Mystery pneumonia in China

Clusters of undiagnosed pneumonia in Beijing and North China

What’s behind China’s mysterious wave of childhood pneumonia?

China, surge in respiratory illnesses, including pneumonia, in children.

International society for infectious diseases

https://promedmail.org

https://www.telegraph.co.uk/global-health/science-and-disease/china-disease-latest-who-covid-infection-children/

https://www.dailymail.co.uk/health/article-12779783/child-pneumonia-outbreak-china-hospitals.html

Program for Monitoring Emerging Diseases

(International Society for Infectious Diseases)

Clusters of “undiagnosed pneumonia”

We expected a surge in respiratory disease this time of year, but what is happening in China is unusual.

? more than rebound

? community immune debt

Hospitals in Beijing and 500 miles northeast in Liaoning are 'overwhelmed with sick children' with unusual symptoms that include

Radio Free Asia reported

said that more than 3,500 cases of 'respiratory infection' had been admitted to the Beijing Children's Hospital at the start of October,.

1000 new cases per day

https://emedicine.medscape.com/article/223609-overview

China has now included Mycoplasma pneumoniae as well as other known respiratory pathogens, like influenza, covid and RSV

Local reports

inflammation in the lungs

a high fever but no cough

Mycoplasma pneumoniae

It is among the most common causes of community-acquired pneumonia in school age children.

Generalized aches and pains
Fever usually ≤ 102°F, (38.9’C)
Cough - Usually nonproductive
Sore throat (nonexudative pharyngitis)
Headache/myalgias
Chills but not rigors
Nasal congestion with coryza
Earache
General malaise

Pneumonia develops in only 5-10% of persons who are infected.

The Beijing Center for Disease Control and Prevention (CDC)

https://edition.cnn.com/2023/11/28/health/china-respiratory-illness-surge-wellness/index.html

https://foreignpolicy.com/2023/11/28/chinese-hospitals-pandemic-outbreak-pneumonia/

The World Health Organization

Upsurge of respiratory illnesses among children-Northern China

23rd November

https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON494

The WHO requested information
Using International health regulations

Laboratory results and data

Recent trends in the spread of respiratory illnesses,

from China’s health authorities last week.

WHO said China’s health authorities have said rise in hospitalizations since October to known pathogens,

such as adenoviruses, influenza virus, and RSV,

(which tends to cause only mild, cold-like symptoms)

Common winter infections — as opposed to any new pathogens — are behind the spike in hospitalizations.

https://themessenger.com/health/china-respiratory-illness-outbreak-mysterious-beijing-covid-2023

Chinese medical statistics remain deeply unreliable; the country still claims that total COVID-19 deaths sit at just over 120,000, whereas independent estimates suggest the number may have been over 2 million in just the initial outbreak alone.

https://www.reuters.com/world/china/nearly-2-million-excess-deaths-followed-chinas-sudden-end-covid-curbs-study-2023-08-25/

Nature news explainer, 27th November

https://www.nature.com/articles/d41586-023-03732-w

China’s first without COVID-19 restrictions since the pandemic began in 2020.

Mycoplasma pneumonia and RSV are known to affect children more than adults.

No changes in the disease presentation were reported by the Chinese health authorities.

Chinese authorities advised that, since mid-October, enhanced outpatient and inpatient surveillance has been implemented for respiratory illnesses

What is unusual, say epidemiologists, is the high prevalence of pneumonia in China.

UK, respiratory syncytial virus (RSV) mostly drove spikes in illness.

November 2022, more hospitalized influenza in US

Main cause of pneumonia

Mycoplasma pneumoniae,

bacterium that infects the lungs.

Normally causes a milder ‘walking pneumonia’,

doesn’t require bed rest or hospitalization.

Medscape

Slow spread throughout households is common, with a mean incubation period of 20-23 days. Disease tends to not be seasonal, except for a slight increase in late summer and early fall.

Benjamin Cowling, epidemiologist, University of Hong Kong

“This is a typical ‘winter surge’ in acute respiratory infections,”

“It is happening slightly earlier this year, perhaps because of increased population susceptibility to respiratory infections resulting from three years of COVID measures.”

Francois Balloux, computational biologist, University College London

“Since China experienced a far longer and harsher lockdown than essentially any other country on Earth, it was anticipated that those ‘lockdown exit’ waves could be substantial in China,”

However

Mycoplasma pneumoniae infections have very been common.

Teachers getting ill

Bacterial pneumonia is often secondary to viral infections,

Opportunistic infection

Studies show that resistance rates of Mycoplasma pneumoniae to macrolides in Beijing are between 70% and 90%

Erythromycin, clarithromycin, azithromycin,

https://journals.asm.org/doi/10.1128/aac.02060-12

(data up to 2012)

levofloxacin as a secondary choice

Working hypotheses

No evidence of a novel virus or bacterium

Probably dangerous mycoplasma antibiotic resistance

Possible bacterial infection after novel virus, but less likely

New pandemic not immanent due to slow household transmission

Slow spread of multiple antibiotic resistance spread of mycoplasmic pneumonia

Need to optimise immune function, nutrition, vitamin D, sleep, exercise, appropriate antigenic challenge and hygiene hypothesis

Upgrade innate immunity as per Professor Angus Dalgleish and Professor Robert Clancy