{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:18:31Z","timestamp":1785421111467,"version":"3.56.0"},"reference-count":45,"publisher":"American Society for Microbiology","issue":"7","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2026,7,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Mycoplasma pneumoniae<\/jats:italic>\n                      (Mpn) is a common respiratory tract pathogen known to cause cyclic epidemics every 3\u20134 years. For 4 years (2020\u20132023), a low positivity rate (0.64%) for Mpn laboratory testing at Public Health Ontario suggested minimal circulation of Mpn in Ontario, Canada, likely owing, in part, to COVID-19-related non-pharmaceutical interventions. In 2024, we observed a dramatic re-emergence of Mpn, characterized by large increases in the number of laboratory-confirmed cases (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1,122) and the positivity rate (19.1%) of laboratory detections. Patient age distribution of Mpn infections in 2024 did not differ from 2018 to 2019; however, analysis of patient setting at the time of specimen collection as a proxy for disease severity saw a significant increase in the proportion of Mpn-positive specimens collected from patients in hospital emergency departments (ED) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), and a decrease in the proportion from patients in inpatient wards (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001). Macrolide-resistant rates were statistically equivalent in 2024 (14.6%) compared to 2018\u20132019 (12.4%), as was the ratio of\n                      <jats:italic toggle=\"yes\">p1<\/jats:italic>\n                      -1 and\n                      <jats:italic toggle=\"yes\">p1<\/jats:italic>\n                      -2 adhesin subtypes. Combined 2018\u20132024 data show that a significantly greater proportion of Mpn-positive pediatric specimens occurred in community clinics\/private practices (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001), compared with adults, where a greater proportion were in EDs (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.012), or intensive\/critical care units (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Our findings suggest that the magnitude of Mpn infections in 2024 was not due to a novel strain, but rather due to the increased transmission of strains previously circulating in Ontario following the cessation of COVID-19 pandemic-related non-pharmaceutical interventions, and exacerbated by population immunity debt and the cyclic nature of Mpn.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        <jats:italic toggle=\"yes\">Mycoplasma pneumoniae<\/jats:italic>\n                        (Mpn) is a common cause of community-acquired respiratory infection and is known for causing \u201catypical\u201d pneumonia. Infections show seasonal and cyclical patterns with larger epidemics every 3\u20134 years. Because Mpn is transmitted via respiratory droplets, incidence was very low during the COVID-19 pandemic when masking and physical distancing were widely utilized. In late 2023 through 2024, many jurisdictions worldwide reported a surge in Mpn cases. This increase, along with reports of emerging resistance to first-line treatment macrolide antibiotics, raised concerns about the management of severe infections. Here, we describe the post-COVID-19 pandemic re-emergence in Mpn in Ontario, Canada. Despite high case numbers detected in 2024, infections were not more severe than in pre-pandemic years (2018\u20132019). Mpn genotype ratios and macrolide resistance rates were statistically comparable between 2018\/2019 and 2024, suggesting re-emergence of previously circulating strains rather than the introduction of a novel hypervirulent strain.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/jcm.00188-26","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T13:06:46Z","timestamp":1781269606000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Post-pandemic surge of\n                    <i>Mycoplasma pneumoniae<\/i>\n                    in Ontario, 2024: molecular surveillance and resistance trends relative to 2018\u20132023"],"prefix":"10.1128","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4073-3265","authenticated-orcid":true,"given":"Lisa 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