Pneumonia

Pneumonia is one such debilitating lung disease. The lung is inflamed by either bacteria or virus
and rare parasites. The alveolar sacs are filled with pus and solidify in case of severe chronic
disease. Inflammation might be present in both or a single lung, depending upon the severity of
the disease.
Causes
Deciding the severity of pneumonia depends on risk factors. The cause of lung infection is
important because the treatment depends on that. Different organisms cause pneumonia of
different severity. The age of the patient is also a risk factor. Infants and children till age two, and
geriatrics are more at risk of high severity pneumonia.
Patient’s general health also matters; if they have any other disease, whether they are immune-
compromised due to AIDS, cancer, diabetes etc. or an already existing lung or heart disease also
predisposes patients to pneumonia. Drug abusers are also at higher risk than normal population.
Pakistani citizens who do not have proper homes are also included in high risk groups. This
includes people living on the road side constantly inhaling smoke from vehicles, earthquake
victims who recently lost their homes and are now dependent on donation from others. They are
more likely to suffer from pneumonia as they can catch cold because of the drop in temperature
during winters. Colds and flu often lead to bacterial infection and pneumonia.
Symptoms
No one is a hundred percent immune to pneumonia. The bacteria present in the air can invade
anyone with high risk of acquiring the disease. As previously mentioned, the severity of the disease
depends on the risk factors; it is determined by the symptoms.
Symptoms can be mild to severe. Mild symptoms look like a common cold or flu but last much
longer. It includes high grade fever accompanied by sweating and chills. Coughing occurs with
expulsion of phlegm. Most importantly, there is difficulty in breathing. There is chest pain,
shortness of breath and it requires more effort, leaving the patient feeling fatigued. It is also
sometimes accompanied by nausea, vomiting and diarrhea.
Newborns and infants are often diagnosed a little late in the course of the disease as they do not
show symptoms during mild disease. Fever, cough and chest congestion appear later. They may
appear restless and dull, display lack of energy and refuse feed. Older people, on the other hand,
may have lower body temperature. They may show sudden alteration in mental awareness.
If you are having any of the symptoms specifically chest congestion, coughing up pus with
persistent fever, you should see your doctor. People at higher risk of acquiring the disease should
see the doctor immediately as it is a medical emergency as it may rapidly become a life threatening
situation.
Pakistan Synopsis
No disease kills more children aged less than five years than pneumonia, not least in Pakistan
where one-fifth of the population is in this age group. The estimated figures reflected in many
Pakistani studies tells us that the [annual] incidence of ARI [acute respiratory infection] in
Pakistani children aged less than five years is 4% in the community a group constituting roughly
22% of the country’s population of 160 million. Taking this 4% figure, we can calculate that there
are 15 million episodes of ARI every year among under-fives.
Vaccination and Prevention
Preventing pneumonia in children is an essential component of National Immunization Strategy to
reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough
(pertussis) is the most effective way to prevent pneumonia. Pneumococcus is a germ that is
responsible for causing most cases of severe pneumonia, and many cases of meningitis and blood
stream infections in children in Pakistan. Infection by this germ is preventable by vaccine, which
is given as a shot to infants and toddlers. It helps prevent pneumococcal disease, and also stops the
disease from spreading from person to person. Three doses of this vaccine are given in the first
year, preferably at 6 weeks, 10 weeks and 14 weeks of age, and the fourth dose is given at 15
months of age. If the vaccine is not given at above ages, it can be given later as well.
Conclusion
Your symptoms may reduce or disappear over the course of your medication but you should not
stop before the completion of the course. Although symptoms disappear but people still feel tired
and fatigued. In order to recover completely and quickly, get plenty of rest. Do not start work or
studying as soon as you get a little better; rather wait till the coughing completely stops. Take
medication regularly and punctually as prescribed. Keep yourself hydrated.
