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Must -We are worried about the pneumonia epidemic in China?

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Beijing residents walk the streets of the Chinese capital with masks due to the rise in cases of respiratory diseases, November 21, 2023.

  • Mélanie Meloche-Holubowski (View profile)Mélanie Meloche-Holubowski

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In China, the recent surge in hospitalizations due to childhood pneumonia has attracted the attention of the World Health Organization (WHO). The main culprit seems to be the bacteria Mycoplasma pneumoniae. In the middle of flu season, should we be worried about this pathogen? Here are five questions to help you understand.

If we observe a particularly significant epidemic resurgence in China (New window), it should be noted that this bacteria is resurfacing almost everywhere in the world.

France (New window), Vietnam, Nepal (New window) and South Korea are also reporting an increase in cases of childhood pneumonia linked to the bacteria Mycoplasma pneumoniae.

According to European researchers (New window), this increase had been detected in Asia and Europe (particularly in Denmark and Sweden) as early as July 2023.

In Quebec, since infection caused by Mycoplasma pneumoniae is not a notifiable disease, it is difficult to precisely determine the number of cases in the province.

However, the Quebec Ministry of Health indicates that it is closely monitoring the situation in China and that in the event that there is an outbreak caused by Mycoplasma pneumoniae representing a threat to the population, it should be reported to public health authorities.

According to the observations of Dr. Caroline Quach, pediatric microbiologist infectious disease specialist at Sainte-Justine Hospital, and from Dr. Jesse Papenburg, pediatric infectious disease specialist at the Montreal Children's Hospital, the number of cases of pneumonia caused byMycoplasma pneumoniaeremains low.

“We are in the middle of the respiratory virus season, but we have not seen an increase in Myscoplasma< /em>,” says Dr. Quach.

Mycoplasma pneumoniae is a bacteria that can cause pneumonia. It is transmitted by droplets.

The progression to pneumonia is rare in children under 5 years of age, but common in young people aged 5 to 15 years. In adults, the disease is usually mild or without symptoms; However, infection can be serious in elderly or immunocompromised people.

It is typically mild pneumonia, with a little fever, cough, runny nose, headache. Compared to other pneumonias, there is less high fever and chest pain, says Dr. Papenburg.

As is the case cases with COVID-19, it is possible to be contaminated by the bacteria and be asymptomatic.

This bacteria can be detected by PCR test.

Usually, recovery occurs naturally two weeks after the onset of symptoms. An antibiotic may be prescribed to treat pneumonia.

Cases of pneumonia caused by Mycoplasma pneumoniae can occur at any time of the year, but they tend to to be more frequent in winter.

Typically, outbreaks of Mycoplasma pneumoniaeappear at intervals of one to three years. The most recent was identified in the years 2019-2020, especially in Europe and Asia.

As is the case for several viruses respiratory, the presence of the bacteria Mycoplasma pneumoniae has significantly decreased during the COVID-19 pandemic, due to the numerous health measures put in place.

After the lifting of these measures, some countries experienced a very difficult first winter, with the return of several respiratory infections. For its part, China lifted its health measures in December 2022, more than a year after the majority of countries had withdrawn theirs.

This is why the WHO believes that China is experiencing a sort of catch-up, as was the case in many countries last fall and winter.

Data from China sent to the WHO shows an increase in several types of respiratory illnesses, including respiratory syncytial virus (RSV), influenza (influenza) and COVID-19.

This is their first winter [without measures against COVID-19]. They have three cohorts of children who have not experienced respiratory viruses. It’s somewhat normal to see sky-high rates. Here, this is our third winter where respiratory viruses have started to circulate again. We must not forget that two autumns ago, we had a monstrous RSV season, says Dr. Quach.

Among other explanations possible for high hospitalization rates, remember that a person can be simultaneously infected with SARS-CoV-2 and other viruses or bacteria. A study showed that co-infection with SARS-CoV-2 and mycoplasma is very common and leads to more serious complications.

Finally, experts argue that COVID-19 infections have weakened the immune systems of many people, making it easier to become infected with another virus or bacteria. Although there is evidence of persistent immune dysfunction in some people who have contracted COVID-19, it is not known whether this applies to the general population.

Another reason why we see so many hospitalizations for Mycoplasma pneumoniae pneumonia in China is that a high number of antibiotic-resistant pneumonias are reported there.

< p class="StyledBodyHtmlParagraph-sc-48221190-4 hnvfyV">This doesn't really surprise Dr. Papenburg, who points out that in Asia, macrolides are the preferred treatment for treating Mycoplasma pneumoniaerespiratory tract infections /em>, seem not very effective against this bacteria.

According to a 2016 study (New window), the proportion of pneumonias caused by Mycoplasma pneumoniae that are resistant to antibiotics varied between 0 and 15 % in Europe and the United States (12% in Canada (New window)) and was around 30% in Israel. In Asia, it’s over 90%.

[China] has had resistant strains for several years, which we don't see as much here, adds Dr. Papenburg.

That said, for cases that are resistant to macrolides, Dr. Quach says there are other treatments.

“I don't think families in Quebec right now need to worry about Mycoplasma pneumoniae , says Dr. Papenburg. The most likely cause of pneumonia is respiratory viruses. »

According to the two doctors, a mixture of respiratory viruses is currently circulating in Quebec and Canada.

In recent weeks, among adults, 15 to 30% of pneumonias have been caused by SARS-CoV-2.

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In children, 32.5% of pneumonia is caused by respiratory syncytial virus; 20.8%, by rhinovirus or enterovirus; and less than 3%, by SARS-CoV-2. In pediatrics, our bug is RSV, says Dr. Quach.

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COVID-19 continues to cause more complications in adults, but hospitalizations related to the disease in children are uncommon, adds -telle.

Besides, the influenza season hasn't quite started. In the coming weeks and months, there are going to be a lot of children who are going to have coughs and fevers, Dr. Papenburg believes.

That's why Dr. Papenburg and Dr. Quach remind us that it's not too late to get a vaccine against influenza or COVID-19. Both are offered free of charge to all Quebecers.

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