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the news of major children's hospitals full has once again occupied the hot search! Yes, another respiratory infectious disease season is coming.

According to recent data from China's National Influenza Center and major hospitals, various respiratory infectious diseases are on the rise rapidly. The five pathogens, influenza virus, human adenovirus (HAdV), respiratory syncytial virus (RSV), new coronavirus and Mycoplasma pneumoniae, have come together. Compared with previous years, this wave of infectious diseases not only rose relatively earlier, but also many patients were infected with multiple pathogens, and the spread was more complicated.

Among these pathogens, Mycoplasma pneumoniae is particularly eye-catching this year, and its spread in children and adolescents is very "outstanding". Since children's immunity is relatively low, once they get sick, they often affect the whole family, so it is not surprising that the topic is hot.

The positive rate of Mycoplasma pneumoniae nucleic acid detection in Shenzhen Third Hospital is high. Source: Shandong CDC, China Post Securities Research Institute

So what exactly is Mycoplasma pneumoniae? Which public companies do this provide?

1. understanding "MPP"

According to the definition of the Beijing Center for Disease Control and Control, Mycoplasma pneumoniae is a kind of between bacteria and viruses, the world has been known to survive independently of the smallest microorganisms. Structurally, Mycoplasma pneumoniae has no cell wall, which makes it look like a naked bacterium.

Mycoplasma pneumoniae can cause Mycoplasma pneumoniae pneumonia (MPP), which is more common in spring and autumn. In terms of symptoms, most patients have fever, fatigue and cough as the main manifestations, and some patients also have sudden high fever and obvious headache, myalgia and other systemic manifestations. A few patients even develop critical illness, with prominent manifestations such as dyspnea and respiratory failure. The course of MPP is related to the severity of symptoms and usually lasts for 2 or even 4 weeks. Although all age groups are more susceptible to Mycoplasma pneumoniae, it is more common in children over 5 years of age and adolescents. The immune system of children and adolescents is not yet perfect, and symptoms are often more severe after infection.

Mycoplasma structure source: Jiangsu disease control, the author finishing

In fact, Mycoplasma pneumoniae pneumonia is distributed every year, but it is not obvious in most years, but there is a relatively large-scale epidemic every 3-7 years. This year is undoubtedly the year of high incidence of Mycoplasma pneumoniae infection . This is generally thought to have something to do with the new crown pandemic that has lasted for many years. Due to less interpersonal contact and stricter protection during the epidemic, the transmission chain of respiratory viruses is cut off, the human body is less exposed to various pathogens, and the immune barrier to these pathogens is gradually weakened. There are also studies that suggest that people infected with the new crown after the immune system disorders, prone to respiratory-related diseases. In 2022, respiratory syncytial virus infection in the United States and Canada surge , other regions in the relaxation of control measures also ushered in the epidemic of respiratory diseases, coupled with the recent wave of domestic menacing, these phenomena may be the inevitable after the new crown prevention and control turn.

speaking of this, the author thinks that many infectious diseases and human beings have a somewhat "symbiotic" relationship. the lack of chance of infection for a long time may not be a good thing for human beings.

2. azithromycin is widely recommended

Regarding medication, the National Health Commission just released a version of the Guidelines for the Diagnosis and Treatment of Mycoplasma Pneumoniae Pneumonia in Children (2023 Edition) this year. Among them, macrolide antibiotics are used as the preferred treatment drugs, including azithromycin , clarithromycin and erythromycin and other antibiotics. Azithromycin is also used as a first-line drug and is widely recommended in many relevant guidelines abroad.

The clinical characteristics of influenza virus and mycoplasma infection are quite different. Source: National Health Commission, China Post Securities Research Institute

indeed, many popular science articles will mention azithromycin if friends like the author who have been recruited in this round of search for what medicine to take. How about the localization process of this "old drug", which was approved for listing in China in 1996?

Unfortunately, the products of multinational pharmaceutical company Pfizer are still in short supply in the market today.

in fact, there are a lot of approval documents for azithromycin drugs in the hands of domestic pharmaceutical companies. there are as many as 629 approved approval documents for azithromycin drugs in China, and 9 of the 10 pharmaceutical companies in the approval quantity system are domestic pharmaceutical companies. However, the sales performance of domestic products is not ideal. Hospital sales data show that the total domestic azithromycin sales in 2022 will be 1.371 billion yuan, and Pfizer will get 0.652 billion yuan. Many domestic pharmaceutical companies can only catch up with Pfizer.

the source of the list of enterprises with azithromycin approval: internet, compiled by the author

as mentioned in the previous article, mycoplasma pneumoniae pneumonia is common among children and adolescents, so what is the reason why the domestic brand azithromycin is not popular with parents of children?

