The Lancet: Digital Health (Jun 2021)
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, ProfDPhil,
- Melissa J Jansen van Rensburg, ProfDPhil,
- David Shaw, MD,
- Noel D McCarthy, ProfDPhil,
- Keith A Jolley, PhD,
- Martin C J Maiden, ProfPhD,
- Mark P G van der Linden, PhD,
- Zahin Amin-Chowdhury, BSc,
- Désirée E Bennett, PhD,
- Ray Borrow, PhD,
- Maria-Cristina C Brandileone, PhD,
- Karen Broughton, MSc,
- Ruth Campbell,
- Bin Cao, ProfMD,
- Carlo Casanova, PhD,
- Eun Hwa Choi, ProfMD,
- Yiu Wai Chu, PhD,
- Stephen A Clark, PhD,
- Heike Claus, PhD,
- Juliana Coelho, PhD,
- Mary Corcoran, PhD,
- Simon Cottrell, PhD,
- Robert J Cunney, MD,
- Tine Dalby, PhD,
- Heather Davies, NZCS,
- Linda de Gouveia, NatDipMicro,
- Ala-Eddine Deghmane, PhD,
- Walter Demczuk, BSc,
- Stefanie Desmet, PharmD,
- Richard J Drew, MD,
- Mignon du Plessis, PhD,
- Helga Erlendsdottir, ProfMSc,
- Norman K Fry, PhD,
- Kurt Fuursted, MD,
- Steve J Gray, PhD,
- Birgitta Henriques-Normark, ProfMD,
- Thomas Hale, PhD,
- Markus Hilty, PhD,
- Steen Hoffmann, MD,
- Hilary Humphreys, ProfMD,
- Margaret Ip, MD,
- Susanne Jacobsson, PhD,
- Jillian Johnston, MBBS,
- Jana Kozakova, MD,
- Karl G Kristinsson, ProfMD,
- Pavla Krizova, MD,
- Alicja Kuch, PhD,
- Shamez N Ladhani, MD,
- Thiên-Trí Lâm, MD,
- Vera Lebedova, MD,
- Laura Lindholm, MSc,
- David J Litt, PhD,
- Irene Martin, BSc,
- Delphine Martiny, ProfPhD,
- Wesley Mattheus, PhD,
- Martha McElligott, PhD,
- Mary Meehan, PhD,
- Susan Meiring, MBChB,
- Paula Mölling, PhD,
- Eva Morfeldt, PhD,
- Julie Morgan, HND,
- Robert M Mulhall, PhD,
- Carmen Muñoz-Almagro, ProfMD,
- David R Murdoch, ProfMD,
- Joy Murphy, BA Hons,
- Martin Musilek, PhD,
- Alexandre Mzabi, MD,
- Amaresh Perez-Argüello, MLT,
- Monique Perrin, MD,
- Malorie Perry, MSc,
- Alba Redin, BSc,
- Richard Roberts, MPH,
- Maria Roberts, BSc,
- Assaf Rokney, PhD,
- Merav Ron, PhD,
- Kevin J Scott, PhD,
- Carmen L Sheppard, PhD,
- Lotta Siira, PhD,
- Anna Skoczyńska, ProfPhD,
- Monica Sloan,
- Hans-Christian Slotved, PhD,
- Andrew J Smith, ProfPhD,
- Joon Young Song, MD,
- Muhamed-Kheir Taha, MD,
- Maija Toropainen, PhD,
- Dominic Tsang, MD,
- Anni Vainio, PhD,
- Nina M van Sorge, PhD,
- Emmanuelle Varon, MD,
- Jiri Vlach, PhD,
- Ulrich Vogel, ProfMD,
- Sandra Vohrnova, MD,
- Anne von Gottberg, PhD,
- Rosemeire C Zanella, PhD,
- Fei Zhou, PhD
Affiliations
- Angela B Brueggemann, ProfDPhil
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK; Correspondence to: Prof Angela B Brueggemann, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford OX37LF, UK
- Melissa J Jansen van Rensburg, ProfDPhil
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
- David Shaw, MD
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
- Noel D McCarthy, ProfDPhil
- Trinity College Dublin, Dublin, Ireland
- Keith A Jolley, PhD
- Department of Zoology, University of Oxford, Oxford, UK
- Martin C J Maiden, ProfPhD
- Department of Zoology, University of Oxford, Oxford, UK
- Mark P G van der Linden, PhD
- Department of Medical Microbiology, German National Reference Center for Streptococci, University Hospital RWTH Aachen, Aachen, Germany
- Zahin Amin-Chowdhury, BSc
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
- Désirée E Bennett, PhD
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
- Ray Borrow, PhD
- Meningococcal Reference Unit, National Infection Service, Public Health England, Manchester Royal Infirmary, Manchester, UK
- Maria-Cristina C Brandileone, PhD
- National Laboratory for Meningitis and Pneumococcal Infections, Center of Bacteriology, Institute Adolfo Lutz, São Paulo, Brazil
- Karen Broughton, MSc
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, UK
- Ruth Campbell
- Public Health Agency, Belfast, Northern Ireland
- Bin Cao, ProfMD
- 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
- Carlo Casanova, PhD
- Swiss National Reference Centre for invasive Pneumococci, Institute for Infectious Diseases, University of Bern, Bern, Switzerland
