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Pneumonia kills 30,000 people – you can protect yourself 

The annual flu epidemic has suddenly become serious. Few could have missed the alarming headlines last week about the dramatic rise in cases — GP consultations for ‘flu’ up by 78 per cent, hospital admissions up by 50 per cent and intensive care admissions up by 65 per cent compared with the week before.

Nearly 2,000 people have now been hospitalised because of complications owing to this year’s flu outbreak, according to Public Health England — and 85 have died as a result.

Worryingly, the danger is far from over, with the flu season set to last at least to the end of February, and possibly as late as May, according to the Department of Health’s Communicable Disease Centre.

It’s not the flu virus itself that claims lives, but ‘almost always flu-related pneumonia, the most common cause of death from flu’, explains Dr Ben Marshall, a consultant respiratory physician at Southampton General Hospital.

 Official figures show the NHS is in the midst of its worst flu outbreak in seven years, with the number of patients visiting their GP with symptoms doubling in a single week

It’s been reported that the tragic death this month of Bethany Walker, 18, from Applecross in Wester Ross, Scotland, was due to flu-related pneumonia.

What many people may not realise is that there is a pneumonia vaccine that can help protect against the bacteria most commonly responsible for the disease, Streptococcus pneumoniae (also known as pneumococcus). This one-off vaccine can last for up to 20 years.

But while it’s been available for 17 years and is offered for free on the NHS to at-risk groups, uptake remains low — this includes the over-65s, with around a third (four million people) declining the free jab.

Uptake is even lower among people with conditions that raise the risk of pneumonia, including long- term kidney, liver and heart problems such as congenital heart disease, anyone with COPD (chronic obstructive pulmonary disease), diabetes and those having chemotherapy for cancer or on long-term steroids for severe asthma or arthritis — with just four in ten having the jab.

This is deeply worrying, says Dr Marshall. ‘We know the vaccine protects around 45 per cent of people over 65 and those with chronic illness, compared to around 70-75 per cent of those with healthy immune systems.

‘But this is still very worthwhile. For people of any age, I would recommend consideration of vaccination for pneumonia if there’s an underlying medical condition that might increase the risk of serious complications.’

Experts suspect that one reason people don’t have the jab is simply because most don’t know about it. The rate of vaccination among the general population — who have to pay a £70 fee to a pharmacy to have the jab privately — is perhaps, not surprisingly, even lower than among at-risk groups.

And if they do know about the jab, many people think pneumonia is a serious concern only for people at the end of their lives.


What can you do to protect yourself against pneumonia? First and foremost, says Dr Richard Russell, a consultant chest physician and medical director of the British Lung Foundation, it’s important to have the flu vaccine, as this helps to protect the immune system (as well as reducing the risk of getting flu).

But what about the pneumonia jab? This is not free to everyone. So, should you pay to have it (at a High Street chemist such as Boots)? ‘The risk of young and middle-aged adults dying of pneumonia is tiny,’ says Dr Tim Peto, a professor of medicine at the University of Oxford. ‘The only real risk is in babies and older people.’ Yet ironically, the jab is most effective in healthy people. ‘It reduces the risk of pneumonia in people with a healthy immune system by around 75 per cent, while for frailer people over 65 and those with chronic conditions, protection is around 45 per cent,’ says Dr Russell.

‘But,’ he adds, ‘it’s still worth having, as there’s a huge bonus for frail people or those with chronic illness. It effectively provides protection against sepsis, a high-risk type of blood poisoning that is most commonly caused by pneumonia.’

For those who don’t get it on the NHS, at £70, the vaccine ‘may sound a lot of money, but it could certainly be a worthwhile investment,’ says Dr Russell.

Yet another preventive measure for those with degenerative diseases could be regular visits to the dentist. Research published in the journal Neuropsychiatric Disease and Treatment reported that problems with swallowing and saliva control may be the principal reason pneumonia is a leading cause of death in people with Parkinson’s.

Patients who had improved their oral health were less likely to be admitted to hospital with pneumonia.

