What is causing the 'white lung' pneumonia spike in China and the US? How worried should you be? And

Nearly two weeks ago, news broke of an outbreak of a ‘mysterious’ pneumonia in China affecting children. 

While the spread began in May, the world only learned about it last week, prompting the World Health Organization to send official requests to China for more data.

Pneumonia is not a virus itself. It is used to describe any infection that inflames the lungs, whether that be a virus like Covid or a bacteria like strep.

Data shared with the WHO and Centers for Disease Control and Prevention revealed the surge in cases in China was not being caused by a novel pathogen, like the Covid pandemic was.

Rather, testing shows the pneumonia cases are being caused by several seasonal illnesses – including flu, RSV and the lesser-known mycoplasma.

The above highlights the two locations where rises in pneumonia cases in children have been reported in the US so far. They are Warren County, Ohio, and East Longmeadow, in Massachusetts

The above graph shows deaths from pneumonia and flu among children aged under 18 years old since the 2019 to 2020 flu season

Mycoplasma pneumonia is a bacterial infection that infects at least 2million Americans each year – but it rarely makes headlines because cases are mild and deaths extremely rare.

The difference this time is that children’s immunity, globally, is low following lockdowns, school closures and mask mandates.

Those who locked down harder and longer, like China, are seeing bigger outbreaks, but even Sweden, which notoriously did not shut down its society, has recorded a rise in child pneumonia cases. 

Similar outbreaks of the strain of pneumonia — dubbed ‘white lung syndrome’ because of the distinctive white patches on chest x-rays of affected children — have been reported in Denmark, the Netherlands, and at least two states in the US – Ohio and Massachusetts. 

Health authorities across the globe are assuring the public the world is not on the precipice of another pandemic.

Below DailyMail.com explains why: 

What is the current situation? 

The WHO has placed an additional request to China for more information on its outbreak and data showed the country is experiencing an increased number of children sick with mycoplasma pneumoniae – bacteria that causes mild infections of the respiratory system – since May. 

And in signs eerily reminiscent of Covid, Chinese officials have called for masks and social distancing.

While China continues to deal with its own overrun hospitals and children out sick from school, outbreaks have begun to crop up in Europe. 

On Thursday, Danish health officials said they were also dealing with a surge in the same type of pneumonia afflicting China. 

Denmark’s Statens Serum Institut (SSI) revealed rates of the illness have tripled over the past five weeks and warned more kids will likely become sick this winter.

That news came days after the Netherlands reported its own alarming spike in children battling pneumonia, with a similar situation unfolding in Denmark’s neighbor Sweden. 

Meanwhile, in the US, doctors in Massachusetts and Ohio began reporting this week a spike in pneumonia cases among children similar to the outbreak in China and parts of Europe.

In Warren County, 30 miles outside of Cincinnati, there have been 142 pediatric cases of the condition since August. 

The state’s department of health said the situation meets its definition of an outbreak.

And in Massachusetts, doctors are seeing an increase in walking pneumonia, a mild form of the lung disease.

What is causing the spike in pneumonia cases? 

The outbreaks in the US, like China, are not being caused by a novel pathogen and not all of the pneumonia cases are being caused by the same infection. 

Experts say a mixture of several seasonal bacterial and viral bugs are hitting at once, putting pressure on hospitals. 

Many patients with respiratory symptoms are testing positive for a bacterium called mycoplasma pneumoniae, a pathogen that causes mild pneumonia.

Positive tests have also returned for adenovirus, a normally benign respiratory infection, and strep. 

Dr Amesh Adalja, an infectious disease expert from Johns Hopkins University in Maryland, told DailyMail.com he believes the pneumonia outbreaks cropping up around the world could be due to the ‘cyclical’ nature of mycoplasma.

Bacterial respiratory infections usually flare up every five years, normally as people are recovering from a wave of flu or other viral illnesses. 

Most infections are mild, but those who have recently recovered from a respiratory infection are at higher risk. 

