Local Pediatric Pneumonia Cases Surge as Mycoplasma Infections Rise

Local families may have noticed an increase in children being diagnosed with pneumonia this fall. Virginia Department of Health (VDH) confirmed the increase in November with a statement noting Emergency Room visits with a pneumonia diagnosis tripled the week of November 10-17 compared to the prior two years.

Additionally, a number of public schools have reported clusters of students with pneumonia and unspecified respiratory illnesses to VDH. 

The Centers for Disease Control (CDC) issued several statements this fall regarding the increase in Mycoplasma pneumonia (M. Pneumoniae), a common cause of mild respiratory illness that has seen a significant resurgence in 2024. In the United States, cases have increased across all age groups since late spring, peaking in August and remaining high through the fall.

Notably, young children aged 2–4 years have seen a substantial increase in infections, reversing previous trends where older children and adolescents were most affected.

The CDC reported that cases are increasing most among children, with infections in those aged 2–4 years rising from 1% to 7%, and in children aged 5–17 rising from 3.6% to 7.4%. This rise in infections among 2–4-year-olds is significant, as M. pneumoniae historically hasn’t been recognized as a leading cause of pneumonia in this age group.

Dr. Lana Ismail, a Pediatric Hospitalist and Medical Director of the Children’s National Pediatric Hospital Medicine Program at Mary Washington Healthcare, confirmed that both Fredericksburg and Stafford hospitals are seeing a sharp increase in pneumonia cases, including both community-acquired and M. pneumoniae-related pneumonia. She noted that the 2–4-year-old age group has experienced a marked rise, although cases are up across all age groups.

Ismail said local pediatricians are likely handling the majority of milder cases, while more severe cases may visit the Emergency Room. Some pediatric patients required hospitalization, or needed to be transferred to Children’s National Hospital or VCU Children’s Hospital in Richmond. In some severe cases, patients can develop other issues not related to the lungs, like inflammation around the brain,  and reactions in mucosal membranes that require more intensive treatment.

Antibiotics are commonly prescribed to treat pneumonia. Dr. Ismail advised that the period of contagion is generally tied to the onset of symptoms. If a patient has been on antibiotics for 24 hours and shows signs of improvement, they may be able to return to school. However, anyone exhibiting symptoms should avoid contact with vulnerable or immunocompromised individuals, as well as babies. Wearing a mask and practicing good hand hygiene can also help reduce the risk of spreading the infection to others.

The CDC noted that cyclical increases in M. pneumoniae infections are common every 3 to 5 years. Cases sharply declined during the COVID-19 pandemic but began rising again in 2023. By February 2024, cases remained below pre-pandemic levels, but the frequency of positive test results for M. pneumoniae increased from 0.7% in late spring to 3.3%.

Common symptoms of M. pneumoniae include fatigue, fever, headache, sore throat, and worsening cough. Children younger than 5 may also experience diarrhea, a stuffy or runny nose, sneezing, vomiting, and watery eyes.

M. pneumoniae infections are typically mild and often present as “walking pneumonia,” a form of bacterial pneumonia where individuals may not feel sick enough to stay in bed. Outbreaks tend to occur in crowded environments, such as schools, college dormitories, and nursing homes, where the bacteria spreads through respiratory droplets from coughing or sneezing. Preventive measures such as good hand hygiene and covering coughs and sneezes can help limit transmission.

Although M. pneumoniae infections can occur year-round, they are most common in summer and early fall. The long incubation period—ranging from one to four weeks—and the bacteria’s ability to persist in the respiratory tract for months can lead to prolonged outbreaks.

Dr. Ismail emphasized, “Mycoplasma is one of the few prominent respiratory infections for which we don’t have a vaccine. We have vaccines for many other contagious illnesses, like the flu, RSV, pertussis, and COVID.” She added that vaccines and good hygiene are the best measures to prevent the spread of highly contagious illnesses.

Healthcare providers diagnose M. pneumoniae infections through physical exams, respiratory swab tests, or chest X-rays if pneumonia is suspected. Treatment with macrolide antibiotics, such as azithromycin, is typically effective, while over-the-counter medications can help manage symptoms for mild cases.