(Focus - India)
As we step into a new year filled with hope and aspirations, it is crucial to consider our well-being. While we are making resolutions and embracing fresh starts, it is also essential to stay informed about health matters that might affect us. In this edition, we explore a critical health issue affecting millions worldwide – pneumonia.
Statistics from the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) depict a stark reality: pneumonia stands as the leading infectious cause of death in children globally. It claims over 700,000 lives among children under five each year, illustrating the urgency to comprehend and address this respiratory illness.
In an effort to understand more about this critical health issue, we had the privilege of interviewing Dr. Anand Kumar, a renowned pulmonologist from India who shares valuable insights into the strategies for battling pneumonia in India. Dr Kumar also emphasizes timely vaccination and stresses the importance of appropriate antibiotic use to combat antibiotic resistance.
Dr. Anand Kumar is a Pulmonologist currently serving at Dr. Murarilal Chest Hospital, Kanpur, India.
One of the primary challenges in pediatric healthcare is the limitation in conducting comprehensive tests. Children have small airways. After early infection, they progress to the severe stage very quickly because of poor immunity. Consequently, they are unable to cope with treatment.
We understand that early and accurate diagnosis of pneumonia is crucial in its management. Could you comment on the latest advancements in diagnostic tools and techniques for pneumonia in India?
Dr. Kumar - Presently, the tools are almost the same, but the technology has probably changed. Currently, we are able to get the sample and get it checked for multiple organisms at the same time. Previously, we had to perform different tests, say for bacteria and viruses. Even within bacteria, we had to check for aerobic gram-positive or gram-negative bacteria or anaerobic bacteria. However, we now have technologies that accurately diagnose bacterial or fungal infections from a simple sample. So, the technology has improved, but the tools remain the same.
For instance, we have genome sequencing for tuberculosis. Similarly, we have it for bacterial pneumonia as well. So, technology has improved drastically over the years.
What is your opinion on the new test panels entering the market?
Dr. Kumar - I am not entirely sure, but one panel that we have heard of is BioFire, which is being used in various corporate hospitals. Since we are working in the government sector, we are unable to use it. However, we are aware that this panel gives the result within 2 to 4 hours and a wide variety of etiological diagnoses within a day.
Pneumonia continues to be the leading cause of mortality in children worldwide, with India accounting for 20% of those deaths and a higher burden of childhood pneumonia than any other country [1]. What are the unique challenges that you face while managing pneumonia in children?
Dr. Kumar - One of the primary challenges in pediatric healthcare is the limitation in conducting comprehensive tests. Children have small airways. After early infection, they progress to the severe stage very quickly because of poor immunity. Consequently, they are unable to cope with treatment.
Moreover, obtaining sufficient diagnostic samples is an additional hurdle. For instance, if we conduct a sputum examination, bronchoscopy, or alveolar lavage, the children must be intubated because these procedures are very difficult to do in them. Most of the time, the treatment is more clinical because we do not have a lot of investigative procedures. The biggest challenge is making etiological diagnoses in children.
Various societies are stressing more about making guidelines and training individuals practicing respiratory medicine to follow these guidelines, particularly antibiotic stewardship programs. We need to start better promotion of antibiotic stewardship programs. Fortunately, a few pharmaceutical companies have developed antibiotic stewardship programs that we follow. That helps us in dealing with antibiotic resistance. In my opinion, I feel we need to rationalize the use of antibiotics, and that comes only with training and teaching programs.
What specific interventions are in place to protect the pediatric population
Dr. Kumar - Unfortunately, I do not think there are any specific interventions that can help protect children. The only thing that I can hope for is adequate and timely vaccination for children, particularly influenza and other infectious disorders, because that can lead to the prevention of bacterial pneumonia. Timely vaccination is very crucial for the prevention of any infectious diseases. As per Indian and International guidelines, vaccination should be provided free of cost to every child who is prone to respiratory pneumonia.
Antibiotic resistance is a growing concern globally which severely hampers the effective treatment of infectious diseases [2]. How is India addressing antibiotic resistance in the context of pneumonia treatment?
