Pneumonia

Three new vaccines will be introduced into governments expanded programme on immunisation (EPI) at a cost of R1.1 billion, government spokesman Themba Maseko said on Thursday.

South African researchers have expressed concern about the increasing number of bacterial infections that are becoming resistant to the available range of antibiotics.

Contaminated intravenous equipment and poor infection control measures were found to be the source of an outbreak of klebsiella pneumoniae which killed 21 babies in a KwaZulu-Natal hospital.

Tuberculosis, influenza and pneumonia, and cerebrovascular diseases emerged as the leading causes of death amongst South Africans from a study of death notification forms.

The Integrated Management of Childhood Illness (IMCI) approach helps community nurses and medical assistants assess and treat sick children at primary health facilities in poor countries. They use a combination of symptoms, signs and investigations to decide on treatment and referral. Could this approach also be used for initial diagnosis in hospitals? Nurses and medical assistants often conduct the preliminary assessment of children arriving at hospital, with limited supervision from senior staff and a lack of reliable laboratory services. Researchers from the KEMRI/Wellcome Trust Research Laboratories in Kenya developed an assessment protocol involving replies to eight questions, examination for 12 physical signs, measurement of oxygen levels and microscopy for malaria. These results guide the choice of six different treatment strategies: * anti-malarials * intravenous fluids * specific nutritional support * oxygen * blood transfusion. They tested the protocol at Kilifi District Hospital in Kenya’s Coast Province and compared the results with final diagnoses by a paediatrician. The study included 3 705 children under 13 years-old who did not have an obvious simple diagnosis, such as sickle cell disease. They found that: 63 per cent fit the definition for at least one severe syndrome. Mortality in this group is 7.8 per cent. the 1 378 children without a severe syndrome most commonly have a final diagnosis of malaria (48 per cent), pneumonia (13 per cent) or gastroenteritis (19 per cent) these children have milder disease, lower mortality (one per cent) and short inpatient stays (average two days) mortality is lower among children who need fewer treatments. Two-thirds of all deaths in the severe syndrome group are in those who need two or three treatments positive predictive value (the likelihood that a child really has a certain disease if they receive that initial diagnosis) for the IMCI approach ranges from 46 to 70 per cent for severe pneumonia, diarrhoea and malaria the IMCI approach picks up at least 96 per cent of children who have these three syndromes as their final diagnosis. But it identifies only 56 per cent of children who have meningitis. The researchers conclude that this approach may give clearer guidelines for targeting treatment and making decisions about admission. Syndrome definitions should minimise the risk from failure to treat, promote the rational use of scarce resources and prevent unnecessary invasive procedures. But they emphasise that health planners introducing this approach will need to: balance the risk of not admitting children who are less severely ill with the improved quality of care resulting from having fewer admissions define the syndrome hierarchy – which to tackle first focus on a limited number of features to ensure it works under operational conditions develop a well-organised record form for the protocol to guide the choice of treatment consider adding two additional simple laboratory tests (microscopy of spinal fluid and measurement of blood haemoglobin) to the protocol, which would considerably improve practice. Contributor(s): Mike English (Source:id21HealthNews Number 43, August 2003).

South Africans warned on pneumonia areas As health authorities scrambled yesterday to contain a lethal new form of pneumonia that has killed nine people in four countries, local experts warned that South Africans should consider avoiding the affected areas. The outbreak of Severe Acute Respiratory Syndrome (SARS) has prompted the World Health Organization to issue a rare global health warning. Airports and hospitals around the world are on high alert for the illness, which appears to have been spread by air travel and does not respond to standard medical treatment. The original source of the illness is unclear, but during the past week almost 200 suspected cases have been reported on three continents, with outbreaks clustered in Guangdong province in China, Hong Kong, and the Vietnamese capital Hanoi. Suspected cases have also been reported in the UK, Canada, France, Germany, Indonesia, the Philippines, Singapore, Switzerland, Slovenia and Thailand. Hong Kong's Cathay Pacific Airways ordered staff not to check in any passengers who showed signs of the illness, as did airlines in Australia, Japan, New Zealand and Vietnam. SA Airways (SAA) spokesman Rich Mkhondo said pilots and flight attendants had been briefed on the symptoms, which include high fever and one or more respiratory symptoms, including cough, shortness of breath and difficulty breathing. A health ministry spokesman said SA had stepped up border health controls after the outbreak. Andrew Jamieson, medical director of the SAA Netcare Travel Advisory Clinic, said South Africans should consider alternatives to visiting affected areas, monitor the media and consider taking flu vaccinations. Sometimes severe pneumonia is caused by a flu virus, and even though we don't yet know what the bug is, (a flu shot) is the only thing we can advise at present. With SAPA-AFP ( Source: Business Day, 18 March 2003 For more information see the WHO Press release, 03/15/03. (http://www.who.int/mediacentre/releases/2003/pr23/en/).

