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Developing Pneumonia from Flu

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14 February 2025

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5 minute read

Developing Pneumonia from Flu

By Dr. Harpreet Kaur A/p Harnam Singh

The popular TV drama series Meteor Garden’s star, Barbie Tsu, has tragically passed away at just 48 years old, leaving fans around the world in shock. Her untimely death has sparked widespread conversations about flu-related pneumonia. This raises important questions: what is flu-related pneumonia exactly, how does it spread, and what steps can we take to protect ourselves? To gain deeper insight, we spoke to Dr. Harpreet Kaur from Columbia Asia Hospital – Tebrau, to shed some light on the topic.

What is flu-related pneumonia and how does it develop from flu?

“Flu-related Pneumonia is a lung infection that develops as a result of complications from an influenza (flu) infection. Influenza is a viral infection of the upper respiratory tract. It can spread easily in the community through coughing and sneezing. The Influenza virus can weaken the immune system in certain individuals, making it harder for them to fight off the infection, resulting in the influenza virus infecting the lungs.”

“Once in the lungs, the influenza virus can cause inflammation and accumulation of fluid in the air spaces, which can severely affect a person’s breathing. Additionally, with a weakened immune system, the damage caused by the influenza virus in the lung, can also cause bacteria to infect the lungs. This is referred to as a secondary bacterial pneumonia.”

Can influenza lead to sepsis, as mentioned in several newspaper articles regarding Barbie Tsu? If so, how does that happen?

“Yes, Influenza can lead to sepsis. Sepsis occurs when the immune system has an exaggerated response to an infection. The normal body response to a viral infection involves the activation of certain immune cells and the release of chemical substances known as cytokines to combat the virus. In some cases, the release of this immune response is excessive, that it causes widespread inflammation throughout the body. This can lead to tissue damage and organ failure.”

Why are some individuals more vulnerable to these serious complications from the flu, namely pneumonia and sepsis?

“There are a number of factors which may contribute to a higher risk of complications. These factors are related to an impaired immune function.  Age is a factor that needs to be considered. The paediatric population (children and adolescents) is susceptible to complications from the flu as their immune systems are not fully mature. The elderly are susceptible as aging weakens the immune response. Those with underlying medical illnesses are also susceptible to complications, as individuals who suffer from chronic diseases such as chronic lung disease, heart disease and diabetes, have a weakened immune response.

“Those with a suppressed immune system such as those suffering from cancer must take special precaution as they too are susceptible to complications from the flu. Pregnant women experience changes to their immune system as well that renders them susceptible to complications of the flu. Both obesity and malnutrition can reduce the immune response and result in complications from the flu.”

What factors might have contributed to the rapid spread of influenza in Japan and other countries?

“The rapid spread of influenza is influenced by a number of factors:

Human Behaviour:

  • Close Contact: Overcrowded environments contribute to the spread of the virus. These include environments such as schools and public transportation
  • Travel Patterns: With global travel, the virus can easily spread across borders, particularly during peak travel seasons when many people travel domestically and internationally, and this can contribute to the rapid spread of influenza.
  • Vaccination: Low vaccination rates can also lead to higher susceptibility within a community. Lack of public awareness about the importance of flu vaccination coupled with poor hygiene techniques, can have an effect on the spread of the virus.

Environmental Conditions

  • Seasonal Variations: Influenza viruses typically peak during colder weather. The winter season in countries with a cold climate can create the optimal environment for rapid transmission of the virus, i.e. dry air and an increase in indoor crowding.
  • Climate: Changes in climate and weather patterns can affect the timing and intensity of flu seasons, potentially leading to increased outbreaks.

Viral Factors

  • Influenza viruses mutate regularly. This leads to new strains that can evade immunity from a previous infection or vaccination, making individuals more susceptible to developing the flu.
  • Different subtypes of the influenza virus (such as H1N1, H3N2) can vary in its severity and transmissibility, which impacts how quickly the virus can spread through populations.

Socioeconomic Factors

  • Urban areas with high population density are susceptible to a much faster rate of transmission of the virus due to the higher number of close contacts.
  • Individuals who are in a lower socioeconomic group may have less access to healthcare and education, which makes them more vulnerable to developing severe influenza
  • Large scale events such as football matches, concerts and festivals, are conditions where there are large groups that come together in a confined area. This facilitates the spread of influenza.

How true is it that weakened immune systems post-pandemic have made us more susceptible to the flu?

“The COVID-19 pandemic has had multiple effects on our immune system and may have indirectly contributed to the increase in susceptibility to influenza and other infections. Additionally, the unfortunate disruption in our healthcare during the pandemic, as well as other factors such as the reduced exposure to pathogens, psychological stress, vaccine hesitancy amongst the community and lifestyle changes all play significant roles in the increased transmission of infections.

