000594 - The Role of Asthma and COVID-19 in Shaping the Severity of Pediatric Mycoplasma pneumoniae Infections: A Regional Perspective from the United States

The COVID-19 pandemic led to a decline in Mycoplasma pneumoniae infections in children, followed by a sharp increase in 2024. Asthma, a common comorbidity, may worsen the severity of respiratory infections. Non-pharmaceutical interventions (NPIs) implemented during the pandemic likely altered infection dynamics, with long-term effects on disease severity. This study evaluates the severity of M. pneumoniae infections in pediatric patients with asthma before and after NPIs, focusing on how social determinants of health, such as rural-urban status (Rural-Urban Commuting Area – RUCA) and Child Opportunity Index (COI), influence disease outcomes.

This retrospective cross-sectional study, approved by the University of Arkansas for Medical Sciences IRB (Little Rock, Arkansas, USA), included pediatric patients (≤18 years) at Arkansas Children’s Hospital (ACH) and Arkansas Children’s Northwest (ACNW), tertiary care centers, from November 2017 to September 2024. Inclusion criteria required testing for Mycoplasma pneumoniae using a multiplex respiratory panel using the syndromic approach. Data were collected from electronic health records and the ACH Research Informatics Core, including demographics, comorbidities (e.g., asthma), WHO OSI (Ordinal Scale for Improvement) scores, and social determinants of health (RUCA and COI). We compared disease severity before and after NPIs using the Kruskal-Wallis test with multiple comparison correction to assess the impact of asthma and social determinants on severity.

A total of 612 subjects met the inclusion criteria, which required testing positive for Mycoplasma pneumoniae. Seventy-six subjects were identified in the pre-NPI period (November 2017–March 2020), 518 in the post-NPI period (April 2021–September 2024), and 18 during the NPI period (April 2020–March 2021). Children with asthma had significantly higher WHO OSI scores compared to those without asthma, both before and after the implementation of NPIs (pre-NPI: 4.05 vs. 3.02, p=0.0005; post-NPI: 2.62 vs. 2.50, p=0.7404). The severity of infections was higher in the pre-NPI period for children with asthma (p=0.03), but no significant difference was observed in the post-NPI period. Rural children had significantly higher WHO OSI scores than urban children in the post-NPI period (urban: 2.44 vs. rural: 3.06, p<0.05). Additionally, high/very high and low/very low COI areas showed significant reductions in WHO OSI scores from pre- to post-NPI (p<0.05).

Asthma is a significant comorbidity associated with increased severity of M. pneumoniae infections in pediatric patients, particularly before NPIs were implemented. The findings highlight the need for continued monitoring of M. pneumoniaeinfection severity post-pandemic, focusing on asthma management and public health strategies for diagnosis and treatment, especially in rural areas. The impact of NPIs on the severity and epidemiology of pediatric respiratory infections warrants further investigation.