Health Advisory

Summary

• Fairfax Health District is experiencing a significant increase in diagnosed pneumonia. Visits to emergency departments and urgent care (UC) centers with diagnosed pneumonia comprised 5.5% of all ED/UC visits for the week of October 20-26, the highest experienced in Fairfax to date.
• Among ED/UC visits in Fairfax facilities during the week of Oct. 20-26, 14% of visits for children ages 5- 17 years and 12% of visits for children ages 2-4 years had a discharge diagnosis of pneumonia.
• VDH has also reported an increased number of respiratory outbreaks causing pneumonia across the state, most occurring in K-12 schools. Patients have tested negative for COVID-19, influenza, and RSV, while many are testing positive for a combination of enterovirus, rhinovirus, and Mycoplasma pneumoniae. Similarly, CDC has reported an increase in M. pneumoniae infections, particularly among children. Several clusters among school-aged children of pneumonia with confirmed M. pneumoniae infection also have been reported in the Fairfax Health District.

Suggested Actions

• Providers should consider collecting specimens from persons with pneumonia to determine the cause of the infection. Consider Mycoplasma pneumoniae as a possible cause of infection among children with community-acquired pneumonia.
• Use droplet precautions when evaluating patients with suspected or confirmed pneumonia.
• 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. Consider collecting both an NP and OP swab to improve the likelihood of detection in respiratory swab specimens.
• 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.
• Consider antimicrobial post-exposure prophylaxis (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.
• Encourage healthy habits with your 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.
• While individual M. pneumoniae cases are not reportable to public health, please report suspect clusters of 3 or more cases to the Fairfax County Health Department at (703)-246-2433 or HDCD@fairfaxcounty.gov.

Additional Information

• Mycoplasma pneumoniae is a leading cause of pneumonia among school-aged children and young adults. From March 31st to October 5th, 2024, the proportion of pneumonia-associated ED visits with a M. pneumoniae infection increased among children ages 5-17 years from 3.6% to 7.4% and among 2–4-year-olds from 1.0% to 7.2% nationally. The increase in younger children (2-4 years) is notable because M. pneumoniae has historically not been recognized as a leading cause of pneumonia in this age group.
• Approximately 25% of infected school-aged children will develop pneumonia with cough and rales within days after onset of constitutional symptoms. Cough, initially nonproductive, can become productive, persist for 3-4 weeks, and be accompanied by wheezing. Approximately 10% of children with M. pneumoniae infection will exhibit a rash, which most often is maculopapular.