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Another pandemic? Pediatric pneumonia surges in United States; raises global concerns amid China outbreak

The article discusses a surge in pediatric pneumonia cases in Massachusetts and Ohio, explores potential causes, including seasonal infections and weakened immunity, and highlights global concerns with similar outbreaks in China and Europe.

Another pandemic? Pediatric pneumonia surges in Massachusetts, Ohio; raises concerns amid China outbreak snt
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First Published Dec 1, 2023, 9:32 PM IST

In recent weeks, doctors in parts of Massachusetts and Ohio in the United States have reported a concerning spike in pediatric pneumonia cases, echoing outbreaks witnessed in China and parts of Europe. Health officials in Warren County, Ohio, have identified 142 cases of a condition termed 'white lung syndrome' since August, raising alarms due to its exceptionally high incidence.

Warren County, located just outside Cincinnati, has declared the surge an outbreak, as it surpasses both county and state averages. The affected children, with an average age of eight, tested positive for various infections, including mycoplasma pneumoniae, adenovirus, and strep. The outbreak's cause remains under investigation, with theories suggesting a combination of seasonal bacterial and viral infections.

"We do not think this is a novel/new respiratory disease, but rather a large uptick in the number of pneumonia cases normally seen at one time. As we approach the holiday season, when many of us will be gathering together with family and friends, please remember to take necessary precautions to protect your health. Wash your hands, cover your cough, stay home when ill and stay up to date on vaccines," read a release from the Warren County Health District.

Warren County's medical director Dr Clint Koenig said, "We have seen hospitalizations [for child pneumonia] tick up in the last couple of weeks so we do ask parents to be vigilant. 'Our school districts have called in starting roughly in August, but really picking up in mid to late October. 'We've also been noticing a lot of cases of kids being absent and the resulting diagnosis being pneumonia."

Experts emphasize that the pneumonia outbreaks may not be due to a novel pathogen but rather a convergence of multiple seasonal infections. Factors such as the cyclical nature of mycoplasma, weakened immunity in children due to pandemic-related measures like lockdowns and school closures, and the lifting of COVID-19 restrictions leading to increased viral and bacterial infections are considered contributors.

In western Massachusetts, physicians are observing a rise in walking pneumonia, a milder form of the lung condition caused by a mix of bacterial and viral infections. The main culprit identified is Respiratory Syncytial Virus (RSV), a respiratory virus that disproportionately affects young children and the elderly, causing upper and lower respiratory infections.

"This is the season for RSV and we're seeing a whole lot of it… a lot of kids with upper viral respiratory infections, cough, runny nose, some fevers and the thinking with RSV is that it can cause lower viral respiratory infections, so they get spread to your lungs," Dr John Kelley, from Redwood Pediatrics in East Longmeadow, told Western Mass News.

He added that walking pneumonia is observed in 80 percent of children who initially contract the Respiratory Syncytial Virus (RSV), with the remaining 20 percent typically attributed to bacterial infections such as mycoplasma pneumoniae.

Also read: H9N2 avian influenza explained: Causes, symptoms and precautions amid recent outbreaks in China

Similar pneumonia outbreaks have been reported in the Netherlands and Denmark, raising concerns about a potential global resurgence of respiratory infections. Experts suggest that China's simultaneous increase in COVID-19, flu, RSV, and mycoplasma cases may be indicative of the cyclical nature of these infections, exacerbated by the absence of pandemic restrictions.

While the Centers for Disease Control and Prevention (CDC) has been monitoring the situation, a source mentions that nationally, 'nothing is out of the ordinary' in the data. However, the CDC faces pressure to provide more information about the pneumonia outbreak in China, which has seen a surge in cases since May.

Infectious disease experts, including Dr Amesh Adalja from Johns Hopkins University, caution against extrapolating the situation in one county to the entire US population. They suggest that the winter outbreak may be less severe than the previous year's, which saw thousands of children hospitalized with RSV and flu.

"I would caution against extrapolating one Ohio county to a country of 330million people," Dr Adalja told the Daily Mail. Dr Adalja also suggested that the global emergence of pneumonia outbreaks may be attributed to the recurring or 'cyclical' nature of mycoplasma.

"Mycoplasma goes through epidemic cycles every few years and that may be what's occurring globally at the moment."

Dr Adalja noted that China might be facing a dual challenge of viral and bacterial infections as it enters its first winter without pandemic restrictions. The country is witnessing surges in COVID-19, flu, Respiratory Syncytial Virus (RSV), and mycoplasma cases. Reflecting on the situation, Dr. Adalja stated that the current scenario in China aligns with the dominance of COVID-19, flu, and RSV when restrictions were lifted last year.

While he anticipates this winter's outbreak to be 'less severe' than the previous year, marked by thousands of children hospitalized with RSV and flu, Dr. Adalja acknowledged that lockdowns have played a role in the emerging global phenomenon. He explained that newborns, who haven't encountered infectious diseases, contribute to the lower threshold for outbreaks as their numbers increase in the population. The pandemic has, over time, allowed the accumulation of susceptible individuals, contributing to the observed trend.

Dr Scott Roberts, an infectious diseases expert at Yale School of Medicine in Connecticut, indicated that the increase in cases is likely a result of compromised immunity in children. Speaking to DailyMail.com, he stated, "This is probably a recurrence of known pathogens that are hitting us a bit harder because of low immunity to them." 

Dr Roberts proposed that children's immune systems may still be affected by the consequences of COVID-19 restrictions, limiting their exposure to beneficial germs crucial for immune development. Additionally, he highlighted the natural waning of immunity over time as a contributing factor.

As the investigations into the pneumonia outbreaks continue, health officials emphasize the importance of taking necessary precautions, including hand hygiene, cough etiquette, staying home when ill, and staying up-to-date on vaccines. The global phenomenon underscores the need for ongoing vigilance and research to understand the factors contributing to the increased incidence of respiratory infections among children.

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