Effect Measure


Some people find posts like this tiresome. There are so many things that need doing and so little time and resources to do them. Adding to the list makes our eyes glaze over. I understand. But that doesn’t make this any less of a Big Deal.

Last week CDC was notified of another 22 pediatric deaths from swine flu. They didn’t all occur in the same week, but the total for this flu season is now 74. At this rate hitting 200 pediatric deaths — deaths insomeone under the age of 18 — seems likely. Most of the flu season is still ahead of us. These swine flu deaths are pneumonia deaths. Each is a terrible tragedy for some family. But 200 deaths, if they happen, is a drop in the bucket when it comes to children under the age of 5 who die of pneumonia. In the global account book the yearly toll is estimated to be 2 million. In fact pneumonia kills more children than anything else. Most people don’t know that, so today is a good day to mark that melancholy fact, since it is World Pneumonia Day. 40 organizations on 6 continents are noting it, we among them. Our particular aim is to drive home this brute fact: if the US sets a flu record of 200 pediatric deaths, it is still only one ten thousandth of world wide pneumonia deaths in children.

It’s a dreadful number, in two ways. It reminds us of the dread of parents whose little ones are so vulnerable. Life is fragile and no where is that fact more evident than with our children. But it’s dreadful in another way: many of those deaths are preventable. Pneumonia is an infection of the lungs and can be caused by lots of different organisms, but there are vaccines against some of the biggest killers. Half of the deaths are caused by Hemophilus influenzae and pneumococcus. There are effective vaccines for both. Supplementing the diet with zinc can reduce pneumonia risk in children still further, up to 25% (see Niessen LW, Hove ten AC, Hilderink HH, Weber M, Mulholland K, Ezzati M. Comparative impact assessment of child pneumonia interventions. Bull World Health Organ. 2009;87(6):472-478). Measles and influenza also cause their share of pneumonia and there are vaccines for them, too. We hardly have measles at all in the US, much less children dying of measles pneumonia. When I was young, there was lots of measles and I got it the old fashioned way — from some other kid (presumably). Now it’s almost extinct in the US. That’s because of vaccination.

The other day I was at the pharmacy (one of the few compounding pharmacies in our town), and a mother was trying to get Tamiflu for her daughter who was away at college. The pharmacist told her it was prescription only. She looked and sounded frantic. She was afraid for her child (who was hardly a child). Most of us who are parents understand what that feels like. It’s often not very rational, as in her case. It doesn’t matter. It’s hard wired into our brains. If it weren’t, we probably wouldn’t have survived as a species. It isn’t confined to white middle class moms and dads. Around the world, on average, parents will have their worst fears realized every 15 seconds. 5500 grieving parents a day. Every day. The culprit will be pneumonia.

Preventable pneumonia.


  1. #1 betty
    November 2, 2009

    US pediatric deaths from H1N1 are already over 200, according to flutrackers.com – not that this makes anyone feel any better.

  2. #2 Jenna
    November 2, 2009

    Thanks so much for posting on World Pneumonia Day. Vaccines and micronutrient supplementation are two of the most cost-effective interventions in global health. Hopefully, coverage like this will help pneumonia get the attention it deserves from policy makers and donors.

  3. #3 D. C. Sessions
    November 2, 2009

    Learn something every day. If you’d asked me, I would have figured diarrhea instead of pneumonia.

  4. #4 allison
    November 2, 2009

    The vaccines you mention are HiB and PneumoVax? are there other versions?

  5. #5 revere
    November 2, 2009

    allison: HiB, pneumovax, influenza, measles, pertussis, RSV.

  6. #6 Phila
    November 2, 2009

    Learn something every day. If you’d asked me, I would have figured diarrhea instead of pneumonia.

    Posted by: D. C. Sessions | November 2, 2009 4:03 PM[kill]​[hide comment]

    I would’ve thought so too. It kills “only” 1.5 million, though.

    Which is pretty mindboggling, in the 21st century.

  7. #7 Marc Lipsitch
    November 2, 2009

    Pneumovax is the 23-valent pure polysaccharide vaccine for adults. Pneumococcal conjugate vaccine (7 valent now, 13 valent coming soon), or Prevnar (trade name) is the pneumococcal vaccine for kids.

  8. #8 floormaster squeeze
    November 3, 2009

    Wait. You are supporting the use of the RSV vaccine? How widely? For poor people all over the world?

    It is interesting that despite the high correlations of poverty and pneumonia and the widespread public health effort to increase nutrition you chose to talk exclusively about vaccines.

    I really appreciated you finally offering a wider perspective on the flu coverage but if you want to save children’s lives (and the anguish of their parents) a key part of that solution is economic. And to go against the prevailing economic interests (and that includes the concentrated economic interests in medicine too many times) in the name of people requires real courage.

  9. #9 Texas Reader
    November 3, 2009

    At age 45 with NO special risk factors I got pneumonia and spent 8 days in the hospital. (I developed an electrolyte imbalance as well as infection in both lungs). I went to the ER seeking something to stop me from vomiting after throwing up all night – I wasn’t wheezing and had NO idea I had pneumonia until they diagnosed me with it and admitted me.

    I have purchased a fingertip pulse oximeter for about $200 and will use to keep track of my oxygen level the next time I get any kind of respiratory infection.

    Why aren’t parents encouraged to get oximeters as well as thermometers for home use?

  10. #10 Jeff
    November 4, 2009

    This new study suggests one way to prevent flu-related pneumonia:

    “A new study explains how antioxidants can protect your lungs from flu-related damage. “The recent outbreak of H1N1 influenza and the rapid spread of this strain across the world highlights the need to better understand how this virus damages the lungs and to find new treatments,” said Sadis Matalon, co-author of the study. “Additionally, our research shows that antioxidants may prove beneficial in the treatment of flu.””

    “All flu viruses, including H1N1 swine flu, produce a protein named M2. The production of M2 protein disrupts cells lining the lungs, causing fluid to build up in the lungs and setting the stage for pneumonia.”

    “The researchers proved that M2 induced its damage through a mechanism of free radicals, which progressively rise as the virus replicates. They further showed that glutathione, the primary cellular antioxidant, stopped the M2-induced free radical damage, thus preventing the problem.”

    “This is a new discovery and a significant finding in support of nutrition to help offset one of the major problems of the flu. Those low in antioxidants that help produce or sustain cellular glutathione are more at risk for developing a more advanced case of respiratory distress. Because the H1N1 swine flu has the ability to infect the lower respiratory tract, this information is of relevance.”

    One proven way to increase intracellular glutathione is by taking the dietary supplement N-Acetylcysteine.

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