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.
Keywords: COVID-19; lower respiratory infections; pneumococcal pneumoniae; respiratory viruses.
【저자키워드】 COVID-19, lower respiratory infections, pneumococcal pneumoniae, respiratory viruses., 【초록키워드】 respiratory infections, SARS-CoV-2, Pneumonia, lockdown, Influenza, children, COVID-19 pandemic, Nonpharmaceutical interventions, Transmission, activity, Adenovirus, respiratory viruses, Prevalence, polymerase chain reaction, Cohort, Ethnicity, respiratory infection, Surveillance, rhinovirus, respiratory virus, respiratory syncytial virus, nasopharyngeal, incidence rate, influenza viruses, age, Pathogens, chest X-ray, chest X-rays, incidence, distribution, disease, Hypothesis, invasive pneumococcal disease, parainfluenza, human metapneumovirus, followed by, Chain Reaction, monthly rate, reduction, serotype, Previous studies, density, reductions, disappearance, previous study, pneumoniae, colonization, pneumococcus, métapneumovirus, alveolar, pneumococcal, nonpneumonia, polymerase chain, resulting, reduced, adjusted, magnitude, expected, implicated, declined, 【제목키워드】 Prospective, persistent, respiratory, Decline, suppression, seasonal,