Mycoplasma pneumoniae surveillance in England and Wales, January 2019 to March 2024
Published 3 October 2024
Applies to England and Wales
© Crown copyright 2024
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Summary of findings
The main findings are that:
- Mycoplasma pneumoniae epidemic peaks tend to happen every 4 to 7 years
- laboratory reports from the winter season of 2023 to 2024 indicate there was an epidemic period of Mycoplasma pneumoniae infections, with laboratory detections in January 2024 exceeding detections in the previous epidemic in 2019 to 2020 three-fold
- this increase may also be partially explained by changes in testing methods that have occurred around the COVID-19 pandemic; during the 2023 to 2024 winter season, 89.4% (2,318 out of 2,593) of Mycoplasma pneumoniae detections were determined using PCR tests, compared with 32.6% (302 out of 927) in 2019 to 2020 when serological methods predominated
- in the 2023 to 2024 winter season, laboratory detections of Mycoplasma pneumoniae were highest in children aged 5 to 9 years, followed by those aged 10 to 14 years
- in January and February 2024, macrolide (a group of antibiotics used for treating Mycoplasma pneumoniae) resistance was identified in 5.2% (16 out of 309) and 4.7% (13 out of 276) of Mycoplasma pneumoniae positive samples tested, respectively; throughout the entire 2019 to 2020 season, genotypic markers of resistance were detected in less than 1% (1 out of 110) of samples
- Mycoplasma pneumoniae detections were minimal in the years between the 2019 to 2020 season and the 2023 to 2024 season
- from October 2023 to February 2024, hospital admissions of Mycoplasma pneumoniae increased by 461% (from 110 to 617 admissions); this increase appears to be primarily driven by an increase in admissions in children aged 0 to 14 years old
- hospital admissions associated with Mycoplasma pneumoniae in children aged 0 to 14 years old accounted for 11.2% (224 out of 1,998) of all pneumonia admissions in children aged 0 to 14 years old in January 2024 and 11.7% (236 out 2,020) in February 2024
Clinical picture
Mycoplasma pneumoniae is a bacterium which is a major cause of respiratory infections – particularly pneumonia (atypical pneumonia), predominantly in children, but it can cause infection in all ages. Mycoplasma pneumoniae has a wide clinical syndrome, ranging from causing mild respiratory symptoms to severe pneumonia and death. Rarely, it has also been associated with severe complications such as encephalitis.
Epidemiology and surveillance of Mycoplasma pneumoniae in England and Wales
Mycoplasma pneumoniae epidemic peaks occur periodically in the UK and worldwide every 4 to 7 years (1). Although the transmission of Mycoplasma pneumoniae is not fully understood, the periodicity of these peaks may be determined by changes in community immunity or the introduction of new strains into the population (2). Mycoplasma pneumoniae is found in all age groups however it is one of the most common etiological agents of CAP found in children with pneumonia over 5 years old (3,4,5).
No single surveillance system fully captures national changes in Mycoplasma pneumoniae activity. This report presents data from three distinct systems which collectively describe recent trends: laboratory detections from local and hospital laboratories, macrolide resistance testing from the UK Health Security Agency (UKHSA)’s reference laboratories, and hospital admissions. These systems are detailed in the Data Sources and Methodology section.
To capture the winter peak activity in one reporting period, some data is presented by season rather than by calendar year. A season captures the full 12 months of a year, starting from October and ending in September of the subsequent year.
Mycoplasma pneumoniae laboratory detections presented here are based on laboratory reports of Mycoplasma pneumoniae from October 2019 to March 2024 in England and Wales (EW) extracted from UKHSA’s voluntary surveillance database Second Generation Surveillance System (SGSS). Data in SGSS only captures data reported by local and hospital laboratories. Previously reported data is shown for comparison and context.
The inclusion of updated data may mean data differ from those in earlier publications. Mycoplasma pneumoniae is a non-notifiable organism in England and Wales, and therefore data is reported on a voluntary basis, and only positive results are reported. This may lead to an underestimate of disease caused by Mycoplasma pneumoniae.
