(CNN) — Hospitals in northern China and Beijing have reported an increase in the number of children suffering from respiratory illnesses, including pneumonia. Last week, the World Health Organization asked China to provide more information on the issue.
How worrisome are these cases based on what is known so far? Why are respiratory illnesses increasing? Should people traveling to China reconsider their plans? What additional precautions should governments, health systems and individuals take?
To help us understand the situation, I spoke with CNN’s health expert Dr. Leana Wen. Dr. Moon is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s health commissioner.
How concerning is the increase in reported respiratory illnesses in China?
Dr. Wen Lina: Based on what we know so far from the World Health Organization, I don’t think the rise in respiratory illnesses should be a cause for global concern. The international medical community is more worried about whether a new pathogen will emerge, just like Covid-19 in the winter of 2019. But that currently appears not to be the case.
After the World Health Organization asked Chinese health authorities for more information, it received data suggesting that an increase in outpatient and hospital visits may be due to an increase in known existing pathogens. Specifically, pneumonia caused by Mycoplasma pneumoniae has increased since May, and pneumonia caused by influenza, adenovirus, and respiratory syncytial virus (RSV) has increased since October. The World Health Organization said the increase was “not unexpected” given the lifting of restrictions due to Covid-19, with similar developments occurring in other countries.
Of note, no new pathogens have been detected. There were also no unusual clinical manifestations in which the child’s condition was much more severe than normal.
Why is China experiencing such growth now?
arts: It will undoubtedly be crucial for the WHO and other members of the international medical community to independently verify these data, especially given the delay in China’s authorities alerting the international community about Covid-19. However, the situation in China actually mirrors what happened in the United States and many other countries last year.
Last winter, 2022, children’s hospitals in the United States were overwhelmed with children infected with Covid-19, influenza, RSV, and other common viruses. The disease is largely attributed to the end of Covid-19 mitigation measures.
During the peak of the pandemic, respiratory illnesses declined dramatically. In particular, children who would have been exposed to multiple infections a year did not get sick. When mitigation measures were lifted, contagious diseases swept through schools and day care centers, leading to increased infection rates among children and, therefore, more children requiring hospitalization.
China lifted mitigation measures later than the United States and most other countries. It makes sense that during the first full winter after the end of “zero COVID” policies, they would experience a surge in respiratory illnesses like many places around the world.
Chinese health authorities attribute an increase in pediatric pneumonia cases to Mycoplasma pneumoniae. what is that?
arts: Pneumonia is a lung infection that can be caused by bacteria, viruses, and fungi. Mycoplasma pneumoniae is a common bacterial pneumonia. Some estimates suggest that approximately 1% of the U.S. population is infected with mycoplasma each year. Only 5% to 10% of people infected with mycoplasma will develop pneumonia.
Pneumonia caused by mycoplasma is called “atypical” pneumonia. The onset of the disease is usually gradual, with patients experiencing nonspecific symptoms such as low-grade fever, fatigue, and headache. Some people report persistent coughing or chest pain from coughing. Sore throat, runny nose, and earache may also occur, and in rare cases, individuals may experience rash, joint pain, and gastrointestinal symptoms.
According to the U.S. Centers for Disease Control and Prevention, M. pneumoniae infections are most common in young adults and school-age children. People who live and work in crowded environments, such as schools, are at greater risk.
Most patients with this type of pneumonia do not require hospitalization and improve with outpatient antibiotic treatment. Those most at risk of severe illness are young children, the elderly, immunocompromised people and people with serious underlying medical conditions.
Could cases of pneumonia also be caused by other microorganisms?
arts: Yes. Streptococcus is another common cause of pneumonia. RSV and Covid-19 are types of viruses that can also cause pneumonia. Many medical centers try to diagnose the source of pneumonia and determine whether it is bacterial or viral. However, diagnostic capabilities may be more limited in some areas. In addition, a person can be infected with multiple viruses at the same time, so it is not always easy to attribute the manifestations of pneumonia to a single microorganism.
Should people avoid traveling to China right now?
arts: The World Health Organization made it clear that it does not recommend “any travel or trade restrictions based on available information about this incident.” While it does recommend that people in China take steps to reduce the spread of respiratory illnesses, it also doesn’t recommend that travelers to China take any specific precautions. This includes staying home when sick, ensuring good ventilation, regular hand washing and “wearing a mask where appropriate.”
I think all of this is reasonable and would also add that people who are susceptible to serious illness from respiratory illnesses should take extra precautions, including wearing N95 masks or similar items in closed, crowded areas.
What additional precautions should be taken by governments and health systems, especially in other parts of China and neighboring countries?
arts: I agree with the World Health Organization that restrictions on travel or trade are not justified at this time, although the World Health Organization should certainly continue to pressure China to release up-to-date, accurate data.
At the same time, governments and hospitals can strengthen their own infrastructure. They should be aware of rising cases of influenza-like illnesses and pneumonia and seek prompt testing.
They must also ensure they have the capacity to treat patients who require inpatient care. Other areas, especially those that previously had strict virus mitigation measures in place, may see an increase in respiratory illness this winter. Health systems must prepare for a possible influx of patients, as they did during the peak of Covid-19.