Increase in Pneumonia and Pertussis Infections
November 19, 2024
Dear Colleague:
This letter provides updates on increases in pneumonia and pertussis in Virginia.
Increase in Pneumonia Among Children
Since September 2024, the Virginia Department of Health (VDH) has observed a significant rise in emergency department and urgent care visits involving diagnosed pneumonia. During the week of November 10-16, 2024, there were 2,029 emergency department and urgent care visits with diagnosed pneumonia among children aged 0-17 years. This is more than triple the weekly peak observed in the past two years. There are also increases in visits among adults aged 18-64 years. In addition to this upward trend, numerous K-12 schools have reported clusters of students with pneumonia and unspecified respiratory illness. Laboratory testing has identified a variety of pathogens, primarily rhinoviruses/enteroviruses as well as Mycoplasma pneumoniae.
Rhinovirus infections are the most frequent cause of the common cold. Rhinovirus infections can exacerbate chronic respiratory diseases like asthma and chronic obstructive pulmonary disease (COPD). Enteroviruses have a broad spectrum of clinical presentations that can range from mild upper respiratory symptoms to more severe. It is uncommon for these viruses to cause pneumonia, so additional testing is being performed to type and analyze infecting viruses.
M. pneumoniae infections are generally mild and mostly present as a chest cold but may also present as pneumonia. Symptom onset is typically gradual and can include fever, cough, and sore throat. The Centers for Disease Control and Prevention (CDC) recently released a bulletin about a national increase in M. pneumoniae infections, especially in children 2-4 years of age. This differs from previous years in which most infections were observed among school-aged children and adolescents.
Providers are encouraged to:
- Promote routine and seasonal immunizations and other healthy respiratory habits (e.g., staying home when sick, covering coughs and sneezes, frequently washing hands) to help prevent respiratory infections that can lead to pneumonia.
- Consider enterovirus, rhinovirus, and pneumoniae as possible causes of infection among children with community-acquired pneumonia.
- When possible, perform full respiratory panel testing if pneumonia is suspected, especially among hospitalized children, to ensure appropriate treatment is administered.
- Consider swabbing both the throat and nasopharynx to improve the likelihood of pathogen detection in respiratory swab specimens.
- Be aware of treatment recommendations for pneumoniae infections and promote the judicious use of antibiotics by prescribing only when indicated by clinical and/or laboratory evidence.
For more information, please see CDC’s Pneumonia and M. pneumoniae webpages.
Increase in Pertussis
VDH continues to respond to an increase in cases of pertussis (whooping cough). This trend was first reported in August and is linked to outbreaks in group settings, including universities, schools, religious communities, and childcare settings.
Providers are encouraged to:
- Ensure all patients are up to date on DTaP and Tdap vaccination.
- Maintain a heightened index of suspicion for pertussis in patients presenting with respiratory illness, especially with prolonged cough.
- Obtain a nasopharyngeal (NP) swab or aspirate for testing of suspected cases. Contact your local health department to request pertussis testing at Virginia’s state public health laboratory.
- Ensure appropriate antibiotic treatment (e.g., azithromycin, erythromycin) for pertussis patients. Please note that ciprofloxacin and doxycycline are not recommended for pertussis treatment.
- Ensure timely receipt of post-exposure prophylaxis (PEP) antibiotics for contacts meeting high-risk criteria. People who refuse PEP should be excluded from high-risk settings for 21 days.
Thank you again for your continued partnership in keeping Virginians safe from respiratory illnesses. Although influenza, COVID-19 and RSV activity is currently stable in Virginia, we expect these trends to increase in the coming weeks. Please visit the VDH website for current public health guidance on respiratory diseases in Virginia and other information.
Sincerely,
Karen Shelton, MD
State Health Commissioner