Laboratory testing at local and hospital laboratories
For this report, laboratory detections included were limited to those using:
- serological methods on blood, serum or plasma.
- nucleic acid amplification testing (NAAT) methods, including polymerase chain reaction (PCR) on blood, serum, plasma, throat, nose or nasal, bronchial, upper respiratory tract, broncho-alveolar lavage (BAL), alveolar, naso-pharyngeal aspirate (NPA), endotracheal aspirate, trachea or sputum
Testing for Mycoplasma pneumoniae has changed significantly from before the COVID-19 pandemic. Prior to the pandemic, serology was the primary means of laboratory diagnosis. During and post the pandemic, serology has been largely replaced by PCR based methods. Commercial respiratory pathogen multiplex PCR tests that include Mycoplasma pneumoniae as a target are increasingly available, simple and rapid to implement and are highly sensitive.
By contrast, diagnosis of acute infection using serology is limited by the need for acute and convalescent sera 2 weeks apart, which delays results and is being used less. Raised Mycoplasma pneumoniae IgM (which occurs around 7 days post symptom onset) and/or a four-fold increase in IgG levels between the initial sample and the convalescent sample indicate an active or recent Mycoplasma pneumoniae infection. Increases in IgG, without an increase in IgM levels, can also be seen with a re-infection for up to three months. Hence, results from serological analyses can be difficult to interpret as the presence of IgG alone may not definitively indicate a new infection but could also signify a recent re-infection (6).
It is important to note that Mycoplasma pneumoniae exposure can result in asymptomatic carriage (7). Therefore, detections of Mycoplasma pneumoniae may be incidental and not indicative of a pathological infection. These factors should be borne in mind when considering all laboratory detections.
Mycoplasma pneumoniae detections (local and hospital laboratory only)
Overview of the 2023 to 2024 season
During the winter period 2023 to 2024 there was an increase in Mycoplasma pneumoniae laboratory detections compared to the previous winter. Between October 2023 and March 2024, there were 2,592 Mycoplasma pneumoniae detections, a substantial increase compared to 364 in the 2022 to 2023 winter season (Figure 1).
Six European countries and the United States also saw increases in infections due to Mycoplasma pneumoniae since October 2023. Data is limited as the infection is not notifiable in most countries, and as a result any comparisons should be made with caution (2).
The last notable epidemic of Mycoplasma pneumoniae occurred in the 2019 to 2020 winter period and was reported across Europe (8) Both seasons in 2019 to 2020 and 2023 to 2024 saw epidemic peaks in January, with the peak rate in January 2024 being 1.09 cases (95% CI, 1.01 to 1.18) per 100,000 population compared to 0.27 per 100,000 population (95% CI, 0.23 to 0.31) in January 2020 during the 2019 to 2020 epidemic (Figure 2).
The number of detections in January 2024 was 4 times higher than in January 2020, with 650 PCR and serological detections compared to only 160 in the 2019 to 2020 season (Figure 3). However, these figures must be interpreted in the light of changes in testing patterns, particularly the increased use of PCR testing since the COVID-19 pandemic, as detailed above. These trends are described in figures 4, 5 and 6 below.
Figure 1. Cumulative monthly reported Mycoplasma pneumoniae detections (PCR and serological) in England and Wales
Figure 2. Monthly reported Mycoplasma pneumoniae detections (PCR and serological) per 100,000 population in England and Wales
Figure 3. Monthly reported Mycoplasma pneumoniae detections (PCR and serological) in England and Wales
Historically before the COVID-19 pandemic, PCR tests amounted to fewer than 200 detections per year. In the 2023 to 2024 season, however, most detections were from PCR testing (Figure 1 and 3 versus Figure 4 and 5). Before the availability and implementation of commercial respiratory PCR testing panels, serological testing for Mycoplasma pneumoniae would have been requested. The use of respiratory pathogen multiplex PCR tests that include Mycoplasma pneumoniae as a target means that respiratory samples can be tested for Mycoplasma pneumoniae routinely, regardless of which pathogen might have been clinically indicated. This increase in the volume of tests being performed that can detect Mycoplasma pneumoniae may therefore have contributed to the increased detections in the 2023 to 2024 winter season. The shift to PCR testing over time is presented in Figure 6.
