Epidemiological changes of <i>Mycoplasma pneumoniae</i> among children before, during, and post the COVID-19 pandemic in Henan, China, from 2017 to 2024

Studies characterizing the epidemic of <i>Mycoplasma pneumoniae</i> (<i>M. pneumoniae</i>) in Henan Province are scarce. Our research investigated the epidemiological changes of <i>M. pneumoniae</i> and macrolide-resistant mutations of <i>M. pneumonia</i>e (MRMP) among children under 18 years from January 2017 to December 2024. The study was categorized into three stages based on the COVID-19 timeline (pre-pandemic, pandemic, and post-pandemic) to analyze the impact of nonpharmaceutical interventions (NPIs) on <i>M. pneumoniae</i> in Henan Province. Among 27,056 children, 28.36% tested positive for <i>M. pneumoniae</i>, with the lowest positivity rate in 2022 (12.56%) and the highest in 2023 (35.01%). The positivity rate was greatest in the 6-17 years (41.08%) and lowest in ≤1 year (12.38%). Epidemic seasons were predominantly in autumn (36.71%) and winter (23.12%). The MRMP rate increased from 36.68% in 2018 to 87.16% in 2023, averaging 71.00%. The positivity rate of <i>M. pneumoniae</i> was 26.12% during the pre-pandemic stage, significantly declined during the pandemic stage (14.97%), and rebounded to a high level in the post-pandemic stage (31.88%). The MRMP rate also increased across the three stages: 46.74%, 72.63%, and 83.31%, respectively. These results indicate a significant influence of COVID-19 NPIs on the transmission of <i>M. pneumoniae</i> and MRMP.IMPORTANCE<i>M. pneumoniae</i> is a significant cause of community-acquired pneumonia with a high MRMP rate in China. Various NPIs in the COVID-19 pandemic have impacted the prevalence of <i>M. pneumoniae</i> and could have important implications for <i>M. pneumoniae</i> prevention and control strategies. Our study documented <i>M. pneumoniae</i> and MRMP detection before, during, and post the COVID-19 pandemic in Henan, China, from 2017 to 2024, aiming to investigate the impact of NPIs on <i>M. pneumoniae</i> transmission and continue to monitor the evolution of the epidemiological characteristics of <i>M. pneumoniae</i> infection after the pandemic when restrictive measures are no longer needed.