Yet figures from the British Lung Foundation show that, even in healthy people, the risk of contracting pneumonia increases year on year — with those in their 50s, for instance, having a 40 per cent increased risk of contracting bacterial pneumonia compared with those in their 40s.

‘There are clear benefits for people of all ages having a pneumonia vaccination,’ says Dr Richard Russell, a consultant chest physician at Lymington New Forest Hospital and a senior lecturer at the Nuffield Department of Medicine at the University of Oxford.

‘Should a fit 30-year-old man have the pneumonia vaccine? As their doctor, I would support their decision to have the jab if that’s what they choose to do.

‘Although people are only offered a free vaccination for pneumonia over the age of 65, the fact remains that the risk of getting pneumonia increases significantly over the age of 50.’

And with fears that the flu jab is not as effective this year, there are concerns there could be more cases of pneumonia as a result.

‘People think of pneumonia as a relatively minor chest infection that is only dangerous to older people, but that’s not the case,’ says Dr Marshall.

The infection ‘is a killer’, adds Dr Russell.


Pneumonia is a rapidly progressing acute infection that affects around a quarter of a million people in the UK every year, killing on average 29,000 of them, making it the leading cause of death from an infectious disease and the sixth biggest cause of death overall in Britain.


Pneumonia affects the alveoli inside the lungs. A chesty cold or bronchitis is an infection of the bronchial tubes or airways.

Pneumonia is much more serious and lasts longer than bronchitis, which people usually get over in two to three weeks. It’s usually caused by bacteria. Bronchitis is almost always a viral illness.

Pneumonia frequently causes a high fever with shaking chills. Bronchitis normally doesn’t.

Pneumonia causes a cough that brings up thick green or blood-tinged mucus from the lungs. Bronchitis starts with a dry, hacking cough and, after a few days, a cough that brings up clear or yellow mucus from the lungs. However, with both disorders, the cough may last for several weeks.

Both bronchitis and pneumonia can cause moderate to severe chest pain when coughing or drawing breath.

With pneumonia, an X-ray can reveal fluid on the lung. Bronchitis normally doesn’t show.

‘Breathlessness and lethargy are an important sign of pneumonia, too — even in young people — and if someone’s lethargy is getting worse, rather than better, then pnuemonia is more likely,’ says consultant chest physician Dr Richard Russell. ‘Other strong indicators are the production of green discoloured sputum or, on occasion, coughing up blood.

‘If in doubt, see your doctor. Don’t wait. Pneumonia is a killer.’

The infection causes the clusters of tiny, balloon-like air sacs (known as alveoli) that lie at the end of the bronchial tubes in the lungs to become inflamed and fill up with mucus.

‘It’s the same gungy fluid that we all cough up when we are beginning to recover from a heavy cold,’ explains Dr Russell.

But, trapped in the lungs, mucus becomes highly toxic.

The alveoli, he points out, play a vital role in getting oxygen-rich air into the lungs, filtering out carbon dioxide and sending oxygen into the bloodstream to nourish the body’s tissues and organs.

‘When this process stops working efficiently, you start to develop all the symptoms of pneumonia, including shortness of breath, chest pain, a high temperature and a bad cough,’ says Dr Russell.

‘If left untreated, oxygen levels in the body start to fall and you begin to suffer severe confusion, heart failure and, eventually, coma and death may result.’

Most at risk of dying of the disease are those who are older and frail, or who are already seriously ill.

Pneumonia can often be diagnosed by a GP by listening to noises in the chest and lungs through a stethoscope.

As with any fast-developing disorder, speed in diagnosing it is of the essence and symptoms can be confused with other respiratory conditions including the much less serious bronchitis or flare-ups of asthma, or smoking-related conditions such as emphysema. For patients and their families, the experience of pneumonia can be terrifying: one minute, they’re managing normal cold or flu symptoms — and the next, they find themselves requiring an urgent referral to A&E.

‘GPs sometimes have to make what can be a life-and-death decision on whether the patient can remain at home with the infection managed by oral antibiotics, or whether an admission to a hospital that at the moment is already chock-a-block is required,’ says Dr Russell.


occasionally, pneumonia can be caused by viruses, for instance occurring as a complication of the viruses that cause colds and flu. But it’s most frequently caused by the pneumococcus bacteria.