In the 2019 to 2020 season, PCR detections accounted for only 32.6% of total Mycoplasma pneumoniae detections, compared to 89.4% in the 2023 to 2024 season.
Figure 4. Cumulative monthly reported Mycoplasma pneumoniae detections (PCR only) in England and Wales
Figure 5. Monthly reported Mycoplasma pneumoniae detections (PCR only) in England and Wales
Figure 6. Number of Mycoplasma pneumoniae (PCR and serological) detections over time in England and Wales
From October 2023 to March 2024, the greatest number of detections were reported from the East of England with 20.2% (524 out of 2,592), the South East with 18.9% (489 out of 2,592) and the North West with 17.4% (450 out of 2,592) of total detections, respectively (Table 1). Similarly, these regions had the highest rates in the January 2024 peak (Figure 7) with rates of 2.02 (95% CI, 1.7 to 2.4) in East of England, 1.9 per 100,000 (95% CI, 1.6 to 2.3) in the North West, and 1.42 (95% CI, 1.2 to 1.7) in the South East. Note that differences in numbers of detections may in part be due to differences in testing and reporting patterns in different regions.
Table 1. Number and Proportion (%) of Mycoplasma pneumoniae (PCR and serological) detections by region within England and Wales and winter season [note 1]
| 2019 to 2020 | 2020 to 2021 | 2021 to 2022 | 2022 to 2023 | 2023 to 2024 | |
|---|---|---|---|---|---|
| East Midlands | 51 (5.5%) | 29 (7.3%) | 41 (9.1%) | 49 (13.5%) | 98 (3.8%) |
| East of England | 163 (17.6%) | 130 (32.7%) | 148 (32.8%) | 58 (15.9%) | 524 (20.2%) |
| London | 109 (11.8%) | 15 (3.8%) | 25 (5.5%) | 22 (6.0%) | 342 (13.2%) |
| North East | 9 (1.0%) | 2 (0.5%) | 0 (0.0%) | 12 (3.3%) | 109 (4.2%) |
| North West | 115 (12.4%) | 3 (0.8%) | 18 (4.0%) | 47 (12.9%) | 450 (17.4%) |
| South East | 257 (27.7%) | 116 (29.1%) | 151 (33.5%) | 129 (35.4%) | 489 (18.9%) |
| South West | 10711.5%) | 61 (15.3%) | 35 (7.8%) | 13 (3.6%) | 246 (9.5%) |
| West Midlands | 55 (5.9%) | 18 (4.5%) | 19 (4.2%) | 7 (1.9%) | 38 (1.5%) |
| Yorkshire & Humber | 52 (5.6%) | 20 (5.0%) | 9 (2.0%) | 23 (6.3%) | 284 (11.0%) |
| Wales | 9 (1.0%) | 4 (1.0%) | 5 (1.1%) | 4 (1.1%) | 12 (0.5%) |
| Total | 927 (100.0%) | 398 (100.0%) | 451 (100.0%) | 364 (100.0%) | 2,592 (100.0%) |
Note 1: the 2023 to 2024 season only covers data up to March 2024.
Figure 7. Rates per 100,000 of Mycoplasma pneumoniae (PCR and serological detections) by month and region, in England and Wales, 2023 to 2024
Figures 8a and 8b show the number and proportions of Mycoplasma pneumoniae detections by test type over time. Detections in Wales, the East of England, South West, Yorkshire and the Humber, West Midlands and North East regions were primarily from serological tests until the 2023 to 2024 winter season, when PCR detections became more prevalent. The East Midlands is the only UKHSA region where serological tests still make up a majority of detections. In London and the North West, PCR detections were more prevalent throughout this period except in the 2020 to 2021 and 2021 to 2022 winters for London, and 2021 to 2022 winter for the North West. In all regions, the number of detections were lower in the 2020 to 2021 and 2021 to 2022 pandemic years compared to non-pandemic years.
