No M pneumoniae cases in samples tested since Jan in India: Health ministry

Amid a rise in hospitalisations of children due to pneumonia in China, India has reported no cases of mycoplasma pneumonia — the pathogen suspected to be behind the surge in China — in the 611 samples tested since January 2023.

The Union health ministry issued a statement clarifying that among the 611 samples analysed by the Department of Microbiology at the All India Institute of Medical Sciences (AIIMS) in New Delhi, no mycoplasma pneumonia cases were detected. This testing was part of the Indian Council of Medical Research’s (ICMR’s) comprehensive respiratory pathogen surveillance, primarily focusing on severe acute respiratory illness (SARI), which accounted for about 95 per cent of the cases, conducted through real-time PCR. ICMR serves as India’s apex medical research body.

The health ministry’s statement followed a media report suggesting that between April and September 2023, AIIMS Delhi had identified seven bacterial cases associated with the recent surge in pneumonia cases in China. AIIMS did not respond to questions from Business Standard.

“It is clarified that these seven cases have no link whatsoever to the recent surge in respiratory infections in children reported from some parts of the world, including China. The seven cases have been detected as a part of an ongoing study at AIIMS Delhi in the six month period (April to September 2023) and is no cause for worry,” the statement added.

Doctors highlighted that mycoplasma pneumonia is a prevalent pathogen contributing to pneumonia cases, estimated to account for nearly 36 per cent of pneumonia cases in India. Vivek Nangia, principal director and head of Pulmonology at Max Super Speciality Hospital, Saket, New Delhi, told Business Standard that there hasn’t been an observable increase in pneumonia cases being admitted, and routine procedures include sending such samples for genome sequencing.

The World Health Organisation (WHO) has attributed the increase in respiratory pathogens like Sars-CoV-2, respiratory syncytial virus (RSV), influenza and mycoplasma pneumoniae to the clusters of pneumonia cases observed in China.

This bacterial infection, like several other common respiratory infections, remained subdued during the pandemic due to measures such as social distancing, mask-wearing and reduced outdoor activities.

An article in The Lancet Microbe titled ‘Mycoplasma pneumoniae: delayed re-emergence after Covid-19 pandemic restrictions’ highlighted that mycoplasma pneumoniae commonly causes respiratory tract infections, predominantly community-acquired pneumonia.

The Lancet Microbe report indicated that infections occur globally throughout the year in various climates, with occasional epidemics every few years. Prior data suggested intervals of 1–3 years between M pneumoniae epidemics in Europe and Israel. The most recent epidemic occurred in late 2019 to early 2020, predominantly in Europe and Asia. The introduction of non-pharmaceutical interventions (NPIs) against Covid-19 in March 2020 abruptly halted these epidemics and significantly reduced M pneumoniae detection worldwide.

In comparison to the pre-pandemic incidence of M pneumoniae (8.61 per cent from 2017 to 2020), a substantial reduction was observed in the first year following the implementation of NPIs.

“The first global prospective surveillance study of M pneumoniae (ESGMAC MAPS study) was initiated in April 2022 to allow for rapid notification regarding the geographical location of any substantial increase in activity via monthly website updates alerting clinicians,” the report said.

However, despite occurring at very low levels, a slight increase in case numbers was noted in several countries in the last months of the third year (January to March 2023), leading to heightened vigilance. Reports from the Independent suggested a spike in pneumonia cases in the Netherlands and Denmark as well. “In the Netherlands, the number of children aged 5 to 14 years with pneumonia increased to 130 per 100,000 children in the week leading up to 26 November, the Netherlands Institute for Health Services Research (NIVEL) reported. At its peak last year, there were 58 per 100,000 children,” the report mentioned.

(Sanket Koul contributed to this report)

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