Statistics South Africa Report NrP0309.2 The full report can be found on the STATSSA website http://www.statssa.gov.za/ look under 'releases' and follow the drop down menu to select 'Causes of Death in South Africa 1997-2001' EXECUTIVE SUMMARY This study was undertaken by Statistics South Africa to investigate the causes of death in South Africa during the period 1997-2001. It was based on a 12 percent stratified random sample of deaths occurring during the study period. Causes of death were coded by utilizing guidelines contained in the tenth revision of the International Classification of Diseases (i.e.,ICD-10).The results of this study depict changes in mortality patterns over time. These changes have tended to affect South Africans differently, depending on population group, sex and age. The five leading underlying causes of death among South Africans between 1997 and 2001 were unspecified unnatural causes (e.g., suicide, drowning, motor accidents), ill-defined causes, TB, HIV, and influenza and pneumonia, accounting for 40,9 percent of deaths in the sample. Mortality due to unspecified unnatural causes declined significantly during the study period. This decline seems to have been offset by a steep rise in mortality due to HIV, TB, and influenza and pneumonia. For example, the proportion of deaths due to HIV nearly doubled from 4,6 percent in 1997 to 8,7 percent in 2001, whereas the proportion of deaths due to unspecified unnatural causes declined from 15,3 to 8,2 percent during the same period. Females were more likely to die from HIV and influenza and pneumonia. Males, on the other hand, had the highest prevalence of TB and unspecified unnatural causes, the proportion of males dying from unspecified unnatural causes being about three times that of females. Causes of death differ significantly by age group. Children aged 0-14 primarily died from intestinal infectious diseases. Between 1997 and 2001 the proportion of children dying from HIV and influenza and pneumonia increased, while deaths due to unspecified unnatural causes declined. The prevalence of TB was lowest among children aged 0-14, the proportion dying due to this cause being approximately 2 percent. Males aged 15-39 experienced the highest mortality attributable to unspecified unnatural causes, whereas females in the same age category died primarily as a result of HIV infections. For both males and females, there was a sharp decline in deaths due to unspecified unnatural causes. By contrast, the proportion dying from TB, HIV, and influenza and pneumonia increased significantly. However, the proportion of deaths due to HIV was about three times higher among females aged 15-29 than among males, the proportion due to this cause being 22,5 and 8,5 percent, respectively. In the age group 40-49 the two leading underlying causes of death among males were unspecified unnatural causes and TB, whereas ill-defined causes and HIV were the two leading causes among females. The cause of death pattern among persons aged 50 and above is unique in that TB, HIV, and influenza and pneumonia are not significant causes of death. Rather, cerebrovascular diseases, other forms of heart disease and general symptoms and signs feature prominently. Diabetes is also a significant cause of death among females aged 50 and above, ranking as the fifth leading cause. An analysis of sample data by population group reveals striking differentials in mortality patterns by population group. While the main causes of death among Africans and coloureds were TB, HIV, influenza and pneumonia, and unspecified unnatural causes, whites and Indians tend to die of diabetes, ischaemic heart disease and cerebrovascular diseases. It is interesting to note that for African and coloured males, the leading causes of death are unspecified unnatural causes and TB, while for Indian and white males the leading causes are cerebrovascular diseases and unspecified natural causes. By contrast, HIV is the leading cause of death among African females. Cerebrovascular diseases is the leading cause of death among coloured females and ischaemic heart disease the leading cause among Indian and white females. Results of this study show that the highest prevalence of HIV deaths is among African females (13,5 percent), females aged 15-29 (24,3 percent) and females aged 30-39 (20,5 percent). The lowest prevalence of HIV deaths is among white females, with only 0,7 percent of deaths due to this cause.(Source: Statistics South Africa Report NrP0309.2)

More than 500 000 lives in developing countries stand to benefit from the discovery of a vaccine that reduces the incidence of pneumonia in vaccinated children by more than 20%. This comes after scientists from the University of the Witwatersrand and Emory University in Georgia, US, found that a new version of a pneumococcal vaccine reduced the incidence of pneumonia in vaccinated children following clinical trials among 40 000 children in Soweto. According to the World Health Organisation (WHO), pneumonia is the leading cause of death in children worldwide and is responsible for about four million deaths a year, most of which occur in developing countries. Although pneumonia has many different causes, the pneumococcus bacterium is the primary cause. Until recently, no vaccine was available to prevent pneumococcal disease in young children. In addition to pneumonia, pneumococcus can cause meningitis, ear infections and sinusitis. The universities said the vaccine reduced the incidence of invasive pneumococcal disease by more than 80% in children not infected with the HIV virus and by more than 50% in those that were HIV-positive. The study was conducted under the auspices of the WHO and the Medical Research Council of SA and Wyeth Pharmaceuticals, which developed the vaccine. (Source: Business Day, 9 May 2002)

According to the World Health Organization, the Czech Republic is a world leader in a deadly trend of antimicrobial resistance that is leaving patients helpless against powerful infections.