Figure 8a. Number of Mycoplasma pneumoniae (PCR and serological) detections over time by English region and Wales, winter 2019 to 2020 to winter 2023 to 2024 [note]
Note: 2023 to 2024 only has data until 31 March 2024.
Figure 8b. Proportion (%) of Mycoplasma pneumoniae by test method (PCR or serology) over time by English region and Wales, winter season 2019-20 to 2023-2024 [note]
Note: 2023 to 2024 only has data until 31 March 2024.
Figure 9: Monthly reported Mycoplasma pneumoniae (PCR and serological) detections by age group in England and Wales
Detections of Mycoplasma pneumoniae have been higher during the winter 2023 to 2024 season in all age groups compared to previous years (Figure 9). The highest numbers of detections are in children aged 14 years old and under, however children may be more likely to be tested which may account for the higher number of detections than in older age groups.
In January 2024, 20.2% (131 out of 650) of all Mycoplasma pneumoniae detections were in children 0 to 4 years old, 25.4% (165 out of 650) were in children aged 5 to 9 years, and 17.5% (114 out of 650) were in children aged 10 to 14 years (Table 2).
Figure 10 shows a distinct difference between rate across the age groups, with those aged 14 years and under having a higher rate than the older age groups.
At the peak of the epidemic, the age group with the highest Mycoplasma pneumoniae detection rate in the 2023 to 2024 winter season was 5 to 9 year old children, at 4.9 per 100,000 population (95% CI, 4.2 to 5.8), followed by the 0 to 4 year olds at 4.3 per 100,000 (95% CI, 3.6 to 5.1) and the 10 to 14 years old with 3.3 per 100,000 population (95% CI, 2.8 to 4.0).
Whilst the 15 to 44 years old age group had the highest number of Mycoplasma pneumoniae detections, the detection rate for this group was lower owing to a larger denominator population, 0.8 per 100,000 (95% CI, 0.66 to 0.9).
Between October 2023 and March 2024, 24.8% (642 out of 2,592) of all Mycoplasma pneumoniae detections were in children aged 5 to 9 years old, and 21.2% (550 out of 2,592) were in children aged 0 to 4.
There does not appear to be any consistent difference in patterns of detections amongst males and females over past seasons (Figure 11).
Table 2. Number and proportion (%) of Mycoplasma pneumoniae (PCR and serological) detections by age groups (years) and month, 2023 to 2024 winter season
| Age groups (years) | Oct | Nov | Dec | Jan | Feb | Mar | Total |
|---|---|---|---|---|---|---|---|
| 0 to 4 | 22 (20.4%) | 57 (19.9%) | 68 (18.2%) | 131 (20.2%) | 130 (23.9%) | 142 (22.5%) | 550 (21.2%) |
| 5 to 9 | 31 (28.7%) | 69 (24.0%) | 94 (25.2%) | 165 (25.4%) | 140 (25.8%) | 143 (22.7%) | 642 (24.8%) |
| 10 to 14 | 18 (16.7%) | 33 (11.5%) | 63 (16.9%) | 114 (17.5%) | 87 (16.0%) | 108 (17.1%) | 423 (16.3%) |
| 15 to 44 | 25 (23.1%) | 86 (30.0%) | 93 (24.9%) | 167 (25.7%) | 117 (21.5%) | 167 (26.5%) | 655 (25.3%) |
| 45 to 64 | 3 (2.8%) | 24 (8.4%) | 28 (7.5%) | 44 (6.8%) | 43 (7.9%) | 48 (7.6%) | 190 (7.3%) |
| 65 and over | 9 (8.3%) | 18 (6.3%) | 27 (7.2%) | 29 (4.5%) | 26 (4.8%) | 23 (3.6%) | 132 (5.1%) |
| Total | 108 (100.0%) | 287 (100.0%) | 373 (100.0%) | 650 (100.0%) | 543 (100.0%) | 631 (100.0%) | 2,592 (100.0%) |
Figure 10. Monthly rate of reported Mycoplasma pneumoniae (PCR and serological) detections by age group in England and Wales, 2023 to 2024
Figure 11. Age-sex pyramid of reported Mycoplasma pneumoniae PCR and serology detections in England and Wales, 2019/2020 to 2023/2024 [note]
Note: 2023 to 2024 only has data until 31 March 2024.