There have been studies to indicate that some individuals may have weakened immune systems post-pandemic, which increases their susceptibility to the flu and other respiratory infections. Some individuals experience residual symptoms after recovery from COVID-19, this is known as Long COVID. There is some evidence to indicate that Long COVID can lead to a persistently weakened immune system, making individuals more susceptible to other infections.

There is also some evidence that the immune response to the COVID virus may affect how the immune system reacts to other viruses, such as influenza. For example, there are studies to suggest that COVID-19 may change the balance of certain immune cells, potentially impairing the immune system response to other viruses / bacteria.

What are the key signs that someone should seek medical help if they have the flu?

“If they are experiencing short or laboured breathing or chest pains or discomfort. Additionally, if the person is also experiencing non-respiratory symptoms such as abdominal pain or severe vomiting or diarrhoea, they may also need to consult a doctor as this can lead to extreme dehydration and worsening of their condition.

  • A persistent high spiking fever with severe headache which is unrelieved by medication is also another indication to see a doctor.
  • If an individual with the flu suddenly becomes confused, disoriented or is unable to stay awake, this is indicative of a serious and possibly fatal problem and medical help must be sought immediately.
  • The elderly as well as young children, those with compromised immune systems and those with underlying medical conditions, should seek medical attention sooner as they are at increased risk of complications from the flu.”

How can we differentiate between regular flu symptoms and more serious complications like pneumonia?

 “Regular flu symptoms tend to be milder and improve over a short period of time. They tend to present with fever, body aches and a cough. Pneumonia typically involves more severe symptoms, such as shortness of breath, chest discomfort and a productive cough. The symptoms persist for a longer period of time and worsen over time, in spite of taking regular treatment for the flu.”

What role does vaccination play in preventing severe flu-related complications?

“Vaccination plays a very important part in the prevention of severe flu related complications. The flu vaccine helps the body develop immunity against the most common strains of the virus. This significantly reduces the chance of developing complications from the flu. Even if a person gets the flu while already vaccinated, the symptoms are relatively mild and the risk of complications or need for hospitalisation is lower compared to those who remain unvaccinated.

“Vaccination of an entire community, i.e. herd immunity, slows down the spread of the flu virus. This provides protection not only to those who are vaccinated but also to those who are more susceptible to the infection but are not able to get the vaccine.

“Vaccination also reduced the risk of developing secondary bacterial infections, such as pneumonia, which is a potentially serious complication of Influenza. The more people that are vaccinated, the fewer people will contract the flu and the fewer people that are at risk of developing complications.

“The flu virus evolves every year and with each season, which is why the vaccine is regularly updated to include newer strains that are expected to circulate. Annual vaccinations with the flu vaccine ensures continued protection against the newer dominant strains.”

Are there any specific precautions Malaysians should take when traveling to countries with high flu activity like Japan?

“It is important to get vaccinated before travelling. The flu vaccine is recommended for anyone travelling in areas with a high number of influenza cases, particularly during flu season. When travelling, it is important to pay close attention to your health, particularly while on long flights or train rides. If you are feeling unwell, please seek medical attention promptly to prevent worsening of symptoms, as well as to reduce the spread of illness to others.

“Crowded spaces are the breeding ground for bacteria and viruses. Therefore, it is recommended to minimise your time in crowded areas such as public transport and tourist attractions. Wearing a mask is a good idea especially in public places. Wearing a mask can help prevent the spread of infection and protects you from inhaling airborne viruses in crowded areas such as in airports or the trains.

“Follow the local health guidelines. Every country has a different set of health guidelines particularly during flu season. It is important to adhere to local guidelines and recommendations for social distancing, wearing a mask and health monitoring while travelling.”

What simple everyday habits can help protect us and our families from the flu?

  • Wash your hands frequently, especially after coughing, sneezing or touching public surfaces. This will help protect you from germs. If soap and water are not available, use a hand sanitizer.
  • Cover your mouth when you cough or sneeze. Use a tissue or the sleeve of your elbow to prevent spreading germs to others
  • Avoid touching your face unnecessarily as germs can enter the body through the nose and mouth.
  • Keep your environment clean. Wipe down doorknobs, light switches, phones and keyboards regularly
  • Take care of yourself. Make sure to get enough sleep as rest helps the immune system to fight against illnesses. Ensure a healthy diet and stay hydrated to boost the immune system. Regular exercise is important for immune function and general well-being.
  • If you are unwell, stay at home, rest and recover. Avoid spreading germs to others

This article first appeared in The Star, 14 Feb 2025.

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14 February 2025

•

5 minute read

Developing Pneumonia from Flu

By Dr. Harpreet Kaur A/p Harnam Singh

Dr. Harpreet Kaur A/p Harnam Singh

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