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‘The cough that keeps on giving’: Why your child keeps getting pneumonia
More than four times the number of school-aged children are visiting NSW emergency departments for pneumonia than before the pandemic, prompting doctors to urge families to wear masks and social distance to help curb a wave of respiratory illnesses spreading across the globe.
Last week there were 317 children aged between five and 16 who visited NSW emergency departments with pneumonia, a five-fold increase on the last week of April 2019 when there were about 65 cases.
Associate Professor Philip Britton, a paediatric infectious diseases physician based at The Children’s Hospital at Westmead, said the most frequent cause of pneumonia in school-aged children was the bacterium Mycoplasma pneumoniae, which spreads in crowded environments and damages the lining of the lungs, throat and windpipe.
Emergency hospital visits among five- to 16-year-olds have tripled since the first week of January, when NSW Health issued a public health alert to doctors warning them admissions due to mycoplasma pneumonia were “starting to increase”.
Emergency departments don’t often capture the exact cause of a patient’s pneumonia, as a diagnosis usually requires further testing, but Britton said the trend was reflected in laboratory data from NSW and across the eastern seaboard which has seen “a very significant increase” of mycoplasma in school-aged children.
“There’s never going to be one cause that accounts for all of it [increased ED presentations], but I think it’s reasonable to conclude that mycoplasma pneumonia is a pretty big player at the moment,” he said.
‘Children need to be exposed to some level of infections … [but] immunity was relatively compromised for children [during COVID].’
Associate Professor Phillip Britton from the Children’s Hospital at Westmead
Epidemics of mycoplasma pneumonia occur every three to five years, but the 2024 version “seems to be a bit more pronounced”.
Although there was limited evidence to suggest contracting COVID increases the chances of getting another cause of pneumonia, Britton said many children could be more susceptible to the bacterium because they weren’t exposed to it during lockdowns and social distancing.
“Children need to be exposed to some level of infections in order for their immune system to be trained effectively,” he said. “But we had a couple of years when that training of respiratory immunity was relatively compromised for children … that happened in lots of countries around the world and similar phenomena have seen been seen in the wake of that.”
Mycoplasma pneumonia is sometimes referred to as “walking pneumonia” because patients are mostly well and can go about their day.
But infectious diseases expert Robert Booy said that, for some children, the effects on the lung and even the brain were more severe.
“It’s mostly a walking pneumonia in school aged kids, but it’s important to recognise that in a minority, you can get a more serious chest infection or encephalitis, and that’s an inflammation of the brain,” said Booy, an honorary professor at the University of Sydney.
The data, compiled for the Herald by NSW Health, also shows the number of babies and toddlers (up to four-year-olds) and younger adults (17- to 34-year-olds) visiting emergency departments with pneumonia has doubled since the start of the year.
GPs have also noticed an uptick in mycoplasma pneumonia since the beginning of the year.
‘We don’t want to cause alarm … most kids are fine, they just need to be identified and get treatment.’
Sydney GP Rebekah Hoffman
Dr Rebekah Hoffman, a GP in Sydney’s Sutherland Shire, said cases had risen over Easter and the return from school holidays as children mix with each other at family gatherings or in the classroom.
Hoffman, also the NSW and ACT chair of the Royal Australian College of General Practitioners (RACGP), said doctors across the state were treating young patients who were mostly well except for a “persistent, annoying cough that just won’t go away”.
“It’s really the cough that keeps on giving,” she said. “We don’t want to cause alarm … most kids are fine, they just need to be identified and get treatment.”
Hoffman said children can be tired or have a temperature initially, but a dry cough is often the only symptom. If this persists, a GP will usually prescribe antibiotics other than penicillin. The Mycoplasma pneumoniae bacterium is naturally resistant to penicillin because it lacks a cell wall.
She said it can be avoided by “doing all the sensible stuff we did during COVID: wearing masks, washing your hands, [and] using hand sanitiser.”
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