Macrolide resistance (reference laboratory data only)
During the 2023 to 2024 epidemic season there was an increase in the number of respiratory samples submitted to the UKHSA reference laboratory at the Respiratory and Vaccine Preventable Bacteria Reference Unit (RVPBRU) for Mycoplasma pneumoniae confirmation and testing for macrolide resistance (Table 3). Macrolide testing is only available at the UKHSA’s reference laboratory in RVPBRU.
Reference laboratory data is held within local Laboratory Information Management System (LIMS) and is not captured in SGSS, which holds data from local and hospital laboratories only.
Approximately half of the samples received and tested by the reference laboratory could be matched to a sample reported in SGSS. However, as Mycoplasma pneumoniae detections do not comprise a notifiable disease, there is an inconsistent approach data sharing across the laboratory network. As such, initial detection data for many samples referred to the UKHSA reference laboratory and subsequently reported via the local LIMS are not represented in SGSS, making data matching across the two data systems incomplete. Further investigations are needed to establish this relationship; hence the data has been treated separately in this report.
A total of 1,824 samples were received by the reference laboratory between October 2023 and March 2024, with a median age of patient of 11 years old (IQR 5 to 34), compared to 324 over the 2019 to 2020 epidemic season, with a median age of patients of 34 years old (IQR 8 to 61). Of those 1,824 samples tested, mycoplasma pneumoniae was detected by PCR in 1,164 samples in 2023 to 2024, with a median age of 10 years old (IQR 5 to 30), compared to only 131 Mycoplasma pneumoniae PCR positive samples in 2019 to 2020, with a median age of 23 years old (IQR 7 to 40).
There was also an increase in macrolide resistant samples detected in the early months of 2024, relative to previous months, with 5.2% (95% CI, 3.1 to 8.4) of samples tested in January 2024, and 4.7% (95% CI, 2.6 to 8.1) in February 2024, having genotypic markers of resistance detected. In contrast, throughout the entire 2019 to 2020 season, genotypic markers of resistance were detected in less than 1% of samples (1 out of 110). 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 (309 in January and 276 in February).
Table 3. Reporting of Mycoplasma pneumoniae and macrolide resistance testing by UKHSA bacterial reference laboratory from March 2023 to March 2024 [note 1][note 2]
| Month | Year | Samples received in the reference laboratory (n) | PCR detections by reference laboratory (n) | Macrolide resistant samples (n) | Macrolide sensitive samples (n) | Samples with valid PCR macrolide testing (n) | Resistant samples out of PCR detections (%) | 95% Confidence interval |
|---|---|---|---|---|---|---|---|---|
| Mar | 2023 | 16 | 1 | 0 | 1 | 1 | 0.0 | 0.0 to 94.5 |
| Apr | 2023 | 12 | 0 | 0 | 0 | 0 | NA | NA |
| May | 2023 | 10 | 0 | 0 | 0 | 0 | NA | NA |
| Jun | 2023 | 14 | 1 | 0 | 1 | 1 | 0.0 | 0.0 to 94.5 |
| Jul | 2023 | 14 | 1 | 0 | 1 | 1 | 0.0 | 0.0 to 94.5 |
| Aug | 2023 | 13 | 3 | 0 | 3 | 3 | 0.0 | 0.0 to 69.0 |
| Sep | 2023 | 32 | 10 | 1 | 9 | 10 | 10.0 | 0.5 to 45.9 |
| Oct | 2023 | 32 | 9 | 0 | 8 | 8 | 0.0 | 0.0 to 40.2 |
| Nov | 2023 | 53 | 23 | 0 | 22 | 22 | 0.0 | 0.0 to 18.5 |
| Dec | 2023 | 300 | 190 | 6 | 141 | 147 | 4.1 | 1.7 to 9.1 |
| Jan | 2024 | 536 | 351 | 16 | 293 | 309 | 5.2 | 3.1 to 8.4 |
| Feb | 2024 | 438 | 306 | 13 | 263 | 276 | 4.7 | 2.6 to 8.1 |
| Mar | 2024 | 354 | 285 | 8 | 246 | 254 | 3.1 | 1.5 to 6.3 |
| Total | - | 1,824 | 1,180 | 44 | 988 | 1,032 | 4.3 | 3.1 to 5.7 |
Note 1: these numbers represent the overall numbers of samples received by the reference lab. Some patients may have multiple samples taken from illness episode. Note 2: cut-off date of these number was the 22 April 2024. Therefore, April numbers are incomplete. There may be under reporting of the reference laboratory in the most recent months, due to reporting delay.
