Mycoplasma pneumoniae incidence, phenotype, and severity in children and adolescents in Denmark before, during, and after the COVID-19 pandemic: a nationwide multicentre population-based cohort study

Kia H S Dungu; Mette Holm; Ulla Hartling; Lise H Jensen; Allan Bybeck Nielsen; Lisbeth S Schmidt; Lise B Toustrup; Lotte H Hansen; Kathrin W Dahl; Kirstine T Matthesen; Anne C Nordholm; Søren Uldum; Hanne-Dorthe Emborg; Maren J H Rytter; Ulrikka Nygaard

doi:10.1016/j.lanepe.2024.101103

Mycoplasma pneumoniae incidence, phenotype, and severity in children and adolescents in Denmark before, during, and after the COVID-19 pandemic: a nationwide multicentre population-based cohort study

Kia H S Dungu
, Mette Holm
, Ulla Hartling
, Lise H Jensen
, Allan Bybeck Nielsen
, Lisbeth S Schmidt
, Lise B Toustrup
, Lotte H Hansen
, Kathrin W Dahl
, Kirstine T Matthesen
, Anne C Nordholm
, Søren Uldum
, Hanne-Dorthe Emborg
, Maren J H Rytter
, Ulrikka Nygaard^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

BACKGROUND: Mycoplasma pneumoniae infections resurged globally in 2023-2024 after a three-year decline during the COVID-19 pandemic. We explored the incidence and severity of M pneumoniae infections in children and adolescents before, during, and after the pandemic.

METHODS: This nationwide, population-based cohort study included all Danish children and adolescents aged 0-17 years with a positive M pneumoniae PCR test from May 1, 2016, to April 30, 2024. We obtained clinical details for patients hospitalised for 24 h or more. Risk ratios for infections, hospitalisations, and disease manifestations in 2023-2024 versus pre-COVID-19 seasons were calculated using Fisher's exact and Pearson's χ2 tests. A season was defined from May 1 to April 30.

FINDINGS: Among the Danish population of 1,152,000 children and adolescents, 14,241 with a positive PCR test for M pneumoniae were included. In 2023-2024, children and adolescents with a positive PCR rose 2.9-fold (95% CI 2.8-3.1; p < 0.0001) compared to the pre-COVID-19 seasons, and hospitalisations rose 2.6-fold (95% CI 2.0-3.3; p < 0.0001). M pneumoniae-induced rash and mucositis increased 5.3-fold (95% CI 1.8-15.3; p = 0.0007). In 2023-2024 compared to the pre-COVID-19 seasons, there was no difference in the proportion of hospitalisation (360 [4%] of 8165 versus 230 [4%] of 6009; p = 0.09), the median duration of hospital stay (3 days [IQR 2-5] versus 3 days [IQR 2-5]; p = 0.84), or paediatric intensive care unit admission (14 [4%] of 360 versus 9 [4%] of 230 p = 1.00).

INTERPRETATION: In Denmark, M pneumoniae infections and hospitalisations increased three-fold in 2023-2024 compared with the pre-COVID-19 seasons, indicating an immunity debt caused by the decline in M pneumoniae during the COVID-19 pandemic. While the severity of M pneumoniae infections did not change in 2023-2024, the five-fold increase in M pneumoniae-induced rash and mucositis in children and adolescents highlights M pneumoniae as an important pathogen causing mucocutaneous eruptions.

FUNDING: Innovation Fund Denmark and Rigshospitalets Forskningsfond.

Original language	English
Article number	101103
Number of pages	12
Journal	The Lancet regional health. Europe
Volume	47
DOIs	https://doi.org/10.1016/j.lanepe.2024.101103
Publication status	Published - Dec 2024

Funding

Funding was received from Innovation Fund Denmark (0176-00020B).

Funders	Funder number
Danish Council for Strategic Research	0176-00020B

Keywords

Corticosteroids
Covid-19
Mirm
Mycoplasma
Mycoplasma induced rash and mucositis
Mycoplasma pneumoniae
Mycositis
Reactive infectious mucocutaneous eruptions
Resurgence
Rime

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Cite this

Dungu, K. H. S., Holm, M., Hartling, U., Jensen, L. H., Nielsen, A. B., Schmidt, L. S., Toustrup, L. B., Hansen, L. H., Dahl, K. W., Matthesen, K. T., Nordholm, A. C., Uldum, S., Emborg, H.-D., Rytter, M. J. H., & Nygaard, U. (2024). Mycoplasma pneumoniae incidence, phenotype, and severity in children and adolescents in Denmark before, during, and after the COVID-19 pandemic: a nationwide multicentre population-based cohort study. The Lancet regional health. Europe, 47, Article 101103. https://doi.org/10.1016/j.lanepe.2024.101103

