Increase in Pediatric Pneumonia Cases

Increase in Pediatric Pneumonia Cases

4 November 2024

Dear Colleague:

CDC and VDH have recently reported substantial increases in diagnosed cases of pneumonia among children – Mycoplasma pneumoniae (M. pneumoniae) – over the past year. Locally, Arlington County Public Health Division (ACPHD) is also seeing similar increases in Arlington pediatric emergency room visits with pneumonia diagnoses.  

Based on the most recent best practices and guidance from CDC and VDH, ACPHD recommends the following:  

ACTIONS FOR PROVIDERS TO TAKE

1. IDENTIFY CASES (TESTING). Consider M. pneumoniae as a possible cause of infection among children with community-acquired pneumonia (Attachment I. Pneumonia Fact Sheet(PDF, 117KB)).
   • Consider collecting specimens from persons with pneumonia (or suspected pneumonia) to determine the cause of the infection. Collecting both an NP and OP swab can improve detection in respiratory swab specimens.
   • Perform testing when M. pneumoniae is suspected to ensure appropriate antibiotic therapy is administered, as beta-lactams are ineffective against M. pneumoniae.
   • Nucleic acid amplification tests are preferred, as serologic tests may yield a false-positive result.
2. TREATMENT. Macrolides, including azithromycin, clarithromycin, and erythromycin, are the preferred antimicrobial agents for treatment of M. pneumoniae infection in school-aged children with moderate to severe infection and those with underlying conditions, such as sickle cell disease. CDC reports macrolide-resistant M. pneumoniae remains relatively uncommon in the U.S.
3. POST-EXPOSURE PROPHYLAXIS (PEP) CONSIDERATIONS. Consider antimicrobial PEP with a macrolide or a tetracycline (doxycycline) for people at increased risk for severe illness, such as children with sickle cell disease, who are close contacts of a person with M. pneumoniae infection.
   • PEP is not routinely recommended for close contacts with lower risk because secondary illnesses are generally mild and self-limited.
4. PREVENTION. Encourage healthy habits to slow the spread with patients as a control measure to decrease M. pneumoniae transmission, including hand hygiene, respiratory etiquette, and cleaning and disinfecting of commonly touched surfaces.
   • Review vaccination history with patients and encourage them to stay up-to-date on all seasonal and recommended vaccines for optimal protection against respiratory illnesses.
5. REPORT CLUSTERS OF CASES TO ACPHD. While individual M. pneumoniae cases are not reportable to public health, please report suspect clusters of 3 or more cases to ACPHD: Monday to Friday, from 8 AM to 4:30 PM, call 703-228-5200, option #1; Nights and weekends, call 703-558-2222, ask for the Public Health Duty Officer. 

Thank you for all you do to control and prevent the spread of communicable diseases in our community.

Sincerely,

Reuben K. Varghese, MD, MPH

Health Director & Director, Public Health Division

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