Hospitalisations (England NHS Hospitals only)
Mycoplasma pneumoniae related admissions (as identified by relevant ICD-10 diagnosis codes – see ‘Data sources and methodology’ section for definitions) began to increase in May 2023, peaking in February 2024 at 617 (Table 4). This represented a 461% increase between admissions in October 2023 and February 2024.
The observed increase was driven by an increase in admissions in children aged 0 to 14 years old. Both Mycoplasma pneumoniae and all bacterial and viral pneumonia admissions increased between September 2023 and March 2024 (Table 5, Figure 12) in children under the age of 15 years. In children under the age of 15 years, Mycoplasma pneumoniae accounted for 11.2% of all bacterial, viral pneumonia admissions in January and 11.7% in February, an increase from 5.4% in October 2023 (Table 5).
The percentage of all bacterial and viral pneumonia admissions associated with Mycoplasma pneumoniae in children under the age of 15 years, began to increase from 0.39% in May 2023 to a peak of 11.7% in February 2024 (Table 5, figure 12).
Furthermore, the highest Mycoplasma pneumoniae associated admission rates were in children aged 5 to 9 years, with a peak rate of 3.5 admissions per 100,000 population in January 2024 (Figure 13). Children aged 0 to 4 and 10 to 14 years have also shown high admission rates when compared to individuals aged 15 and over, with rates of 2.4 and 2.0 per 100,000 in February and January 2024, respectively.
Table 4. Monthly total of overall hospital admissions in England associated with Mycoplasma pneumoniae and monthly proportion change (%) August 2023 to March 2024 [note 1]
| Month | Year | Total Mycoplasma pneumoniae hospital admissions | Percentage (%) change (from previous month) |
|---|---|---|---|
| Aug | 2023 | 62 | 77.1 |
| Sep | 2023 | 61 | -1.6 |
| Oct | 2023 | 110 | 80.3 |
| Nov | 2023 | 231 | 110.0 |
| Dec | 2023 | 406 | 75.8 |
| Jan | 2024 | 534 | 31.5 |
| Feb | 2024 | 617 | 15.5 |
| Mar | 2024 | 588 | -4.7 |
Note 1: ICD-10 codes used to identify Mycoplasma pneumoniae B96.0, J15.7 and J200.
Table 5. Monthly change in proportion (%) of all bacterial and viral pneumonia hospital admissions in England associated with Mycoplasma pneumoniae in children age 0 to 14 years, August 2023 to March 2024 [note 1]
| Month | Year | Percentage (%) of admissions detected as Mycoplasma pneumoniae | Percentage change (%) (from previous month) |
|---|---|---|---|
| Aug | 2023 | 2.4 | +1.1 |
| Sep | 2023 | 3.8 | +1.4 |
| Oct | 2023 | 5.4 | +1.5 |
| Nov | 2023 | 6.3 | +0.9 |
| Dec | 2023 | 6.0 | -0.3 |
| Jan | 2024 | 11.2 | +5.2 |
| Feb | 2023 | 11.7 | +0.5 |
| Mar | 2024 | 11.5 | -0.1 |
Note 1: ICD-10 codes used to identify Mycoplasma pneumoniae B96.0, J15.7 and J200
Figure 12. Total number of monthly all bacterial and viral pneumonia admissions for children aged 0 to 14 years in England, November 2023 to March 2024 [note 1][note 2][note 3]
Note 1: bars correspond to left hand axis, line corresponds to right hand axis. Note 2: ICD-10 codes used to identify Mycoplasma pneumoniae B96.0, J15.7 and J200. ICD-10 codes for pneumonia are found in Annexe 1. Note 3: red line corresponds to percentage which were positive for mycoplasma pneumoniae.