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title = "Mycoplasma pneumoniae incidence, phenotype, and severity in children and adolescents in Denmark before, during, and after the COVID-19 pandemic: a nationwide multicentre population-based cohort study",

abstract = "BACKGROUND: Mycoplasma pneumoniae infections resurged globally in 2023-2024 after a three-year decline during the COVID-19 pandemic. We explored the incidence and severity of M pneumoniae infections in children and adolescents before, during, and after the pandemic.METHODS: This nationwide, population-based cohort study included all Danish children and adolescents aged 0-17 years with a positive M pneumoniae PCR test from May 1, 2016, to April 30, 2024. We obtained clinical details for patients hospitalised for 24 h or more. Risk ratios for infections, hospitalisations, and disease manifestations in 2023-2024 versus pre-COVID-19 seasons were calculated using Fisher's exact and Pearson's χ2 tests. A season was defined from May 1 to April 30.FINDINGS: Among the Danish population of 1,152,000 children and adolescents, 14,241 with a positive PCR test for M pneumoniae were included. In 2023-2024, children and adolescents with a positive PCR rose 2.9-fold (95\% CI 2.8-3.1; p < 0.0001) compared to the pre-COVID-19 seasons, and hospitalisations rose 2.6-fold (95\% CI 2.0-3.3; p < 0.0001). M pneumoniae-induced rash and mucositis increased 5.3-fold (95\% CI 1.8-15.3; p = 0.0007). In 2023-2024 compared to the pre-COVID-19 seasons, there was no difference in the proportion of hospitalisation (360 [4\%] of 8165 versus 230 [4\%] of 6009; p = 0.09), the median duration of hospital stay (3 days [IQR 2-5] versus 3 days [IQR 2-5]; p = 0.84), or paediatric intensive care unit admission (14 [4\%] of 360 versus 9 [4\%] of 230 p = 1.00).INTERPRETATION: In Denmark, M pneumoniae infections and hospitalisations increased three-fold in 2023-2024 compared with the pre-COVID-19 seasons, indicating an immunity debt caused by the decline in M pneumoniae during the COVID-19 pandemic. While the severity of M pneumoniae infections did not change in 2023-2024, the five-fold increase in M pneumoniae-induced rash and mucositis in children and adolescents highlights M pneumoniae as an important pathogen causing mucocutaneous eruptions.FUNDING: Innovation Fund Denmark and Rigshospitalets Forskningsfond.",

keywords = "Corticosteroids, Covid-19, Mirm, Mycoplasma, Mycoplasma induced rash and mucositis, Mycoplasma pneumoniae, Mycositis, Reactive infectious mucocutaneous eruptions, Resurgence, Rime",

author = "Dungu, \{Kia H S\} and Mette Holm and Ulla Hartling and Jensen, \{Lise H\} and Nielsen, \{Allan Bybeck\} and Schmidt, \{Lisbeth S\} and Toustrup, \{Lise B\} and Hansen, \{Lotte H\} and Dahl, \{Kathrin W\} and Matthesen, \{Kirstine T\} and Nordholm, \{Anne C\} and S{\o}ren Uldum and Hanne-Dorthe Emborg and Rytter, \{Maren J H\} and Ulrikka Nygaard",

note = "{\textcopyright} 2024 The Author(s).",

year = "2024",

month = dec,

doi = "10.1016/j.lanepe.2024.101103",

language = "English",

volume = "47",

journal = "The Lancet regional health. Europe",

issn = "2666-7762",

publisher = "Elsevier",

}

Dungu, KHS, Holm, M, Hartling, U, Jensen, LH, Nielsen, AB, Schmidt, LS, Toustrup, LB, Hansen, LH, Dahl, KW, Matthesen, KT, Nordholm, AC, Uldum, S, Emborg, H-D, Rytter, MJH & Nygaard, U 2024, 'Mycoplasma pneumoniae incidence, phenotype, and severity in children and adolescents in Denmark before, during, and after the COVID-19 pandemic: a nationwide multicentre population-based cohort study', The Lancet regional health. Europe, vol. 47, 101103. https://doi.org/10.1016/j.lanepe.2024.101103

Mycoplasma pneumoniae incidence, phenotype, and severity in children and adolescents in Denmark before, during, and after the COVID-19 pandemic: a nationwide multicentre population-based cohort study. / Dungu, Kia H S; Holm, Mette; Hartling, Ulla et al.
In: The Lancet regional health. Europe, Vol. 47, 101103, 12.2024.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Mycoplasma pneumoniae incidence, phenotype, and severity in children and adolescents in Denmark before, during, and after the COVID-19 pandemic

