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White Lung Syndrome: Now Massachusetts and Ohio report child cases 'similar' to those in China and Europe

Ohio has reported 142 cases of pediatric pneumonia, dubbed as 'White Lung Syndrome' cases since August

OHIO and MASSACHUSETTS: Doctors in parts of Ohio recently noticed a spike in child pneumonia cases, dubbed as "White Lung Syndrome," similar to the outbreak affecting children in China and parts of Europe, News Nation reported. 

While experts and officials have not commented on the fatality of the illness at the time of writing, the Warren County Health District (WCHD) mentioned that the number of cases "meets the Ohio Department of Health definition of an outbreak." 

Meanwhile, physicians in western Massachusetts have noticed "a whole lot of" of Respiratory Syncytial Virus (RSV) in kids, alongside symptoms of walking pneumonia, a milder form of the lung condition caused by a mixture of bacterial and viral infections, as well a combination of RSV and other respiratory illnesses, Western Mass News reported. 

The latest report comes after the Netherlands and Denmark revealed that they noticed mysterious spikes in pneumonia cases, many of which are allegedly being partly attributed to mycoplasma.

What is known about the White Lung Syndrome? 

The "White Lung Syndrome," a term being used to define a form of respiratory illness in children, garnered global attention after the Program for Monitoring Emerging Diseases (ProMED) reported about clusters of undiagnosed pneumonia among children in China on November 22. 

Shortly after, the World Health Organization (WHO) asked China to provide more information about the hike in respiratory illnesses and clusters of pneumonia in children. 

"Since mid-October 2023, the World Health Organization (WHO) has been monitoring data from Chinese surveillance systems that have been showing an increase in respiratory illness in children in northern China," a WHO release mentioned.

"At a press conference on 13 November 2023, China’s National Health Commission reported on a nationwide increase in the incidence of respiratory diseases, predominantly affecting children. Chinese authorities attributed this increase to lifting of COVID-19 restrictions and the arrival of the cold season, and due to circulating known pathogens such as influenza, Mycoplasma pneumoniae, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Mycoplasma pneumonia and RSV are known to affect children more than adults," it stated. 

WHO also held a teleconference with Chinese health authorities from the Chinese Center for Disease Control and Prevention and the Beijing Children’s Hospital, facilitated by the National Health Commission and the National Administration of Disease Control and Prevention on November 23. 

Officials reportedly provided WHO with the requested data, which indicated "an increase in outpatient consultations and hospital admissions of children due to Mycoplasma pneumoniae pneumonia since May, and RSV, adenovirus and influenza virus since October."

"Some of these increases are earlier in the season than historically experienced, but not unexpected given the lifting of COVID-19 restrictions, as similarly experienced in other countries," WHO stated in its report. 

As per WHO, Chinese authorities advised 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."

Officials further assured that the rise in respiratory illness "has not resulted in patient loads exceeding hospital capacities."

They also shared that since mid-October, "enhanced outpatient and inpatient surveillance has been implemented for respiratory illnesses covering a broad spectrum of viruses and bacteria, including, for the first time, Mycoplasma pneumoniae."

"This complements existing respiratory surveillance mechanisms and may have contributed to the observed increase in detection and reporting of respiratory illness in children," officials from China reportedly told WHO. 

According to the Centers for Disease Control and Prevention (CDC), Mycoplasma pneumoniae is a bacteria that usally causes mild infections of the respiratory system;

At times, these bacteria can also cause more serious lung infections that require hospital care.

However, in light of the latest "White Lung Syndrome" outbreak, a CDC source told the Daily Mail "nothing is out of the ordinary" in the national data so far.

What did Ohio say about the rise in pediatric pneumonia? 

According to WCHD, "an extremely high number of pediatric pneumonia cases" has been reported this fall season, with 142 cases since August.

The number is not only above the county average but also meets the Ohio Department of Health definition of an outbreak.

However, the WCHD does not "think this is a novel/new respiratory disease but rather a large uptick in the number of pneumonia cases normally seen at one time."

"To date, there has not been a definitive etiology determined or a common thread linking these pneumonias," the statement mentioned.

"We have an ongoing investigation to examine possible linkages and risk factors," it added. 

The press release further noted that the average age of children effected by the disease is "around 8 years old" with cases spanning multiple school districts. 

"There have been no conclusive patterns among the children diagnosed," it reported, adding, "based on some data responses from a recent parent questionnaire, most common symptoms included cough, fever and fatigue."