The bacteria can either be inhaled as airborne droplets delivered from someone’s uncovered cough, or reach the lungs via the bloodstream from a bacterial infection elsewhere in the body, such as the middle ear (a common cause of pneumonia in children) or the urinary tract (most commonly in older women).

‘This transmission is so simple because we’re all awash with Streptococcus pneumoniae, the bacteria being one of several that colonise the respiratory tract, the sinuses and the naval cavity,’ explains Dr Marshall.

‘But in someone with a healthy immune system, there’s little danger — you’re only at risk of pneumonia when there’s a chink in your immune system armour.

‘That can occur for a whole range of reasons — because you have a chronic lung condition such as COPD or heart failure or kidney disease, or you are taking chemotherapy drugs for cancer.’

One of the major causes of poor immunity, though, is having flu. ‘Having flu can paralyse your immune system and can increase your risk of pneumonia by up to 100 times — and this can impact on the immune system for a few weeks after the infection has cleared up,’ adds Dr Marshall.

People can get clear of flu, then they suddenly become really ill from pneumonia that develops on the back of the flu, says Dr Rod Daniels, deputy director of the Worldwide Influenza Centre in London. ‘That’s because the flu virus can really mess up your immune system.’

 This year, however, there¿s concern that the flu vaccine may be ¿only of moderate effectiveness, which means only 30 to 40 per cent of flu cases will be avoided among people who have the vaccine

 This year, however, there’s concern that the flu vaccine may be ‘only of moderate effectiveness, which means only 30 to 40 per cent of flu cases will be avoided among people who have the vaccine

And so, while pneumonia can take hold at any time of the year, ‘it tends to peak during the flu season’, says Dr Marshall.

Interestingly, he adds, the flu vaccine, has resulted in a long-term downward trend in cases of fatal pneumonia — with just 17,460 excess deaths in 2013/14.

This year, however, there’s concern that the flu vaccine may be ‘only of moderate effectiveness, which means only 30 to 40 per cent of flu cases will be avoided among people who have the vaccine’, Dr John McCauley, director of the Worldwide Influenza Centre, said last week.

If certain conditions make you more at risk, another factor can be what doctors call ‘a poor cough’ — one that’s simply insufficiently powerful to clear the build-up of mucus in the lungs. Short-term, this build-up of mucus in the lungs is a normal, healthy immune response to a viral or bacterial infection.

But if the cough doesn’t easily clear the phlegm, bacteria-laden mucus creates the perfect environment for an infection to take hold.

Another potential problem is having a degenerative disease, such as Parkinson’s, where a common symptom is difficulty swallowing, which inevitably interferes with robust coughing.

Chris Failes, a 72-year-old retired estate agent and mother of two with two grandchildren, from Lymington in Hampshire, was diagnosed with Parkinson’s two years ago.

Last May, her GP told her that the cough she’d suffered from over a few weeks was a mild form of pneumonia and she was prescribed antibiotics and told to rest. Through the summer and early autumn, Chris’s cough seemed to improve — though, looking back, she says, the cough didn’t ever really go away and, in the run-up to Christmas, it became worse.

‘I think it was the cold weather that made me so ill,’ she says. ‘It was horrible. My chest felt very uncomfortable and tight, as though I couldn’t breathe. I couldn’t get rid of the phlegm in my lungs. I had no energy.’

But if the cough doesn¿t easily clear the phlegm, bacteria-laden mucus creates the perfect environment for an infection to take hold

But if the cough doesn’t easily clear the phlegm, bacteria-laden mucus creates the perfect environment for an infection to take hold

She spent Christmas in bed and was then put on a third course of antibiotics by her GP. But by January 5, her doctor referred her to a chest consultant at the local hospital — where scans confirmed she had pneumonia.

‘I remember sitting in the hospital waiting for the results, my body lolling over to one side, my head drooped down onto my chest. I felt so lifeless.’