In order to prevent pneumonia, make sure you are vaccinated against some types of pneumonia
(for which vaccines are available). Get your infants and children vaccinated as well. Practice good
hygiene. Make it a habit to keep your hands clean. Use quality anti-bacterial soap. Avoid smoking
and eat healthy to keep your immune system strong.
Asthma
Asthma occurs when certain triggers cause inflammation in the lungs. This results in coughing,
wheezing, breathlessness, and tightness in the chest. Severity of the condition and the types of
triggers can vary from person to person. Asthma attacks can occur suddenly and get worse after
exposure to a trigger.
Treatments include medication and lifestyle changes to relieve the symptoms of asthma. Asthma
has no one single cause, but genetics are a key factor.
Health impact of asthma in Pakistan over time
The annual mortality rate per 100,000 people from asthma in Pakistan has decreased by 30.3%
since 1990, an average of 1.3% a year. Though this has been the trend overall, adjust the filters at
the top of the visualization to see how the mortality rate for asthma has changed over time for men
and women of specific age groups in Pakistan.
Asthma in Pakistan by sex over a lifetime
For men, the deadliness of asthma in Pakistan peaks at age 80+. It kills men at the lowest rate at
age 15-19. At 317 deaths per 100,000 men in 2013, the peak mortality rate for men was higher
than that of women, which was 186.6 per 100,000 women.
Women are killed at the highest rate from asthma in Pakistan at age 80+. It was least deadly to
women at age 20-24.
Breakdown of asthma risk factors in Pakistan
These risk factors contributed to, and were thought to be responsible for, an estimated 27.4% of
the total deaths caused by asthma in Pakistan during 2013.
Adjust the filters at the top of the visualization to see how which risk factors caused the highest
mortality for men and women of different age groups.
Asthma relative to other chronic respiratory diseases (Pakistan)
The three most deadly chronic respiratory diseases in Pakistan during 2013 were chronic
obstructive pulmonary disease, asthma, and pneumoconiosis respectively.
Though this was the trend in Pakistan overall, different demographic groups are affected
differently and is likely much different between men and women at different ages in life.
Polio
Description
Polio, also known as Poliomyelitis, is caused by one of three poliovirus (PV) serotypes belonging
to the Picornaviridae family. It is a highly contagious illness transmitted by close person to person
contact, mainly through the oral-fecal route – an infected person who does not practice proper hand
or body hygiene passes the infection to another person. It can also spread through infected saliva
and respiratory system secretions. Polioviruses grow in the intestinal system and are shed through
feces. The infection typically spreads in areas with poor water and sewage sanitation; wild
poliovirus is found in this type of environment and puts unvaccinated people at risk.
Risk
As a result of global eradication efforts, Polio is now only endemic in Afghanistan, Nigeria, and
Pakistan. However, countries with low vaccination rates continue to be at risk for re-introduction
of the virus due to imported cases resulting from travel. Unvaccinated travelers, especially
children, pregnant women, and those with a weakened immune system going to areas with Polio
outbreaks are at risk.
Symptoms
In the majority of cases, the infection is asymptomatic – persons do not exhibit symptoms. Those
that do have very mild symptoms and the infection may go unnoticed. Symptoms include fever,
headache, fatigue, stiff neck, muscle pain, and vomiting. In some cases, the virus enters the
bloodstream to attack the Central Nervous System which causes paralysis, usually in the legs. This
is also known as Acute Flaccid Paralysis where the limbs become floppy. In severe cases, patients
can become quadriplegic when the thorax and abdomen muscles become paralyzed and have
difficulty breathing, swallowing, or speaking. Post-Polio Syndrome, characterized by muscle
weakness, joint and muscle pain, and severe fatigue, can occur in survivors 15 to 40 years after
being exposed to the virus. Treatment includes supportive care of symptoms, antispasmodic
medication, physiotherapy, and even orthopedic surgery.