- Eun Hwa Choi, ProfMD
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Yiu Wai Chu, PhD
- Department of Health, Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Hong Kong Special Administrative Region, China
- Stephen A Clark, PhD
- Meningococcal Reference Unit, National Infection Service, Public Health England, Manchester Royal Infirmary, Manchester, UK
- Heike Claus, PhD
- German National Reference Center for Meningococci and Haemophilus influenzae, Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- Juliana Coelho, PhD
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, UK
- Mary Corcoran, PhD
- 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
- Simon Cottrell, PhD
- Public Health Wales, Cardiff, UK
- Robert J Cunney, MD
- 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
- Tine Dalby, PhD
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
- Heather Davies, NZCS
- Meningococcal Reference Laboratory, Institute of Environmental Science and Research Limited, Porirua, New Zealand
- Linda de Gouveia, NatDipMicro
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
- Ala-Eddine Deghmane, PhD
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France
- Walter Demczuk, BSc
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
- Stefanie Desmet, PharmD
- National Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Richard J Drew, MD
- 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
- Mignon du Plessis, PhD
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
- Helga Erlendsdottir, ProfMSc
- Department of Clinical Microbiology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Norman K Fry, PhD
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
- Kurt Fuursted, MD
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
- Steve J Gray, PhD
- Meningococcal Reference Unit, National Infection Service, Public Health England, Manchester Royal Infirmary, Manchester, UK
- Birgitta Henriques-Normark, ProfMD
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
- Thomas Hale, PhD
- Blavatnik School of Government, University of Oxford, Oxford, UK
- Markus Hilty, PhD
- Swiss National Reference Centre for invasive Pneumococci, Institute for Infectious Diseases, University of Bern, Bern, Switzerland
- Steen Hoffmann, MD
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
- Hilary Humphreys, ProfMD
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
- Margaret Ip, MD
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Susanne Jacobsson, PhD
- Department of Laboratory Medicine, National Reference Laboratory for Neisseria meningitidis, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Jillian Johnston, MBBS
- Public Health Agency, Belfast, Northern Ireland
- Jana Kozakova, MD
- National Reference Laboratory for Streptococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
- Karl G Kristinsson, ProfMD
- Department of Clinical Microbiology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Pavla Krizova, MD
- National Reference Laboratory for Meningococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
- Alicja Kuch, PhD
- National Reference Centre for Bacterial Meningitis, National Medicines Institute, Warsaw, Poland
- Shamez N Ladhani, MD
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
- Thiên-Trí Lâm, MD
- German National Reference Center for Meningococci and Haemophilus influenzae, Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- Vera Lebedova, MD
- National Reference Laboratory for Haemophilus Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
- Laura Lindholm, MSc
- Finnish Institute for Health and Welfare, Helsinki, Finland
- David J Litt, PhD
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, UK
- Irene Martin, BSc
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
- Delphine Martiny, ProfPhD
- 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
- Wesley Mattheus, PhD
- National Reference Centre for Neisseria meningitidis, Sciensano, Brussels, Belgium