T2 - a nationwide multicentre population-based cohort study

AU - Dungu, Kia H S

AU - Holm, Mette

AU - Hartling, Ulla

AU - Jensen, Lise H

AU - Nielsen, Allan Bybeck

AU - Schmidt, Lisbeth S

AU - Toustrup, Lise B

AU - Hansen, Lotte H

AU - Dahl, Kathrin W

AU - Matthesen, Kirstine T

AU - Nordholm, Anne C

AU - Uldum, Søren

AU - Emborg, Hanne-Dorthe

AU - Rytter, Maren J H

AU - Nygaard, Ulrikka

PY - 2024/12

Y1 - 2024/12

N2 - BACKGROUND: Mycoplasma pneumoniae infections resurged globally in 2023-2024 after a three-year decline during the COVID-19 pandemic. We explored the incidence and severity of M pneumoniae infections in children and adolescents before, during, and after the pandemic.METHODS: This nationwide, population-based cohort study included all Danish children and adolescents aged 0-17 years with a positive M pneumoniae PCR test from May 1, 2016, to April 30, 2024. We obtained clinical details for patients hospitalised for 24 h or more. Risk ratios for infections, hospitalisations, and disease manifestations in 2023-2024 versus pre-COVID-19 seasons were calculated using Fisher's exact and Pearson's χ2 tests. A season was defined from May 1 to April 30.FINDINGS: Among the Danish population of 1,152,000 children and adolescents, 14,241 with a positive PCR test for M pneumoniae were included. In 2023-2024, children and adolescents with a positive PCR rose 2.9-fold (95% CI 2.8-3.1; p < 0.0001) compared to the pre-COVID-19 seasons, and hospitalisations rose 2.6-fold (95% CI 2.0-3.3; p < 0.0001). M pneumoniae-induced rash and mucositis increased 5.3-fold (95% CI 1.8-15.3; p = 0.0007). In 2023-2024 compared to the pre-COVID-19 seasons, there was no difference in the proportion of hospitalisation (360 [4%] of 8165 versus 230 [4%] of 6009; p = 0.09), the median duration of hospital stay (3 days [IQR 2-5] versus 3 days [IQR 2-5]; p = 0.84), or paediatric intensive care unit admission (14 [4%] of 360 versus 9 [4%] of 230 p = 1.00).INTERPRETATION: In Denmark, M pneumoniae infections and hospitalisations increased three-fold in 2023-2024 compared with the pre-COVID-19 seasons, indicating an immunity debt caused by the decline in M pneumoniae during the COVID-19 pandemic. While the severity of M pneumoniae infections did not change in 2023-2024, the five-fold increase in M pneumoniae-induced rash and mucositis in children and adolescents highlights M pneumoniae as an important pathogen causing mucocutaneous eruptions.FUNDING: Innovation Fund Denmark and Rigshospitalets Forskningsfond.

AB - BACKGROUND: Mycoplasma pneumoniae infections resurged globally in 2023-2024 after a three-year decline during the COVID-19 pandemic. We explored the incidence and severity of M pneumoniae infections in children and adolescents before, during, and after the pandemic.METHODS: This nationwide, population-based cohort study included all Danish children and adolescents aged 0-17 years with a positive M pneumoniae PCR test from May 1, 2016, to April 30, 2024. We obtained clinical details for patients hospitalised for 24 h or more. Risk ratios for infections, hospitalisations, and disease manifestations in 2023-2024 versus pre-COVID-19 seasons were calculated using Fisher's exact and Pearson's χ2 tests. A season was defined from May 1 to April 30.FINDINGS: Among the Danish population of 1,152,000 children and adolescents, 14,241 with a positive PCR test for M pneumoniae were included. In 2023-2024, children and adolescents with a positive PCR rose 2.9-fold (95% CI 2.8-3.1; p < 0.0001) compared to the pre-COVID-19 seasons, and hospitalisations rose 2.6-fold (95% CI 2.0-3.3; p < 0.0001). M pneumoniae-induced rash and mucositis increased 5.3-fold (95% CI 1.8-15.3; p = 0.0007). In 2023-2024 compared to the pre-COVID-19 seasons, there was no difference in the proportion of hospitalisation (360 [4%] of 8165 versus 230 [4%] of 6009; p = 0.09), the median duration of hospital stay (3 days [IQR 2-5] versus 3 days [IQR 2-5]; p = 0.84), or paediatric intensive care unit admission (14 [4%] of 360 versus 9 [4%] of 230 p = 1.00).INTERPRETATION: In Denmark, M pneumoniae infections and hospitalisations increased three-fold in 2023-2024 compared with the pre-COVID-19 seasons, indicating an immunity debt caused by the decline in M pneumoniae during the COVID-19 pandemic. While the severity of M pneumoniae infections did not change in 2023-2024, the five-fold increase in M pneumoniae-induced rash and mucositis in children and adolescents highlights M pneumoniae as an important pathogen causing mucocutaneous eruptions.FUNDING: Innovation Fund Denmark and Rigshospitalets Forskningsfond.

KW - Corticosteroids

KW - Covid-19

KW - Mirm

KW - Mycoplasma

KW - Mycoplasma induced rash and mucositis

KW - Mycoplasma pneumoniae

KW - Mycositis

KW - Reactive infectious mucocutaneous eruptions

KW - Resurgence

KW - Rime

U2 - 10.1016/j.lanepe.2024.101103

DO - 10.1016/j.lanepe.2024.101103

M3 - Article

C2 - 39469091

SN - 2666-7762

VL - 47

JO - The Lancet regional health. Europe

JF - The Lancet regional health. Europe

M1 - 101103

ER -

Mycoplasma pneumoniae incidence, phenotype, and severity in children and adolescents in Denmark before, during, and after the COVID-19 pandemic: a nationwide multicentre population-based cohort study

Abstract

Funding

Keywords

Access to Document

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