Data source: Admitted patient care (APC).
Figure 13. Total monthly Mycoplasma pneumoniae admission rates, per 100,000 population, in England, by age group, November 2020 to March 2024 [note 1]
Note 1: ICD-10 codes used to identify Mycoplasma pneumoniae B96.0, J15.7 and J200.
Data sources and methodology
Laboratory detections
The Second-Generation Surveillance System (SGSS) is the national database of microbiological and virological at local and hospital laboratory detections and includes the recording of positive detections of Mycoplasma pneumoniae. The cut-off date of SGSS detection in this report was 31 March 2024. Rates of laboratory detection were calculated using the 2021 mid-year resident population estimates in England and Wales released by the Office for National statistics.
Reference laboratory data is held within local Laboratory Information Management System (LIMS) and is not captured in SGSS.
Macrolide resistance data
Reference laboratory methods for Mycoplasma pneumoniae testing
Respiratory samples were submitted to the national reference laboratory at the Respiratory and Vaccine Preventable Bacteria Reference Unit (RVPBRU), UKHSA for Mycoplasma pneumoniae confirmation and macrolide resistance testing. Samples received were predominantly PCR positive samples (locally).
Respiratory samples were initially tested using an in-house qPCR assay based on the detection of Mycoplasma pneumoniae P1 adhesion gene. Mycoplasma pneumoniae PCR positive samples were subjected to macrolide resistance testing using a Sanger sequencing method for determination of known point mutations in domain V of 23S rDNA conferring macrolide resistance (MR) to Mycoplasma pneumoniae (Table 1).
Table 1. Known mutations in Domain V of 23S rDNA conferring macrolide resistance (MR) to Mycoplasma pneumoniae.
| Resistance locus | Mutation | Sequence | Result |
|---|---|---|---|
| 2053-2067 | |||
| Wild type | AACGGGACGGAAAGA | MR mutation not detected | |
| A 2063 G | AACGGGACGGGAAGA | MR mutation detected | |
| A 2063 C | AACGGGACGGCAAGA | MR mutation detected | |
| A 2064 G | AACGGGACGGAGAGA | MR mutation detected | |
| A 2064 C | AACGGGACGGACAGA | MR mutation detected | |
| A 2067 G | AACGGGACGGAAAGG | MR mutation detected | |
| 2609-2619 | |||
| Wild type | GGTTGGTCCCT | MR mutation not detected | |
| C 2617 G | GGTTGGTCGCT | MR mutation detected | |
| C 2617 A | GGTTGGTCACT | MR mutation detected |
Mycoplasma pneumoniae PCR positive samples (excluding viral transport medium (VTM) samples) with CT value <30 as well as all macrolide-resistant samples were cultured for identification. Antimicrobial susceptibility testing (AST) is not offered in RVPBRU.
The data used for this report was extracted on 22 April 2024. This extract only includes samples received from England and Wales. Only samples with definitive PCR results were included in this analysis. Some reporting delay is expected.
Hospitalisations
Figures in this report include NHS hospitals in England only. These may include patients whose usual residence is outside of England but were admitted to a hospital in England.
Hospital admissions for Mycoplasma pneumoniae were identified in the Admitted Patient Care (APC) dataset using the ICD-10 codes: B96.0 (Mycoplasma pneumoniae as the cause of diseases classified to other chapters), J15.7 (Pneumonia due to Mycoplasma pneumoniae) and J200 (Acute bronchitis due to Mycoplasma pneumoniae). Hospital admissions were grouped by admission category and then aggregated by calendar month.
