What ‘mysterious disease’ in China is India closely watching? Know all about the pneumonia affecting children

The Union Health Ministry has said it is closely monitoring the outbreak of H9N2 and clusters of respiratory illness in children in northern China.

ByChetana Belagere

Published Nov 24, 2023 | 5:25 PMUpdatedNov 24, 2023 | 6:36 PM

China has seen a recent increase in respiratory illnesses. (Wikimedia Commons)

The recent increase in respiratory illnesses among children in northern China has raised concerns globally, and India is no exception.

The Union Health Ministry on Friday, 24 November, stated that it was closely monitoring the outbreak of H9N2 and clusters of respiratory illness in children in northern China.

Meanwhile, epidemiologists, public health experts, and doctors have raised concern over the infection and said that though there was no need for panic, India should continue to monitor the situation closely.

“There is a low risk to India from both the avian influenza cases reported in China as well as the clusters of respiratory illness,” the ministry said in a statement.

It also said that “there has been no identification of an unusual pathogen”.

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The developments so far

Since mid-October, the World Health Organization (WHO) has been closely monitoring the situation in China following reports from the country’s surveillance systems indicating a rise in respiratory diseases that predominantly affect children.

The WHO requested additional information following reports from the outbreak surveillance network ProMed about “undiagnosed pneumonia” cases in northern China. This network was instrumental in initially bringing Covid-19 to the world’s attention.

This request aimed to determine if the reported pneumonia clusters were separate events or part of the general increase in respiratory illnesses.

While China’s National Health Commission (NHC) acknowledged a nationwide increase in respiratory diseases, the surge was attributed to the lifting of Covid-19 restrictions and the onset of colder weather.

“The increase is primarily due to known pathogens like influenza, Mycoplasma pneumoniae, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Notably, Mycoplasma pneumoniae and RSV are more likely to affect children than adults,” the NHC told reporters in the second week of November.

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What is this mysterious disease?

On 23 November, the WHO held a teleconference with Chinese health authorities. The data provided indicated a rise in outpatient consultations and hospital admissions of children due to pneumonia caused by Mycoplasma pneumoniae since May, and due to RSV, adenovirus, and influenza virus since October.

The Chinese health authorities were said to have reported no detection of any unusual or novel pathogen.

Meanwhile, Chinese authorities have reportedly enhanced outpatient and inpatient surveillance for respiratory illnesses since mid-October, covering a broad spectrum of viruses and bacteria, including Mycoplasma pneumoniae.

This enhanced monitoring may have contributed to the increased detection and reporting of respiratory illness in children.

Since mid-October, Chinese authorities have emphasised the need to strengthen healthcare system capacity alongside enhancing disease surveillance.

China’s existing systems capture information on trends in influenza, influenza-like illness (ILI), RSV, SARS-CoV-2, pneumonia, and other severe acute respiratory infections (SARI).

These systems report influenza detections to platforms like the Global Influenza Surveillance and Response System (GISRS), led by the WHO.

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Current risk assessment 

As per the risk assessment by the WHO, the current outbreak’s reported symptoms align with several respiratory diseases.

The WHO, in its risk assessment report, said clinical manifestations, as per Chinese surveillance and hospital systems, are caused by known pathogens in circulation.

Mycoplasma pneumoniae, a common cause of paediatric pneumonia, is treatable with antibiotics. Enhanced surveillance systems have been implemented in China for respiratory illness, covering a broad spectrum of respiratory viruses and bacteria, including Mycoplasma pneumoniae,” the report said.

However, it also noted that limited information was available to fully characterise the overall risk of these reported respiratory illness cases in children.

Then again, the WHO also said that with the winter’s arrival and the co-circulation of respiratory viruses, an increasing trend in respiratory illnesses was expected, potentially straining healthcare facilities.

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WHO advises against travel 

The WHO recommended that people in China adhere to measures reducing respiratory illness risk.

These include vaccination against influenza, Covid-19, and other respiratory pathogens; maintaining distance from the ill; staying home when sick; getting tested and seeking medical care as needed; wearing masks appropriately; ensuring good ventilation; and regular handwashing.

No specific measures were recommended for travellers to China. However, travellers with respiratory-illness symptoms were advised to avoid doing so if possible and seek medical attention while sharing their travel history with healthcare providers.

The WHO also advised against any travel or trade restrictions based on the current information on this outbreak.

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Should India be worried?

Paediatricians and public health experts told South First that given the global interconnectedness and the proximity to China, India should closely monitor the situation.

“While the current outbreak in China is attributed to known respiratory pathogens and though Mycoplasma is a bacterial pneumonia, which doesn’t have pandemic potential, vigilance is crucial,” IMA Telangana’s Scientific Committee Convenor Dr Kiran Madhala told South First.

“India’s health authorities should be prepared to manage any potential spillover, especially considering the high population density and the challenges posed by healthcare infrastructure,” he added.

Deeming it definitely a matter of concern, noted epidemiologist, public health expert, and former Covid Task Force member Dr Giridhara R Babu from Karnataka told South First, “The recent increase in respiratory illnesses among children in China is a concern, though there is inadequate detailed data for a full risk evaluation.”

He explained that the patients there showed symptoms that overlapped with those from common respiratory pathogens, particularly those seen in influenza-like illnesses such as A (H3N2) and B/Victoria lineage viruses, which are typical for this season.

He also said these cases could be due to bacterial infections like Mycoplasma pneumoniae, a known contributor to paediatric pneumonia, which fortunately responds well to antibiotics.

However, Babu says the main challenge was the absence of a comprehensive risk analysis. “Vigilant and sustained tracking of surveillance data is imperative to determine if the frequency and severity of these cases surpass expected levels for common strains and illnesses,” he said.

Meanwhile, Telangana’s Magna Centre’s paediatric consultant Dr Sivaranjani Santosh told South First, “China is likely experiencing a major wave of childhood respiratory infections now as this is the first winter after their lengthy lockdown, which must have drastically reduced the circulation of respiratory bugs, and hence decreased immunity to endemic bugs.”

This was akin to the tsunami of respiratory infections that India had last year, she said.

Proactive measures such as enhanced surveillance, public health messaging, and preparedness in healthcare facilities would be prudent, said Dr KM Anand, an MD in paediatrics from Kochi.

He said India should ensure people especially start masking up, follow all the hygiene protocols that existed during the Covid-19 days, and maintain robust international collaboration and information sharing, particularly with the WHO and neighbouring countries.