Mysterious pneumonia-like illness grips China, sparks fear of a pandemic

A map of northern China showing Beijing. Credit: iStock

The World Health Organization (WHO) on November 22, 2023 requested the Chinese government for a detailed report after Beijing and Liaoning in northern China reported a widespread outbreak of an undiagnosed respiratory illness that has led to children’s hospitals being besieged with worried parents and sick children.

The agency sought to know about all pathogens in circulation including influenza, SARS-CoV-2, respiratory syncytial virus (RSV), and mycoplasma pneumonia. It also sought details on the current burden on the health system due to a sudden outbreak of pneumonia in the country.

Going by China’s lack of transparency in the past, parents questioned whether the authorities were covering up the epidemic, ProMED, a publicly-available surveillance system conducting global reporting of infectious disease outbreaks reported on November 21.

Beijing Children’s Hospital is reported to be overcrowded. Children have developed high fever and pulmonary modules, a citizen said, ProMED reported. Some 800 kilometres away from the Chinese capital, sick children were seen receiving intravenous drips at Dalian Children’s Hospital in Liaoning Province. A staff member of the hospital complained that patients had to wait in line for two hours at the emergency department.

Since mid-October, the region has reported an increase in influenza-like illness compared to the same period over the last three years, the WHO indicated. It is not clear as to when this outbreak started as it would be unusual for so many children to be affected so quickly, ProMed said.

Ending COVID-19 restrictions is the cause behind the latest upsurge in influenza-like illnesses, Chinese authorities said at a press conference on November 13. They emphasised enhancing surveillance and the capacity of the healthcare system.

Amesh Adalja, an infectious disease specialist and senior scholar at the Johns Hopkins Center for Health Security, United States told Down to Earth (DTE), “China lifted restrictions later than all parts of the world. So this cluster may be the result of common pathogens, whose transmission had been interrupted, all striking at once.”

Adalja added that a similar episode happened in the US last year with simultaneous high rates of COVID-19, RSV, and influenza. “It will be important for China to be transparent regarding what pathogens are responsible,” he told DTE.

The expert said anytime there is a cluster of respiratory illness, it is critical to understand what pathogen, or pathogens are behind it. “From the limited data that is emerging from China, this pediatric cluster seems to be related to several different common respiratory pathogens all increasing their prevalence,” Adalja told DTE.

Krutika Kuppalli, a medical officer for COVID-19 health operations at the WHO’s Health Emergencies Program wrote on X, that we need more information, but if this is Mycoplasma it is important to remember that it can cause extra-pulmonary disease and it can be treated with Azithromycin in children (although macrolide resistance is reported).

Mycoplasma pneumoniae is a bacterial pathogen that is very common and causes pneumonia, and it is treated with a standard course of antibiotics, Adalja explained.

According to a commentary in The Lancet Microbe, “Mycoplasma pneumoniae is a common cause of respiratory tract infections with community-acquired pneumonia as the major disease-related burden. Compared with other pathogens, M pneumoniae is atypical in many ways: it is one of the smallest self-replicating organisms.”

Epidemics occur every few years, the most recent being the epidemic that emerged in late 2019–early 2020, simultaneously across multiple countries, predominantly in Europe and Asia.

Several factors, including waning herd immunity or introduction of new subtypes into the population, account for the periodic occurrence of epidemics, the commentary said.

WHO recommend recommended the following measures to people in China:

• Keeping distance from people who are ill

• Staying home when ill

• Getting tested and getting medical care as needed

• Wearing masks as appropriate; ensuring good ventilation;

• Regular hand-washing.

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