Michigan is experiencing a four-fold increase in kids with pneumonia compared to this same time last year, as both the state health department and the CDC are warning about a sharp increase in Mycoplasma pneumoniae infections.
But pediatric infectious disease doctors and public health experts say they’re less concerned about one individual kind of bacteria or virus, so much as the confluence of several concerning trends in kids heading into cold and flu season:
- The post-pandemic “wild card” infection. This year, that appears to be this surge in Mycoplasma, a bacterial infection that can cause chest colds and pneumonia. It’s re-emerging after being pretty dormant during the COVID era. Most illnesses are mild, but the CDC is looking into early reports that it may be leading to more severe illness and complications in kids. And Mycoplasma-related pediatric hospital admissions are up in Michigan and other states.
- Influenza. We just set a “grim milestone,” according to the CDC: a record 200 kids in the U.S. died of influenza during the 2023-2024 season. About 80% weren’t fully vaccinated.
- Meanwhile, whooping cough cases in the U.S. are five times as high nationally as they were this time last year, as vaccination rates continue to fall.
- And RSV usually picks up in the late fall and early winter. “Year after year, pediatricians and children's hospitals prepare for this massive onslaught of RSV cases, affecting our youngest patients: infants and young children,” said Dr. Andrea Hadley, the division chief of pediatric acute care at Helen DeVos Children's Hospital. “It has been the leading cause of hospital admissions yearly for this age group.”
Lester Graham/Michigan RadioCaitlyn Houston and her seven-week-old daughter, Parker waited in the ER in December 2022 at Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan. At the time, flu and RSV were overwhelming children's hospitals.
What does this mean?
What everyone wants to avoid is a repeat of the 2022-2023 virus season, when a surge of RSV and flu overwhelmed children’s hospitals, leading to long ER wait times, and forcing some hospitals to double up on rooms and even turn patients away.
“The scary part in 2024 is we have some vaccine-preventable diseases like pertussis that are coming back in a roar, because of the less [vaccine] uptake among the whole population, both adults and children,” said Dr. Jason Newland, division chief of infectious diseases at Nationwide Children's Hospital in Ohio, one of the largest in the U.S.
“And then you add on something, some wild card we weren't expecting, like Mycoplasma. It is fair to be worried about what you saw a couple of years ago, for 2024.”
The good news: there’s a growing list of tools that can keep kids safe and lessen the strain on pediatric resources. From vaccines for flu, COVID and whooping cough, to monoclonal antibodies that can prevent RSV hospitalizations, to antibiotics that treat Mycoplasma, here’s what you need to know.
What is Mycoplasma?
Mycoplasma pneumoniae is a type of bacteria that commonly causes respiratory infections, which are usually mild.
In adults, it’s often just a chest cold (fever, headache, cough) but it can look slightly different in kids under five (diarrhea, sneezing, sore throat, vomiting, and wheezing). Even if it does progress to a lung infection, you’ll often hear it referred to as “walking pneumonia,” because people don’t feel sick enough to stay in bed. But in rare cases, it can lead to severe illness, especially in kids.
“What we know for certain is that our communities didn't see some of these viruses [and pathogens] for two or three years,” said Dr. Natasha Bagdasarian, the chief medical executive for the state of Michigan. “And that's going to lead to a change in how our immune systems are responding to them.”
Mycoplasma was practically nonexistent for about three years during the pandemic, similar to other respiratory infections that circulated less during lockdowns and social distancing. But now it’s rapidly re-emerging, and the CDC is looking into early reports about kids with more severe complications.
“We've heard a lot of the same anecdotal reports… of hospitals and state and local health departments reporting a lot of pneumonia in children, and a lot of sick kids who are having prolonged hospital stays,” said Chris Edens, the lead of the Legionella and Atypical Pathogens Team at the Centers for Disease Control and Prevention (CDC.)
“And so it's something we're super concerned about, and we're definitely working as fast as we can…to do the analysis and frankly, get the data out to the public as quickly as possible.”
More kids are being hospitalized for Mycoplasma-related infections at C.S. Mott Children’s Hospital in Ann Arbor, Helen DeVos Children’s Hospital in Grand Rapids, and Nationwide Children’s Hospital in Toledo, according to doctors and spokespeople at those hospitals.
The Michigan Health Alert Network recently sent out a bulletin about Mycoplasma-related infections, as well as a “a notable 4-fold increase in patients 5-19 years of age presenting with pneumonia” between August 1- October 16, 2024, compared to the same time period last year.
“This is something we didn't necessarily expect, and it is causing kids to be pretty sick related to both general pneumonia and the Mycoplasma, which is atypical,” said Dr. Hadley.
It's also noteworthy that this seems to be impacting younger kids, since it’s typically been considered mostly “a school-age disease,” Edens said. “So kind of a five-to-17 year old disease. But in our surveillance data from E[mergency] D[epartments], we're seeing comparable levels of Mycoplasma diagnoses in that two-to-four year age group, which is different than what we saw pre-pandemic.”
Part of this could be because we’re testing for Mycoplasma more often, even in younger kids. There’s also a theory that kids’ immune systems might be responding differently to these pathogens, after a prolonged period of not being exposed to them.
“What we know for certain is that our communities didn't see some of these viruses [and pathogens] for two or three years,” said Dr. Natasha Bagdasarian, the chief medical executive for the state of Michigan. “And that's going to lead to a change in how our immune systems are responding to them.”
Mycoplasma is also resistant to certain antibiotics, but generally responds to a type of antibiotics called macrolides.
“Macrolide antibiotics are very effective,” Edens said. “They can shorten hospitalization times. They can make kids get better more quickly. And that's not the kind of treatment you're going to give somebody if you think they're infected with a virus. And so ensuring that [doctors are] thinking about Mycoplasma, specifically thinking about Mycoplasma for that younger age cohort in general.”
How can you keep your kid safe this year?
Prevention
Chances are you’ve heard this before: try to stay home if you’re sick. Wash your hands. Stock up on some COVID tests, too, if you can.
“No matter what is causing that illness, no matter which viral or bacterial pathogen is causing that illness, it's a good idea to stay at home,” Dr. Bagdasarian said.
“Keep some COVID tests on hand because you can test for COVID. And if it ends up being COVID, we've got great antivirals for COVID. Take a flu test because, again, we've got antivirals for influenza. If you have to be around other people and you still are coughing and have the sniffles, wear a mask to protect those around you.”
Immunizations and vaccinations
Make sure you and your kids are up to date on your flu, COVID, and pertussis (whooping cough) shots.
Vaccination rates fell when the pandemic hit, and schools shut down, or people couldn’t visit their pediatricians. But even now, vaccination rates for illnesses like whooping cough still haven’t returned to their pre-pandemic rates, Dr. Bagdasarian said.
“I think that vaccines were politicized,” she said. “I think that being anti-vax became a political statement for many. And I think some of the negative pieces of misinformation and disinformation about the COVID-19 vaccines spilled over onto other types of vaccines.”
If you’ve got concerns or questions about vaccinations, talk to your doctor or your pediatrician.
“Pertussis can actually kill a baby, and they can't get vaccinated until two months of age,” Dr. Newland said. “So people around them have to be vaccinated.”
When it comes to RSV, vaccines are available for pregnant women and adults over 60. And just last year, the FDA approved RSV immunizations for pregnant women and infants that are “at least 80–90% effective in preventing babies from being hospitalized with RSV,” according to the CDC.
“I am looking forward to the day where we…don't have our hospitals overrun with RSV children, who can be so sick, and so scary,” Dr. Newland said. “And we now have that opportunity.”
