Changes in the incidence of invasive disease due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis during the COVID-19 pandemic in 26 countries and territories in the Invasive Respiratory Infection Surveillance Initiative: a prospective analysis of surveillance data

Angela B Brueggemann; Melissa J Jansen van Rensburg; David Shaw; Noel D McCarthy; Keith A Jolley; Martin C J Maiden; Mark P G van der Linden; Zahin Amin-Chowdhury; Désirée E Bennett; Ray Borrow; Maria-Cristina C Brandileone; Karen Broughton; Ruth Campbell; Bin Cao; Carlo Casanova; Eun Hwa Choi; Yiu Wai Chu; Stephen A Clark; Heike Claus; Juliana Coelho; Mary Corcoran; Simon Cottrell; Robert J Cunney; Tine Dalby; Heather Davies; Linda de Gouveia; Ala-Eddine Deghmane; Walter Demczuk; Stefanie Desmet; Richard J Drew; Mignon du Plessis; Helga Erlendsdottir; Norman K Fry; Kurt Fuursted; Steve J Gray; Birgitta Henriques-Normark; Thomas Hale; Markus Hilty; Steen Hoffmann; Hilary Humphreys; Margaret Ip; Susanne Jacobsson; Jillian Johnston; Jana Kozakova; Karl G Kristinsson; Pavla Krizova; Alicja Kuch; Shamez N Ladhani; Thiên-Trí Lâm; Vera Lebedova; Laura Lindholm; David J Litt; Irene Martin; Delphine Martiny; Wesley Mattheus; Martha McElligott; Mary Meehan; Susan Meiring; Paula Mölling; Eva Morfeldt; Julie Morgan; Robert M Mulhall; Carmen Muñoz-Almagro; David R Murdoch; Joy Murphy; Martin Musilek; Alexandre Mzabi; Amaresh Perez-Argüello; Monique Perrin; Malorie Perry; Alba Redin; Richard Roberts; Maria Roberts; Assaf Rokney; Merav Ron; Kevin J Scott; Carmen L Sheppard; Lotta Siira; Anna Skoczyńska; Monica Sloan; Hans-Christian Slotved; Andrew J Smith; Joon Young Song; Muhamed-Kheir Taha; Maija Toropainen; Dominic Tsang; Anni Vainio; Nina M van Sorge; Emmanuelle Varon; Jiri Vlach; Ulrich Vogel; Sandra Vohrnova; Anne von Gottberg; Rosemeire C Zanella; Fei Zhou

doi:10.1016/S2589-7500(21)00077-7

Changes in the incidence of invasive disease due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis during the COVID-19 pandemic in 26 countries and territories in the Invasive Respiratory Infection Surveillance Initiative: a prospective analysis of surveillance data

Lancet Digit Health. 2021 Jun;3(6):e360-e370. doi: 10.1016/S2589-7500(21)00077-7.

