China’s Mysterious Pneumonia: A New Threat to Global Health Security

By the end of 2023, China was facing a mysterious pneumonia that caused children to be hospitalized. The surge of cases of this disease had burdened China's health care system.

By the end of 2023, China was facing a mysterious pneumonia that caused children to be hospitalized. The surge of cases of this disease had burdened China’s health care system. It also triggered global concern over the possibility of a new pandemic similar to COVID-19 that occurred a few years ago. The phenomenon of mysterious pneumonia originated from a number of cases of pneumonia of unknown cause that occurred in several cities in China since October 2023. The cases mainly affected children, and caused symptoms such as high fever, lung nodules, and difficulty breathing. The outbreak was first reported by Chinese media in May 2023, which noted an increase in cases of mycoplasma pneumoniae infection in several children’s hospitals in China (Lodhi, 2023).

According to a WHO report on November 23, 2023, Chinese health authorities attributed the increase in hospital admissions to known pathogens, such as adenovirus, influenza virus, and respiratory syncytial virus (RSV), which tend to cause only mild symptoms such as colds. However, the increase in the number of children hospitalized since May 2023, was mainly caused by mycoplasma pneumoniae, a bacterium that infects the lungs. This mysterious pneumonia is a common cause of ‘walking pneumonia’, a form of disease that is usually relatively mild and does not require rest or hospitalization, but this disease has a great impact on children this year (Aljazeera, 2023).

Mycoplasma pneumoniae is an unusual bacterium, which has no cell wall and can easily adapt to different environments. The bacterium can spread through direct contact, droplets, or air, and has a fairly long incubation period, between 2 to 4 weeks. Symptoms of Mycoplasma pneumoniae infection can vary, from mild to severe, depending on the age, health condition, and immune system of the patient. Symptoms generally include cough, fever, headache, chest pain, and shortness of breath. In some cases, the infection can also cause complications such as brain inflammation, heart inflammation, hemolytic anemia, and Stevens-Johnson syndrome (Global Center for Health Security, 2023).

This mysterious pneumonia has spread to several regions in China and outside China, thus attracting global attention over concerns that it could threaten global health security. Based on a report from ProMED, a surveillance system that reports globally on infectious disease outbreaks, this mysterious pneumonia infection has spread to Beijing and Liaoning city in northeast China, which is 800 kilometers away. The number of infected patients reached 1,200 people per day at one of the major hospitals in Beijing (ProMED, 2023). In addition to China, cases of this mysterious pneumonia have also been reported in the Netherlands, where a 9-year-old child was diagnosed with mycoplasma infection after visiting China in November 2023. Dutch health authorities said that this case was not related to COVID-19. Mysterious Pneumonia and COVID-19 are two different diseases, although both can cause inflammation in the lungs. The cause of Mysterious Pneumonia is suspected to be caused by mycoplasma bacteria, while COVID-19 is caused by the SARS-CoV-2 virus (MacIntyre et al., 2023).

Although this mysterious pneumonia is still endemic, it has raised global concern because it reminds of the beginning of the COVID-19 pandemic, which also originated from cases of pneumonia of unknown cause in China at the end of 2019 (Harsona, 2023). COVID-19 has spread worldwide and killed more than millions of people to date. This mysterious pneumonia also threatens global health security because it has the potential to spread from person to person through close contact, such as coughing, sneezing, or sharing glasses (Handayani, 2020). Mycoplasma bacteria are also resistant to some antibiotics, making treatment difficult. This mysterious pneumonia also challenges the capacity and readiness of health systems in various countries, especially in the midst of the ongoing COVID-19 pandemic (The National Health Commission China, 2023).

