Abstract
SummaryBackgroundStreptococcus 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.MethodsIn 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.Findings27 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.InterpretationThe 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.FundingWellcome 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).
Highlights
Invasive bacterial diseases, bacteraemic pneumonia, meningitis, and sepsis, are leading causes of global morbidity and mortality among all age groups, especially among young children, adolescents, and older adults
Our study showed that the incidence of invasive disease due to S pneumoniae, H influenzae, and N meningitidis declined sharply in all participating countries following the introduction of COVID-19 containment measures in early 2020, whereas the incidence of invasive disease due to S agalactiae did not
There was a substantial and sustained reduction in the number of invasive cases of S pneumoniae, H influenzae, and N meningitidis diagnosed between March and May, 2020, versus the previous 2 years
Summary
Bacteraemic pneumonia, meningitis, and sepsis, are leading causes of global morbidity and mortality among all age groups, especially among young children (aged 65 years). In 2016, there were 336 million episodes of lower respiratory infections worldwide, leading to 2·4 million deaths.. Respiratory infections were the sixth leading cause of death among all ages and the most common cause of death in children younger than 5 years.. S pneumoniae was estimated to have caused 197 million episodes of pneumonia, which led to more than 1·1 million deaths worldwide—more deaths than the combined total number of pneumonia deaths due to H influenzae serotype b, influenza, or respiratory syncytial virus.. The number of deaths due to meningitis among all ages was around 300 000 in 2016, from an estimated 2·8 million meningitis episodes.. In 2016, there were 336 million episodes of lower respiratory infections worldwide, leading to 2·4 million deaths. Respiratory infections were the sixth leading cause of death among all ages and the most common cause of death in children younger than 5 years. S pneumoniae was estimated to have caused 197 million episodes of pneumonia, which led to more than 1·1 million deaths worldwide—more deaths than the combined total number of pneumonia deaths due to H influenzae serotype b, influenza, or respiratory syncytial virus. Globally, the number of deaths due to meningitis among all ages was around 300 000 in 2016, from an estimated 2·8 million meningitis episodes. Meningitis outbreaks due to these three bacteria (N meningitidis in particular) have occurred worldwide.
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