France - Unusual increase in cases of Mycoplasma pneumoniae - November 29, 2023

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“An unusual increase” in cases of Mycoplasma pneumoniae: the worrying alert from the Directorate General of Health


Health
Published on11/29/2023 at 1:01 p.m. , update at 1:22 p.m.
MANON LOZANO

This Wednesday, November 29, 2023, in a message sent to health professionals, the General Directorate of Health (DGS) alerted of an “unusual increase” in cases of respiratory infections due to Mycoplasma pneumoniae. Several “cases requiring hospitalization among adults and children in France” have also been identified.

Last Wednesday, the WHO was concerned about an increase in respiratory diseases in China. The country assured that it was not the emergence of a new pathogen but an increase in cases of influenza, RSV and, more particularly, mycoplasma pneumoniae. This is a bacteria discovered in 1944, responsible for acute respiratory infections.

This Wednesday, November 29, the General Directorate of Health (DGS) alerted health professionals of an “unusual resurgence” of cases of respiratory infections caused by Mycoplasma pneumoniae, “including cases requiring hospitalization in adults and children. children in France", reports BFMTV .

Consultations for pneumonia up 36% among those under 15 years old

This “atypical” bacteria has been closely monitored since SOS Médecins reported an increase in lung infections among children at the end of November, particularly among those aged 6 to 15. From November 13 to 19, consultations for pneumonia increased by 36% among those under 15 years old. Visits to emergency rooms for the same cause increased by 28%, still among children under 15 years old. Sudden increases, without comparison with the number of cases in previous years, during the same period.

According to this same document, Mycoplasma pneumoniae is responsible for respiratory infections, very common in children over 4 years old and young adults, the vast majority of which are benign and heal spontaneously. “Human-to-human transmission occurs via droplets and incubation is 1 to 3 weeks,” we further learn.

Should we be worried?

Infectious diseases are not very contagious and epidemics are quite rare. These come back every 4 to 7 years. “ The cyclical nature of epidemics is favored by the loss of immunity over time after an infection and the existence of different genotypes of M. pneumoniae circulating in the population”, notes in a document published in 2019, the French Society of microbiology.

The infection first manifests itself as tracheobronchitis, a dragging cough. The evolution is slow and favorable. But this can be complicated by "a picture of primary atypical pneumonia, often progressive in onset, with a febrile syndrome, signs of the ENT sphere and a dry cough", specifies the French Society of Microbiology. Which adds that the bacteria “even comes first in community-acquired pneumonia in children requiring hospitalization”. The diagnosis is confirmed by carrying out a PCR test in the laboratory. Treatment consists of taking antibiotics such as roxithromycin, azithormycin or clarithromycin.

If viral symptoms persist in a child, it is advisable to consult a doctor.

https://www.midilibre.fr/2023/11/29/une-recrudescence-inhabituelle-des-cas-de-mycoplasma-pneumoniae-lalerte-inquietante-de-la-direction-generale-de-la-sante-11609960.php

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DATE: 11/24/2023 REFERENCE: DGS-URGENT N°2023_23

TITLE: INCREASE IN CASES OF RESPIRATORY MYCOPLASMA INFECTIONS
PNEUMONIA IN FRANCE
...

Geographic area ☒National ☐Territorial

Ladies and gentlemen,

Health authorities have been informed of an unusual increase in cases of respiratory infections from
Mycoplasma pneumoniae including cases requiring hospitalization in adults and children in France.

Mycoplasma pneumoniae is a so-called “atypical” bacteria responsible for respiratory infections, which are very common in
children over 4 years old and young adults. It represents after pneumococcus, the second cause of pneumonia
acute community infection (CAP) bacterial 1. Human-to-human transmission occurs via droplets and incubation is
1 to 3 weeks.

The vast majority of Mycoplasma pneumoniae infections are benign and resolve spontaneously.

Clinical diagnosis in the city may be considered in the face of pneumonia, particularly if it is associated with
muscle pain, dermatological lesions and hepatic cytolysis, especially in the presence of cases
grouped into a community. First-line probabilistic antibiotic therapy for Mycoplasma pneumonia
pneumoniae relies on macrolides, as monotherapy, according to the recommended dosages.

