Increasing respiratory illness hospitalizations

Advisory Alert

The importance of symptom assessment, treatment, and immunization

December 12, 2024

*Cette information est seulement disponible en anglais.

To: Local Health System Partners

FOR IMMEDIATE ATTENTION

Local respiratory activity

Sudbury and districts is entering peak respiratory infection season, and with that we are observing an increase in the number of respiratory illness hospitalizations, including those resulting from respiratory syncytial virus (RSV), COVID-19 and mycoplasma pneumoniae (M. pneumoniae) infections. The pattern observed thus far this season is different than that observed last year, with

lower COVID-19 activity than last year (though increased above baseline)
higher and earlier RSV activity and
increased ICU admissions due to mycoplasma pneumoniae, particularly in children

Table 1: RSV and COVID-19 hospitalizations for surveillance weeks 47 and 48 (roughly November 17-30) for 2023 and 2024

Activity	2024	2023
RSV hospitalizations	19	5
COVID-19 hospitalizations	23	135

There were 32 average daily people in hospital for the treatment of RSV during the week of November 17 to 23, most of whom were children under 5 (21 patients) and adults over 65 (5 patients), the 2 groups at highest risk of severe outcomes of RSV infections.

M. pneumoniae is not a reportable disease and therefore Public Health has limited data on it. Public Health Ontario Laboratory testing has identified no positive results in Sudbury and district residents; however, most testing is completed in other laboratories. Ontario Health has advised of a province-wide increase of associated ICU admissions.

RSV

RSV symptoms usually begin within 3 to 5 days of exposure, and are usually mild cold-like symptoms, including

runny nose
coughing
sneezing
wheezing
fever
decrease in appetite and energy

In infants, symptoms may also include

irritability
difficulty breathing
decreased appetite or feeding
decreased activity

RSV infection usually lasts 1 to 2 weeks and repeated infections are common.

Immunocompromised persons and those with other medical conditions are at highest risk of having severe disease.
In infants and very young children, RSV can cause more serious infections such as ear infections or pneumonia and bronchiolitis.
An older child or adult is contagious for up to eight days; an infected infant can be contagious for as long as 3 to 4 weeks.
RSV can be tested using Public Health Ontario Laboratory’s multiplex respiratory virus panel. This test will also assess for influenza, COVID-19, and other viruses.

Mycoplasma pneumoniae

M. pneumoniae typically causes a mild infection, most often in young adults and school-aged children, 5 to 15 years of age.

Mild (“walking”) pneumonia is a relatively common presentation.
Immunocompromised persons and those with respiratory conditions are at risk for severe disease.
Symptoms develop 4 to 23 days after exposure.
Contagious 2 to 8 days before the symptom onset, until several weeks after infection.
Both PCR and serologic testing is available. Please consult your local laboratory or Public Health Ontario Laboratory for testing protocols.

Common manifestations of mycoplasma pneumoniae infection include pharyngitis and tracheobronchitis, symptoms of which include

cough (dry)
fever
headache
malaise

Children may also present with

coryza without fever
diarrhea
vomiting
wheezing

Illness onset may be gradual and subacute, slowly progressing to a higher fever and persistent cough. Dyspnea presents if illness progresses to pneumonia.

Please review the Ontario Health Biweekly Primary Care Communications Bulletin from November 26 for additional details. It is attached here for convenience.

Immunization

Ontario’s publicly funded RSV immunization program is available through primary care and hospitals for:

adults, age 60 years and older who meet the eligibility criteria (updated)
infants in the first year of life, and some children up to 24 months of age
pregnant persons, with the goal of providing maternal antibodies to newborns

In addition, influenza and COVID-19 vaccines are available through pharmacies and primary care.

For more information about respiratory illnesses (such as influenza, COVID-19, and RSV) and vaccination opportunities, please visit phsd.ca or call Public Health Sudbury & Districts at 705.522.9200 (toll-free 1.866.522.9200).

Sincerely,

Original Signed By

M. Mustafa Hirji, MD, MPH, FRCPC
Acting Medical Officer of Health and Chief Executive Officer

NOTE: All Advisory Alerts are found on our website.

Section A – for dissemination to your memberships

Mycoplasma Resistance Patterns

Sent on behalf of the Office of the Chief Medical Officer of Health, Public Health

Ontario is experiencing increased Mycoplasma pneumoniae activity, especially in young and school aged children. M. pneumoniae tends to occur in late summer and early fall, with cyclical increases every three to seven years. Total specimens tested, total positive specimens, and percent positivity have increased compared to same period last year. Activity has remained high since August.

Common symptoms of M. pneumoniae infection are fever, headache, and a slowly worsening cough. Activity is highest in those aged 10-19 years, and they may present with prolonged fever and cough, progressive shortness of breath and fatigue, and oxygen desaturation. Kids 9 and younger may present with milder symptoms including prolonged dry cough for weeks; worse at night and difficulty sleeping. If they also present with wheezing or work of breathing, please consider managing co-morbidities including asthma. Those with pre-existing lung conditions may be at higher risk of more severe disease.

Key messages

Most patients with a mild M. pneumoniae infection will recover without antibiotics
Amoxicillin is the first-line antibiotic in this age group to treat bacterial pneumonia. However, M. pneumoniae is treated with a macrolide. If your patient has worsening symptoms (excluding isolated cough) after 72 hours of amoxicillin or is not getting better in 5-7 days, consider testing and/or switching antibiotics.
- For patients with suspected or confirmed M. pneumoniae infection who aren’t improving on macrolides, consider using a second-line antibiotic regimen, such as doxycycline or levofloxacin.
Be aware of how to test for M. pneumoniae, using PHO’s testing kit or their local / institutional laboratory practice.
- To order testing supplies from PHO, complete the Requisition for Specimen Containers and Supplies and fax completed requisitions to your closest PHO laboratory
- Mycoplasma pneumoniae/Chlamydophila pneumoniae PCR Kit (6-Pack) – collection instructions
While there is no vaccine for M. pneumoniae, continue to promote the recommended vaccines for other respiratory pathogens for all patients, based on age and health status, including the annual influenza vaccine, an updated COVID-19 vaccine, an RSV vaccine (if eligible), and a pneumococcal vaccine (at age 65)

Kindly note that there will be additional guidance information coming in the upcoming weeks from Ontario College of Family Physicians and Sick Kids.

This item was last modified on December 13, 2024