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. 2021 Jul:6:100112.
doi: 10.1016/j.lanepe.2021.100112. Epub 2021 Jun 7.

Trends in respiratory virus circulation following COVID-19-targeted nonpharmaceutical interventions in Germany, January - September 2020: Analysis of national surveillance data

Djin-Ye Oh  1   2 , Silke Buda  3 , Barbara Biere  1 , Janine Reiche  1 , Frank Schlosser  4   5 , Susanne Duwe  1 , Marianne Wedde  1 , Max von Kleist  6 , Martin Mielke  7 , Thorsten Wolff  1 , Ralf Dürrwald  1
Affiliations

Trends in respiratory virus circulation following COVID-19-targeted nonpharmaceutical interventions in Germany, January - September 2020: Analysis of national surveillance data

Djin-Ye Oh et al. Lancet Reg Health Eur. 2021 Jul.

Abstract

Background: During the initial COVID-19 response, Germany's Federal Government implemented several nonpharmaceutical interventions (NPIs) that were instrumental in suppressing early exponential spread of SARS-CoV-2. NPI effect on the transmission of other respiratory viruses has not been examined at the national level thus far.

Methods: Upper respiratory tract specimens from 3580 patients with acute respiratory infection (ARI), collected within the nationwide German ARI Sentinel, underwent RT-PCR diagnostics for multiple respiratory viruses. The observation period (weeks 1-38 of 2020) included the time before, during and after a far-reaching contact ban. Detection rates for different viruses were compared to 2017-2019 sentinel data (15350 samples; week 1-38, 11823 samples).

Findings: The March 2020 contact ban, which was followed by a mask mandate, was associated with an unprecedented and sustained decline of multiple respiratory viruses. Among these, rhinovirus was the single agent that resurged to levels equalling those of previous years. Rhinovirus rebound was first observed in children, after schools and daycares had reopened. By contrast, other nonenveloped viruses (i.e. gastroenteritis viruses reported at the national level) suppressed after the shutdown did not rebound.

Interpretation: Contact restrictions with a subsequent mask mandate in spring may substantially reduce respiratory virus circulation. This reduction appears sustained for most viruses, indicating that the activity of influenza and other respiratory viruses during the subsequent winter season might be low,whereas rhinovirus resurgence, potentially driven by transmission in educational institutions in a setting of waning population immunity, might signal predominance of rhinovirus-related ARIs.

Funding: Robert Koch-Institute and German Ministry of Health.

Keywords: Nonpharmaceutical interventions; Respiratory virus; Rhinovirus; SARS-CoV-2; Surveillance.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig 1
Fig. 1
Spatial Distribution of Sentinel Clinics over Germany. Shown are the geographical locations of clinics participating in the national sentinel system for monitoring acute respiratory infections (ARI), particularly influenza. High population density is reflected in high practice density. Different colors represent different specialties. GP, General Practioner.
Fig 2
Fig. 2
Respiratory virus surveillance results in the context of public health measures. Please note the complementary figures S2, S3 and S4 in the Supplementary section. A. Specimen numbers per sampling week/ year. Each column represents the numbers of samples obtained from patients presenting with acute respiratory illness in the calendar week indicated. Shades of grey / pink indicate the sampling year. B. 2020 sentinel prevalence of respiratory viruses in the temporal context of NPIs and mobility, compared to 2017-2019 sentinel prevalence. Areas of colored segments in each piechart represent the detection prevalence of a respiratory virus in samples obtained during the indicated week / year. Included is a 2020 mobility chart, displaying the relative change [%] in population mobility as compared to the corresponding 2019 week; an overview of NPIs; and summer vacation periods, which vary by region: each horizontal staggered line represents the vacation block of one Bundesland (state). Asterisks denote statistical significance level of 2020 respiratory virus prevalence being lower than in 2017-2019: **, p<0.005 based on both binomial and Fisher's exact tests. IV: Influenza A/B, HRV: Human Rhinovirus, RSV: Respiratory Syncytial Virus, HMPV: Human Metapneumovirus, PIV: Parainfluenzavirus, SARS-CoV-2: SARS Coronavirus 2, 0: negative for the tested viruses, >1: more than 1 virus detected. Both PIV and SARS-CoV-2 were only tested for in 2020. C. Rhinovirus rebound by age group. Heatmap diagram showing the percentage of rhinovirus-positive specimens by age group (Y-axis) and time (X-axis); time scale corresponds to two-week-blocks in 2020.
Fig 3
Fig. 3
Sustained decrease of case numbers for viral infections in 2020 and its temporal association with public health measures. Shown is the number of cases reported to local or federal health authorities in 2017-2020 for each of three notifiable viral diseases: seasonal influenza, norovirus gastroenteritis (non-enveloped virus) and rotavirus gastroenteritis (non-enveloped virus). The public health measures in order to curb the spread of COVID-19 (table 1) are indicated.
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Further readings

