BACKGROUND: The Invasive Respiratory Infection Surveillance (IRIS) Consortium was established to assess the impact of the COVID-19 pandemic on invasive diseases caused by Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Streptococcus agalactiae. We aimed to analyse the incidence and distribution of these diseases during the first 2 years of the COVID-19 pandemic compared to the 2 years preceding the pandemic. METHODS: For this prospective analysis, laboratories in 30 countries and territories representing five continents submitted surveillance data from Jan 1, 2018, to Jan 2, 2022, to private projects within databases in PubMLST. The impact of COVID-19 containment measures on the overall number of cases was analysed, and changes in disease distributions by patient age and serotype or group were examined. Interrupted time-series analyses were done to quantify the impact of pandemic response measures and their relaxation on disease rates, and autoregressive integrated moving average models were used to estimate effect sizes and forecast counterfactual trends by hemisphere. FINDINGS: Overall, 116 841 cases were analysed: 76 481 in 2018-19, before the pandemic, and 40 360 in 2020-21, during the pandemic. During the pandemic there was a significant reduction in the risk of disease caused by S pneumoniae (risk ratio 0·47; 95% CI 0·40-0·55), H influenzae (0·51; 0·40-0·66) and N meningitidis (0·26; 0·21-0·31), while no significant changes were observed for S agalactiae (1·02; 0·75-1·40), which is not transmitted via the respiratory route. No major changes in the distribution of cases were observed when stratified by patient age or serotype or group. An estimated 36 289 (95% prediction interval 17 145-55 434) cases of invasive bacterial disease were averted during the first 2 years of the pandemic among IRIS-participating countries and territories. INTERPRETATION: COVID-19 containment measures were associated with a sustained decrease in the incidence of invasive disease caused by S pneumoniae, H influenzae, and N meningitidis during the first 2 years of the pandemic, but cases began to increase in some countries towards the end of 2021 as pandemic restrictions were lifted. These IRIS data provide a better understanding of microbial transmission, will inform vaccine development and implementation, and can contribute to health-care service planning and provision of policies. FUNDING: Wellcome Trust, NIHR Oxford Biomedical Research Centre, Spanish Ministry of Science and Innovation, Korea Disease Control and Prevention Agency, Torsten Söderberg Foundation, Stockholm County Council, Swedish Research Council, German Federal Ministry of Health, Robert Koch Institute, Pfizer, Merck, and the Greek National Public Health Organization.

Bacterial Respiratory Infection Service Scottish Microbiology Reference Laboratories Glasgow Royal Infirmary Glasgow UK

Bacterial Respiratory Infection Service Scottish Microbiology Reference Laboratories Glasgow Royal Infirmary Glasgow UK; College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK

Blavatnik School of Government University of Oxford Oxford UK

Centre for Infectious Disease Control National Institute for Public Health and the Environment Bilthoven Netherlands

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

Department of Biology University of Oxford Oxford UK

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 Medical Microbiology and Infection Prevention and Netherlands Reference Laboratory for Bacterial Meningitis Amsterdam University Medical Center University of Amsterdam Amsterdam Netherlands

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

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

Department of Microbiology Royal College of Surgeons in Ireland Dublin Ireland; Department of Clinical Microbiology Beaumont Hospital Dublin Ireland

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

Department of Pulmonary and Critical Care Medicine Center of Respiratory Medicine National Clinical Research Center for Respiratory Diseases Institute of Respiratory Medicine Chinese Academy of Medical Sciences Peking Union Medical College Beijing China

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

Immunisation and Countermeasures Division UK Health Security Agency London UK

Immunisation and Vaccine Preventable Diseases Division and Respiratory and Vaccine Preventable Bacteria Reference Unit UK Health Security Agency London UK

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

Instituto Nacional de Salud Bogotá Colombia

Irish Meningitis and Sepsis Reference Laboratory Children's Health Ireland Dublin Ireland

Irish Meningitis and Sepsis Reference Laboratory Children's Health Ireland Dublin Ireland; Department of Microbiology Royal College of Surgeons in Ireland Dublin Ireland

Irish Meningitis and Sepsis Reference Laboratory Children's Health Ireland Dublin Ireland; Department of Microbiology Royal College of Surgeons in Ireland Dublin Ireland; Clinical Innovation Unit Rotunda Dublin Ireland

Karolinska Institutet Karolinska University Hospital Public Health Agency of Sweden Stockholm Sweden