Authors

Angela B Brueggemann¹, Melissa J Jansen van Rensburg², David Shaw², Noel D McCarthy³, Keith A Jolley⁴, Martin C J Maiden⁴, Mark P G van der Linden⁵, Zahin Amin-Chowdhury⁶, Désirée E Bennett⁷, Ray Borrow⁸, Maria-Cristina C Brandileone⁹, Karen Broughton¹⁰, Ruth Campbell¹¹, Bin Cao¹², Carlo Casanova¹³, Eun Hwa Choi¹⁴, Yiu Wai Chu¹⁵, Stephen A Clark⁸, Heike Claus¹⁶, Juliana Coelho¹⁰, Mary Corcoran¹⁷, Simon Cottrell¹⁸, Robert J Cunney¹⁷, Tine Dalby¹⁹, Heather Davies²⁰, Linda de Gouveia²¹, Ala-Eddine Deghmane²², Walter Demczuk²³, Stefanie Desmet²⁴, Richard J Drew¹⁷, Mignon du Plessis²¹, Helga Erlendsdottir²⁵, Norman K Fry⁶, Kurt Fuursted¹⁹, Steve J Gray⁸, Birgitta Henriques-Normark²⁶, Thomas Hale²⁷, Markus Hilty¹³, Steen Hoffmann¹⁹, Hilary Humphreys⁷, Margaret Ip²⁸, Susanne Jacobsson²⁹, Jillian Johnston¹¹, Jana Kozakova³⁰, Karl G Kristinsson²⁵, Pavla Krizova³¹, Alicja Kuch³², Shamez N Ladhani⁶, Thiên-Trí Lâm¹⁶, Vera Lebedova³³, Laura Lindholm³⁴, David J Litt¹⁰, Irene Martin²³, Delphine Martiny³⁵, Wesley Mattheus³⁶, Martha McElligott⁷, Mary Meehan⁷, Susan Meiring³⁷, Paula Mölling²⁹, Eva Morfeldt³⁸, Julie Morgan³⁹, Robert M Mulhall⁷, Carmen Muñoz-Almagro⁴⁰, David R Murdoch⁴¹, Joy Murphy¹¹, Martin Musilek³¹, Alexandre Mzabi⁴², Amaresh Perez-Argüello⁴⁰, Monique Perrin⁴², Malorie Perry¹⁸, Alba Redin⁴⁰, Richard Roberts¹⁸, Maria Roberts¹⁸, Assaf Rokney⁴³, Merav Ron⁴³, Kevin J Scott⁴⁴, Carmen L Sheppard¹⁰, Lotta Siira³⁴, Anna Skoczyńska³², Monica Sloan¹¹, Hans-Christian Slotved¹⁹, Andrew J Smith⁴⁴, Joon Young Song⁴⁵, Muhamed-Kheir Taha²², Maija Toropainen³⁴, Dominic Tsang¹⁵, Anni Vainio³⁴, Nina M van Sorge⁴⁶, Emmanuelle Varon⁴⁷, Jiri Vlach³³, Ulrich Vogel¹⁶, Sandra Vohrnova³⁰, Anne von Gottberg²¹, Rosemeire C Zanella⁹, Fei Zhou¹²

Affiliations

¹ Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK. Electronic address: [email protected].
² Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK.
³ Trinity College Dublin, Dublin, Ireland.
⁴ Department of Zoology, University of Oxford, Oxford, UK.
⁵ Department of Medical Microbiology, German National Reference Center for Streptococci, University Hospital RWTH Aachen, Aachen, Germany.
⁶ Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK.
⁷ Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
⁸ Meningococcal Reference Unit, National Infection Service, Public Health England, Manchester Royal Infirmary, Manchester, UK.
⁹ National Laboratory for Meningitis and Pneumococcal Infections, Center of Bacteriology, Institute Adolfo Lutz, São Paulo, Brazil.
¹⁰ Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, UK.
¹¹ Public Health Agency, Belfast, Northern Ireland.
¹² Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China.
¹³ Swiss National Reference Centre for invasive Pneumococci, Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
¹⁴ Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
¹⁵ Department of Health, Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Hong Kong Special Administrative Region, China.
¹⁶ German National Reference Center for Meningococci and Haemophilus influenzae, Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany.
¹⁷ Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland; Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
¹⁸ Public Health Wales, Cardiff, UK.
¹⁹ Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.
²⁰ Meningococcal Reference Laboratory, Institute of Environmental Science and Research Limited, Porirua, New Zealand.
²¹ Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa.
²² Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France.
²³ National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.
²⁴ National Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
²⁵ Department of Clinical Microbiology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
²⁶ Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
²⁷ Blavatnik School of Government, University of Oxford, Oxford, UK.
²⁸ Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
²⁹ Department of Laboratory Medicine, National Reference Laboratory for Neisseria meningitidis, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
³⁰ National Reference Laboratory for Streptococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic.
³¹ National Reference Laboratory for Meningococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic.
³² National Reference Centre for Bacterial Meningitis, National Medicines Institute, Warsaw, Poland.
³³ National Reference Laboratory for Haemophilus Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic.
³⁴ Finnish Institute for Health and Welfare, Helsinki, Finland.
³⁵ National Reference Centre for Haemophilus influenzae, Laboratoires des Hôpitaux Universitaires de Bruxelles, Universitaire Laboratorium Brussel, Brussels, Belgium; Faculté de Médecine et Pharmacie, Université de Mons, Mons, Belgium.
³⁶ National Reference Centre for Neisseria meningitidis, Sciensano, Brussels, Belgium.
³⁷ Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa.
³⁸ Public Health Agency of Sweden, Solna, Sweden.
³⁹ Streptococcal Reference Laboratory, Institute of Environmental Science and Research Limited, Porirua, New Zealand.
⁴⁰ Instituto de Recerca Pediatrica, Hospital Sant Joan de Deu, Barcelona, Spain.
⁴¹ Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.
⁴² Laboratoire National de Sante, Dudelange, Luxembourg.
⁴³ Government Central Laboratories, Ministry of Health, Jerusalem, Israel.
⁴⁴ Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratories, Glasgow, UK.
⁴⁵ Department of Internal Medicine, Division of Infectious Diseases, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
⁴⁶ Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands; Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands.
⁴⁷ Laboratory of Medical Biology and National Reference Centre for Pneumococci, Intercommunal Hospital of Créteil, Créteil, France.

