Introduction

According to the most recent ECDC report (15/12/2023), primary care consultation for respiratory illness have been gradually increasing, as expected, in the EU/EEA since September 2023. Several viral and bacterial respiratory pathogens are expected to continue co – circulating at variable levels during the coming months. This is typical of every winter season. Widespread implementation of non – pharmaceutical measures during the pandemic led to very low circulation of both viral and bacterial respiratory pathogens which resulted in reduced population immunity. This may exacerbate the respiratory disease burden this winter, particularly among those with few or no pre – existing exposures, such as young children. Paediatricians in primary care throughout Europe should not forget the tripledemic experience last year when we had to cope with flu, covid -19 and RSV infection – and streptococcal infection -  earlier that the expected seasonal distribution of the most common respiratory pathogens.

Since October 2023, increases in respiratory infections due to Mycoplasma pneumonia were reported by six EU/EEA countries (France, Norway, Sweden, Netherlands, Denmark, and Italy). There was an increase in recent weeks in rates of influenza – like illness in sentinel hospitals across China, however, levels were below the peaks observed in the winter of 2022/2023. An increase in M. pneumoniae infections to levels similar to pre-pandemic seasons has also been observed in South Korea. Increases in respiratory infections have also been reported from Japan, with an earlier start of the season compared to previous years (including pre-pandemic seasons). Similar experiences reported from USA.

M. pneumoniae is not notifiable in most EU/EEA countries, leading to limited available information regarding diagnosed cases, proportion of detections amongst respiratory laboratory samples or historical detection data. As a result, country level or historic comparisons should be made with caution. Covid -19 , flu and RSV cases have been increasing in most European countries during the last weeks.

Recommendations

- Keep children home when ill (at least 24 hours with no temperature and good condition before returning to nursery or school) and communicate with paediatricians when there are signs of respiratory distress or there is no improvement in clinical condition or signs of dehydration appear.

- Good hand hygiene

 - Appropriate ventilation of indoor spaces

 - Vaccination with available vaccines (flu, RSV, pneumococcal, covid -19) according to the National Vaccination Schedule

- Taking into account the icreased levels of antibiotic resistance in many countries, parents should be educated in order not to demand antibiotics or/and chest X- Ray. Paediatricians are  responsible for the diagnosis based on the detailed clinical examination and when needed on the performance of rapid antigen test for flu, RSV, COVID-19 or group A streptococcus.

References

1.ECDC, 15 December 2023, Epidemiological update

2. WHO statement on reported clusters of respiratory illness in children in northern China , 22 November 2023

3.WHO, Disease outbreak news: Upsurge of respiratory illnesses among children – Northern China , 23 November 2023

4.WHO, News: Respiratory infectious diseases on the rise across WHO European Region, 15 December 2023

5. www.cdc.gov Resources to prepare for flu, COVID- 19 and RSV

6. Bloomberg News: China’s Children Battling Pneumonia shows the Dangers of Drug Resistance, 11 December 2023

7. Independent News: What is ‘white lung syndrome?’’ Ohio pneumonia outbreak explained, 7 December 2023

8. Medical Xpress: Doctors  say RSV is again sending people to the hospital, 11 December 2023

9. Medscape Medical News: How the New Outbreak in China is Hitting Clinics Elsewhere, Allison Shelley, 4 December 2023

10.The Conversation: Childhood pneumonia is surging – while the germs causing it are known, the effects of co – infections aren’t

11.Click on Detroit: White lung syndrome: Doctor seperates fact from fiction by Frank McGeorge, MD, 5 December 2023

12.Prevention: What is White Lung Syndrome and how is it treated? Doctors explain by Korin Miller, 5 December 2023

13.Hindustan Times: What is white lung syndrome? Signs, symptoms and preventive measures of mystery pneumonia, 4 December 2023

14.The Indian Express: Is White Lung Syndrome caused by a new pathogen? Here is what you need to know, 3 December 2023

15. NBC News: What is mycoplasma pneumonia, the illness driving an outbreak in Ohio?, 1 December 2023

16. NBC News: Respiratory illness surge in China not due to new virus, CDC director tells Congress, 30 November 2023

17. Reuters: China says no unusual pathogens found after WHO queries respiratory outbreaks, 24 November 2023