    1. Takashita E, Kawakami C, Momoki T, Saikusa M, Shimizu K, Ozawa H, Kumazaki M, Usuku S, Tanaka N, Okubo I, Morita H, Nagata S, Watanabe S, Hasegawa H, Kawaoka Y. Increased risk of rhinovirus infection in children during the coronavirus disease-19 pandemic. Influenza Other Respir Viruses. 2021 Mar 14. doi: 10.1111/irv.12854. Epub ahead of print. PMID: 33715290. - PMC - PubMed
    1. Huang QS, Wood T, Jelley L, Jennings T, Jefferies S, Daniells K, Nesdale A, Dowell T, Turner N, Campbell-Stokes P, Balm M, Dobinson HC, Grant CC, James S, Aminisani N, Ralston J, Gunn W, Bocacao J, Danielewicz J, Moncrieff T, McNeill A, Lopez L, Waite B, Kiedrzynski T, Schrader H, Gray R, Cook K, Currin D, Engelbrecht C, Tapurau W, Emmerton L, Martin M, Baker MG, Taylor S, Trenholme A, Wong C, Lawrence S, McArthur C, Stanley A, Roberts S, Rahnama F, Bennett J, Mansell C, Dilcher M, Werno A, Grant J, van der Linden A, Youngblood B, Thomas PG; NPIsImpactOnFlu Consortium, Webby RJ. Impact of the COVID-19 nonpharmaceutical interventions on influenza and other respiratory viral infections in New Zealand. Nat Commun. 2021 Feb 12;12(1):1001. doi: 10.1038/s41467-021-21157-9. PMID: 33579926; PMCID: PMC7881137. - PMC - PubMed
    1. van der Toorn W, Oh DY, von Kleist M; working group on SARS-CoV-2 Diagnostics at RKI. COVIDStrategyCalculator: A software to assess testing- and quarantine strategies for incoming travelers, contact person management and de-isolation. Patterns (N Y). 2021 Apr 20:100264. doi: 10.1016/j.patter.2021.100264. Epub ahead of print. PMID: 33899035; PMCID: PMC8057763. - PMC - PubMed
    1. van der Toorn W, Oh D-Y, Bourquain D, et al. COVIDStrategyCalculator: a standalone software to assess testing- and quarantine strategies for incoming travelers, contact person management and de-isolation. medRxiv 2020 2020.11.18.20233825.
    1. Janine Michel; Markus Neumann; Eva Krause; Thomas Rinner; Therese Muzeniek; Marica Grossegesse; Georg Hille; Franziska Schwarz; Andreas Puyskens; Sophie Förster; Barbara Biere; Daniel Bourquain; Cristina Domingo; Annika Brinkmann; Lars Schaade; Livia Schrick; Andreas Nitsche, Ph.D. Resource-efficient internally controlled in-house real-time PCR detection of SARS-CoV-2 (2021). Virology Journal, accepted. - PMC - PubMed