Childhood pneumonia outbreak: What's driving the surge in China?

Evan Walker
Evan Walker TheMediTary.Com |
Parents and their children queueing up at a hospital amid a surge in penumonia and respiratory illness in ChinaShare on Pinterest
China and a few other countries have experienced a recent surge in respiratory illness cases among children. Costfoto/NurPhoto via Getty Images
  • This winter, the number of children in China with pneumonia has hit new highs, resulting in severely overcrowded hospitals.
  • For some, the situation is reminiscent of the early days of COVID-19, though experts are largely unanimous in expressing assurance that this is not the start of a new pandemic.
  • While there are several possible causes, including common seasonal viruses and bacteria such as mycoplasma and antibiotic resistance, no unusual pathogens have been reported.

With memories fresh regarding the outbreak of COVID-19 from Wuhan, China, it is not surprising that some are concerned about a substantial spike in hospitalizations due to cases of pneumonia among children in China. Experts say, however, that this is likely not a possible pandemic but rather the result of a few predictable, non-worrisome factors.

This is China’s first winter without COVID-19 protections in place since 2020, and Reuters reports that WHO China said “Chinese health authorities advised that the current numbers they are observing is not greater than the peak in the most recent cold season prior to the COVID-19 pandemic.”

Some individuals have claimed the increase in pneumonia cases seen is due to ‘immunity debt’, the idea that children were not exposed to usual childhood infections during lockdowns, and will get those infections at a later date as they have not encountered those bacteria and viruses to build up an immunity to them.

However, it is not necessarily the case that they will experience a worse infection. A paper published in The Lancet Infectious Diseases in January 2023 attempted to quantify the scale of immunity debt on cases of respiratory syncytial virus, or R.S.V., a virus that causes common childhood respiratory infections. However, it is an unproven concept which has been blamed for previous outbreaks, such as the hepatitis outbreak seen among children in the U.K. in spring 2022, and the outbreak of Group A Strep in many countries in winter 2022.

The common strain of pneumonia, Mycoplasma pneumoniae, that is currently widespread is a “walking pneumonia” that is not typically life threatening and can be treated with antibiotics.

Children who have viral infections can also have complicated bacterial infections such as M. pneumoniae, although it is more common in a hospital setting.

In fact, “The high incidence of pneumonia is probably due to the overloaded children’s hospitals. Since many sick children were in the crowded hospitals, there are opportunities for cross-infection, leading to mixed infections of respiratory agents. Both could lead to an increased incidence of pneumonia,” said Dr. Zhang.

Dr. Schaffner said viruses “create inflammation in the respiratory tract, and then the bacteria which you are normally carrying back in your throat can take advantage of that, get through the barrier of the mucus membranes, and get into the lung and cause pneumonia.”

Dr. Ganjian addressed the possibility that in some cases, the under-treatment of viruses has resulted in pneumonia cases in China.

“This is because parents may be more likely to seek medical attention for their children if they have symptoms of pneumonia,” he said, “which can be more severe than symptoms of a common cold or flu.

At the same time, M. pneumoniae does not require a preceding infection.

Mycoplasma pneumonia is everywhere and always has been everywhere,” said Dr. Schaffner.

“This is not something new. It’s just not discussed as much. [In] the United States, [it is] certainly not one of the illnesses that’s routinely reportable by state regulation to public health authorities. So we don’t have as much data on mycoplasma pneumonia that usually comes from studies done by academic medical centers,” he explained.

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