Faced with bacterial pneumonia, and in the absence of immediate signs suggestive of atypical bacteria (early
progressive, extra-respiratory signs, general condition preserved, opacity not systematized), initial treatment
The intention remains amoxicillin or the amoxicillin/clavulanic acid combination according to the usual recommendations. In
In this case, clinical re-evaluation at 48-72 hours of initial antibiotic therapy is imperative and the diagnosis of Mycoplasma
pneumoniae should be considered in the event of failure, prompting an antibiotic change to a macrolide after
have performed a control chest x-ray to rule out pleural effusion and/or CRP.
...
Chest radiography can guide the diagnosis in the face of a bilateral diffuse interstitial pulmonary infiltrate.
Radiological abnormalities are inconsistent and low-dose chest CT has better performance
in this indication. As a reminder, additional investigations depend on the severity of the pneumonia and do not
should not delay the initiation of probabilistic processing.

Confirmation of the diagnosis of Mycoplasma pneumoniae infection is done, if necessary, in a hospital environment by PCR2
on respiratory, pharyngeal or nasopharyngeal sampling and/or by serological diagnosis. PCR, in particular multiplex, is
to be preferred allowing early diagnosis. Coverage of the PCR test by health insurance is currently not
not possible on an outpatient basis.

This alert should not make us forget the search first for viral influenza pneumonia, Covid-19 or
VRS.

Concerning the investigation of this signal, Public Health France (SpF) is continuing its analyzes at the national level in order to
clarify the characteristics and current dynamics of the Mycoplasma pneumoniae community epidemic. Moreover,
the National Agency for the Safety of Medicines and Health Products (ANSM) ensures reinforced monitoring of the
consumption of antibiotics used in winter as part of the fight against shortages of
drugs.

We will inform you of any developments in the situation and thank you in advance for your vigilance.

Dr. Grégory Emery
General Director of the
Health

https://sante.gouv.fr/IMG/pdf/dgs-urgent_no2023_23_mycoplasma_pneumoniae.pdf

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Increase in Mycoplasma pneumoniae infections in France

Public Health France publishes a situation update as of November 30, 2023 on the increase in Mycoplasma pneumoniae infections in France and reminds of the barrier gestures to adopt.

Updated November 30, 2023

Mycoplasma pneumoniae is a bacteria mainly responsible for infections of the upper (angina, pharyngitis, etc.) or lower respiratory tract. After pneumococcus, it is the bacterial agent most frequently involved in acute community-acquired pneumonia (CAP), representing 30 to 50% of these infections in children. In the majority of cases, the symptoms are benign. Complications such as exacerbation of asthma or rare manifestations, particularly skin or neurological, may require hospitalization.

Human-to-human transmission occurs by respiratory route via droplets and incubation is generally 1 to 3 weeks ^[1] . Infections occur throughout the year but may be more common in summer and fall. Clustered cases are described, particularly in children's communities but also in adults. Epidemic peaks are observed cyclically every 3 to 7 years. In Europe, several countries experienced epidemics over the period 2015–2017 ^[2;3] .

Point position

In 2023, unusual increases in Mycoplasma pneumoniae respiratory infections were reported in France in week 47, on the one hand in cities for suspected community cluster cases in schools and on the other hand for confirmed cases in hospital. in intensive care in several regions.

In France, there is no national reporting or surveillance system dedicated to Mycoplasma pneumoniae infections . As part of the investigation of this signal, Public Health France analyzes the situation by mobilizing, in conjunction with its partners, several sources of data (clinical, microbiological, epidemiological; in town and in hospitals).

Investigations carried out in France to date point to an increase in cases of respiratory infections caused by Mycoplasma pneumoniae since the end of summer, more marked since October 2023, notably with an increased occurrence of CAP attributed to this germ.