Laboratoire National de Sante Dudelange Luxembourg

Laboratorio Central de Salud Pública Asunción Paraguay

Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria Centro Nacional de Microbiología Instituto de Salud Carlos 3 Majadahonda Madrid Spain; CIBER de Enfermedades Infecciosas Instituto de Salud Carlos 3 Madrid Spain

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

Meningococcal National Reference Centre Sciensano Belgium

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

Microbiology Department Institut Recerca Sant Joan de Déu Hospital Sant Joan de Deu Barcelona Spain

Microbiology Department Institut Recerca Sant Joan de Déu Hospital Sant Joan de Deu Barcelona Spain; CIBER of Epidemiology and Public Health Madrid Spain

Microbiology Department Institut Recerca Sant Joan de Déu Hospital Sant Joan de Deu Barcelona Spain; CIBER of Epidemiology and Public Health Madrid Spain; Medicine Department Universitat Internacional de Catalunya Barcelona Spain

Ministère de la Santé Direction de la santé Luxembourg Luxembourg

National Belgian Reference Centre for Haemophilus influenzae Laboratoire des Hôpitaux Universitaires de Bruxelles Universitair Laboratorium van Brussel Brussels Belgium

National Belgian Reference Centre for Haemophilus influenzae Laboratoire des Hôpitaux Universitaires de Bruxelles Universitair Laboratorium van Brussel Brussels Belgium; Faculty of Medicine and Pharmacy University of Mons Mons Belgium

National Center for Microbiology and CIBER of Respiratory Research Instituto de Salud Carlos 3 Madrid Spain

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

National Meningitis Reference Laboratory Department of Public Health Policy School of Public Health University of West Attica Athens Greece

National Microbiology Laboratory Public Health Agency of Canada Winnipeg MB Canada

National Reference Centre for Bacterial Meningitis Department of Epidemiology and Clinical Microbiology National Medicines Institute Warsaw Poland

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 Meningococci National Center of Microbiology Instituto de Salud Carlos 3 Madrid Spain

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

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

NSW Pneumococcal Reference Laboratory Institute of Clinical Pathology and Medical Research NSW Health Pathology Sydney NSW Australia

NSW Pneumococcal Reference Laboratory Institute of Clinical Pathology and Medical Research NSW Health Pathology Sydney NSW Australia; Sydney Institute for Infectious Diseases University of Sydney NSW Australia

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

Population Health Medicine Public Health and Primary Care Trinity College Dublin Dublin Ireland

Public Health Agency Belfast UK

Public Health Agency of Sweden Solna Sweden

Public Health Laboratories Jerusalem Public Health Services Ministry of Health Jerusalem Israel

Public Health Wales Cardiff Wales UK

Respiratory and Vaccine Preventable Bacteria Reference Unit UK Health Security Agency London UK

Staphylococcus and Streptococcus Reference Section AMRHAI UK Health Security Agency London UK

Statens Serum Institut Department of Bacteria Parasites and Fungi Copenhagen Denmark

Statens Serum Institut Department of Infectious Disease Epidemiology and Prevention Copenhagen Denmark

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

Swiss National Reference Center for Invasive Pneumococci Institute for Infectious Diseases University of Bern Bern Switzerland

University of Otago Christchurch New Zealand

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

Zobrazit více v PubMed

GBD 2019 Antimicrobial Resistance Collaborators Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;400:2221–2248. PubMed PMC

Mazamay S, Guégan JF, Diallo N, et al. An overview of bacterial meningitis epidemics in Africa from 1928 to 2018 with a focus on epidemics “outside-the-belt”. BMC Infect Dis. 2021;21 PubMed PMC

Antimicrobial Resistance Collaborators Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399:629–655. PubMed PMC

Brueggemann AB, Jansen van Rensburg MJ, Shaw D, et al. 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;3:e360–e370. PubMed PMC

Casanova C, Küffer M, Leib SL, Hilty M. Re-emergence of invasive pneumococcal disease (IPD) and increase of serotype 23B after easing of COVID-19 measures, Switzerland, 2021. Emerg Microbes Infect. 2021;10:2202–2204. PubMed PMC

Deghmane AE, Taha MK. Changes in Invasive Neisseria meningitidis and Haemophilus influenzae infections in France during the COVID-19 pandemic. Microorganisms. 2022;10:907. PubMed PMC

Steens A, Knol MJ, Freudenburg-de Graaf W, de Melker HE, van der Ende A, van Sorge NM. Pathogen- and type-specific changes in invasive bacterial disease epidemiology during the first year of the COVID-19 pandemic in the Netherlands. Microorganisms. 2022;10:972. PubMed PMC