Mysterious Pneumonia as a New Threat to Global Health Security Post COVID-19

For countries outside China, reports of respiratory disease outbreaks have reminded of the early days of the COVID-19 pandemic, which first emerged as a case of mysterious pneumonia in the city of Wuhan at the end of 2019 and its origin was never known for sure but threatened global health security. Health security is one aspect of non-traditional security, which is a concept of security that not only focuses on military threats, but also on non-military threats that can disrupt the well-being, human rights, and dignity of human beings. Non-traditional security recognizes the interconnection and interdependence between various issues, actors, and regions, and requires cross-sectoral and multilateral cooperation to address these threats (Trihartono et al., 2020). Mysterious Pneumonia caused by mycoplasma pneumoniae bacteria is one example of a global health security threat. Mysterious Pneumonia in China can threaten global health security for several reasons, including:

Mycoplasma pneumoniae bacteria can cause mild to severe respiratory tract infections, depending on the health condition and immune system of the individual. This infection can spread through close contact with the patient, such as coughing, sneezing, or respiratory droplets of the patient.

Mysterious pneumonia in China has spread to several provinces and cities, and attacked children with an average age of 6 years. Children are a group that is vulnerable to infection and health complications, so they need special attention and protection. This pneumonia is more prone to children because children have short respiratory tracts. So the infection that occurs in the upper respiratory tract, will be easier to enter the lung tissue because the tract is short (Ibid).

Mysterious pneumonia in China also has the potential to spread to other countries, especially those that have trade, tourism, or high mobility relations with China. This can increase the risk of a pandemic, which can disrupt economic, social, and political stability at the global level as well as the COVID-19 pandemic (Rokom, 2018).

Other countries are worried about the mysterious pneumonia in China because they do not want to experience the same negative impact as the COVID-19 pandemic, which has caused casualties, economic losses, and health crises around the world. Many countries are concerned about the long-term potential of this mysterious pneumonia, especially Asian countries that are adjacent to China both geographically and have cooperative relations, especially South Korea, Japan, Vietnam, India, Indonesia, and other countries that have close relations with China in terms of trade, investment, tourism, and cooperation. Developed countries, such as the United States, the European Union, and Australia, are also concerned about the mysterious pneumonia in China, because they want to maintain their strategic interests, security, and welfare in the Asia-Pacific region (The Economic Times, 2023).

Taiwan’s response, based on a statement from the Taiwan Ministry of Health, urged children, the elderly, and patients with immune system disorders not to travel to mainland China. Taiwan also increased health surveillance at airports and ports, and strengthened cooperation with WHO and China. The data on mysterious pneumonia cases in Taiwan is not yet known for sure, but Taiwan has confirmed one imported case from China on November 28, 2023 (Aktas, 2023). Then in India, according to a statement from the Ministry of Health and Family Welfare of India, India is one of the countries that has been alert to this pneumonia outbreak. India has issued guidelines for the prevention and control of Mycoplasma pneumoniae infection in health facilities, as well as prepared a surveillance and laboratory system to detect suspicious cases. The data on mysterious pneumonia cases in India is not yet known for sure, but India has reported 1,200 cases of pneumonia in children in the state of Uttar Pradesh on November 27, 2023 (HT News Desk, 2023).

Furthermore, Indonesia also through a statement from the Director General of Disease Prevention and Control of the Indonesian Ministry of Health stated that, Indonesia has taken quick steps by issuing a circular on alertness to the occurrence of Mycoplasma pneumoniae in Indonesia. This circular is addressed to health policy makers throughout Indonesia, and urges residents not to panic, but to remain vigilant and maintain health. The data on mysterious pneumonia cases in Indonesia is not yet known for sure, but Indonesia has reported 2,000 cases of pneumonia in children in West Java province on November 29, 2023 (Loasana, 2023).

World Health Organization Response

Since mid-October 2023, the World Health Organization (WHO) has been monitoring data from China’s surveillance system that shows an increase in respiratory diseases in children in northern China. At a press conference on November 13, 2023, the National Health Commission of China reported an increase in respiratory disease incidence nationally, mostly affecting children. Chinese authorities attributed the increase to the lifting of COVID-19 restrictions and the arrival of winter, and due to the circulation of known pathogens such as influenza, Mycoplasma pneumoniae, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Mycoplasma pneumonia and RSV are known to affect children more than adults (Chinese Center for Disease Control and Prevention, 2023).

