How common is Mycoplasma pneumoniae infection in children during the COVID-19 pandemic?
During the COVID-19 pandemic, non-pharmaceutical interventions like masking and social distancing reduced the spread of many respiratory infections, including Mycoplasma pneumoniae (M. pneumoniae). As a result, M. pneumoniae infections in children became much less common during the pandemic. However, after pandemic restrictions were relaxed, infections rebounded strongly, often exceeding pre-pandemic levels. This pattern has been observed in multiple studies from different regions.
What the research says
A large meta-analysis of 70 studies found that the pooled prevalence of M. pneumoniae in children was 21.72% before the pandemic, dropped to 10.73% during the pandemic, and then rose to 28.64% after the pandemic 2. This pattern was consistent across age groups, with school-age children (over 6 years) having the highest rates in all periods 2.
Studies from specific regions confirm this trend. In Guangzhou, China, the annual positive rate among hospitalized children was only 1.2% in 2021 and 5.3% in 2022, but jumped to 29.4% in 2023 after the pandemic 5. Similarly, in Ningbo, China, the M. pneumoniae positive rate was 6.35% during the period of strict non-pharmaceutical interventions (NPIs) and rose to 34.28% after NPIs were relaxed 7.
During the pandemic, macrolide resistance remained high. One study during the pandemic (2021-2022) found a macrolide resistance rate of 92.7% in children with M. pneumoniae pneumonia 6. After the pandemic, resistance rates continued to be high, with one study reporting 94.4% resistance in 2023-2024 3. Co-infections with other respiratory pathogens also increased after the pandemic 7.
What to ask your doctor
- Given the recent rise in Mycoplasma pneumoniae infections, should I watch for specific symptoms in my child?
- If my child has a persistent cough or fever, could Mycoplasma be a possible cause even if they had COVID-19 before?
- Are there any changes in treatment recommendations for Mycoplasma pneumoniae due to high macrolide resistance rates?
- Should my child be tested for Mycoplasma pneumoniae if they have pneumonia symptoms, especially after the pandemic?
This question is drawn from common patient questions about Infectious Disease and answered using cited medical research. We do not provide individualized advice.