HPR volume 18 issue 6: news (25 July)
Updated 25 July 2024
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Responding to a springtime signal of elevated pneumonia rates in children
In March 2024, syndromic surveillance at UKHSA highlighted increased levels of lower respiratory tract infections (LRTI) in GP consultations and pneumonia emergency department (ED) attendances in England in children aged 5 to 14 years where the seasonally expected winter peak had not decreased as was seen in previous years (figure 1). Absolute numbers of ED pneumonia attendances remained low: around 10 to 15 attendances a day across the UKHSA ED syndromic surveillance network (as compared to 2 to 4 per day during the same period for the past few years). This signal continued despite decreases in detections in seasonal respiratory viruses.
Seven-day moving average of daily* emergency department (ED) attendances pneumonia, aged 5-14 years, 1 January 2019 to 30 June 2024, including 110 type 01 EDs across England
*29 February excluded, not adjusted for bank holidays.
To investigate the signal, data linkage was undertaken between ED attendances in the non-syndromic Emergency Care Data Set (ECDS) and Second Generation Surveillance System (SGSS) database of microbiological sample laboratory data. Paediatric ED attendances coded with respiratory infections diagnostic codes were linked to laboratory reports in SGSS within 7 days of attendance. This revealed that, while detections of Mycoplasma pneumoniae (M. pneumoniae) in SGSS laboratory data remained stable overall during the period January to May 2024, in the 5 to 14 year-old age group, M. pneumoniae may have been the main driver behind these persistently elevated ED pneumonia attendances. However, although more recent syndromic surveillance suggests that there has been a decline in ED pneumonia attendances and GP LRTI consultations from week 15 (from 8 April), the syndromic indicators and mycoplasma detections remain elevated.
M. pneumoniae is a bacterium that commonly causes acute respiratory infections, which are typically mild, but can in rare instances cause severe pneumonia and disease outside the respiratory system such as encephalitis. NICE guidelines outline how to treat these infections with antibiotics such as macrolides. Winter 2023/24 in England was an epidemic season for M. pneumoniae, which are known to occur every few years and which last occurred in 2019. Higher rates of M. pneumoniae respiratory infection in winter 2023/24 were also seen in several European countries (including France, Sweden, Norway, Denmark and the Netherlands) and the USA. Advances in availability of molecular testing for M. pneumoniae have also likely contributed to rising case notifications in the UK over the last few years.
The UKSHA reference laboratory (Respiratory and Vaccine Preventable Bacteria Reference Unit; RVPBRU) undertakes confirmatory M. pneumoniae PCR testing and macrolide resistance testing of referred samples using a PCR and sequencing method for determination of point mutations. In December 2023, UKHSA requested that diagnostic laboratories refer any M. pneumoniae positive samples to RVPBRU so that macrolide resistance could be monitored, and there was a subsequent increase in samples being referred. As of 18 July 2024, macrolide resistance rates in M. pneumoniae samples were highest in January and February, with 4.7% (95% CI, 2.7 to 7.9) and 5.2% (95% CI, 2.9 to 9.0), respectively. Bias in samples submitted may be a limitation of this estimate and the wide confidence intervals reflect the number of samples tested for macrolide resistance by the reference laboratory, which remained relatively small (342 in January and 274 in February). Rates of macrolide resistance continue to be closely monitored by UKHSA.
Infection reports
Group A streptococcal infections: fifth update report on seasonal activity in England, 2023 to 2024
Common animal-associated infections (England): first quarter 2024
Creutzfeldt-Jakob disease (CJD) surveillance update 2023
Vaccine coverage reports
Shingles vaccine coverage (England): report for quarter 1 of the financial year 2023 to 2024