"Among the pathogens recovered included Mycoplasma pneumoniae, Streptococcus pnuemoniae and Adenovirus," the statement revealed.

WCHD is currently working with the Ohio Department of Health, local children’s hospitals and primary care providers "in hopes to determine a cause and further prevent the spread of illness."

The health district also recommended "providers to have a lower threshold to test children presenting with cough, fever and/or fatigue and consider nasopharyngeal swabs for respiratory viruses, mycoplasma and pertussis."

Last week, WCHD sent out a notification with education to Warren County providers "in an effort to further clarify the nature of the outbreak."

"As we approach the holiday season, when many of us will be gathering together with family and friends, please remember to take necessary precautions to protect your health: wash your hands, cover your cough, stay home when ill, and stay up to date on vaccines," the district advised. 

Meanwhile, Dr. Clint Koenig, the medical director of Warren County Health District told ABC News, "There is zero evidence that what we're seeing in Warren County has any connection to any respiratory activity in the state, in the country, or in the world."

He also spoke to local reporters and said, "We have seen hospitalizations [for child pneumonia] tick up in the last couple of weeks so we do ask parents to be vigilant."

"Our school districts have called in starting roughly in August, but really picking up in mid to late October. We've also been noticing a lot of cases of kids being absent and the resulting diagnosis being pneumonia," Dr Koening added. 

What is the current health situation of children in Massachusetts? 

In Massachusetts, it is RSV, a respiratory virus that kills more than 10,000 Americans each year, especially young children and the elderly, that is the main cause of concern. 

Dr John Kelley, from Redwood Pediatrics in East Longmeadow, told Western Mass News, "This is the season for RSV and we're seeing a whole lot of it… a lot of kids with upper viral respiratory infections, cough, runny nose, some fevers and the thinking with RSV is that it can cause lower viral respiratory infections, so they get spread to your lungs."

While he said that that most young patients get better within days, a major challenge is "there are no medications to give to cure."

"Once you have it, is all supportive care," Dr Kelley shared. He said also said that 80 percent of the chidren infected with walking pneumonia develop the virus as a result of first having RSV, while the remaining 20 percent of the cases are usually caused by bacteria, which can be treated with antibiotics.

Dr Kelley advised that parents should keep an eye out for children with worsening symptoms but recommended visiting a pediatrician first before heading to the hospital in order to avoid crowding the emergency rooms, which may be full of patients experiencing more acute symptoms.

What are experts saying about White Lung Syndrome? 

Dr Amesh Adalja, an infectious disease expert from Johns Hopkins University in Maryland, told the Daily Mail, "I would caution against extrapolating one Ohio county to a country of 330 million people."

However, he said he would not be completely surprised if "some places in the US are above baseline" this year. Dr Adalja also shared that he believes the pneumonia outbreaks around the world could be due to the "cyclical" nature of mycoplasma.

"Mycoplasma goes through epidemic cycles every few years and that may be what's occurring globally at the moment," he stated, adding, that China may be facing a double attack of viral and bacterial infections.

"So what's happening in China makes sense," Dr Adalja said. "Last year we were dominated by so much Covid, flu and RSV when we opened up," he added.

The doctor also shared that he feels this year's winter outbreak will be "less severe" than last year, when thousands of children were hospitalized with RSV and flu.

However, he also admitted that lockdowns may have contributed to the emerging global phenomenon. "When children are born they haven't experienced any infectious diseases so more of them you have in population so lower threshold for outbreak to start," Dr Adalja said.

"That group of children born provide new people for illnesses. The pandemic allowed the number of these susceptible people to build up over years," he explained. 

Dr Scott Roberts, an infectious diseases expert at Yale School of Medicine, Connecticut, told the publication that the surge in cases was likely still being driven by weakened immunity in children.

"This is probably a recurrence of known pathogens that are hitting us a bit harder because of low immunity to them," he opined.

Dr Roberts suggested children's immune systems could still be suffering from the effects of Covid restrictions which blocked their exposure to "good germs" for building immunity.

Meanwhile, CDC director Dr Mandy Cohen testified in Congress and said uptick in respiratory illnesses in China was not down to a novel pathogen.

"We do not believe this is a new or novel pathogen. We believe this is all existing [pathogens] — meaning Covid, flu, RSV, mycoplasma. But they are seeing an upsurgence."

A source at the Centers for Disease Control and Prevention (CDC) also said that their data showed childhood pneumonia levels in other states were following "seasonal trends."

"Nothing is flagging out of the ordinary, but we are continuing to monitor," the centre assured.