Should France fear a pneumonia epidemic?

In China, an epidemic of childhood pneumonia seems linked to contamination by Mycoplasma pneumoniae, a bacteria well known to infectious disease specialists. Is France in turn at risk of being affected by a similar epidemic wave? In any case, the bacteria is already circulating in the territory, because specialists are already noticing an increase in cases of “atypical pneumonia”. An unusual increase in emergency room visits, particularly among young people, is raising fears of an “epidemic outbreak”.

“Since April there has been an increase in the circulation of Mycoplasma pneumoniae around the world, particularly in Asia but also in Europe. Whether in the city or in rural areas, we are indeed recording an increase in the number of hospitalizations in France,” confirms Dr Alexandre Bleibtreu, member of the French-language Society of Infectious Pathology (SPILF). . Last week alone, 2,150 visits to the emergency room for pneumonia were recorded by SOS Médecins for children under 15 years old. For ten years, this figure has never been reached for this type of pulmonary infection.

» READ ALSO - Pneumonia is very dangerous for older people

If adults are also affected, 30% of cases of pneumonia induced by Mycoplasma pneumoniae occur in very young people. Up to 50% for the 5 to 15 year old age group. Transmission occurs by droplets or direct contact with an infected person. “Fever, fatigue, runny nose and dry cough are the first symptoms. This can progress to respiratory distress after a few weeks, which signals the onset of atypical pneumonia or atypical pneumonia as opposed to pneumococcal pneumonia,” describes Dr. Gilles Pialoux, head of the infectious and tropical diseases department at the Tenon hospital in Paris.

In the most serious cases, mycoplasma infection progresses outside the lungs in cutaneous or even neurological forms. However, don't panic. “It is too early to talk about an epidemic,” reassures Gilles Pialoux. “We are not in a situation similar to Covid. It’s simply the re-emergence of a known pathogen,” adds Dr Bleibtreu.

» READ ALSO - Epidemic of childhood pneumonia in China: what do we know

The Mycoplasma pneumoniae bacteria circulates regularly in France but in a minority compared to other pulmonary infections such as influenza or bronchiolitis. “Typically, this pathogen becomes epidemic every 5 to 7 years. The last major epidemic in Europe took place in 2019. It mainly affected northern countries, sparing France,” explains Alexandre Bleibtreu. During the Covid-19 pandemic, the infectious agent had also kept a low profile. But, unlike other respiratory pathogens, it did not reappear in force after the end of confinement.

How then can we explain its abnormal presence throughout the territory? “At the moment no one knows,” admits Dr. Pialoux. Since the bacteria has not circulated epidemically for ten years, it is very likely that human immunity to this pathogen has declined. “We are facing a population that has not had an immune response for ages and is therefore poorly equipped to defend itself,” insists the doctor. Added to this is an apparent relaxation of the French on barrier gestures. However, underlines Dr Bleibtreu, it is possible that a new variant of this bacteria could spread across the territory. There is no information to confirm this at the moment and this hypothesis remains “very unlikely”.

» READ ALSO - Concerns about the progression of certain antibiotic resistances in France

The other question that bothers infectious disease specialists concerns the risks of bacterial resistance. Usually, pneumonia is treated using a family of antibiotics, macrolides. “But we have no information on the rate of antibiotic resistance. We were at 10% a few years ago but we currently do not have enough information to measure it due to the lack of circulation of the bacteria,” indicates Gilles Pialoux.

French health authorities therefore remain on guard. A surveillance system is currently deployed throughout the country to identify new cases and determine the extent of the spread. If the increase in pneumonia were to be confirmed and persist, the authorities could be required to sound the alert. But we are not there yet. Barrier gestures and wearing a mask remain strongly recommended to avoid getting sick.