Ohio pneumonia outbreak is not ‘white lung’ or linked to China, Europe


Health authorities are monitoring an outbreak of pneumonia in children in an Ohio county, stressing it appears driven by familiar pathogens with no connection to pneumonia clusters in China and parts of Europe.

Officials in Warren County, which is in the Cincinnati area, reported 145 cases of pneumonia in children ages 3 to 14 since August. The caseload is higher than normal and reaches the state’s threshold for an outbreak, but there have been no deaths or evidence of increased severity, officials said.

The Centers for Disease Control and Prevention has been in touch with Ohio officials and is also monitoring the increases in respiratory illness among children, including potential elevated rates of pediatric pneumonia, in parts of the United States. Officials said the reported trends do not appear to be due to a new virus or other novel pathogen, but instead attribute the increases to several viral or bacterial causes expected during the respiratory illness season.

“As of today, we are not seeing anything that is atypical in terms of pneumonia-related emergency department visits,” CDC Director Mandy Cohen told reporters Friday, noting that “a lot of kids” are going to the emergency department for respiratory illness such as flu and RSV, or respiratory syncytial virus, which can be dangerous for some infants and young children.

The CDC monitors overall respiratory illnesses using data reported daily from about 80 percent of the country’s emergency departments. Nationwide data as of Nov. 25 show that diagnosed pneumonia rates in children are not unusual for this time of year, CDC officials said.

The Ohio cases have not caused undue strain on the state’s health-care system and the overall respiratory virus trends are typical for this time of year, Cohen said. “Hospital capacity is fine. Children are recovering at home,” she said. “There’s no evidence that any of those increases are connected to other outbreaks nationally or internationally.”

Respiratory illness is spreading in most of the country, and CDC officials said they expect levels of covid-19, influenza and RSV to continue to increase. “RSV season is in full swing,” Cohen said, and flu spread is “accelerating fast.” Covid-19 remains the primary cause of new respiratory hospitalizations and deaths, with about 15,000 hospitalizations and about 1,000 deaths every week, according to the CDC.

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The outbreak in Warren County attracted outsize attention that erroneously linked it to clusters of childhood pneumonia in northern China. The CDC and independent public health experts who monitor China say the cases appear driven by the usual mix of respiratory viruses including influenza, coronavirus and RSV, as well as Mycoplasma pneumoniae, a type of bacteria that can infect the lungs. All of these pathogens circulate in the United States.

Mycoplasma pneumoniae can cause several types of infection, including chest colds and pneumonia. While some media outlets have used the term “white lung syndrome” to describe illness caused by mycoplasma, public health authorities do not use the term and some experts caution it creates a misleading perception of a dangerous unknown disease.

In fact, the bacteria is fairly common, and when it causes pneumonia, it’s not as severe as other types of bacterial pneumonias, which is why it is often referred to as “walking pneumonia,” said Paul Offit, a professor of pediatrics at Children’s Hospital of Philadelphia. Offit said he has never heard the term “white lung” in reference to this disease. Although physicians treat the disease with antibiotics, such as azithromycin, it often resolves on its own.

Since the pandemic, he said, parents and physicians may be paying more attention to symptoms of respiratory illness — cough, runny nose, fever, difficulty breathing — because people want to know whether it’s covid-19. “That’s caused people to pay more attention to respiratory infections, and more importantly, pay more attention to making the diagnosis,” Offit said.

Warren County officials said it’s unclear why they are experiencing a rise in pneumonia, which usually isn’t reported to health authorities.

“We have no evidence whatsoever of any connection to any outbreaks statewide or internationally,” said Clint Koenig, a family physician and medical director at the Warren County Health Department. “We don’t have any evidence to suggest this is anything but routine, standard winter bugs causing pneumonia in higher rates in kids.”

A mix of pathogens are behind the pneumonia cases, he said, with few cases linked to mycoplasma.

Koenig said school nurses alerted his agency to unusually high numbers of sick students, spurring further investigation and news releases about the pneumonia outbreak. He said those announcements were meant to encourage health providers to test children coming in with symptoms and to encourage parents to be vigilant about hand washing and keeping kids home when sick — not to warn the nation.

The fall and winter respiratory season is typically a tough time for children’s hospitals and pediatric offices, but doctors say they worry more about RSV, influenza and covid than pneumonia.

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Jason Terk, a pediatrician in Texas, said he has treated several suspected mycoplasma pneumonia cases in the last six weeks, which is not out of the norm.

“This is a bacterial infection and will sporadically cause clusters of cases,” Terk said. “I don’t think this is on the freaking out scale for most parents generally. Sometimes, when it is going around, awareness and concern may increase about it among parents.”

Widespread media coverage of a pneumonia spike in western Massachusetts was dispelled Friday by pediatrician John Kelley, whose comments to a local news outlet about how children with RSV sometimes develop pneumonia were inaccurately reported as confirmation of a second outbreak. Kelley told The Washington Post he is not seeing unusual pneumonia trends or any parallels to China in his office. Massachusetts health officials said a statewide increase in pediatric pneumonia is expected this time of year, with no evidence suggesting a link to mycoplasma.

Mycoplasma, which causes epidemics in countries every several years, is landing on the radar of pediatricians because it is re-emerging in parts of Europe and Asia for the first time since the covid-19 pandemic, according to a paper recently published in the Lancet journal.

The researchers found mycoplasma was most frequently detected between April and October in Denmark, with Singapore, Sweden and Switzerland further behind.

Danish health officials said the country normally sees mycoplasma epidemics about every four years and expected an increase in cases, driven by children who did not build up immunity due to covid-19 restrictions.



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