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Asian neighbours ‘put guard up’ amid fears China’s wave of disease will spread

Visitors pass by the children's hospital with a sign "Patient entrance" in Beijing, Friday, Nov. 24, 2023.
Visitors walk past a children's hospital in Beijing - Ng Han Guan/AP

Countries across Asia are bracing for a wave of disease currently sweeping through China’s hospitals amid fears it could soon cross international borders.

Governments including India, Nepal, Taiwan and Thailand have ramped up surveillance and told doctors to be on alert for pneumonia cases within their populations.

Chinese paediatric hospital wards have been overwhelmed in recent weeks, as respiratory viruses and the bacteria mycoplasma pneumoniae surge following years of suppressed transmission due to stringent Covid-19 restrictions.

Health authorities in neighbouring countries are now preparing their own health systems to fight this mass wave of infections, should it spread beyond China.

“We’re putting our guard up,” said Dr Cholnan Srikaew, Thailand’s Public Health Minister, while India’s Health Ministry said it had “proactively decided to review the [country’s] preparedness measures against respiratory illnesses, as a matter of abundant caution.”

Students are dismissed from a school in Beijing, China
Students are dismissed from a school in Beijing amid the respiratory outbreak - MARK R CRISTINO/EPA-EFE/Shutterstock

The scale of disease spreading through China’s hospitals is “yet unknown,” according to the analytics firm Airfinity.

In a situation report published on Monday, it said Shanghai’s Renji Hospital has seen a 175 per cent rise in paediatric outpatient visits since the start of November compared to last year, while appointments at Beijing Aviation General Hospital jumped by 50 per cent.

According to the Chinese CDC, different groups of children have been hit by slightly different pathogens. Among those under four, influenza and rhinovirus are most prevalent; those aged five to 14 have been hit by influenza, mycoplasma pneumoniae, and adenovirus; while older age groups are commonly infected with influenza, rhinovirus, or human metapneumovirus.

Health officials across Asia are now preparing for similar outbreaks.

In India, the Health Ministry has directed all the state governments to hospital readiness and ensure there are enough hospital beds, drugs, vaccines, oxygen, antibiotics, personal protective equipment and testing kits to tackle a potential surge of respiratory illnesses.

Illness ‘not a new infectious disease’

Meanwhile on Friday, Taiwan’s Centre for Disease Control warned people travelling to China to pay attention to their hygiene, get vaccinated against the flu prior to their trip, wear a face mask and avoid visiting crowded places.

Thailand has also advised people to wear face masks and wash their hands regularly, and has also tightened surveillance – especially in tourist hotspots and at hospitals.

Yet China is not the only country in the region to already report a spike in respiratory illnesses, including mycoplasma pneumoniae.

South Korea recorded a 31 per cent increase in these cases in mid-November – of 236 people hospitalised with acute bacterial respiratory infections in the second week of the month, 96 per cent had mycoplasma and 80 per cent of these were children. But it looks like the growth rate is levelling off and infection rates could decline in the coming weeks, Airfinty said.

However, in a statement to the Telegraph, the Korea Disease Control and Prevention Agency said that although mycoplasma had recently been showing a gradual increase, cases remained low compared to 2019.

“Mycoplasma is not a new infectious disease like Covid-19, but the outbreak situation in China is being closely monitored through the WHO and media reports,” the agency said.

Dr Jerome Kim, director general of the International Vaccine Institute in Seoul said the outbreaks of respiratory diseases including mycoplasma pneumonia, adenovirus and flu were “things you would normally expect at this time of year.”

Although there had been an uptick in influenza activity in South Korea and other countries in the region, “it doesn’t at this stage appear to be a new Covid strain or new version of Omicron,” he said.

Meanwhile, paediatric wards in southern Vietnam are full of patients with a mix of seasonal infections, including RSV, influenza and hand, foot and mouth disease, prompting hospitals to expand their bed capacity and bring in extra staff.

At Can Tho Children’s Hospital, an average of 1,100 children with respiratory diseases visited every day in October, according to a report from Toui Tre News.

“[It’s] nothing unusual, except they all seem to have come at once,” a doctor in Ho Chi Minh City told the Telegraph.

There are also some concerns in Nepal, which has already reported an increase in respiratory infections including influenza and mycoplasma pneumonia.

“Children are increasingly experiencing flu-like symptoms,” Dr Sher Bahadur Pun, the Head of Sukraraj Tropical and Infectious Disease Hospital in Teku, Kathmandu, told the Telegraph.

“In light of the growing number of tourists visiting Nepal in recent weeks, I believe it’s crucial for us to prepare for a potential outbreak originating from China.”

Pandemic flashbacks

Fears about China’s wave of sickness erupted last week when ProMed – a surveillance system which monitors disease outbreaks worldwide – said the symptoms described in media reports did not align with mycoplasma pneumoniae, which was cited as the cause.

China has been tackling the bacterial infection since May. It spread north from southern provinces like Guangong to areas including Beijing, Liaoning and Shanghai, which reported a 70-80 per cent positivity rate in children in early November.

The ProMed alert, which warned of a potentially “undiagnosed pneumonia,” sparked flashbacks to late 2019, when it first raised the alarm over a mystery virus later named Sars-Cov-2.

China’s initial secrecy then has also damaged trust now, and the World Health Organisation responded with a rare and unusually public “official request” for more information.

Within 24 hours China was forthcoming with data, the UN agency later said, adding there had been “no detection of any unusual or novel pathogens”, but instead a surge of multiple diseases.

While some remain unconvinced – including the US ambassador to Japan, who said “serious questions” remain – many public health experts believe this was to be expected in China’s first post-lockdown winter.

“It is typical that outbreaks of respiratory diseases may occur after a prolonged lockdown,” said Prof Charin Modchang, an epidemiologist at Mahidol University in Bangkok, adding that this trend has not been unique to China.

“This is because the fraction of people who lost their immunity to other diseases might increase during the lockdown, as the lockdown should reduce the circulation of pathogens. So, after the pandemic restrictions had been lifted, we might see unusual outbreaks of some diseases.”

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