Impact of polio in Pakistan
Polio has had drastic effects on the health of the population of Pakistan and on the nation's
healthcare infrastructure and economy. The WHO estimates that 65–75% of polio cases in
developing countries occur in children under 3 years of age, with 95% of all cases occurring in
children under 5 years of age. Researchers at the School of Public Health at Johns Hopkins
University quantified the disease burden of various diseases in Pakistan; in the year 1990, a
Pakistani person with polio averaged a loss of 1.13 healthy life years to the disease. The duration
of disability of polio, averaged over 1000 people, was 81.84 years, the equivalent of diseases
including diphtheria, childhood meningitis, and measles.
There has been limited research into the impacts of polio in Pakistan in recent years, but a 1988
health survey found that the most common handicaps among polio sufferers were associated with
mobility, occupation, and social integration. The survey found differences in participants based on
whether they lived in a village or a slum area: there was a higher rate of handicap in the village
population, and higher frequencies of infectious, respiratory, and digestive diseases in the slum
area. Both areas saw polio victims suffer from a higher incidence of musculoskeletal system
diseases, as well as infections of the ear, and respiratory tract. Given 1–2 years with occupational
therapists, 80% of patients with handicaps showed improvement in function.
Prevention
Wash your hands thoroughly and frequently with soap and water. If not available, use an alcohol-
based hand sanitizer. Practice good body hygiene.
Vaccination
People of all ages should ensure that they are up-to-date with their polio vaccination. If you have
been fully vaccinated as a child, you should get a polio booster once as an adult. A primary
vaccination series is necessary for those not previously or only partially vaccinated. The
inactivated injectable vaccine is available in Canada and the USA and the live attenuated oral
vaccine is available in some countries. Polio-containing combination vaccines are also available
for children. All provide life-time protection.

Malaria
There are approximately 500,000 cases of malaria in Pakistan per year so malaria is still a risk in
Pakistan. It is prominent throughout the country and malarial transmission occurs all year round.
It is estimated that around 12% of people who live in the rural areas of Pakistan carry the malarial
parasite without showing any symptoms, which is dangerous and so rapid diagnosis is desperately
needed in this country.
All areas below 2500m are at risk of malaria. Rural areas are the most at risk due to lack of proper
sanitation in some of these areas. Flood affected areas also have an increased malarial transmission
because the large amounts of water provide a moist environment in which the mosquito thrives.
The risk of malaria is greatest in the July to August period but there is also a peak in October where
transmission is at its highest.
The malaria parasites in Pakistan are Chloroquine resistant so this is not an effective malaria tablet
in this region of the world. You will usually be prescribed Mefloquine, Malarone or Doxycycline
to protect you from malaria and you need to complete your full course of tablets to ensure
protection. However, malaria tablets are not 100% protective. You will also need to see insect
protection measures and these are essential, as you want to avoid being bitten as much as possible.
Sleep in an air-conditioned room with the doors and windows shut at all times. If this is not
possible, you will need to sleep under a mosquito net. You will also need to use insect repellent
and wear long sleeves to cover as much of your skin as possible. Stay indoors between dusk and
dawn, as this is the time in which the mosquitoes are most active.
Tuberculosis
Description
Tuberculosis (TB) is an air bone bacterial infection caused by Mycobacterium tuberculosis. TB
can be acquired by breathing contaminated air droplets coughed or sneezed by a person nearby
who has active Tuberculosis. Humans can also get ill with TB by ingesting unpasteurized milk
products contaminated with Mycobacterium bovis, also known as Bovine Tuberculosis. The most
common form of the infection is pulmonary TB which affects the lungs. In some cases, the bacteria
can also attack the lymphatic system, central nervous system, urogenital area, joints, and bones.
Risk
Mycobacterium tuberculosis is present worldwide and typically spreads in cramped, overcrowded
conditions. There is no evidence that pulmonary TB is more easily transmitted in airplanes or other
forms of public transportation. Long-term travelers, those with a weakened immune system or
visiting friends and relatives (VFR travelers) in areas where Tuberculosis is endemic are at risk.
