Undiagnosed pneumonia outbreak in China puts pressure on pediatric hospitals, prompts questions

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Baby boy on oxygen
izulhalmi / iStock

An undetermined pneumonia outbreak in China is hitting children hard, with media reports describing overwhelmed children's hospitals in multiple locations, according a post on ProMED Mail, the online reporting system of the International Society for Infectious Diseases. So far, there is no indication that the infections are deadly. But reports of a spike in pneumonia cases in China are eerily similar to early reports of a mystery pneumonia outbreak in late 2019 in Wuhan, which heralded the emergence of COVID-19.

Children's main symptoms are high fever, with some kids developing pulmonary nodules.

The media reports reference swamped pediatric hospitals in multiple locations, including Beijing and Liaoning, which is nearly 500 miles away. Reports also say the pneumonia outbreaks have led to school cancellations and some illnesses in teachers.

Some observers speculate the outbreak could be caused by Mycoplasma pneumoniae, commonly known as "walking pneumonia." FluTrackers, an infectious disease news message board, has been tracking reports of overwhelmed pediatric hospitals and clinics and Mycoplasma pneumonia since the beginning of summer.

More information needed

US Centers for Disease Control and Prevention (CDC) background information on Mycoplasma pneumoniae infection notes that the bacterium typically causes mild respiratory infections that can sometimes lead to serious illnesses that can require hospitalization. In children, the infection resembles a chest cold. The illness can spread in crowded settings, including schools and college residence halls.

On Twitter (X) today, Krutika Kuppalli, MD, an infectious disease physician who is with the WHO's Health Emergencies Program, said it's possible that China could be seeing a surge in respiratory infections as other countries did their first winter after lockdowns lifted.

The point is we need information.

She added that China has already reported a Mycoplasma pneumonia surge, but the current outbreaks could be anything. She also said respiratory syncytial virus, COVID-19, and flu could be contributing factors. "The point is we need information."

Chlorine-based cleaner ineffective against C diff, study finds

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A new study by researchers in the United Kingdom shows that a chlorine-based cleaner used on surfaces in UK hospitals is ineffective against Clostridioides difficile bacteria.

Nurse cleaning floor
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The study, conducted by researchers at the University of Plymouth and published in the journal Microbiology, examined the effect of clinical concentrations of sodium hypochlorite disinfectant (NaOCL) on C difficile spores, which can survive on hospital surfaces for months. C difficile is the leading cause of healthcare-associated diarrhea, and causes an estimated 29,000 deaths in the United States and 8,382 in Europe each year. While chlorine-releasing agents are used in the disinfection of fluid spills, blood, and feces in UK hospitals, recent studies have found signs of emerging sporicidal resistance.

Three different strains of C difficile were exposed to NaOCL at concentrations of 1,000, 5,000, and 10,000 parts per million (PPM) for 10 minutes. Spore recovery was reduced for one of the strains, but examination of spores from all three strains showed no changes to the outer spore coat and no significant reduction in spore viability, indicating a tolerance to the disinfectant.

Scrubs, gowns could act as fomites

The researchers then applied spores from the three C difficile strains onto patient gowns and surgical scrubs and treated them with NaOCL. Although fewer spores were recovered from the fabrics than the liquid, the investigators still found that the scrubs and gowns retained the spores, and that the spores still survived treatment with NaOCL when it was applied directly to the fabric. This indicates that scrubs and gowns could serve as vectors of C difficile transmission in hospitals.

The study authors say the findings highlight an urgent need to review current C difficile disinfection guidelines.

"This study highlights the ability of C. diff spores to tolerate disinfection at in-use and recommended active chlorine concentrations," lead study author Tina Joshi, PhD, associate professor in molecular microbiology at the University of Plymouth, said in a university press release. "It shows we need disinfectants, and guidelines, that are fit for purpose and work in line with bacterial evolution, and the research should have significant impact on current disinfection protocols in the medical field globally."

Malaria vaccine shipments in Africa signal shift to broader, routine use

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Plasmodium malaria parasite
NIAID / Flickr cc

Signaling a shift from the pilot phase of malaria vaccine use in Africa to routine use, the World Health Organization (WHO) today said a shipment of the first WHO-recommended vaccine RTS,S began arriving in Cameroon, which hadn't been previously involved in pilot programs.

Cameroon is set to receive 331,200 doses of RTS,S, which has been in the making for more than 30 years. Immunization efforts first launched in Malawi in 2019 as part of a pilot program that also included Ghana and Kenya. Africa is the world's hardest-hit malaria region, accounting for most of the world's illnesses and deaths.

