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).

Bacterial Respiratory Infection Service Scottish Microbiology Reference Laboratories Glasgow UK

Blavatnik School of Government University of Oxford Oxford UK

Centre for Respiratory Diseases and Meningitis National Institute for Communicable Diseases Division of the National Health Laboratory Service Johannesburg South Africa

Department of Bacteria Parasites and Fungi Statens Serum Institut Copenhagen Denmark

Department of Clinical Microbiology Beaumont Hospital Dublin Ireland

Department of Clinical Microbiology Landspitali The National University Hospital of Iceland Reykjavik Iceland

Department of Health Microbiology Division Public Health Laboratory Services Branch Centre for Health Protection Hong Kong Special Administrative Region China

Department of Internal Medicine Division of Infectious Diseases Korea University Guro Hospital Korea University College of Medicine Seoul South Korea

Department of Laboratory Medicine National Reference Laboratory for Neisseria meningitidis Clinical Microbiology Faculty of Medicine and Health Örebro University Örebro Sweden

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

Department of Medical Microbiology German National Reference Center for Streptococci University Hospital RWTH Aachen Aachen Germany

Department of Microbiology The Chinese University of Hong Kong Hong Kong Special Administrative Region China

Department of Microbiology Tumor and Cell Biology Karolinska Institutet Stockholm Sweden; Department of Clinical Microbiology Karolinska University Hospital Stockholm Sweden

Department of Pathology and Biomedical Science University of Otago Christchurch New Zealand

Department of Pediatrics Seoul National University College of Medicine Seoul South Korea

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

Department of Zoology University of Oxford Oxford UK

Division of Public Health Surveillance and Response National Institute for Communicable Diseases Division of the National Health Laboratory Service Johannesburg South Africa

Finnish Institute for Health and Welfare Helsinki Finland

German National Reference Center for Meningococci and Haemophilus influenzae Institute for Hygiene and Microbiology University of Würzburg Würzburg Germany

Government Central Laboratories Ministry of Health Jerusalem Israel

Immunisation and Countermeasures Division National Infection Service Public Health England London UK

Institut Pasteur Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influenzae Paris France

Instituto de Recerca Pediatrica Hospital Sant Joan de Deu Barcelona Spain

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

Laboratoire National de Sante Dudelange Luxembourg

Laboratory of Medical Biology and National Reference Centre for Pneumococci Intercommunal Hospital of Créteil Créteil France

Meningococcal Reference Laboratory Institute of Environmental Science and Research Limited Porirua New Zealand

Meningococcal Reference Unit National Infection Service Public Health England Manchester Royal Infirmary Manchester UK

National Laboratory for Meningitis and Pneumococcal Infections Center of Bacteriology Institute Adolfo Lutz São Paulo Brazil

National Microbiology Laboratory Public Health Agency of Canada Winnipeg MB Canada

National Reference Centre for Bacterial Meningitis National Medicines Institute Warsaw Poland

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

National Reference Centre for Neisseria meningitidis Sciensano Brussels Belgium

National Reference Centre for Streptococcus pneumoniae University Hospitals Leuven Leuven Belgium; Department of Microbiology Immunology and Transplantation KU Leuven Leuven Belgium

National Reference Laboratory for Haemophilus Infections Centre for Epidemiology and Microbiology National Institute of Public Health Prague Czech Republic

National Reference Laboratory for Meningococcal Infections Centre for Epidemiology and Microbiology National Institute of Public Health Prague Czech Republic

National Reference Laboratory for Streptococcal Infections Centre for Epidemiology and Microbiology National Institute of Public Health Prague Czech Republic

Nuffield Department of Population Health Big Data Institute University of Oxford Oxford UK

Public Health Agency Belfast Northern Ireland

Public Health Agency of Sweden Solna Sweden

Public Health Wales Cardiff UK

Respiratory and Vaccine Preventable Bacteria Reference Unit National Infection Service Public Health England London UK

Streptococcal Reference Laboratory Institute of Environmental Science and Research Limited Porirua New Zealand

Swiss National Reference Centre for invasive Pneumococci Institute for Infectious Diseases University of Bern Bern Switzerland

Trinity College Dublin Dublin Ireland

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