Humanitarian and healthcare personnel working in communities with active TB are also at
increased risk. Persons with active TB should not travel.
Symptoms
The majority of persons with the illness (90% to 95%) have latent TB infection (LTBI) and do not
exhibit any symptoms. The bacteria can remain inactive for many years and the chance of
developing active TB diminishes over time.
Persons with active TB have symptoms which include excessive coughing (sometimes with blood),
chest pain, and general weakness, lack of appetite, weight loss, swollen lymph glands, fever, chills,
and night sweats. It can be misdiagnosed for bronchitis or pneumonia. If untreated, active TB can
fatal.
Tuberculosis treatment involves taking antibiotics for a minimum of 6 months. Drug-resistant TB
is a major concern as an increasing number of people are no longer able to be treated with
previously effective drugs. Due to misuse of antibiotic therapies, patients can develop multi-drug
resistant Tuberculosis (MDR TB). When a second line of antibiotics fail to cure the multi-drug
resistant infection, it is known as extensively drug-resistant Tuberculosis (XDR TB).
Prevention
 Avoid exposure to people known to who have active Tuberculosis.
 Only consume pasteurized milk products.
 Travelers at higher risk should have a pre-departure tuberculin skin test (TST) and be re-
tested upon their return home.
 Those at increased risk should also consult their healthcare provider to determine if the
Bacillus Calmette-Guérin (BCG) vaccine is recommended.
Typhoid Fever
Description
Typhoid Fever is a gastrointestinal infection caused by Salmonella enterica typhi bacteria. It is
transmitted from person to person through the fecal-oral route where an infected or asymptomatic
individual (who does not exhibit symptoms) with poor hand or body hygiene passes the infection
to another person when handling food and water. The bacteria multiply in the intestinal tract and
can spread to the bloodstream. Paratyphoid fever, a similar illness, is caused by Salmonella
enterica paratyphoid A, B, and C.
Risk
The bacteria are present in many Southeast Asian countries as well as in Africa, Central and South
America, and Western Pacific countries in areas where there is poor water and sewage sanitation.
Floods in these regions can also quickly spread the bacteria. All travelers going to endemic areas
are at risk, especially long-term travelers, adventure travelers, humanitarian workers, and those
visiting friends or relatives in areas with poor sanitation. Note that original infection does not
provide immunity to subsequent infections.
Symptoms
Usually symptoms appear 1 to 3 weeks after exposure to the bacteria. Depending on the virulence
of the infection symptoms can range from mild to severe. The illness is characterized by extreme
fatigue and increasing fever. Other symptoms include headache, lack of appetite, malaise, and an
enlarged liver. Sometimes patients have diarrhea, constipation, or a rash on their trunk. Severe
symptoms may appear 2 to 3 weeks after onset of the illness and may include intestinal hemorrhage
or perforation. Some people who recover from Typhoid Fever and Paratyphoid Fever continue to
be carriers of the bacteria and can potentially infect others. Treatment includes antibiotics and
supportive care of symptoms. Antibiotic resistance to S. typhi is increasing worldwide.
Prevention
Wash your hands frequently and thoroughly, and practice proper body hygiene. Drink purified
water (boiled or unhampered bottled water) and only eat well cooked foods. Use the mantra Boil
it, Cook it, Peel it, or forget it!
Vaccination
There are two types of vaccines available; the inactivated injectable vaccine (lasting 2-3 years) and
the live attenuated oral vaccine (lasting 5-7 years). Discuss your best options with your healthcare
provider, including revaccination schedules which differ in the USA and Canada. A combined
Typhoid Fever and Hepatitis A vaccine is also available in Canada and Europe. Although Typhoid
Fever vaccines do not provide 100% protection, they will reduce the severity of the illness. There
is no vaccine available against Paratyphoid Fever.