First and foremost is the quality issue. Between 2011 and 2021, there were 41 pieces of azithromycin sampling quality unqualified information, mainly domestic drugs. Although the "metaphysics" of consistency evaluation makes domestic drugs look shorter than imported drugs in terms of efficacy, such uneven quality is difficult to prevent parents from voting with their feet.

in addition dosage form is also an influencing factor, we in the "warm wind frequency blowing, children's medication, into the fast lane!" As mentioned in the article, dosage form is an important aspect to consider in children's medication. In the dosage form of azithromycin products, domestic pharmaceutical companies mainly layout in the injection, this piece benefited from the promotion of collection, the share of domestic pharmaceutical companies has exceeded Pfizer. However, in the dosage form of dry suspension, which is convenient for children to use, the performance of independent brand products is still difficult to say ideal, and Pfizer still occupies an absolute leading position.

The competition for azithromycin products is also becoming fierce. Since 2023, four domestic pharmaceutical companies such as Renfu Pharmaceutical (600079) have been approved for related products, and six pharmaceutical companies have submitted and declared the consistency evaluation of azithromycin dry suspension, and the multi-dose azithromycin tablets of Dx & Vx, a South Korean pharmaceutical company, have just been officially listed.

since September 2022, stone medicine group won the first domestic azithromycin dry suspension listing approval, 31 domestic pharmaceutical companies have obtained the listing approval. And what is the annual sales volume of this dosage form? In 2022, the physical pharmacies of domestic public hospitals will be around 0.8 billion yuan , which is true to be more monks and less porridge. I'm afraid it is difficult to expect azithromycin products to bring bright performance to listed companies for a while. However, going to sea is another feasible way for pharmaceutical companies. azithromycin for injection by Puli Pharmaceuticals (300630) has been approved by more than 10 countries such as Virtue.

It should be noted that this round of Mycoplasma pneumoniae epidemic has a characteristic, that is, drug resistance is more common. Many patients are not sensitive to azithromycin treatment. According to the data of Beijing area, from 2015 to 2020, more than 90% of Mycoplasma pneumoniae have certain drug resistance. Moreover, macrolide antibiotics also have the characteristics of cross-resistance, that is to say, once patients are resistant to azithromycin, they will often be resistant to other similar antibiotics such as erythromycin. Therefore, if the dressing is changed, tetracycline antibacterial drugs such as doxycycline will generally be selected. However, these drugs have certain contraindications in the field of children's medication. The instructions of doxycycline clearly indicate that "children under 8 years old are prohibited".

3. detection kit and traditional Chinese medicine also contain opportunities

Before medication, it is natural to go through testing and diagnosis. Mycoplasma is a prokaryote with a volume of about 50-300 nanometers, between bacteria and viruses, and is not easily observed under a microscope. Therefore, mycoplasma in the traditional way of diagnosis, it is difficult to be diagnosed in the early stage, often delay medication.

Comparison of the size of bacteria, mycoplasma and viruses Source: Sohu, BOC Securities

and the application of molecular detection technology of mycoplasma pneumoniae detection kit can solve this problem, the layout of domestic enterprises is also a lot.

According to data from the State Drug Administration, as of October 2023, there have been 112 Mycoplasma pneumoniae-related test kits, most of which (105) are domestic brands. In terms of listed companies, Antu Bio (603658) holds 5 kit registration certificates in the first place, followed by Yahui Long (688575), Innott (688253) and Novizan (688105).

Listed companies Mycoplasma pneumoniae test kit registration certificate combing source: State Drug Administration, Guojin Securities Research Institute. (Data as of 23/10/19)

In addition to these means, Chinese medicine intervention may also be a way. The health departments in Sichuan, Jiangsu, Zhejiang, Henan and other places have provided suggestions for decoction and external treatment of mycoplasma pneumoniae pneumonia with traditional Chinese medicine. Kangyuan Pharmaceutical (600577)'s Jinzhen oral liquid and other listed company products are also included in the various medical guidelines. It is generally believed that traditional Chinese medicine can better deal with antibiotic resistance, and some external treatment methods are more friendly to children.

The immune gap created during the neo-crown pandemic still exists, and cyclical epidemics of respiratory infectious diseases such as Mycoplasma pneumoniae pneumonia may become the norm for a longer period of time in the future. As for us, it is still necessary to prepare certain preventive measures and prepare for face-to-face with various pathogens. For the relevant listed companies, the product layout is advancing in an orderly manner, however, limited by the limited market size corresponding to seasonal epidemics and the strong occupancy of multinational pharmaceutical companies, the imagination space may be more limited.

Note: This article does not constitute any investment advice. The stock market is risky and you need to be cautious when entering the market. No sale, no harm.