1. *
The medical condition & its public health implications
Created by Sarah Versackas
Summer 2012

2. *
* 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:

3. *
• 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).

4. *
• 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).

5. *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)

6. 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
*

7. Name of Organism Type
Pneumonia
Mycoplasma Mycoplasma pneumonia Bacteria-like
Hospital-acquired MRSA (Methicillin Resistant Bacterial
Staphylococcus aureus)
Aspiration Foreign matter Often happens when vomit
while unconscious or
trouble swallowing & food
goes in lung
Viral Influenza, parainfluenza, Viral
adenovirus, rhinovirus, herpes
simplex, respiratory syncytial,
hantavirus, or CMV
Community- Streptococcus pneumoniae, Usually bacterial
staphylococcus aureus,
acquired Haemophilus influenzae Klebsiella
pneumoniae, Moraxella
catarrhalis or a fungi or parasite
Legionella Legionella pneumophila Bacterial
Chlamydia Chlamydophila pneumoniae Bacterial
*

8. *
Watch how the body has difficulty exchanging oxygen & CO2 due to the
pus lining the alveoli in the lungs:

9. How Mayo Clinic describes Pneumonia:
“Most pneumonia occurs when a breakdown in your body's natural defenses allows
germs to invade and multiply within your lungs. To destroy the attacking organisms, white
blood 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. A
classic sign of pneumonia is a cough that produces thick, blood-tinged or yellowish-greenish
sputum” (Mayo Clinic staff, 2012).

10. *
-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

11. *
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.

12. 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 with
lead to pneumonia. This suppressant, an
antiviral
will only decrease the d antipyretics
medication.
duration not cure it. can all help.

13. 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 clear
lungs. Pain medicine and/or supplemental oxygen may aid in this.
Are not able to keep food/fluids down, and need intravenous
hydration or nutrition. May need electrolyte replacement too.
Are being treated outpatient, but are not getting better.

14. *

15. *
These are not all FDA approved. Patients should discuss which alternative
therapies are safe with their primary physician, especially if they are undergoing
other 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

17. • 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.

18. • 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.

19. • 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.

21. *
There are numerous public health issues that arise due to the
serious health condition pneumonia. This article describes a study
the use of a pneumonia vaccine, specifically a “9-valent PnCV to
define different end points of vaccine efficacy and the preventable
burden of pneumococcal pneumonia in 39,836 children who were
randomized in double-blind, placebo-controlled trial in South Africa”
(Cutland, Klugman, Kuwanda, & Madhi, 2005).

22. 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 examination
relevant 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 lower
who received the vaccine. respiratory tract
infection.
*

23. Majority of children The increase in WHO-
w/pneumonia in study defined mild
would 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 for
HIV-infected children was
6.4-fold greater than The results cannot necessarily be
uninfected 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.
*

24. • 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.
*

25. * 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.

26. 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 is
158.8 per 100,000 population aged 65+ (Gorina et al., 2008).

27. 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.

28. *
* 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.).

29. Resources
British 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 Public
Health 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 from
http://www.healthy.net/scr/article.aspx?Id=3168.
Institute for Work and Health, (2006), Primary, secondary, and tertiary prevention. At Work, 43. Retrieved from
http://www.iwh.on.ca/primary-secondary-and-tertiary-prevention.
Iowa Department of Public Health, (2009). Healthy Iowan. Iowa Chronic Disease Report
http://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 from
http://www.aging.iowa.gov/Documents/Statistics/States%20Ranked%20by%20Age%20Group%20_2011%20Estimates.pdf.
Mayo Clinic staff, (2012). Causes, Pneumonia. Retrieved from
http://www.mayoclinic.com/health/pneumonia/ds00135/dsection=causes.
Swierzewski, S., (2007). Pneumonia Overview. Remedy’s Health Communities.com, Retrieved from
http://www.healthcommunities.com/pneumonia/overview-of-pneumonia.shtml.

30. 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 agenda
item 11.23. Retrieved from http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_26-en.pdf.