Dr. Kumar - Various societies are stressing more about making guidelines and training individuals practicing respiratory medicine to follow these guidelines, particularly antibiotic stewardship programs. We need to start better promotion of antibiotic stewardship programs. Fortunately, a few pharmaceutical companies have developed antibiotic stewardship programs that we follow. That helps us in dealing with antibiotic resistance. In my opinion, I feel we need to rationalize the use of antibiotics, and that comes only with training and teaching programs.
What strategies are being employed in India to ensure the appropriate use of antibiotics for pneumonia cases?
Dr. Kumar - The Indian Association of Pediatrics has started an antibiotic stewardship program. Other societies, such as pulmonary medicine, pharmacology, and microbiology, are some of the departments in medical colleges that have begun providing better understanding and training for undergraduates and postgraduates on the appropriate use of antibiotics and antivirals in patients.
What innovative approaches are being explored or utilized in India to prevent hospital-acquired bacterial pneumonia?
Dr. Kumar - There are various guidelines that are being proposed every year or revised every two years by various societies. The COVID-19 pneumonia outbreak raised public consciousness, leading to widespread usage of masks and improved hygiene practices among both the public and hospital staff. That is the only strategy that I can think of for preventing contamination from one patient to the other.
Currently, what treatment approaches are you using to treat hospital-acquired bacterial pneumonia patients and ventilator-associated bacterial pneumonia patients?
Dr. Kumar - At present, we are following the protocol proposed by the Indian Society of Critical Care Medicine and the Indian Chest Society for diagnosing and managing pneumonia. We are using hand hygiene and N95 masks for the hospital staff as well as affected patients. We are using more disposable rather than reusable items. We are also preparing an antibiogram for ICUs and wards to figure out the prevalent organisms within our healthcare settings and their susceptibility to antibiotics so that we can rationalize, optimize, or use antibiotic recycling programs to prevent the emergence of resistance among patients.
For healthcare professionals, I will say that they must treat pneumonia patients as early as possible. Every healthcare institution should develop self-antibiotic programs or policies that are governed by the Infectious Diseases Society. The pupils should stick to them, and the guidelines should be revised in a timely manner in view of the current evidence being produced by the cultures and other types of presentations. When it comes to treatment, one should find out if a patient is being transferred from a primary to a tertiary or secondary center and which antibiotic has already been given to the patient. That will help us choose the correct antibiotics and prevent waste of time.
Public health initiatives play a critical role in pneumonia prevention. Could you elaborate on the government’s efforts and campaigns to raise awareness and prevent pneumonia amongst the country's general population?
Dr. Kumar - I am not aware of any such program being run by the Indian government. However, I am aware of various scientific societies like the Indian Pediatric Society, Indian Pharmacological Society, Indian Society of Respiratory Medicine, and Indian Society of Critical Care Medicine, which are running awareness programs in their societies, academics, and meetings to perpetuate the prevention of pneumonia cases, particularly hospital-acquired as well as community-acquired.
What would be your key message to the general public and healthcare professionals regarding the ongoing battle against pneumonia in India?
Dr. Kumar - For healthcare professionals, I will say that they must treat pneumonia patients as early as possible. Every healthcare institution should develop self-antibiotic programs or policies that are governed by the Infectious Diseases Society. The pupils should stick to them, and the guidelines should be revised in a timely manner in view of the current evidence being produced by the cultures and other types of presentations. When it comes to treatment, one should find out if a patient is being transferred from a primary to a tertiary or secondary center and which antibiotic has already been given to the patient. That will help us choose the correct antibiotics and prevent waste of time.
Healthcare professionals should also take care of hand hygiene, use personal protective equipment, and use disposable items on patients. During the winter, there is an increased chance of catching a viral or bacterial infection. Due to pollution, there is a rise in respiratory cases in Northern India. So, I will ask the general population to use N95 masks whenever they leave their home and also use hand hygiene frequently. We should also try to reduce environmental pollution by decreasing the use of vehicles, biomass, fuels, and hazardous things. We can use air purifiers to decrease environmental pollution and improve the health status of pneumonia or any other respiratory illness. Patients who have suffered from pneumonia who are below 5 years of age or above 60 should get vaccinated in the future for influenza to prevent such incidences.
Thank you very much for your valuable insights!
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