The elements in favor of this increase are as follows:

• Emergency visits ( OSCOUR® Network ) relating to pneumonia (all types) have increased since the beginning of October, and more markedly from the beginning of November ^[4] , particularly among 6-15 year olds as well as 16 to 49 year olds. years (figure 1). The levels reached in these age groups are much higher than those of 2019 and 2022. This increase is also observed in the analyzes restricted to bacterial pneumonia, which could corroborate the reports reported to date, even if the share attributable to Mycoplasma pneumoniae cannot be precisely estimated from this data source. In addition, the evolution of medical procedures for pneumonia in the SOS Médecins network is comparable to that observed in emergencies [5], with a more marked increase among those under 15 years old and 15-44 year olds.
• The RENAL hospital laboratory network observes that the number of PCR detections of Mycoplasma pneumoniae of all ages increased markedly from October 2023 until reaching levels significantly higher than those of 2019 in week 47 (figure 2) . The number of PCR detections tripled between weeks 40 and 46/2023, with the increase continuing in week 47.
• At the geographical level, several French regions and certain DrOM (Reunion Island, Guyana) have reported consistent observations, particularly from hospital centers. Furthermore, several other European countries have also recently reported increases in Mycoplasma pneumoniae infections (example: Sweden, Netherlands, Norway, Ireland).

All the elements collected to date show an increased circulation of this bacteria in France since the beginning of autumn with a higher number of cases than in 2019 and 2022 at the same period, reflecting an epidemic situation. While hospital microbiological data showed that the circulation of this bacteria in France during the pandemic period was at a very low level, the increase currently observed could be linked to the lifting of control measures put in place during the pandemic, such as this has already been observed for other germs.

Raising awareness among private and hospital health professionals about diagnosis and treatment was carried out by the Ministry of Health .
Figure 1 Weekly rate of emergency room visits for pneumonia per 100,000 emergency room visits by age group, weeks 23 to 47, years 2019, 2022 and 2023, OSCOUR® network

Figure 2 Number and weekly rate of detection by PCR of Mycoplasma pneumoniae, weeks 40/2019 to 47/2023, RENAL hospital laboratory network

...

https://www.santepubliquefrance.fr/les-actualites/2023/augmentation-des-infections-a-mycoplasma-pneumoniae-en-france

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Mycoplasma pneumoniae infections in France: situation update as of December 19, 2023

Public Health France publishes a situation update as of December 19, 2023 following the increase in Mycoplasma pneumoniae infections in France and reminds of the barrier gestures to adopt.

Published on December 26, 2023


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 caused by Mycoplasma pneumoniae has been observed since this fall in France and in other countries, particularly in Europe [ 1] and in South-East Asia [2].

In France, there is no national surveillance system dedicated to Mycoplasma pneumoniae infections . At the end of November 2023, unusual increases in Mycoplasma pneumoniae respiratory infections 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 support an epidemic of Mycoplasma pneumoniae pneumonia 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. Mycoplasma pneumoniae infections can usually be seen throughout the year, most commonly 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 hospitals, the number of PCR detections of Mycoplasma pneumoniae (RENAL hospital laboratory network [5]) has gradually increased since the end of July then more markedly during October 2023, with a positivity rate which doubled between the start 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 the city, the first analyzes of part of the serological data from the 3Labos network [6] show that the positivity rate of IgM tests for Mycoplasma pneumoniae carried out in city medical biology laboratories, all ages combined, has increased in the current of summer 2023. A clear increase was then observed from the beginning of October, until reaching at the end of November (S47) a level much higher than 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 in 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;
• regularly ventilate your home;
• sneezing into your elbow (rather than your hands);
• use a single-use tissue.

...

https://www.santepubliquefrance.fr/les-actualites/2023/infections-a-mycoplasma-pneumoniae-en-france-point-de-situation-au-19-decembre-2023

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Mycoplasma pneumoniae infections in France: situation update as of January 21, 2024

Public Health France publishes a summary bulletin on the evolution of the main indicators available as of January 21, 2024 following the increase in Mycoplasma pneumoniae infections in France reported in November 2023.

Published on February 13, 2024

In France, at the end of November 2023, an unusual increase in the number of M. pneumoniae respiratory infections was identified following reports of clustered cases in schools and reports by clinicians from different regions of several hospitalized cases. Following this feedback from the field, investigations were carried out to confirm the increase in the number of cases and monitor the situation by mobilizing several partners and data sources (clinical, microbiological, epidemiological) in the city and at the hospital.

Initial situation updates have been published based on indicators from the SOS Médecins and Oscour® networks , hospital (RENAL) and city (3Labos) laboratory networks as well as monitoring of the macrolide resistance profile by the Bordeaux University Hospital. This summary presents the evolution of the main indicators available until 01/21/2024 (week 03-2024).

