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China warns of coming surge in respiratory illnesses

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CHINA said a surge in mycoplasma-caused pneumonia in children shows signs of ebbing, but warned that other respiratory illnesses are likely to hit the broader population hard during the mainland’s first winter after COVID restrictions.

Health authorities in Beijing say flu, adenovirus and respiratory syncytial virus have surpassed mycoplasma as the most frequently detected pathogens among patients at the city’s top pediatric medical centers. Nearby Tianjin and financial hub Shanghai have also seen their mycoplasma positivity rates trending down in recent days, according to local media reports.

But even as the mycoplasma danger for kids subsides, China’s National Health Commission said late last week that the spread of several respiratory pathogens could converge into a major outbreak between now and next spring.

The steady rise in pneumonia among children in kindergartens and primary schools flooded hospitals this month and prompted the World Health Organization to make an inquiry with Beijing. China said known germs were causing the outbreak — mostly mycoplasma pneumoniae, a bacterial infection that typically leads to mild colds in older children and adults but could cause more serious illness among younger kids.

The surge sparked a rush to hospitals by anxious parents, putting top pediatric medical centers under strain. Pictures of overcrowded hallways and children on intravenous infusions have gone viral on Chinese social media. More people are wearing masks on public transportation in cities including Beijing and some schools in eastern Zhejiang province suspended in-person teaching after several kids were sick with mycoplasma and other illnesses. Some parents have also called for temporary school shutdowns to prevent the spread.

EXISTING GERM
Outside China, the scenes have, for some, brought back memories of the early days of COVID, which emerged as a mysterious pneumonia — and fueled concerns that the mainland could see another new pathogen emerge.

Health experts, like the government, say the culprit is likely an existing germ.

“The fact that only children are affected suggests this is most likely to be an existing pathogen,” said Jin Dong-yan, a professor specializing in virology and cancer at the University of Hong Kong. “If it’s a new pathogen it should mostly hit adults. It looks like it’s something adults have got accustomed to.”

Mycoplasma is a common pathogen causing pneumonia among children aged five or above and has triggered epidemics in China every two to four years. The latest mycoplasma positivity rate in Beijing — at 40% — is about 1.3 times higher than its 2019 peak, according to health data analytics firm Airfinity Ltd.

Observed symptoms among children in China are aligned with those typical of mycoplasma infections, with low incidence of severe disease, Airfinity said in a report — though it noted atypical symptoms have also been reported at a Sichuan province hospital.

More pressing for China is the mycoplasma strain’s high local resistance to the antibiotic used to treat it. The country has the world’s highest rate of resistance to a type of antibiotics called macrolides, such as the commonly-prescribed azithromycin, data compiled by Airfinity show.

That’s a “significant concern,” Airfinity said, with macrolides currently the only recommended standard of care for children under eight with a mycoplasma infection.

The bacterial infection also appears to have caused upticks in other countries. An analysis of case detections across 23 countries and regions around the world cited by Airfinity showed increases in Denmark, Sweden and Singapore from late 2022 through early 2023, as much of the world grappled with a post-COVID surge in flu and RSV. Taiwan has also warned of a potential outbreak early next year given frequent exchanges with the Chinese mainland. — Bloomberg

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