Children's doctors reporting unusual increase in walking pneumonia cases in Canada

Children’s hospitals across the country are seeing an unusual increase in the number of serious and more complicated cases of walking pneumonia affecting much younger patients, according to medical experts.

Dr. Earl Rubin says he’s seeing more children who are needing treatment for walking pneumonia at the Montreal Children's Hospital.

The disease is common in children and it’s usually a milder form of pneumonia, the division director of pediatric infectious diseases said, but more of them are getting a serious form of the disease.

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The rise of severe walking pneumonia at Montreal Children's Hospital reflects what’s being seen across Canada and the United States, Rubin said in a video interview with CTVNews.ca this week.

Doctors say Mycoplasma pneumonia, known informally as walking pneumonia, is common in school-age children. The contagious pneumonia caused by Mycoplasma pneumoniae bacteria can require treatment for those who experience more severe symptoms, such as breathing problems, they added.

Infectious diseases specialist Dr. Isaac Bogoch said Canada is likely seeing the same trends as the United States, with infections typically seen during fall.

"There likely is more of it around now than in past years," Bogoch, who is based at the Toronto General Hospital, said in a video interview with CTVNews.ca on Thursday. "Certainly, if the United States is reporting more of it, there's likely to be more of it here in Canada as well."

Like other respiratory infections, he said, mycoplasma infections and outbreaks are a clinical and public health concern in Canada.

New trends with walking pneumonia

Rubin said he and his colleagues from other children's hospitals nationwide have observed some patterns with the illness, but that some things are different this year.

“What's happening now is that we are seeing that same spectrum of illness, but in younger kids -- infants, toddlers -- which is unusual," he said. "It always happened, but not as commonly as we're seeing now."

The cases are also more serious than before, he added, with some children needing oxygen as part of their treatment.

Moreover, children's hospitals are seeing a number of different symptoms of the illness, he said.

"We call it the great imitator," he said. "It can cause a multitude of different symptoms -- it can cause rashes, heart issues, brain issues. They're all rare."

He said the reasons behind the trends seen this year are uncertain.

National data not tracked

Walking pneumonia isn't a reportable disease so it's not tracked in Canada.

The Public Health Agency of Canada (PHAC) says it does not monitor this specific disease, though it monitors other respiratory illnesses in Canada and reports the trends in the Respiratory Virus Detection Surveillance System Report, the FluWatch+ Surveillance Program and the COVID-19 epidemiology update.

It’s hard to do tests, Rubin said. The information about the trends he has observed is anecdotal, based on his discussions with his colleagues.

Because more cases have emerged, there's a backlog in tests and delays in getting results, he said. Patients can get diagnosed through various methods, such as nose swabs, throat swabs, blood tests, measuring oxygen and carbon dioxide levels in the blood, a physical exam or a chest X-ray, according to health experts.

Specialized polymerase chain reaction (PCR) tests are more commonly available for those at the hospital, Rubin added.

Cases may dip as winter approaches

With no national data available, CTVNews.ca reached out to doctors at children’s hospitals for a glimpse at what they’re seeing.

The number of walking pneumonia cases spiked in recent months at McMaster Children’s Hospital in Hamilton, Ont., but may decrease as winter approaches, pediatric infectious disease expert Dr. Jeffrey Pernica said.

Since the COVID-19 pandemic, few cases were identified at the hospital, but the situation changed in late spring, Pernica said in a video interview with CTVNews.ca on Monday.

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He said there were periodic mini outbreaks of the lung infection before the pandemic's lockdowns, masking and restrictions on human contact prevented infections.

Pernica said that he observed more children being hospitalized with the illness at the hospital this year. Cases started to grow in May and June, he said, peaking in September.

Positivity rates are still higher than normal at the end of October, Pernica said.

Even with an unusually high number of cases now, he expects the illness to wane while respiratory syncytial virus (RSV) and influenza are projected to surge during winter.

Cases in B.C.