Dr John Kelley, from Redwood Pediatrics in East Longmeadow, Massachusetts, told Western Mass News that 80 percent of kids with walking pneumonia – a mild form of pneumonia – develop the infection as a result of first having respiratory syncytial Virus (RSV).

The remaining 20 percent of cases are usually attributed to bacterial infections like mycoplasma pneumonia.

The above shows a pediatric hospital in California in January 2021, when hospitals in the US were hit by a wave of sick children 

What is mycoplasma pneumonia? 

Mycoplasma pneumonia is caused by a very small, ‘atypical’ bacterium called mycoplasma pneumoniae, which can lead to upper respiratory tract infections and pneumonia.

It causes illness by damaging the lining of the respiratory tract, including the throat, lungs and windpipe and is one of the most common causes of community-acquired pneumonia in the US.

The bacterium causes people with the lung infection to present with ‘atypical’ characteristics compared to those people experience with ‘typical’ pneumonia caused by germs or complications from another illness. 

The bacterium spreads through droplets when an infected person sneezes or coughs. It can linger in the nose and throat without making a person sick, but if it spreads to the lungs, people can develop mycoplasma pneumonia. 

While mycoplasma pneumonia is often a milder form of the lung disease – sometimes referred to as walking pneumonia – its symptoms last longer and people with the illness do not respond to antibiotics used to treat typical pneumonia. 

The Centers for Disease Control and Prevention said the number of infections varies over time and peaks every three to seven years.

An estimated 2million mycoplasma pneumonia cases occur every year and deaths are so rare the CDC doesn’t have a firm estimate.

Why are cases spiking among children?

The outbreak is hitting children the hardest because of their underdeveloped immune systems, doctors told DailyMail.com.

While adults have decades of exposure to common bugs and illnesses that has led to beefed up immunity capable of fighting off colds and viruses, children build up their immune system by gradually being exposed to germs and bacteria at daycare, school, playgrounds and playdates.

However, because so many kids across the globe spent several of their formative years social distancing and wearing masks, they were not exposed to germs and their body was not able to build up resistance.  

And studies have shown that children’s immunity was damaged during the pandemic because of their lack of exposure to common germs that strengthen the immune system against infections.

China had a much harsher and longer lockdown than other nations, under its ‘zero Covid’ policies, which were only officially lifted in January, and this is the country’s first winter in years without restrictions in place. 

Data from Chinese health officials seen by the WHO shows pediatric cases of RSV, adenovirus, influenza and COVID-19 have been rising since the fall. 

Officials say the surge is not completely unprecedented and China would not be the first country to experience post-pandemic outbreaks. 

Both the UK and US experienced a rise in other pediatric illnesses following lockdowns, with rates of respiratory illnesses surging after the countries emerged.

Doctors said at the time the spike in hospitalizations among children was ‘worse than any other’ — as seasonal bugs returned and cases of flu and RSV hit their highest levels in more than a decade.

How worried should you be?

Health authorities are assuring the public the outbreak is not being caused by a novel or unknown virus, but is just a surge in the normal winter virus season. 

Additionally, health experts also say there is no connection between the outbreaks in Massachusetts and Ohio to the one occurring in China. 

The CDC has said the agency is not seeing anything out of the ordinary, but is monitoring the situation closely and doctors have said it is not shocking to have an outbreak of mycoplasma pneumonia now given its cyclical nature. 

No public or global health emergencies have been declared and doctors are advising parents to monitor their children’s health and seek medical treatment if their child begins showing symptoms. 

Additionally, if kids do fall ill, most young patients improve within days.  

How can you protect your children?

To keep children healthy from RSV, flu, pneumonia and mycoplasma pneumonia, it is important to practice good hygiene like hand washing and using hand sanitizer. Covering their mouth when kids sneeze or cough is also key to preventing droplets from spreading. 

Wearing a mask can also help stop the spread.  

Additionally, keeping sick children home from school and activities will help prevent illnesses from spreading child-to-child. A healthy and balanced diet, as well as enough physical activity and sleep can help strengthen the immune system.

Being up to date on vaccinations is also important. Vaccines are available for the flu, RSV and pneumonia.  

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