Decline in Pneumococcal Disease in Young Children during the COVID-19 Pandemic in Israel Associated with Suppression of seasonal Respiratory Viruses, despite Persistent Pneumococcal Carriage: A Prospective Cohort Study

Dana Danino, Shalom Ben-Shimol, Bart Adriaan Van Der Beek, Noga Givon-Lavi, Yonat Shemer Avni, David Greenberg, Daniel M Weinberger, Ron Dagan

Research output: Contribution to journalArticlepeer-review

49 Scopus citations

Abstract

BACKGROUND: The incidence of invasive pneumococcal disease (IPD) declined during the COVID-19 pandemic. Previous studies hypothesized that this was due to reduced pneumococcal transmission resulting from nonpharmaceutical interventions. We used multiple ongoing cohort surveillance projects in children <5 years to test this hypothesis. METHODS: The first SARS-CoV-2 cases were detected in February 2020, resulting in a full lockdown, followed by several partial restrictions. Data from ongoing surveillance projects captured the incidence dynamics of community-acquired alveolar pneumonia (CAAP), nonalveolar lower respiratory infections necessitating chest X-rays (NA-LRIs), nasopharyngeal pneumococcal carriage in nonrespiratory visits, nasopharyngeal respiratory virus detection (by polymerase chain reaction), and nationwide IPD. Monthly rates (January 2020 through February 2021 vs mean monthly rates 2016-2019 [expected rates]) adjusted for age and ethnicity were compared. RESULTS: CAAP and bacteremic pneumococcal pneumonia were strongly reduced (incidence rate ratios [IRRs]: .07 and .19, respectively); NA-LRIs and nonpneumonia IPD were also reduced by a lesser magnitude (IRRs: .46 and .42, respectively). In contrast, pneumococcal carriage prevalence was only slightly reduced, and density of colonization and pneumococcal serotype distributions were similar to previous years. The decline in pneumococcus-associated disease was temporally associated with a full suppression of respiratory syncytial virus, influenza viruses, and human metapneumovirus, often implicated as co-pathogens with pneumococcus. In contrast, adenovirus, rhinovirus, and parainfluenza activities were within or above expected levels. CONCLUSIONS: Reductions in pneumococcal and pneumococcus-associated diseases occurring during the COVID-19 pandemic in Israel were not predominantly related to reduced pneumococcal carriage and density but were strongly associated with the disappearance of specific respiratory viruses.

Original languageEnglish
Pages (from-to)e1154-e1164
Number of pages11
JournalClinical Infectious Diseases
Volume75
Issue number1
DOIs
StatePublished - Jul 2021

Keywords

  • COVID-19
  • lower respiratory infections
  • pneumococcal pneumoniae
  • respiratory viruses

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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