An immunologist spoke about the epidemic of childhood pneumonia looming in Russia: “The season will be difficult”

Following China, European countries began to report a sharp increase in the incidence of pneumonia in children. And although there is no talk of any new pathogen (the culprit of the outbreaks is Mycoplasma Pneumonia, which has long been known to the world), the situation looks alarming. What’s happening? Is mycoplasma pneumonia a threat to Russian children?

World newspapers are full of photos of overcrowded children’s hospitals in China: babies on IVs are placed on mattresses on the floor. According to Chinese experts, Mycoplasma Pneumonia is detected in 40.34% of sick children and 5.59% of adults. The pneumonia caused by this bacterium is called “pneumonia on the legs” (in English – walking pneumonia): in most cases it is easily tolerated. But in young children who do not yet have immunity to this pathogen, the course of the disease can be severe and often requires hospitalization.

Symptoms of mycoplasma pneumonia: severe, irritating cough from the very beginning of the disease, headache, runny nose, fatigue. In China, they often talk about the acute onset of the disease, severe fever, which is poorly relieved by antipyretic drugs, as well as severe lethargy. At the same time, experts call the spread of such cases widespread: they were recorded in different regions of the country.

Local scientists see two main reasons for the increase in incidence. Firstly, there is a significant increase in antibiotic resistance in Mycoplasma Pneumonia. As the famous microbiologist Irina Yakutenko says, in Beijing from 2008 to 2012, the proportion of macrolide-resistant M. pneumoniae increased from 68.9% to 97%: “We can assume that over the past 11 years it has reached or almost reached 100%. In other regions of the world the situation is better, but even there the percentage of resistant strains is growing every year. This means that if a child infected with mycoplasma develops a severe course, we no longer have a safe way to quickly cope with the disease. These children have to be prescribed other antibiotics like fluoroquinolones or tetracycline, which in itself is unhealthy. In addition, if the doctor does not immediately test for resistance (and he usually does not), they first try to treat patients with macrolides, which has no effect and greatly increases the frequency of ending up in intensive care (not due to for the macrolides themselves, but due to the lack of effective treatment)”.

Another reason for the outbreak of pneumonia, which was voiced by representatives of the National Health Commission of China, is the lifting of covid restrictions. After they were lifted, influenza, Mycoplasma Pneumonia, respiratory syncytial virus (RSV), and SARS-CoV-2 began to circulate simultaneously in China. No unusual or new pathogens were detected. The massive spread of “old” viruses in China is due to the fact that during the Covid restrictions, people have lost their immunity to them. “In China, after the advent of Omicron, there was a strict zero covid policy, which was canceled literally in one day last November. And now something that was greatly feared in the West happened: the first cold season after the restrictions were lifted. In Europe and the USA they passed relatively calmly, because there restrictive measures were really strict only in the first act of the pandemic, then moderately strict plus or minus during the delta, and then only limited regulations were in effect. Therefore, a surge in the incidence of influenza, respiratory syncytial virus and other infections that regularly reach moderately high latitude during the cold season, was, but relatively small. By the way, a similar picture of an explosive incidence of respiratory diseases, but on a smaller scale, was observed in Australia and New Zealand, which, due to geographical reasons and tough policies, also kept quite strict Covid measures,” says Irina Yakutenko.

However, following China, a sharp increase in the incidence of pneumonia among children under 15 years of age was reported from France. At the same time, the outbreak reached a level that has not been recorded in the last 10 years. According to the observations of French pediatricians, the disease is manifested by fever, accompanied by severe fatigue (drowsiness) and the subsequent addition of cough. Local doctors also call the main pathogen Mycoplasma pneumoniae. The situation is similar in the Netherlands, where they talk about a sharp increase in the incidence of pneumonia among children 5-14 years old. The weekly incidence rate was 80 cases per 100,000 people.

As the famous immunologist Nikolai Kryuchkov told MK, the increase in the incidence of mycoplasma pneumonia in China began not just recently, but at the beginning of summer: “Outbreaks affect not only children, but also adults. We must take into account that this disease is extremely common: for example, in In the United States, for every 330 million people, there are 2 million cases of Mycoplasma pneumoniae pneumonia annually, but in reality there are many more patients. In most cases, this disease is mild, but it can also be severe, especially in young children. Today, ARVI is on the rise in Russia and Europe, There are many different viruses circulating – it cannot be ruled out that we do not have an increase in mycoplasma. Most likely, there is, and a considerable one. Remember that after the lifting of anti-Covid restrictions, starting in the fall of last year, the risks for all infections that are transmitted have increased by airborne droplets There is no vaccine against mycoplasma, and the only thing that prevents the disease is anti-infective measures and post-infectious protection of the population. Perhaps we had an increase in mycoplasma infection last season, we just didn’t notice it. To notice, you need large outbreaks, like in China, and then epidemiologists begin to closely study this infection. Including in other countries. Apparently, last season they paid less attention to it, because the focus was on influenza and ARVI, and everyone blamed it on them.

– Is it possible that our children’s infectious diseases hospitals will be overcrowded due to an increase in cases of mycoplasma pneumonia?

– There are no prerequisites for this yet. The season will be difficult, and although there will be less flu and ARVI than last year, there will still be a lot. Mycoplasma, since it has become active, will be more numerous than last season, but it is unlikely to be many times greater. And there will be a lot of SARS-CoV-2, which in most cases will not be tested, but outbreaks will be noticeable. I don’t think that children’s hospitals will be overcrowded, unless the causative agent of mycoplasma infection has somehow changed dramatically.

– Are there common strains of mycoplasma that are resistant to antibiotics in our country?

– It is unlikely that we can have a high level of resistance to macrolides; I would not say that it is antibiotic-resistant mycoplasmas that prevail. But it is possible that treatment will be more difficult to choose.

Meanwhile, Irina Yakutenko reminds us that we will hear more than once about resistant mycoplasma, especially given the azithromycin Covid madness in some countries: “Let me remind you, for example, in Russia this antibiotic was widely prescribed prophylactically to “prevent complications in the lungs.” Azithromycin is a macrolide and a drug first choice for treatment of M. pneumoniae. So don’t be surprised if things turn out bad.”