As winter enters one after another in various parts of our country, which viruses have become active? Will the coronavirus become epidemic again?

Ten questions about respiratory infections
in winter

As winter progresses into various places, respiratory infections have also entered the season of high incidence. Mycoplasma pneumoniae, which has been circulating since September, is still the cause of pressure in pediatric diagnosis and treatment.

On November 11, the National Health Commission held a press conference to introduce the prevention and treatment of respiratory diseases in winter. A number of experts answered questions about Mycoplasma pneumoniae, mixed infection, and new crown epidemic trends.


Entering the winter, what is the situation of respiratory infectious diseases in China?

Mi Feng, spokesman for the National Health Commission, said that as winter has entered one after another, respiratory diseases have entered the high incidence season, and a variety of respiratory diseases are intertwined and superimposed. It is necessary to adhere to the prevention and treatment of multiple diseases, pay close attention to the epidemic situation of Mycoplasma pneumoniae, new crown infection, influenza, dengue fever, norovirus infection, etc., strengthen monitoring and early warning, and grasp the changes in the intensity of virus activity and virus mutations.

Among them, in terms of influenza, according to Wang Dayan, director of the National Influenza Center of the Institute of Viral Diseases of the Chinese Center for Disease Control and Prevention, the influenza epidemic season in winter and spring in China is generally from mid to late October to mid to early March of the following year, and generally reaches its peak around January.


What do you think about multi-virus co-infection?

For mixed infection, Tong Zhaohui, director of the Beijing Institute of Respiratory Diseases, introduced that influenza A and B, including respiratory syncytial virus, rhinovirus, metapneumovirus, adenovirus, Mycoplasma pneumoniae, etc., are common respiratory pathogens in winter, and some pathogens have a certain colonization in the respiratory tract of the population.

However, this situation is very rare and does not necessarily depend on the severity of the disease, although some viruses do not have specific drug treatment, but respiratory virus infection is somewhat self-limited, and it is not necessary to take antiviral treatment, and recovery can be achieved with symptomatic symptomatic symptom relief. It is recommended that the elderly, children under 5 years old, and special groups with weakened immunity seek medical attention in time, and doctors will help judge the condition and then carry out corresponding treatment.


What is the difference between influenza and mycoplasma infection?

Tong Zhaohui introduced that Mycoplasma pneumoniae is generally prevalent in autumn and winter in the northern region, and in summer and autumn in the southern region, the clinical manifestations are mainly fever and cough. At the onset, it is manifested as a severe, paroxysmal, irritating dry cough, which may be accompanied by headache, runny nose, sore throat, earache, etc. Compared with previous years, children under the age of 3 have also been infected this year, showing a trend of younger age, but the disease has not worsened significantly.

Influenza is more common in winter and spring, starting with fever and upper respiratory tract infection, followed by worsening cough, dyspnea and pulmonary signs, and even more severe systemic symptoms, such as high fever, rapid progression of the disease, fatigue, headache, muscle aches, imaging and mycoplasma pneumonia have some similarities, so respiratory specimen testing is more important, such as the detection of antigen and nucleic acid of influenza A or B virus can be distinguished. There are also some patients with high fever who have Mycoplasma pneumoniae infection, and the course of the disease tends to progress more slowly than that of influenza, but as the course of Mycoplasma pneumoniae infection progresses, a violent, irritating dry cough may also occur.


The whole family is infected, is the culprit mycoplasma or the new crown?

Tong Zhaohui said that according to the 2016 guidelines for community-acquired pneumonia in China and relevant data monitoring, Mycoplasma pneumoniae is one of the important causes of community-acquired pneumonia in China, with a high incidence in autumn and winter every year, and children and adolescents are susceptible. Mycoplasma pneumoniae is mainly transmitted through respiratory droplets, so unprotected outbreaks can occur in densely populated places such as kindergartens and schools. Mycoplasma infection in family members is also common. Recently, the detection rate of mycoplasma nucleic acid detection in Beijing Chaoyang Hospital was 5.59% for adults and 40.34% for children. Influenza antigen was positive for 29.67% of adults and 4.94% of children.

Acute respiratory infection is a common respiratory disease, and the symptoms caused by Mycoplasma pneumoniae, new coronavirus, influenza virus, etc. are similar, and the etiological diagnosis can be confirmed by antigen and nucleic acid detection. It is recommended that you use drugs after confirming the etiology, rather than relying on guessing about drug abuse.


Does mycoplasma infection in children necessarily develop pneumonia?

Wang Quan, chief physician of Beijing Children's Hospital, said that Mycoplasma pneumoniae infection varies from mild to severe in clinical practice, and the vast majority of children have mild symptoms, and not all Mycoplasma pneumoniae infections will cause pneumonia, and only a very small number may develop severe disease.