Nielsen RT, Dalby T, Emborg HD, et al. COVID-19 preventive measures coincided with a marked decline in other infectious diseases in Denmark, spring 2020. Epidemiol Infect. 2022;150:e138. PubMed PMC

Ciruela P, Soldevila N, García-Garcia JJ, et al. Effect of COVID-19 pandemic on invasive pneumococcal disease in children, Catalonia, Spain. Emerg Infect Dis. 2022;28:2321–2325. PubMed PMC

Tavares T, Pinho L, Bonifácio Andrade E. Group B streptococcal neonatal meningitis. Clin Microbiol Rev. 2022;35 PubMed PMC

Hale T, Angrist N, Goldszmidt R, et al. A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker) Nat Hum Behav. 2021;5:529–538. PubMed

Schaffer AL, Dobbins TA, Pearson SA. Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: a guide for evaluating large-scale health interventions. BMC Med Res Methodol. 2021;21:58. PubMed PMC

Hyndman RJ, Athanasopoulos G. 3rd edn. OTexts; Melbourne, VIC: 2021. Forecasting: principles and practice.

Penfold RB, Zhang F. Use of interrupted time series analysis in evaluating health care quality improvements. Acad Pediatr. 2013;13(suppl):S38–S44. PubMed

Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36:1–48.

Steens A, Stanoeva KR, Knol MJ, Mariman R, de Melker HE, van Sorge NM. Increase in invasive disease caused by Haemophilus influenzae b, the Netherlands, 2020 to 2021. Euro Surveill. 2021;26 PubMed PMC

Bertran M, Amin-Chowdhury Z, Sheppard CL, et al. Increased incidence of invasive pneumococcal disease among children after COVID-19 pandemic, England. Emerg Infect Dis. 2022;28:1669–1672. PubMed PMC

Perniciaro S, van der Linden M, Weinberger DM. Reemergence of invasive pneumococcal disease in Germany during the spring and summer of 2021. Clin Infect Dis. 2022;75:1149–1153. PubMed PMC

Rocafort M, Henares D, Brotons P, et al. Impact of COVID-19 lockdown on the nasopharyngeal microbiota of children and adults self-confined at home. Viruses. 2022;14 PubMed PMC

Willen L, Ekinci E, Cuypers L, Theeten H, Desmet S. Infant pneumococcal carriage in Belgium not affected by COVID-19 containment measures. Front Cell Infect Microbiol. 2022;11 PubMed PMC

Cohen R, Ashman M, Taha MK, et al. Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap? Infect Dis Now. 2021;51:418–423. PubMed PMC

Messacar K, Baker RE, Park SW, Nguyen-Tran H, Cataldi JR, Grenfell B. Preparing for uncertainty: endemic paediatric viral illnesses after COVID-19 pandemic disruption. Lancet. 2022;400:1663–1665. PubMed PMC

SeyedAlinaghi S, Karimi A, Mojdeganlou H, et al. Impact of COVID-19 pandemic on routine vaccination coverage of children and adolescents: a systematic review. Health Sci Rep. 2022;5 PubMed PMC

McQuaid F, Mulholland R, Sangpang Rai Y, et al. Uptake of infant and preschool immunisations in Scotland and England during the COVID-19 pandemic: an observational study of routinely collected data. PLoS Med. 2022;19 PubMed PMC

Causey K, Fullman N, Sorensen RJD, et al. Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study. Lancet. 2021;398:522–534. PubMed PMC

WHO Immunization coverage. July 14, 2022. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage

Agha R, Avner JR. Delayed seasonal RSV surge observed during the COVID-19 pandemic. Pediatrics. 2021;148 PubMed

Koutsakos M, Wheatley AK, Laurie K, Kent SJ, Rockman S. Influenza lineage extinction during the COVID-19 pandemic? Nat Rev Microbiol. 2021;19:741–742. PubMed PMC

Danino D, Ben-Shimol S, van der Beek BA, et al. Decline in pneumococcal disease in young children during the coronavirus disease 2019 (COVID-19) pandemic in Israel associated with suppression of seasonal respiratory viruses, despite persistent pneumococcal carriage: a prospective cohort study. Clin Infect Dis. 2022;75:e1154–e1164. PubMed PMC

Rybak A, Levy C, Angoulvant F, et al. Association of nonpharmaceutical interventions during the COVID-19 pandemic with invasive pneumococcal disease, pneumococcal carriage, and respiratory viral infections among children in France. JAMA Netw Open. 2022;5 PubMed PMC