On November 22, 2023, WHO identified media and ProMED reports of undiagnosed pneumonia clusters in children’s hospitals in Beijing, Liaoning, and elsewhere in China. Through the International Health Regulations mechanism, WHO submitted a formal request to China to provide additional epidemiological and clinical information, as well as laboratory results from the reported cases and data on current trends in respiratory pathogen circulation. The main objective was to identify whether there were “undiagnosed pneumonia clusters” in Beijing and Liaoning as mentioned in the media reports, and if so, whether this was a separate event, or part of a general increase in respiratory disease in the community. WHO then contacted clinical networks to obtain additional information (Conroy, 2023).

On November 23, WHO held a teleconference with Chinese health authorities from the Chinese Center for Disease Control and Prevention and Beijing Children’s Hospital, facilitated by the National Health Commission and the National Administration of Disease Control and Prevention, where the requested data was provided, and showed an increase in outpatient and inpatient consultations of children due to Mycoplasma pneumoniae pneumonia since May, and RSV, adenovirus, and influenza virus since October. Some of these increases occurred at the beginning of the season compared to what had happened before, but this was not unexpected considering the lifting of COVID-19 restrictions, as happened in other countries (Sasongko, 2023). There was no change in the picture of the disease reported by Chinese health authorities. Chinese authorities stated that there had been no detection of unusual or new pathogens or unusual clinical presentations, including in Beijing and Liaoning, but only a general increase in respiratory diseases caused by several known pathogens. Furthermore, they stated that the increase in respiratory diseases did not result in the number of patients exceeding hospital capacity (World Health Organization, 2023).

Chinese authorities stated that, since mid-October, increased outpatient and inpatient surveillance had been implemented for respiratory diseases that covered a wide spectrum of viruses and bacteria, including, for the first time, Mycoplasma pneumoniae. This complements the existing respiratory surveillance mechanisms and may contribute to the increased detection and reporting of respiratory diseases in children.

In addition to increasing disease surveillance in health care facilities and the community, in mid-October Chinese authorities emphasized the need to strengthen the capacity of the health system in handling patients. China has a system for obtaining information on influenza trends, influenza-like illness (ILI), RSV and SARS-CoV-2, pneumonia, and other severe acute respiratory infections (SARI), and reporting influenza detection to platforms such as the Global Influenza Surveillance and Response System (GISRS). GISRS is led by WHO and used for international virological and epidemiological surveillance of human influenza. WHO closely monitors the situation and maintains close contact with national authorities in China. WHO will continue to provide updates as needed.


Mysterious Pneumonia is a disease that does not spread as fast as COVID-19 and has a low mortality rate, so it is still categorized as endemic, which is a disease that is limited to a certain region or group. However, this Mysterious Pneumonia has triggered global concern, especially in Asian countries such as Indonesia, Singapore, Malaysia, Japan, and Taiwan. The main reason for this concern is because the disease has a long incubation period, which is the time between exposure to bacteria and the onset of symptoms, which can reach 2 to 4 weeks. This makes it difficult to detect and prevent the transmission of this disease. In addition, the disease can also affect all ages, but is more risky for children and the elderly, who have weak immune systems. The disease can also cause serious complications, such as brain inflammation, heart inflammation, and kidney inflammation, which can threaten the patient’s life.

The spread of this Mysterious Pneumonia can threaten global health security, which is a condition where there are no threats to human health that can disrupt the social, economic, and political stability of the world. Health security is one aspect of non-traditional security, which is a concept of security that not only relates to military threats, but also to threats to the well-being and survival of human beings, such as natural disasters, terrorism, climate change, and infectious diseases. COVID-19 is one example of an infectious disease that has become a threat to global health security, which has caused widespread and profound negative impacts in various fields.

Therefore, countries must be vigilant and cooperate to prevent and overcome this Mysterious Pneumonia, by conducting surveillance and tracking cases strictly, increasing the capacity and quality of health services, providing education and socialization to the public about the prevention and treatment of this disease, and building regional and international cooperation in terms of information exchange, assistance, and research. Thus, countries can protect the health and security of their people, as well as maintain the stability and harmony of the world.

Silvanah, is a Masters Student in International Relations at Gadjah Mada University. She is interested in researching international issues such as global health, global environmental politics and issues in the East Asia region.