Changes of Mycoplasma pneumoniae infection in children before and after the COVID - 19 pandemic, Henan, China.

In this journal, Li et al., and Zhou et al., successively reported the decline of Streptococcus pneumoniae and Haemophilus influenzae infections in children under the impact of the COVID - 19 pandemic1Li Y. Guo Y. Duan Y. Changes in Streptococcus pneumoniae infection in children before and after the COVID-19 pandemic in Zhengzhou, China.J Infect. 2022; 85: e80-e81https://doi.org/10.1016/j.jinf.2022.05.040Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar,2Zhou J. Zhao P. Nie M. Gao K. Yang J. Sun J. Changes of Haemophilus influenzae infection in children before and after the COVID-19 pandemic, Henan, China.J Infect. 2022; https://doi.org/10.1016/j.jinf.2022.10.019Abstract Full Text Full Text PDF Scopus (14) Google Scholar. Li et al. compared the effect of COVID - 19 on the incidence of Escherichia coli infections in respiratory system and digestive system in children, the results indicated indicate that the COVID - 19 may mainly affect the incidence of respiratory system infection, and has little impact on the incidence of digestive system infection3Li L. Song C. Li P. Li Y. Changes of Escherichia coli infection in children before and after the COVID-19 pandemic in Zhengzhou, China.J Infect. 2022; https://doi.org/10.1016/j.jinf.2022.11.017Abstract Full Text Full Text PDF Scopus (3) Google Scholar. Up to now, there was no data on Mycoplasma pneumoniae (M. pneumoniae) infections during the COVID - 19 pandemic. M. pneumoniae is a prokaryotic microorganism without cell wall, insensitive to cell wall antimicrobial agents such as lactam, and transmitted through air droplets, coughing, sneezing and close contact4Kumar S. pneumoniae Mycoplasma A significant but underrated pathogen in paediatric community-acquired lower respiratory tract infections.Indian J Med Res. 2018; 147: 23-31https://doi.org/10.4103/ijmr.IJMR_1582_16Crossref PubMed Scopus (46) Google Scholar. M. pneumoniae causes up to 40% of community-acquired pneumonia in children and can develop into serious life-threatening diseases such as refractory mycoplasma pneumoniae pneumonia, necrotizing pneumonia, fulminant pneumoniae and M. pneumoniae encephalitis5Feng S. Chen J.X. Zheng P. Zhang J.Z. Gao Z.J. Mao Y.Y. et al.Status epilepticus associated with Mycoplasma pneumoniae encephalitis in children: good prognosis following early diagnosis and treatment.Chin Med J (Engl). 2019; 132: 1494-1496https://doi.org/10.1097/cm9.0000000000000233Crossref PubMed Google Scholar, 6Wang M. Wang Y. Yan Y. Zhu C. Huang L. Shao X. et al.Clinical and laboratory profiles of refractory Mycoplasma pneumoniae pneumonia in children.Int J Infect Dis. 2014; 29: 18-23https://doi.org/10.1016/j.ijid.2014.07.020Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar, 7Tong L. Huang S. Zheng C. Zhang Y. Chen Z. Refractory Mycoplasma pneumoniae Pneumonia in Children: early Recognition and Management.J Clin Med. 2022; 11https://doi.org/10.3390/jcm11102824Crossref Scopus (5) Google Scholar. In China, macrolide-resistant M. pneumoniae is very common and the prevalence ranges from 83% to 95%, which makes it difficult to treat mycoplasma infection6Wang M. Wang Y. Yan Y. Zhu C. Huang L. Shao X. et al.Clinical and laboratory profiles of refractory Mycoplasma pneumoniae pneumonia in children.Int J Infect Dis. 2014; 29: 18-23https://doi.org/10.1016/j.ijid.2014.07.020Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar. Therefore, it is important to dynamically monitor children's M. pneumoniae infection and understand its epidemiological changes so as to formulate preventive strategies. Here we evaluated the changes in M. pneumoniae infection in children before and after the COVID - 19 pandemic, which may help to inform the implementation of clinical prevention strategies. The Henan Children's Hospital was approved as the National Children's Regional Medical Center, Henan Children's Medical Center, and Henan Pediatric Disease Clinical Medical Research Center. In this study, M. pneumoniae infection was monitored in the Henan Children's Hospital from January 1, 2017 to October 31, 2022. From 2017 to 2019, the positive number and positive rate of M. pneumoniae RNA and M. pneumoniae serological tests fluctuated seasonally, while during the two COVID-19 pandemics, the positive number and positive rate of M. pneumoniae RNA and M. pneumoniae serological tests decreased significantly twice (Figs. 1A and 2A). In particular, after the end of the two COVID - 19 pandemics, the positive number and positive rate of M. pneumoniae RNA and M. pneumoniae serological tests continued to decrease for several months, which may inhibit the seasonal upward trend of M. pneumoniae infection. Although the positive number and positive rate of M. pneumoniae RNA and M. pneumoniae serological test in children increased slightly during the recovery period after two COVID - 19 pandemics, it was still lower than that in the same period before COVID - 19 pandemic. Therefore, the epidemic trend of M. pneumoniae infection in children in Henan Province changed before and after the epidemic of COVID - 19.Fig. 2(A) The positive number of M. pneumoniae serological test and the positive rate of M. pneumoniae serological test from January 2017, to October 2022. (B) The number of positive infection of M. pneumoniae serological test form 2017 to 2021. (C) The number of M. pneumoniae serological test positive in different ages from January 2017 to October 2022. (D) The positive rate of M. pneumoniae serological test in different ages from January 2017 to October 2022.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Furthermore, the total number of M. pneumoniae RNA positive patients over 5 years old accounted for 49% of the total number of M. pneumoniae RNA positive between 0 - 18 y old from 2017 to 2021 (Fig. 1B), but this proportion was not significant in M. pneumoniae serological tests (Fig. 2B). In addition, after COVID - 19 pandemic, the positive number and positive rate of M. pneumoniae RNA and M. pneumoniae serological test decreased in < 1y, 1 - 3y, 3 - 5y and 5 - 18y age groups (Figs. 1C, 1D, 2C and 2D), especially in children over 5 years old, indicating that the COVID-19 pandemic reduced the infection of M. pneumoniae in school-age children. This change may be mainly related to a series of strict measures taken during the COVID-19 pandemic, such as suspension of classes (reduced contact between children), increased awareness of wearing masks and paying attention to hand hygiene. M. pneumoniae infection decreased in children of 0 - 18y during the COVID - 19 pandemic. It also shows that the COVID - 19 pandemic is something we must all face. The epidemic knows no borders, and the virus is the common enemy of mankind. The international community must foster the vision of a community with a shared future for mankind, help each other, jointly address risks and challenges, and jointly safeguard the well-being of people around the world. Therefore, we need to closely observe the epidemic changes of various pathogens affecting the respiratory system before and after the epidemic of COVID - 19. In short, M. pneumoniae infections in children of all ages have declined during the COVID - 19 pandemic. Close monitoring of epidemiological trends helps to prevent M. pneumoniae infection in children, especially in children over 5 years of age. The authors declare no conflict of interests. This work was funded by the National Natural Science Foundation of China (32201237), China Postdoctoral Science Foundation (2020M672301), Scientific and technological projects of Henan province (222102310270, 222102310109)