- Martha McElligott, PhD
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
- Mary Meehan, PhD
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
- Susan Meiring, MBChB
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
- Paula Mölling, PhD
- Department of Laboratory Medicine, National Reference Laboratory for Neisseria meningitidis, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Eva Morfeldt, PhD
- Public Health Agency of Sweden, Solna, Sweden
- Julie Morgan, HND
- Streptococcal Reference Laboratory, Institute of Environmental Science and Research Limited, Porirua, New Zealand
- Robert M Mulhall, PhD
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
- Carmen Muñoz-Almagro, ProfMD
- Instituto de Recerca Pediatrica, Hospital Sant Joan de Deu, Barcelona, Spain
- David R Murdoch, ProfMD
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
- Joy Murphy, BA Hons
- Public Health Agency, Belfast, Northern Ireland
- Martin Musilek, PhD
- National Reference Laboratory for Meningococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
- Alexandre Mzabi, MD
- Laboratoire National de Sante, Dudelange, Luxembourg
- Amaresh Perez-Argüello, MLT
- Instituto de Recerca Pediatrica, Hospital Sant Joan de Deu, Barcelona, Spain
- Monique Perrin, MD
- Laboratoire National de Sante, Dudelange, Luxembourg
- Malorie Perry, MSc
- Public Health Wales, Cardiff, UK
- Alba Redin, BSc
- Instituto de Recerca Pediatrica, Hospital Sant Joan de Deu, Barcelona, Spain
- Richard Roberts, MPH
- Public Health Wales, Cardiff, UK
- Maria Roberts, BSc
- Public Health Wales, Cardiff, UK
- Assaf Rokney, PhD
- Government Central Laboratories, Ministry of Health, Jerusalem, Israel
- Merav Ron, PhD
- Government Central Laboratories, Ministry of Health, Jerusalem, Israel
- Kevin J Scott, PhD
- Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratories, Glasgow, UK
- Carmen L Sheppard, PhD
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, UK
- Lotta Siira, PhD
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Anna Skoczyńska, ProfPhD
- National Reference Centre for Bacterial Meningitis, National Medicines Institute, Warsaw, Poland
- Monica Sloan
- Public Health Agency, Belfast, Northern Ireland
- Hans-Christian Slotved, PhD
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
- Andrew J Smith, ProfPhD
- Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratories, Glasgow, UK
- Joon Young Song, MD
- Department of Internal Medicine, Division of Infectious Diseases, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
- Muhamed-Kheir Taha, MD
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France
- Maija Toropainen, PhD
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Dominic Tsang, MD
- Department of Health, Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Hong Kong Special Administrative Region, China
- Anni Vainio, PhD
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Nina M van Sorge, PhD
- 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
- Emmanuelle Varon, MD
- Laboratory of Medical Biology and National Reference Centre for Pneumococci, Intercommunal Hospital of Créteil, Créteil, France
- Jiri Vlach, PhD
- National Reference Laboratory for Haemophilus Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
- Ulrich Vogel, ProfMD
- German National Reference Center for Meningococci and Haemophilus influenzae, Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- Sandra Vohrnova, MD
- National Reference Laboratory for Streptococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
- Anne von Gottberg, PhD
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
- Rosemeire C Zanella, PhD
- National Laboratory for Meningitis and Pneumococcal Infections, Center of Bacteriology, Institute Adolfo Lutz, São Paulo, Brazil
- Fei Zhou, PhD
- 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
- Journal volume & issue
-
Vol. 3,
no. 6
pp. e360 – e370
Abstract
Summary: 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).
