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. 2023 Apr 12;227(7):907-916.
doi: 10.1093/infdis/jiad028.

Changes in the Incidence of Invasive Bacterial Disease During the COVID-19 Pandemic in the United States, 2014-2020

Namrata Prasad  1   2 , Julia Rhodes  1 , Li Deng  1 , Natalie L McCarthy  3 , Heidi L Moline  1 , James Baggs  3 , Sujan C Reddy  3 , John A Jernigan  3 , Fiona P Havers  4 , Daniel M Sosin  5 , Ann Thomas  6 , Ruth Lynfield  7 , William Schaffner  8 , Arthur Reingold  9   10 , Kari Burzlaff  11 , Lee H Harrison  12 , Susan Petit  13 , Monica M Farley  14 , Rachel Herlihy  15 , Srinivas Nanduri  1 , Tamara Pilishvili  1 , Lucy A McNamara  1 , Stephanie J Schrag  1 , Katherine E Fleming-Dutra  1 , Miwako Kobayashi  1 , Melissa Arvay  1
Affiliations

Changes in the Incidence of Invasive Bacterial Disease During the COVID-19 Pandemic in the United States, 2014-2020

Namrata Prasad et al. J Infect Dis. .

Abstract

Background: Descriptions of changes in invasive bacterial disease (IBD) epidemiology during the coronavirus disease 2019 (COVID-19) pandemic in the United States are limited.

Methods: We investigated changes in the incidence of IBD due to Streptococcus pneumoniae, Haemophilus influenzae, group A Streptococcus (GAS), and group B Streptococcus (GBS). We defined the COVID-19 pandemic period as 1 March to 31 December 2020. We compared observed IBD incidences during the pandemic to expected incidences, consistent with January 2014 to February 2020 trends. We conducted secondary analysis of a health care database to assess changes in testing by blood and cerebrospinal fluid (CSF) culture during the pandemic.

Results: Compared with expected incidences, the observed incidences of IBD due to S. pneumoniae, H. influenzae, GAS, and GBS were 58%, 60%, 28%, and 12% lower during the pandemic period of 2020, respectively. Declines from expected incidences corresponded closely with implementation of COVID-19-associated nonpharmaceutical interventions (NPIs). Significant declines were observed across all age and race groups, and surveillance sites for S. pneumoniae and H. influenzae. Blood and CSF culture testing rates during the pandemic were comparable to previous years.

Conclusions: NPIs likely contributed to the decline in IBD incidence in the United States in 2020; observed declines were unlikely to be driven by reductions in testing.

Keywords: COVID-19; United States; invasive bacterial disease; nonpharmaceutical intervention.

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Conflict of interest statement

Presented in part: 12th International Symposium on Pneumococci and Pneumococcal Diseases, Toronto, Canada, 19-23 June.

Figures

Figure 1.
Figure 1.
Overall observed pathogen-specific invasive bacterial disease (IBD) incidence from 2014 to 2020 and expected IBD incidence during the COVID-19 pandemic, March-December 2020, Active Bacterial Core Surveillance, United States. Y-axes vary by pathogen.
Figure 2.
Figure 2.
Overall observed and expected cumulative pathogen specific invasive bacterial disease (IBD) incidences relative to Oxford COVID-19 Government Response Tracker (OxCGRT) stringency index data, Active Bacterial Core Surveillance (ABCs), United States. Colored panels represent the mean monthly OxCGRT stringency index values across US states where ABCs is conducted. The stringency index is a composite measure including data on different indicators such as school and workplace closures, limits to public gatherings, and travel bans that reflect government responses to the COVID-19 pandemic. The index ranges from a value of 0 to 100, with higher (darker) values indicating more intense stringency measures. Red lines represent the observed cumulative incidences in 2020; dark solid lines represent the expected cumulative incidences during the pandemic period generated from autoregressive integrated moving average (ARIMA) models; dashed lines represent the 95% interval estimates of the expected incidences. Y-axes vary by pathogen.
Figure 3.
Figure 3.
Observed and expected Streptococcus pneumoniae-specific invasive bacterial disease incidences per 100 000, and IRR, overall and by age, race, and surveillance site during the COVID-19 pandemic, March-December 2020, Active Bacterial Core Surveillance, United States. Abbreviations: IE, interval estimate; IRR, incidence rate ratio.
Figure 4.
Figure 4.
Observed and expected Haemophilus influenzae-specific invasive bacterial disease incidences per 100 000, and IRR, overall and by age, race, and surveillance site during the COVID-19 pandemic, March-December 2020, Active Bacterial Core Surveillance, United States. Abbreviations: IE, interval estimate; IRR, incidence rate ratio.
Figure 5.
Figure 5.
Observed and expected group A Streptococcus-specific invasive bacterial disease incidences per 100 000, and IRR, overall and by age, race, and surveillance site during the COVID-19 pandemic, March-December 2020, Active Bacterial Core Surveillance, United States. Abbreviations: IE, interval estimate; IRR, incidence rate ratio.
Figure 6.
Figure 6.
Observed and expected group B Streptococcus-specific invasive bacterial disease incidences per 100 000, and IRR, overall and by age, race, and surveillance site during the COVID-19 pandemic, March-December 2020, Active Bacterial Core Surveillance, United States. A model specifically assessing changes in invasive group B Streptococcus disease incidence among infants aged <90 days was developed, with incidence calculated per 100,000 live births. Infants aged <90 days were also included within the 0–4 year age group model. Abbreviations: IE, interval estimate; IRR, incidence rate ratio.
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References

    1. Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998–2007. N Engl J Med 2011; 364:2016–25. - PubMed
    1. Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence 2014; 5:4–11. - PMC - PubMed
    1. Centers for Disease Control and Prevention. Active bacterial core surveillance (ABCs). https://www.cdc.gov/abcs/index.html. Accessed 17 May 2022.
    1. Brueggemann AB, van Rensburg MJ J, 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:e360–70. - PMC - PubMed
    1. 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; 5:529–38. - PubMed

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