Yet, once diagnosed in a timely way, pneumonia is relatively easy to treat — as is clear from Chris’s recovery.

‘A week ago,’ she told Good Health last week, ‘I was so ill that I couldn’t move my head.’

But after just three days in intensive care, receiving intravenous antibiotics and liquids, as well as oxygen to ensure that her bloodstream remained oxygenated, Chris was well enough at the weekend to be discharged and sent home.

‘My doctor has told me I won’t be back to normal for six to eight weeks. And I am under strict instructions not to overdo it,’ says Chris.

‘But it means that I am missing out on looking after my grandchildren aged 18 months and five years — they are so gorgeous. I usually look after them once or twice a week and it’s awful not be able to — though I hope I’ll be better soon and be spending time with them again.’

I felt a bit tired — four days later I had to be admitted to hospital

Shannon Dixon, a freelance marketing consultant from London, rarely takes a day off sick. But four days after developing a ‘chest infection’ last month, she was admitted to hospital with pneumonia.

Just get better or die — that was the thought flashing through my mind as I lay in bed battling pneumonia, although I didn’t know then that this was what I had. I was just aware it was the most unwell I’ve felt in my life.

I rarely cry, but I’ve never before experienced such awful pain. Just a few days earlier, I’d been having supper at a colleague’s house one evening and looking forward to Christmas.

We were eating a pasta dish when I was suddenly overwhelmed by extreme fatigue — I’ve always had a healthy appetite, but I could only manage a couple of forkfuls.

Minutes later, I had to leave. I just didn’t have the energy to stay.

A week earlier, I’d had flu-like symptoms, which put me in bed for three days, but I’d rested after that and, aside from a lingering cough, thought I’d fully recovered.

I assumed the tiredness that evening was unrelated and thought an early night would fix it. But just a couple of hours later, I woke up drenched in sweat.

The next morning, I felt dreadfully nauseous. Every part of my body ached and I had a sharp, stabbing sensation in my right lung, which made it impossible to move my right arm. Whenever I breathed or coughed, I was in agony.

Shannon Dixon, a freelance marketing consultant from London, rarely takes a day off ill

Shannon Dixon, a freelance marketing consultant from London, rarely takes a day off ill

My boss told me to stay at home, and my dad checked in on me that night. We both assumed it was a bug, and he left a couple of hours later.

But the next 24 hours were horrendous. I began vomiting, coughing up phlegm and my temperature climbed to 38.7c.

I became delirious and woke up thinking there were people in the bed with me and that I couldn’t move because I’d wake them all up.

I tried ibuprofen and flu remedies, but whenever they wore off, I’d experience violent shaking and extreme chills. I couldn’t eat a thing and existed on herbal tea and fruit juice.

Deep down, I knew something was seriously wrong: I’d never felt so ill in my life and was crying — something I never do.

At which point, I looked online to check my symptoms. I was supposed to be meeting a friend and texted to say I thought I had pneumonia. I also mentioned it to my mum. Both told me to stop overreacting.

By now, my symptoms had been going on for four days.

Luckily, I had an appointment booked with my GP for something else the next morning.

She diagnosed a chest infection and I was prescribed antibiotics and told to go straight to hospital if my temperature — then 39.8c — rose further.

Hours later, it hit 40.4c. My mum drove me to A&E at St Mary’s Hospital, London, where an X-ray revealed a cloudy shadow over my right lung. The hospital confirmed I had a chest infection, but also pneumonia — caused by a bacterial infection. I was told the flu I’d had could have weakened my immune system, making me more susceptible.

I was severely dehydrated and was admitted to hospital for three days and put on intravenous antibiotics.

I spent a night in the Acute Care Unit, before being moved to a ward.

Within 12 hours of the antibiotics, I felt much better. I realised I was lucky my pneumonia was spotted when it was; it could have turned really dangerous.

When the doctor had told me I had pneumonia, I was scared, but happy to hear I hadn’t been overreacting — I had known something was wrong. Now, I will trust my instincts.Looking back, I was in so much pain. I didn’t even have the energy to watch Netflix!

Interview by HELEN GILBERT