the most common infection. It can also be caused by a respiratory intestinal virus, a viral infection that can turn fatal. Sometimes it can also be caused by a fungal infection, though this remains rare, she adds.

Air Pollution Can Make Children More Susceptible to Pneumonia

Elaborating on risk factors, the doctor says indoor and outdoor air pollution can make matters worse. Living in overcrowded spaces and malnutrition make things worse. India has one of the highest burdens of unimmunised children, adding to the risk factors. There are vaccines available like whooping cough, measles, pentavalent vaccine and pneumococcal vaccine. But if a child is not vaccinated, they are more susceptible to pneumonia.

With large parts of North India batting severe air pollution, the doctor warns that fine particulate matter (PM 2.5, PM 10) can make children susceptible to pneumonia. These fine pollutants are so small in size, they can invade the lung tissue, making it easier for the bacteria to invade the lungs and causing injury and infection, says Dr Gupta. Similarly, indoor air pollution caused by fuels used for cooking can make matters worse for young children.

In 2017, India took a big step including Pneumonia Conjugate Vaccine (PCV) into the Universal Immunisation Programme. But the implementation is currently limited to 5 states. There's a case made for India expanding the programme to all states to meet its UN Sustainable Development Goals by 2025. The vaccine is available at cost for those who can afford it, but it remains expensive, and thus out of reach for thousands of children.

If you talk about deaths in children under 5, 15-20 percent deaths are caused by pneumonia. Within pneumonia deaths, nearly 30 percent are caused by streptococcus pneumoniae, which can easily be prevented via a robust vaccine programme, says Dr Gupta. This is a 13-variant vaccine and can be an important tool to reduce under-5 and childhood mortality.

Pandemic Impact: Should We Take a Pneumonia and Flu Shot?

Dr Gupta points out that routine immunisation was indeed impacted by initial lockdown, with fears it could impact child mortality. The Doctor believes that there is resumption in most areas except containment zones, and we'll be able to undo some of the damage.

On the question of whether we should get an adult pneumonia vaccine shot in the midst of a pandemic, Dr Gupta says influenza vaccine and pneumonia vaccine, especially in the elderly, can help. She says that when it comes to viral infections, it has been often seen that they can be superimposed by bacterial infections. In such a case, it's possible that a bacterial vaccine like pneumococcal vaccine can help.

(The article was first published in FIT and has been republished with permission.)