2023-12-25 22:00:00
After more than three years at a very low level of circulation in the context of the Covid-19 pandemic, an increase in respiratory infections in Mycoplasma pneumoniae has been observed since this fall in France and other countries, particularly in Europe [1] and Southeast Asia [2].
In France, there is no national surveillance system dedicated to infections with Mycoplasma pneumoniae. At the end of November 2023, unusual increases in respiratory infections in Mycoplasma pneumoniae were highlighted on the one hand with the reporting of clustered cases in schools and on the other hand following reports of hospitalized cases by several clinicians. The investigations carried out to analyze this situation reactively mobilized several partners and data sources (clinical, microbiological, epidemiological) in the city and at the hospital.
Several elements are in favor of an epidemic of pneumonia Mycoplasma pneumoniae of unusual intensity in France since the beginning of October 2023, with a very marked increase from the beginning of November. Public Health France is continuing its investigations in conjunction with its partners to monitor the evolution of the situation.
What is the Mycoplasma pneumoniae bacteria?
Mycoplasma pneumoniae is a bacteria that is transmitted through respiratory droplets during close contact after an incubation period of one to three weeks. After pneumococcus, it is the germ most frequently involved in acute bacterial pneumonia, particularly in children and young adults. In the majority of cases, the course of infections is favorable. Complications such as exacerbation of asthma or rare manifestations, particularly skin or neurological, may require hospitalization. Infections with Mycoplasma pneumoniae can usually be seen throughout the year, most frequently in summer and early fall. Epidemic periods occur every 3 to 7 years.
Consultations for pneumonia in town and in hospital
An increase in the use of emergency care for pneumonia (all types combined) was highlighted at the beginning of October 2023 by SurSaUD® syndromic surveillance, whether in town during visits and consultations of the SOS Médecins network. [3] (figure 1) or at the hospital in the emergency services of the Oscour® network [4] (figure 2). This increase was more marked since the beginning of November (W44), continued until W48 while a stabilizing trend began over the following two weeks at the beginning of December (W49 and W50), with disparities according to age. Among 5-14 year olds and 15 to 44 year olds, these increases were more marked, reaching levels much higher than those of 2019 before the pandemic. Among 5-14 year olds, the indicators continued to increase until week 49 then seemed to begin to decrease in S50, while the increase continued among 15-44 year olds.
The share attributable to Mycoplasma pneumoniae cannot, however, be precisely estimated from these data because the diagnosis of Mycoplasma pneumoniae is not systematic when going to the emergency room. Interpretation of data must also be carried out with caution, taking into account the impact of other respiratory pathogens. In addition, the analysis of only bacterial pneumonia will make it possible to refine these trends, the interpretation of which must also take into account the circulation of other germs, particularly in relation to bacterial superinfections of viral infections.
Figure 1 – Weekly share of procedures for pneumonia among the procedures of SOS Médecins associations for all coded causes, by age group, weeks 28 to 50, years 2019-2023, SOS Médecins network
Figure 2 – Weekly share of visits for pneumonia among emergency visits for all causes coded by age group, weeks 28 to 50, years 2019-2023, OSCOUR® network
Monitoring the detection rates of the bacteria in the hospital and in the city
In the hospital, the number of PCR detections of Mycoplasma pneumoniae (network of RENAL hospital laboratories [5]) has gradually increased since the end of July then more markedly during October 2023, with a positivity rate which doubled between the beginning and the end of October, moving from 1.7% (S40) to 4.0% (S44) (figure 3). This increase continued until reaching, at the end of November, a positivity rate almost 4 times higher than that observed during the same period in 2019 (i.e. 7.4% in S47/23 vs. 1.7% in S47/ 19). A decrease began from week 48, and this continued until week 49. An increase in the positivity rate was observed again in week 50 (unconsolidated data).
In town, the first analyzes of part of the serological data from the 3Labos network [6] show that the positivity rate of IgM tests at Mycoplasma pneumoniae carried out in city medical biology laboratories, all ages combined, increased during the summer of 2023. A clear increase was then observed from the beginning of October, until reaching a much higher level at the end of November (S47). to that of 2019 at the same period. This increase was particularly marked among children aged between 5 and 14 years old, knowing that these trends will have to be confirmed following the integration of all the data from the 3Labos network (Eurofins-Biomnis and Cerba).
Figure 3 – Number and weekly rate of detection by PCR of Mycoplasma pneumoniae, weeks 40/2018 to 50/2023, RENAL hospital laboratory network
What actions are underway to monitor the evolution of the epidemic?
In this epidemic context, monitoring of the evolution of the situation by Public Health France continues in conjunction with its partners. Monitoring of the resistance profile to macrolides (first-line treatment against this bacterium without walls and not sensitive to beta-lactams) is carried out by the bacteriology laboratory at Bordeaux University Hospital (Prof. Bébéar’s team), which provides expertise in the absence of referent CNR for this bacterium [7]. Four resistant strains were detected by PCR among the 112 samples amplified since W28 (3.6%). Monitoring of antibiotic consumption has been set up by the ANSM. A survey on the clinical characteristics of hospitalized cases was set up from mid-December 2023 (Mycado Spilf – Coreb study) [8].
Raising awareness among private and hospital healthcare professionals about diagnosis and treatment was carried out from November 2023 by the Ministry of Health [9]. It is important to pay particular attention to the diagnosis of this infection in order to implement appropriate treatment and prevent the appearance of serious forms of the disease, particularly in people most at risk due to their age or the presence chronic diseases including asthma.
Simple actions to adopt
To reduce the risk of contamination, Public Health France recommends simple barrier gestures to adopt:
wear a mask in case of symptoms (cold, fever, sore throat or cough), in busy places and in the presence of vulnerable people; wash your hands frequently with soap and water or with a hydro-alcoholic solution; ventilate your home regularly; sneeze into your elbow (rather than your hands); use a single-use tissue.
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