#17,780
Mainland China's upsurge in respiratory illnesses (see WHO Statement On Reports Of Clusters Of Respiratory Illness In China) which appears to have begun last summer (see FluTrackers threads here, here, and here) continues to garner international attention and speculation.Yesterday the WHO released a Risk Analysis, which reported - after consultation with Chinese Officials - that there was currently no evidence of anything new or novel behind this surge.
In the current outbreak of respiratory illness, the reported symptoms are common to several respiratory diseases and, as of now, at the present time, Chinese surveillance and hospital systems report that the clinical manifestations are caused by known pathogens in circulation. Mycoplasma pneumoniae is a common respiratory pathogen and a common cause of paediatric pneumonia, and is readily treated with antibiotics.
While it is impossible to say anything with certainty, China's respiratory outbreak is currently believed to be due to a mix of influenza, RSV, COVID, and other seasonal viruses and Mycoplasma pneumonia, similar to the resurgences of respiratory diseases reported by other nations in the months following their ending pandemic restrictions.
Hospitals in some provinces, however, do appear to be under unusual pressure. Today, press releases from Taiwan and the ECDC, along with a side note from India.
Overnight Taiwan's CDC published the following (translated) statement and travel advice.
The incidence of respiratory diseases has increased in China recently. People who plan to travel to China are reminded to get the COVID-19 XBB and influenza vaccines as early as possible before departure.
Release date: 2023-11-25The Centers for Disease Control and Prevention stated today (25th) that according to Chinese official public data, the influenza-like epidemic in northern China has been rising rapidly for five consecutive weeks, with the proportion of outpatient and emergency cases reaching 6.2%, which is 2.5 times that of the same period in the past three years.
According to information provided by China published by the World Health Organization (WHO), it is caused by the co-circulation of multiple known respiratory pathogens such as Mycoplasma, influenza, and COVID-19. The CDC will continue to monitor the epidemic situation and remind people who plan to travel to China to get the COVID-19 XBB and influenza vaccines as early as possible before departure.
The Department of Disease Control and Prevention explains that the incidence of respiratory diseases has increased across China recently. The prevalent pathogens include influenza virus, Mycoplasma, respiratory synthetic virus, adenovirus and new coronavirus, etc. Among them, the main affected people are children.
Other reports indicate that in some areas, such as Hospitals in Beijing and Liaoning have experienced "a large increase in patients." This wave of epidemics has also attracted the attention of the WHO. According to the data collected so far, the WHO stated that the known pathogens should be highly prevalent in the community.
Taking mycoplasma pneumonia as an example, the probability of this pathogen causing pneumonia in children is higher than that of other age groups. WHO recommends that community epidemic status should be continuously monitored and observed. In addition, the epidemic situation of influenza-like viruses in China is also higher than that of the same period in the past three years. Currently, the majority of influenza viruses are H3N2 and B/VICTORIA.
The Department of Disease Control and Prevention stated that the airport and port quarantine stations have been fully vigilant. Passengers entering from China, Hong Kong and Macao are reminded on electronic signboards and marquees at the airport that if they have symptoms, they should seek medical treatment and inform their travel history. It has also strengthened its appeal to passengers entering from this area to inform passengers if they have symptoms. If you have fever or flu-like symptoms, you should proactively inform airline personnel and quarantine personnel at the airport and port, and contact the quarantine station and fever screening for evaluation.
The Department of Disease Control and Prevention reminds people from both sides of the Taiwan Strait that there are frequent exchanges. In response to the current epidemic in China, people who have recently traveled to China must wash their hands frequently, wear masks, and pay attention to personal hygiene when they are there. If you have respiratory symptoms, you should seek medical treatment as soon as possible. Do not take medication by yourself. It may cause the medication to be ineffective and may also delay the condition. If you have fever or acute respiratory symptoms after returning to the country, you should wear a mask and seek medical treatment as soon as possible, and proactively inform the TOCC (travel history, occupation, contact history, and whether you have gathered in groups) and other information so that the doctor can evaluate and report timely diagnosis and obtain comprehensive medical care.
From the ECDC's yesterday's weekly Communicable Disease Threats Report (CDTR):
3. Increase of paediatric respiratory infections – China – 2023
Overview:
On 23 November 2023, the World Health Organization (WHO) published a Disease Outbreak News (DON) item providing clarifications on media reports (ProMed ) about clusters of undiagnosed pneumonia in school-aged children in the Beijing and Liaoning regions in China. According to WHO DON, the pneumonia clusters mentioned by ProMed were part of the known general increase in respiratory illnesses in the community, which had been reported at a press conference on 13 November 2023 by China’s National Health Commission.
The Chinese authorities reassured WHO in a teleconference held on 23 November, where they presented surveillance data. An increase in outpatient consultations and hospital admissions of children due to Mycoplasma pneumoniae has been detected in China since May, and due to RSV, adenovirus and influenza virus since October 2023. Some of these increases occurred earlier in the season than usual, but this is not unexpected given the lifting of COVID-19 restrictions, as has been experienced in other countries. No changes in the disease presentation were reported by the Chinese health authorities.
Chinese authorities clarified that there has been no detection of any unusual or novel pathogens or unusual clinical presentations, including in Beijing and Liaoning, but only the aforementioned general increase in respiratory illnesses due to multiple known pathogens. They further stated that the rise in respiratory illnesses has not resulted in patient loads exceeding hospital capacities.
ECDC assessment:
An increase in respiratory infections in the paediatric population is not unexpected during winter months in temperate regions of the world, due to several seasonal pathogens such as RSV, influenza, adenoviruses, SARSCoV-2 and Mycoplasma pneumoniae.
EU/EEA countries and the United Kingdom are also reporting significant increases in respiratory infections in the paediatric population (e.g. bronchiolitis in France). In South Korea, the KDCA has also recently reported an increase in infections in children due to Mycoplasma pneumoniae.
Actions: ECDC received direct information from WHO and the China CDC to perform this assessment.
Somewhat curiously, the Indian press has been including an `outbreak of H9N2' in their reporting of this respiratory surge in China (see here, here, and here).
This is based upon a press release from their Health Ministry which states that they are `. . . closely monitoring the reported outbreak of H9N2 cases and clusters of respiratory illness in children in northern China.'
Last Tuesday, Hong Kong's CHP announced a single case in Sichuan Province (see chart below) in early October, and 4 others have been reported over the previous 6 months, but I'm not aware of any reports of an `outbreak'.
That said, we assume a lot of H9N2 cases are missed, and are never reported (see FluTrackers List). Infection is generally mild, and in most cases, patients are never tested for the virus. Seroprevalence studies, however, suggest people with exposure to infected poultry often develop H9 antibodies.
While not at the very top of our pandemic concern list, the CDC has 2 different lineages (A(H9N2) G1 and A(H9N2) Y280) on their short list of influenza viruses with zoonotic potential (see CDC IRAT SCORE), and several candidate vaccines have been developed.
If China had a better track record of sharing outbreak information there would be far less speculation and concern over these reports. But the CCP continues to treat the release of `bad news' as a national security threat, and so we have little choice but to remain vigilant.