Four nations to get 1.7 million doses

The WHO said several African countries are finalizing their malaria vaccine rollout plans, with 1.7 million more doses that will be delivered in the coming weeks to Burkina Faso, Liberia, Niger, and Sierra Leone. Other African nations will receive doses in the months ahead, with support from Gavi, the Vaccine Alliance. Immunization, as part of routine vaccination, is projected to begin in the first quarter of 2024.

Catherine Russell, executive director of UNICEF, said in the WHO statement that the wider launch of RTS,S produced by GSK, is a real game-changer in the fight against malaria. "Introducing vaccines is like adding a star player to the pitch. With this long-anticipated step, spearheaded by African leaders, we are entering a new era in immunization and malaria control, hopefully saving the lives of hundreds of thousands of children every year," she said.

The WHO recently recommended a second malaria vaccine, R21, that the agency is currently reviewing for prequalification, a step that paves the way for wider distribution and use. R21 was developed by Oxford University and is made by the Serum Institute of India.

Kids largely left out of US trials of COVID-19 treatments

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Child with dad during COVID
Xavier Donat / Flickr cc

Less than 10% of US interventional COVID-19 trials in the first 3 years of the pandemic included children, and only 1.6% enrolled them exclusively, despite this age-group accounting for 18% of infections, Harvard and Boston Children's Hospital researchers report today in JAMA Health Forum.

The team identified all COVID-19 trials registered on ClinicalTrials.gov from January 2020 to December 2022. They noted that children have been underrepresented in clinical research owing to ethical, logistical, and financial reasons.

"The emergence of the COVID-19 pandemic triggered a rapid investment in research activities to identify prevention measures and develop therapeutic interventions," they wrote. "While children were eventually determined to have a milder disease course compared with adults, studying children was critical to elucidate transmission patterns and identify treatments for pediatric patients with severe disease, including multisystem inflammatory syndrome."

Fewer studies included the very young

Of 1,216 trials, 20 (1.6%) enrolled only children, while 120 (9.9%) included only children or both children and adults, and 1,096 (90.1%) enrolled only adults. The percentage of trials enrolling children rose from 45 (7.1%) in 2020 to 27 (15.7%) in 2022.

Relative to adult-only studies, those including children were less likely to focus on COVID-19 treatments (48.3% vs 69.8%) or on testing medications, biologics, or devices (48.3% vs 64.6%). Rather, they tended to focus on prevention (47.5% vs 23.0%), behavior (25.8% vs 16.8%), and vaccines (14.2% vs 5.8%).

Recent methodologic advancements in pediatric extrapolation, pharmacokinetic and pharmacodynamic modeling, and adaptive trial designs, can be applied to support earlier initiation.

Fewer drug studies enrolling children were phase 1 or 2 (42.0% vs 70.4%) or were randomized (69.2% vs 79.3%). Most studies including children (71 [59.2%]) focused on those older than 2 years, with only 49 (40.9%) open to younger kids.

The researchers said that low rates of inclusion of children probably reflect the tradition of delaying interventional trials in children until after adults have been studied.

But more attention is now being paid to the advantages of early pediatric trials. "Recent methodologic advancements in pediatric extrapolation, pharmacokinetic and pharmacodynamic modeling, and adaptive trial designs, can be applied to support earlier initiation," they wrote.

Mucinex launches campaign to raise awareness about antibiotic misuse

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The maker of a popular over-the-counter cold and flu medicine this week launched a new campaign to help counter inappropriate antibiotic use.

The "Flip the Scrip" campaign from Reckitt, maker of Mucinex, aims to educate consumers about antibiotic misuse and the role it plays in promoting antibiotic resistance. The company will provide posters, educational materials, educational videos, and audio public service announcements to urgent care clinics and primary care centers that explain why products like Mucinex, rather than antibiotics, are the best option for treating cold and flu symptoms.

Driver of antibiotic misuse

Although respiratory tract infections are primarily caused by viruses, they are a significant driver of unnecessary antibiotic prescribing, particularly in urgent care clinics. A 2018 study found that nearly half of the patients who visited US urgent care clinics in 2014 for respiratory illnesses that don't require antibiotics ended up with antibiotic prescriptions.

Many patients believe antibiotics will relieve cold and flu symptoms, and clinicians say patient pressure for antibiotics plays a role in unnecessary prescribing.

"People don't realize that antibiotic misuse and antibiotic resistance are a huge societal issue, and they often expect a prescription for antibiotics to help them feel better," Mark Pearson, vice president of marketing for health brands at Reckitt, said in a press release, adding that the campaign aims to help patients feel more confident when their doctors prescribed an over-the-counter medication.

The partnership will focus on urgent care and primary care facilities in states that have a high index of certain antibiotic-resistant pathogens and high rates of antibiotic prescribing.

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