Key points as of January 21, 2024

1. After more than three years at a very low level of circulation in the context of the Covid-19 pandemic, resurgence of Mycoplasma pneumoniae infections linked to the lifting of health measures and the decline in the population's immunity against it infection.
2. Following the report of an unusual increase in the number of M. pneumoniae respiratory infections in schools and hospitals, implementation of monitoring of the situation from November 2023 by structuring a multi-source system coordinated by Public Health France in conjunction with several networks and data sources (clinical, microbiological, epidemiological) in the city and at the hospital.
3. Sharp increase in the use of emergency care for pneumonia in children and young adults, since the end of October 2023 (W43) until the end of December (W52), whether in town during SOS Médecins visits and consultations or at the hospital in the emergency services of the Oscour® network.
4. Share of visits to emergency rooms for bacterial pneumonia at the end of December (W52) among 15-44 year olds and 5-14 year olds far exceeding the values observed during previous epidemics, with levels almost two and four times higher than the average values of the reference period 2015-2020 in these age groups.
5. PCR detection rate of M. pneumoniae in hospital increased significantly since November (W44) until reaching, in mid-December (W50), a positivity rate almost six times higher compared to that observed at the hospital. same period in 2019.
6. Few strains resistant to macrolides (first-line antibiotic treatment) among the samples analyzed between weeks 27/2023 and 02/2024.
7. As of January 21, 2024, trend towards stabilization or decrease in indicators at levels remaining very high in S03.

...

https://www.santepubliquefrance.fr/les-actualites/2024/infections-a-mycoplasma-pneumoniae-en-france-point-de-situation-au-21-janvier-2024

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Health: a “record” epidemic of pneumonia this winter, due to an atypical bacteria

Géraldine Zamansky and Martin Ducret
Saturday at 8:26 a.m. and 12:26 p.m. and Sunday at 10:26 a.m.

If you had or are still having trouble getting rid of a cough this winter, it may be because of a bacteria called Mycoplasma pneumoniae.

Article written by France Info - Géraldine Zamansky
Radio France
Published on 24/02/2024 08:41
Update on 24/02/2024 08:53

Called Mycoplasma pneumoniae, this bacterium which is transmitted through spit, can cause coughs, colds and even pneumonia. Details from Géraldine Zamansky, journalist for the health magazine on France 5.

franceinfo: Has this bacteria reached record levels in recent months? Géraldine Zamansky: Exactly, in a few months, Mycoplasma pneumoniae , has been detected six times more often than before 2020, according to the report published these days by Public Health France. And again, this is only the tip of the iceberg, since in general this bacteria contaminates us very discreetly.

Especially in children, it often causes a simple cold and no one diagnoses it. But it is easily transmitted by spit, and can also cause, as its name suggests, pneumonia and lung infections.

Is it really responsible for the worrying Chinese epidemic that affected Chinese children this fall?

The World Health Organization had called for vigilance. And the surveillance organized by our health authorities this winter gives us hope that the epidemic has finally reached its peak in early January.

On the front line, Professor Charles Cazanave, infectious disease specialist at Bordeaux University Hospital, described the symptoms to me. This “mycoplasma” first triggers a less brutal fever, more around 38°, than the main culprit of pneumonia, pneumococcus. But with a more present cough from the outset.

And above all, one in 4 times, there is damage to the skin, such as plaques on the body, or impressive shapes in the mouth and eyes for example.

And any other strange symptoms?

Yes, Professor Cazanave also wants to point out the very rare neurological signs, such as a change in behavior, especially in children. We must then react quickly. With appropriate antibiotics. Moreover, the diagnosis of this bacteria is often made when the fever persists after a prescription for amoxicillin, the effective weapon against pneumococcus.

The problem is that the PCR diagnostic test, well known for Covid, is not yet reimbursed in the city. So it is mainly carried out in hospitals, for the most serious patients. The majority are adolescents or young adults.

After the acute period, they often complain of a persistent cough for one to two months. This is the consequence of the particular inflammation caused by this mycoplasma. There, Professor Cazanave insists on the importance of a control radio to check that there is nothing abnormal, and he wants to be reassuring: in general, it ends up stopping.

https://www.francetvinfo.fr/replay-radio/c-est-ma-sante/sante-une-epidemie-record-de-pneumonie-cet-hiver-a-cause-d-une-bacterie-atypique_6356170.html