Should YOU have the jab that helps prevent pneumonia?
It’s not only the old and frail who are at risk. Just ask super fit rugby star Gareth Thomas
PNEUMONIA is not limited to the older and in firm, as Welsh rugby union l egend Gareth Thomas will tell you.
Although still in great shape after retiring from the sport four years ago, he was forced to pull out of the pantomime in which he was starring last Christmas after developing the potentially fatal condition. Then just 40, Gareth describes the chest pain he suffered as ‘worse than any rugby injury’.
He’d been struggling with a chest infection and a cold, so hadn’t given his hacking cough much thought, apart from that he was ‘a bit run-down’.
‘I’d been travelling, promoting my book, and had a relentless schedule of rehearsals as I was playing Dandini in Cinderella.’
He says he ‘became used to feeling ill’ and didn’t want to let his fellow cast members down by pulling out of the show. ‘But on the night of December 22, I was coughing so hard and the pain was so bad I thought I’d broken my ribs, something I’ve done several times playing rugby, so my partner Ian drove me to A&E at 4am.’
When he arrived at hospital he was diagnosed with pneumonia.
‘I’d say it took about ten seconds of tapping my chest for them to work it out,’ he says. ‘I could clearly hear the hollow sound when the consultant tapped the right side of my chest, compared to the dull thud on the left where the intense pain was — my left lung was basically full of fluid.’
Pneumonia is an inflammation of the lungs caused by an infection. Around one in 100 adults develops the illness each year, according to the HSE.
THOSE of any age can be affected and more than 1,000 people die in Ireland each year from pneumonia, making it one of the most common single causes of death.
Pneumonia occurs when an infection, either from bacteria or a virus, spreads to the tiny air sacs in the lungs, known as alveoli, from which oxygen passes into your blood.
Infected alveoli fill with fluid and pus and oxygen can’t reach the blood as easily, while carbon dioxide isn’t expelled, causing shortness of breath. If left untreated, oxygen levels can fall. If the body’s tissues — especially in the heart and brain — do not get the oxygen they need, confusion, heart failure, coma and eventually death may result — yet initial symptoms can be hard to distinguish from a lingering cough or cold. ‘Pneumonia does often piggy-back cold and flu viruses,’ says Jeremy Brown, a professor of respiratory infection. ‘So if the cold doesn’t seem tor units course in a week, keep an eye on your symptoms and speak to your GP.
‘As in Gareth’s case, one day you can feel grotty and the next you’re in A&E, but if you’re fit and well you should make a full recovery.’
Typical symptoms of pneumonia are a cough that produces thick mucus and may be tinged with blood, chest pain, fever and shortness of breath. More rarely, it can cause you to cough up blood.
Gareth was admitted to hospital and given intravenous antibiotics, highstrength painkillers and an oxygen mask to assist his breathing as well as to administer decongestant to thin the mucus.
‘I couldn’t believe I had pneumonia — I had to ask the doctors several times to confirm what they’d told me as I thought it was something only old people got. I’d ignored the symptoms for days, to the point where I was in excruciating pain.’
He spent a week in hospital, then another week at home recuperating before rejoining the pantomime. ‘But I felt fragile for several weeks after that,’ he says.
Those over 65 are more at risk — and more likely to have serious complications. People with asthma or other lung conditions, like chronic obstructive pulmonary disease (COPD), are also more vulnerable, as are smokers and anyone with a compromised immune system. Pneumonia can be caused by a number of different bacteria and viruses, including the flu virus.
However, more than half of all pneumonia is caused by the bacteria Streptococcus pneumoniae, or pneumococcus. There is a vaccine for this form called Pneumovax (also known as PPV23 or the pneumo jab). It is offered to ‘ high-risk’ groups by the HSE for free, including the over-65s and those with chronic disease, such as serious heart or kidney disease. Professor Brown says it’s these groups who are least likely to respond to treatment, less able to cope with the stress on the organs and more likely to develop complications.
However, Pneumovax doesn’t work against all strains of pneumococcus bacteria (there are 90 types), and targets a quarter of all types of pneumonia (around 40 per cent of cases), says Professor Brown.
What’s more, it doesn’t stop you getting pneumonia — it simply prevents a pneumococcal infection progressing into a life-threatening blood infection.
There is another, more expensive vaccine, Prevenar, which does prevent pneumococcal pneumonia.
However, the downside is that it targets an even smaller subset of the bacteria. ‘Current data shows it prevents 20 to 25 per cent of pneumonia caused by the pneumococcus, which is just 5 per cent of all pneumonia,’ says Professor Brown.
Prevenar is given to babies as part of the HSE childhood vaccination programme, however research suggests it should be offered to ‘highrisk’ adults (so they get both jabs).
A study published recently in the New England Journal of Medicine involving 80,000 people, found the vaccine was effective in up to 75 per cent of cases for the 13 strains of pneumococcus in the vaccine.
According to Professor Brown, this study led to the Prevenar vaccine being introduced into the high-risk adult population in the US this summer.
Cost would be a factor here. ‘It’s hard to know exact figures, but while a Pneumovax vaccine costs in the region of €30, Prevenar costs many times that as it’s difficult to manufacture,’ says Professor Brown.
And what about people like Gareth who don’t qualify for the vaccine?
The key message is greater awareness, says Professor Brown. ‘We’re all vulnerable, and the sooner pneumonia is picked up, the easier it is to treat — you’re also less likely to suffer long-term complications.’
AS WELL as cold and flulike symptoms and a cough, if your breathing is quick, this suggests the pneumonia is likely to be severe. Feeling confused is also a sign of a more serious infection.
There are simple steps you can take to reduce your risk by avoiding infection from bacteria and viruses — washing your hands properly is key. ‘And if everyone stopped smoking tomorrow, the incidence of pneumonia would fall by about half,’ says Professor Brown. ‘ Drinking alcohol also makes pneumonia more likely.’
Gareth is fit again but will have the Pneumovax jab every five years.
He says: ‘I’m doing everything I can do to raise awareness so others can recognise the signs early.’