Mycoplasma may also cause complications in and out of the lungs, including plastic bronchitis, pleural effusion, or necrotizing pneumonia, and outside the lungs, which may involve the nervous system, urinary system, blood system, including the circulatory system, and may also cause mucocutaneous damage or arthritis.

Due to the imperfect development of the immune system, children's specific and non-specific immune functions are not very mature, including the cough reflex is relatively weak, the motor function of the respiratory cilia is not so sufficient, and the level of immunoglobulins is also low, so it is easy to cause infection.


If my child is infected with mycoplasma, can he take azithromycin on his own?

Wang Quan said that it is not advisable for parents to give their children azithromycin on their own, and it is not recommended.

At present, Mycoplasma pneumoniae infection accounts for a certain proportion of respiratory diseases in children, but on the whole, viruses are still the most common pathogens of respiratory tract infections in children, including influenza virus, rhinovirus, adenovirus and respiratory syncytial virus.

In addition, the child's organ function is not fully developed, and drug abuse may cause some adverse reactions, especially organ damage.

Azithromycin is a macrolide antibacterial drug, which is a prescription drug and should be used under the guidance of a doctor or pharmacist. This standard medication involves giving your child the right dose, the right course of treatment, and the right route of administration.


When does my child need alveolar lavage?

Wang Quan introduced that bronchoalveolar lavage through flexible bronchoscopy is an important treatment method for the clinical treatment of severe mycoplasma pneumonia. However, routine treatment is not recommended for patients with mild mycoplasma pneumonia.

In clinical work, when the doctor suspects that the child has plastic bronchitis or mucus plug obstruction and atelectasis after being infected with Mycoplasma pneumoniae, it is necessary to treat the child with lung lavage as soon as possible, which is conducive to reducing complications and sequelae, and a small number of children may need to undergo multiple lung lavage during the entire hospitalization or in the later stage.


Will the coronavirus become epidemic again?

Since late August, the number of reported cases of new coronavirus infection in the country has declined for 8 consecutive weeks, and the positive rate of new crown nucleic acid testing in sentinel hospitals in fever clinics across the country has also shown a continuous downward trend.

Global and China's surveillance data show that the new crown virus currently circulating in the world and in China belongs to Omicron, and the pathogen sequencing results sampled in the latest week show that all are XBB subclades, and no variants with obvious changes in biological characteristics have been found.


After the new crown epidemic, why do you feel that there are more respiratory infections?

Tong Zhaohui said that during the new crown epidemic, due to the strict respiratory prevention and control measures taken by everyone, including mycoplasma, viruses, and other infections, these acute respiratory diseases have indeed decreased compared with other years. With the normalization of prevention and control, it is normal for the incidence of these respiratory diseases to return to the pre-pandemic level. Compared with the previous three years, everyone thinks that this year's respiratory diseases seem to have increased, but in fact, in the past three years, the global surveillance of mycoplasma infection has been at a low level. Combined with the epidemiological law of mycoplasma itself, it will have periodic epidemics every 3-7 years, so this year's mycoplasma pneumonia in children is showing an epidemic trend.


How to prevent respiratory infections such as the flu?

Wang Dayan said that the most effective and economical way to prevent respiratory infections is vaccination. In addition, the public can reduce the risk of infection and transmission by mastering the basic knowledge of common respiratory infections and adopting scientific prevention methods in their daily lives.

She suggested that in daily life, it is necessary to maintain adequate sleep, adequate nutrition, and moderate physical exercise.

Practising good personal hygiene can reduce the risk of infection. For example, when coughing or sneezing, cover your mouth and nose with a tissue, towel, or elbow; Practice hand hygiene and wash your hands frequently, especially after coughing or sneezing; Try to avoid touching your eyes, nose or mouth.

Take care to keep your home and workplace environment clean. Open the windows regularly indoors for ventilation, and the outdoor temperature is low in winter, so you should also pay attention to keeping warm during the ventilation period. If you have a person with a respiratory infection in your household, wear a mask when caring for the patient.

High-risk groups such as the elderly, children, and patients with underlying diseases should avoid going to crowded public places, especially closed places with poor air circulation, to reduce the chance of contact with sick people. When going to confined and crowded places or taking public transportation, it is recommended to wear a mask and change it in time.

She reminded that once symptoms of respiratory infection such as fever and cough appear, patients should rest at home to avoid transmitting the pathogen to other people. If the symptoms are severe, you should take personal protection and go to the hospital as soon as possible to get effective treatment in a timely manner.

Beijing News reporter Dai Xuan