At a time when the spread of respiratory viruses such as SARS-CoV-2 or RSV is increasing, a series of outbreaks of influenza-like respiratory illnesses and childhood pneumonia in northern China have renewed concerns. This has happened before the declaration of pandemics such as SARS or Covid, leading to WHO consultations on the matter and the reactivation of the international surveillance system.
Since mid-October, new cases in North China have Respiratory Diseases Similar to influenza This prompted the World Health Organization (WHO) to request detailed information on these events and outbreaks on 22 November, compared with the same period in the previous three years. pneumonia in children.
The emergence of new influenza strains or other viruses capable of causing a pandemic often begins with an outbreak of an undiagnosed respiratory disease: both SARS and Covid-19 were first reported as “unusual types of pneumonia,” which undoubtedly brings bad memory. The U.N. health agency rarely asks countries for more detailed public information because such requests are usually made internally.
The World Health Organization noted that China’s National Health Commission authorities reported on Nov. 13 an increase in respiratory illnesses as restrictions were lifted, a pattern also seen in other Asian countries, and a week later they reported unidentified cases of children in northern regions. Confirmed cases of pneumonia. China.
On November 21, the media and ProMED, the global electronic disease outbreak reporting system for monitoring emerging infectious diseases, reported an undiagnosed pneumonia epidemic in children..It’s not clear yet whether they are related to a general increase in respiratory infections previously reported by Chinese authorities, or whether they are independent seasonal events.But the current situation has led to hospital saturation In some areas, Beijing include.
The state-owned China People’s Broadcasting Station published an article online earlier this week saying that the average daily number of patients in the Department of Internal Medicine at Beijing Children’s Hospital exceeded 7,000, exceeding the hospital’s capacity. Health authorities have asked the public to bring children with mild symptoms to clinics and other facilities, the Associated Press reported.
“Chinese authorities attribute this increase to Restrictions due to Covid-19 lifted (China and other countries in Asia lifted anti-COVID control measures later than the West) seasonal cycle During the colder months when pathogens e.g. influenza influenzahe Mycoplasma pneumoniae (A Bacterial infections common, usually affects young children), respiratory syncytial virus (RSV) and SARS-CoV-2“The World Health Organization said in a statement on November 22.
WHO has requested China to provide more epidemiological and clinical information as well as laboratory results for these groups in children reported through the International Health Regulations mechanism, and has initiated a communication network with Chinese scientists and technicians and will Updates as appropriate. Data received.
In the meantime, it advises people in China to follow known precautions to reduce the risk of respiratory illness, including Vaccination Recommend, reserve distance being with patients; stay at home when he is sick, Take the test and receive medical care as needed, wear a mask, ventilation enclosed spaces and handwashing frequently.
China’s National Health Commission recommended in written questions and answers published online by the official Xinhua News Agency on Thursday that children with mild symptoms “first go to primary care facilities or health departments. For pediatricians, go to general hospitals” because large hospitals are overcrowded and have huge waiting lists.
After the COVID-19 epidemic was announced, China’s health authorities paid close attention to the high incidence of infectious diseases in children and “guided local governments to improve overall planning and implement a hierarchical diagnosis and treatment system.”
After the SARS outbreak in southern China in 2002, Beijing officials asked doctors to hide patients, and some patients were transported in ambulances during a visit by World Health Organization scientists to China, leading the World Health Organization to threaten to close its offices in China. Nearly two decades later, after the new virus emerged in late 2019, China shared key details about the coronavirus with the WHO, which praised China’s commitment to stopping the virus weeks before it began spreading around the world.
Experts say it’s too early to worry
David Heymann, London School of Hygiene & Tropical MedicineThe agency that coordinated the World Health Organization’s response to the 2002-2003 SARS outbreak said in a statement that the area may have a history of seasonal respiratory infections. “The challenge now is to identify and isolate the outbreak and determine the cause,” for which genetic sequencing is needed and isolation of cases is crucial.
François Baruch, University College Londonpointed out that China may be experiencing a serious wave of childhood infections because this is First winter since restrictions lifted, which may reduce a child’s immunity to common infections. “Unless proven otherwise, There is no reason to suspect the emergence of new pathogens“.
Adrian Hugo Aginagalde, specialist in preventive medicine and public health, coordinator of the Public Health Section of the Academy of Medical Sciences in Bilbao and head of the Service of the Epidemic Surveillance and Health Information Unit of the Province of Gipuzcoa It was stated on the Science Media Center platform (SMC) that “ Outbreaks of SARS among minors are not uncommon among us. In the context of increasing cases of RSV (respiratory syncytial virus), the situation described appears to be consistent with previously observed patterns. “In addition, improvements in symptomatic surveillance (surveillance of pneumonia cases) allow for early detection of increases in cases.”
Unlike viral respiratory infections, cases caused by mycoplasma (the bacteria that cause respiratory infections) are more difficult to confirm. They are milder, but empiric antibiotic treatment (without microbiological confirmation) makes it difficult to later identify the causative agent, since its growth in sputum samples is inhibited by its action.
“As they are mild pneumonias that do not require hospitalization, they are considered community-acquired pneumonias and the diagnosis is clinical and supported by radiological examination and does not require microbiological confirmation. In summary, this is a plausible hypothesis, which has some basis for confirmation. “Similar situations have occurred in our environment, but they have not had an impact on health care. Nonetheless, it is too early to make a clear assessment of the risks it may pose, pending confirmation by other means, such as serology.”
Sonia Zúñiga, Virologist, National Center for Biotechnology (CNB-CSIC)adding that “given the strict Restrictions in response to Covid-19 This has been the case recently in China, so it is not surprising that there is a general increase in respiratory infections of all kinds, caused by viruses and bacteria, facing the first winter without them. Not surprisingly, a large number of these cases have occurred in children, who previously had much lower immunity than the rest of the population. On the positive side, the scientific community, including the World Health Organization, is conducting more detailed monitoring due to experience gained during the pandemic. ”
Salvador Peiró, an epidemiologist and researcher in the field of health services and pharmacoepidemiological research at the Valencian Community Health and Biomedical Research Promotion Foundation (FISABIO), agrees, “China is the latest to withdraw from its very strict National covid-19 control measures that can significantly reduce the circulation of respiratory pathogens (not just SARS-CoV-2) in the long term. Rebound cases of various types of respiratory infections expected this fall (including Covid-19), as has happened in most countries (albeit earlier than China, predictably, as they were expected to withdraw measures against mainland China). ”
The information currently available is insufficient to assess the overall risk, if any, but it is unlikely . In this context, WHO’s action (requesting information and recommending general measures to control respiratory infections) appears to be appropriate. ”
Quique Bassat, pediatrician and epidemiologist at the Barcelona Institute for Global Health (ISGlobal)adding “any News from China The situation related to the increase in pneumonia cases will be closely monitored. The good news is that the increase in cases was reported quickly and investigations are ongoing rigorously.This growth is likely to be related to Seasonal increase in cases of typical respiratory pathogens Cold weather has occurred in many parts of the world, but in China it does not occur regularly due to restrictions in place until December 2022 (and they are very strict). ”
“China may be going through a The epidemiological situation is similar to what we experienced in our environment last fall and winter. Regardless, we need to monitor closely to make sure this is the case. ”