Hospitalisation data lags behind laboratory data as it may take up to 3 months for diagnoses to be filed in the APC dataset.
Annexe
Bacterial and viral pneumonia hospitalisation codes
| Codes | Code description |
|---|---|
| A01.03 | Typhoid pneumonia |
| A37.01 | Whooping cough due to Bordetella pertussis with pneumonia |
| A37.11 | Whooping cough due to Bordetella parapertussis with pneumonia |
| A37.81 | Whooping cough due to other Bordetella species with pneumonia |
| A37.91 | Whooping cough, unspecified species with pneumonia |
| A481 | Legionnaires disease |
| A54.84 | Gonococcal pneumonia |
| B01.2 | Varicella pneumonia |
| B05.2 | Measles complicated by pneumonia |
| B59 | Pneumocystosis |
| B59X | Pneumocystosis |
| B96.0 | Mycoplasma pneumoniae (M. pneumoniae) as the cause of diseases classified to other chapters |
| J09.X1 | Influenza due to identified novel influenza A virus with pneumonia |
| J11.0 | Influenza due to unidentified influenza virus with unspecified type of pneumonia |
| J11.08 | Influenza due to unidentified influenza virus with specified pneumonia |
| J12 | Viral pneumonia, not elsewhere classified |
| J12.0 | Adenoviral pneumonia |
| J12.1 | Respiratory syncytial virus pneumonia |
| J12.2 | Parainfluenza virus pneumonia |
| J12.3 | Human metapneumovirus pneumonia |
| J12.81 | Pneumonia due to SARS-associated coronavirus |
| J12.89 | Other viral pneumonia (e.g. COVID-19) |
| J12.9 | Viral pneumonia, unspecified |
| J128 | Other viral pneumonia |
| J13 | Pneumonia due to Streptococcus pneumoniae |
| J13X | Pneumonia due to Streptococcus pneumoniae |
| J14 | Pneumonia due to Hemophilus influenzae |
| J14X | Pneumonia due to Haemophilus influenzae |
| J15 | Bacterial pneumonia, not elsewhere classified |
| J15.0 | Pneumonia due to Klebsiella pneumoniae |
| J15.1 | Pneumonia due to Pseudomonas |
| J152 | Pneumonia due to staphylococcus |
| J15.20 | Pneumonia due to staphylococcus unspecified |
| J15.211 | Pneumonia due to Methicillin susceptible Staphylococcus aureus |
| J15.212 | Pneumonia due to Methicillin resistant Staphylococcus aureus |
| J15.29 | Pneumonia due to other staphylococcus |
| J15.3 | Pneumonia due to streptococcus, group B |
| J15.4 | Pneumonia due to other streptococci |
| J15.5 | Pneumonia due to Escherichia coli |
| J15.6 | Pneumonia due to other Gram-negative bacteria |
| J15.7 | Pneumonia due to Mycoplasma pneumoniae |
| J15.8 | Pneumonia due to other specified bacteria |
| J15.9 | Unspecified bacterial pneumonia |
| J16 | Pneumonia due to other infectious organisms, not elsewhere classified |
| J16.0 | Chlamydial pneumonia |
| J16.8 | Pneumonia due to other specified infectious organisms |
| J17 | Pneumonia in diseases classified elsewhere |
| J170 | Pneumonia in bacterial diseases classified elsewhere |
| J171 | Pneumonia in viral diseases classified elsewhere |
| J172 | Pneumonia in mycoses |
| J173 | Pneumonia in parasitic diseases |
| J178 | Pneumonia in other diseases classified elsewhere |
| J18 | Pneumonia, organism unspecified |
| J18.0 | Bronchopneumonia, unspecified organism |
| J18.1 | Lobar pneumonia, unspecified organism |
| J18.8 | Other pneumonia, unspecified organism |
| J18.9 | Pneumonia, unspecified organism |
| J85.1 | Abscess of lung with pneumonia |
| J95.851 | Ventilator-associated pneumonia |
References
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