Abstract

Background: Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, which are typically transmitted via respiratory droplets, are leading causes of invasive diseases, including bacteraemic pneumonia and meningitis, and of secondary infections subsequent to post-viral respiratory disease. The aim of this study was to investigate the incidence of invasive disease due to these pathogens during the early months of the COVID-19 pandemic.

Methods: In this prospective analysis of surveillance data, laboratories in 26 countries and territories across six continents submitted data on cases of invasive disease due to S pneumoniae, H influenzae, and N meningitidis from Jan 1, 2018, to May, 31, 2020, as part of the Invasive Respiratory Infection Surveillance (IRIS) Initiative. Numbers of weekly cases in 2020 were compared with corresponding data for 2018 and 2019. Data for invasive disease due to Streptococcus agalactiae, a non-respiratory pathogen, were collected from nine laboratories for comparison. The stringency of COVID-19 containment measures was quantified using the Oxford COVID-19 Government Response Tracker. Changes in population movements were assessed using Google COVID-19 Community Mobility Reports. Interrupted time-series modelling quantified changes in the incidence of invasive disease due to S pneumoniae, H influenzae, and N meningitidis in 2020 relative to when containment measures were imposed.

Findings: 27 laboratories from 26 countries and territories submitted data to the IRIS Initiative for S pneumoniae (62 837 total cases), 24 laboratories from 24 countries submitted data for H influenzae (7796 total cases), and 21 laboratories from 21 countries submitted data for N meningitidis (5877 total cases). All countries and territories had experienced a significant and sustained reduction in invasive diseases due to S pneumoniae, H influenzae, and N meningitidis in early 2020 (Jan 1 to May 31, 2020), coinciding with the introduction of COVID-19 containment measures in each country. By contrast, no significant changes in the incidence of invasive S agalactiae infections were observed. Similar trends were observed across most countries and territories despite differing stringency in COVID-19 control policies. The incidence of reported S pneumoniae infections decreased by 68% at 4 weeks (incidence rate ratio 0·32 [95% CI 0·27-0·37]) and 82% at 8 weeks (0·18 [0·14-0·23]) following the week in which significant changes in population movements were recorded.

Interpretation: The introduction of COVID-19 containment policies and public information campaigns likely reduced transmission of S pneumoniae, H influenzae, and N meningitidis, leading to a significant reduction in life-threatening invasive diseases in many countries worldwide.

Funding: Wellcome Trust (UK), Robert Koch Institute (Germany), Federal Ministry of Health (Germany), Pfizer, Merck, Health Protection Surveillance Centre (Ireland), SpID-Net project (Ireland), European Centre for Disease Prevention and Control (European Union), Horizon 2020 (European Commission), Ministry of Health (Poland), National Programme of Antibiotic Protection (Poland), Ministry of Science and Higher Education (Poland), Agencia de Salut Pública de Catalunya (Spain), Sant Joan de Deu Foundation (Spain), Knut and Alice Wallenberg Foundation (Sweden), Swedish Research Council (Sweden), Region Stockholm (Sweden), Federal Office of Public Health of Switzerland (Switzerland), and French Public Health Agency (France).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bacterial Infections / epidemiology*
Bacterial Infections / transmission
COVID-19* / prevention & control
Haemophilus influenzae
Humans
Incidence
Interrupted Time Series Analysis
Neisseria meningitidis
Population Surveillance
Prospective Studies
Public Health Practice
Respiratory Tract Infections / epidemiology*
Streptococcus agalactiae
Streptococcus pneumoniae

Abstract

Publication types

MeSH terms

Grants and funding