Mycoplasma pneumoniae detections before and during the COVID-19 pandemic: results of a global survey, 2017–2021

Background: Mycoplasma pneumoniae respiratory infections are transmitted by aerosol and droplet particles among persons in close contact. 

Aim: This study investigated the global M. pneumoniae incidence after the implementation of non-pharmaceutical interventions (NPIs) against COVID-19. 

Methods: We surveyed M. pneumoniae detections from laboratories and surveillance systems (national or regional) across the world from 2020-04-01 to 2021-03-31. Numbers of detections were compared with cases from corresponding periods in 2017-04-01–2020-03-31. Macrolide-resistant M. pneumoniae (MRMp) data were also collected from 2017-04-01–2021-03-31. 

Results: 37 sites from 21 countries in Europe, Asia, America, and Oceania submitted valid datasets (631,104 tests). A total of 30,617 M. pneumoniae detections were reported by direct test methods (62.39%; predominantly PCR), a combination of PCR and serology (34.24%; no distinction between methods), or serology alone (3.37%; IgM considered only). All countries experienced a significant reduction in M. pneumoniae incidence by direct test methods after the implementation of NPIs with 1.69%±3.30% (mean±standard deviation) compared to 8.61%±10.62% during 04/2017–03/2020 (P<0.01). Detection rates decreased with direct but not with indirect test methods (serology) (–93.51% vs. +18.08%; P<0.01). Direct detections remained remarkably low worldwide throughout 04/2020–03/2021 despite widely differing lockdown or school closure periods. MRMp was reported from seven sites (Europe, Asia, and America) and detected in 4.55% (n=1/22) of investigated cases in 04/2020–03/2021 and 23.10% (n=176/762) during 04/2017–03/2020 (P=0.04). 

Conclusions: This is a comprehensive collection of M. pneumoniae detections worldwide showing a correlation between COVID-19 NPIs and a significantly reduced number of M. pneumoniae detections.