B.C. is seeing more walking pneumonia infections than in previous years, most notably among people under 20 years old, according to data provided from BC Centre for Disease Control (BCCDC) and BC Children’s Hospital in an email to CTVNews.ca on Tuesday.

They cited data from Canadian Sentinel Practitioner Surveillance Network, the BCCDC’s Public Health Laboratory and BC Children’s Hospital.

Cases elsewhere in Canada

In Halifax, a major women's and children's hospital reported it has also seen walking pneumonia cases jump. It soared from 11 last year to 113 as of this September, an IWK Health spokesperson said in an email to CTVNews.ca on Tuesday.

In Winnipeg, HSC Children’s Hospital is seeing a "significant increase" in the number of pediatric patients at the emergency department with pneumonia this fall, but the type of pneumonia is unclear, Dr. Karen Gripp, medical director of the emergency department, said in an email to CTVNews.ca on Monday, noting parents should not panic.

There have been no reports so far from the Saskatchewan Health Authority emergency departments, including Jim Pattison Children’s Hospital, that indicate the illness is widespread, spokesperson James Winkel wrote in an email to CTVNews.ca on Monday.

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Ontario’s Ministry of Health doesn’t publish data on walking pneumonia since it’s not a reportable disease, it said in an email to CTVNews.ca. on Tuesday.

Quebec’s Ministry of Health and Social Services is monitoring the rise in infections in some places but current data isn’t concerning, spokesperson Marie-Christine Patry said in an email to CTVNews.ca on Wednesday.

Similarly, the illness is not a notifiable condition in the Northwest Territories and the territory had no reports about it so far, Andrew Wind, spokesperson for the territory’s Department of Health and Social Services, said in an email to CTVNews.ca on Tuesday.

Walking pneumonia symptoms

Many may refer to Mycoplasma pneumonia as walking pneumonia because those who are infected can still function and walk around, Pernica said.

It can take up to a month before symptoms show up, Rubin said.

It's hard to tell if you have the illness unless you get tested since symptoms are similar to the flu and other respiratory illnesses, such as runny noses, coughs, difficulty breathing and headaches, Pernica added.

The illness isn't as severe as other types of bacterial pneumonia such as Streptococcus pneumonia, Pernica said. In fact, most people with walking pneumonia eventually get better on their own, without needing doctors or treatment, he added.

Those with severe walking pneumonia may need supplemental oxygen if they have breathing problems, or IV fluids if they are unable to drink enough liquids, he said. Most patients who are hospitalized need to be treated with antibiotics, he added.

Children with medical conditions, such as lung and heart disease, or who have problems with their immune system, are more likely to have more serious symptoms and may be hospitalized, doctors say.

You may need medical attention if you have a prolonged fever, have whitish or blue lips, be very sleepy or have difficulty waking up, according to BC Centre for Disease Control and BC Children’s Hospital. A child under three months with a fever may be more vulnerable, they added.

Walking pneumonia treatment

If you have respiratory symptoms that aren’t extreme, Pernica recommends staying home from school or work and limiting contact with others.

For many, there is no medicine to help them recover faster, he said.

"They should be sure to drink enough liquids, take it easy and wait to get better," he said.

Is walking pneumonia contagious?

Mycoplasma pneumonia spreads the same way that respiratory viruses spread -- by coughing, being close to other people and sharing air, or touching things with germs on your hands, Pernica said.

While no vaccines can prevent the disease, it’s a good idea to ensure your vaccines are up to date, Dr. Jason Wong, chief medical officer for BCCDC, said in an email to CTVNews.ca on Thursday.

Immunizations against respiratory viruses like influenza and COVID-19 can help reduce the risk of severe illness from secondary bacterial infections such as from Mycoplasma pneumoniae, which causes walking pneumonia, Wong said.

A secondary bacterial infection occurs when someone becomes susceptible to another infection after a flu-type virus initially weakens the person's immune system.

If you are unwell and must leave home, it’s best to wear a mask in indoor public spaces, and cough and sneeze into your elbow, he suggested.