Parents and their children queueing up at a hospital amid a surge in penumonia and respiratory illness in ChinaShare on Pinterest
Experts say there is no cause for alarm for the pneumonia outbreak in China and recent surges in cases across Europe and in the U.S. Costfoto/NurPhoto via Getty Images
  • Pneumonia cases among children in China have recently surged, resulting in severely overcrowded hospitals.
  • For some, the situation is reminiscent of the early days of COVID-19, though most experts have assured 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.

There are also breakouts of M. pneumoniae in Denmark and the Netherlands.

Some U.S. news outlets have been reporting on a mysterious “white lung” pneumonia syndrome cropping up in children in Ohio’s Warren County in the U.S. as being connected to the Chinese pneumonia outbreak.

Experts agree that “white lung” syndrome, which is a medical buzzword to describe the way that affected lung look on an x-ray, is unconnected to what is going on in China.

“White lung” syndrome is not caused by a novel pathogen, can be treated with antibiotics, and most patients do not require hospitalization.

“The recent surge in pneumonia cases among children in China is a concerning trend,” said pediatrician Dr. Daniel Ganjian, “as it has led to overcrowding in hospitals and strained healthcare resources.”

“However, it is important to note that this is not a new phenomenon; there have been similar spikes in pneumonia cases among children in previous winters,” he reminded.

Dr. William Schaffner, professor of preventive medicine, also suggested there is little cause for alarm.

“I think the communication between the Chinese public health authorities and the World Health Organization made clear that they have not discovered a distinctive new viral cause for this, rather than an array of viral and one bacterial pathogens are the causes,” he told Medical News Today.

In addition to M. pneumoniae, cold and flu viruses and R.S.V., are the culprits in most recorded cases in China this winter.

Epidemiologist Dr. Zuo-feng Zhang predicted, “If the Chinese children had had high vaccine coverage for COVID-19, flu, RSV [respiratory syncytial virus], and pneumonia — there is no vaccine for mycoplasma — the outbreak would not be so severe because a high proportion of the cases with mycoplasma have mixed infections with other respiratory infectious agents.”

Respiratory virus expert Dr. Andrew Pekosz noted that “A younger-aged population is protected from infection with a number of different viruses and bacteria during public health lockdowns.”

“When those lockdowns are removed, there is a larger portion of the population that lacks immunity to those pathogens and are therefore more susceptible to infection,” he told MNT.

That children encounter so many common pathogens is not a bad thing. It helps them build much-needed antibodies that will serve them well throughout life.

Dr. Schaffner said that children “acquire infections and spread them among themselves very readily because they play on top of each other, almost literally, and are not very hygienic. Children have the distribution franchise for the environment, and that’s normal.”

“Even though I’m a physician dealing with sick patients, I never got sick until our firstborn went to day care and brought home to daddy a whole series of viral infections,” he said.

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.

M. pneumoniae, similar to other infections, is becoming increasingly antibiotic-resistant.

A May 2023 study found that M. pneumoniae was between 70% to 90% resistant to one commonly prescribed type of antibiotics, macrolides, in Beijing.

“We need to be worried about the high antibiotics-resistance rate of mycoplasma pneumonia globally. The resistance rate of mycoplasma to antibiotics in Asia is about 90%, but in the U.S. is about 10%,” Dr. Zhang cautioned.

“You have to go to alternate antibiotics,” said Dr. Schaffner.

However, Dr. Zhang added that “we do need to worry about potential transmission through international travel which might lead to an increased proportion of the mycoplasma-infected individuals with resistant strains and will be difficult to be treated.”

Dr. Pekosz said that antimicrobial resistance was a major public health issue for a number of bacteria.

“We need to invest in next-generation antibiotics that have broader activity, as well as be mindful of how antibiotics are being prescribed. We need to move forward on multiple fronts to stem the problem of antimicrobial resistance,” he added.