Background Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, which are typically transmitted via respiratory droplets, are leading causes of invasive diseases, including bacteraemic pneumonia and meningitis, and of secondary infections subsequent to post-viral respiratory disease. The aim of this study was to investigate the incidence of invasive disease due to these pathogens during the early months of the COVID-19 pandemic. MethodsIn this prospective analysis of surveillance data, laboratories in 26 countries and territories across six continents submitted data on cases of invasive disease due to S pneumoniae, H influenzae, and N meningitidis from Jan 1, 2018, to May, 31, 2020, as part of the Invasive Respiratory Infection Surveillance (IRIS) Initiative. Numbers of weekly cases in 2020 were compared with corresponding data for 2018 and 2019. Data for invasive disease due to Streptococcus agalactiae, a non-respiratory pathogen, were collected from nine laboratories for comparison. The stringency of COVID-19 containment measures was quantified using the Oxford COVID-19 Government Response Tracker. Changes in population movements were assessed using Google COVID-19 Community Mobility Reports. Interrupted time-series modelling quantified changes in the incidence of invasive disease due to S pneumoniae, H influenzae, and N meningitidis in 2020 relative to when containment measures were imposed. Findings 27 laboratories from 26 countries and territories submitted data to the IRIS Initiative for S pneumoniae (62 434 total cases), 24 laboratories from 24 countries submitted data for H influenzae (7796 total cases), and 21 laboratories from 21 countries submitted data for N meningitidis (5877 total cases). All countries and territories had experienced a significant and sustained reduction in invasive diseases due to S pneumoniae, H influenzae, and N meningitidis in early 2020 (Jan 1 to May 31, 2020), coinciding with the introduction of COVID-19 containment measures in each country. By contrast, no significant changes in the incidence of invasive S agalactiae infections were observed. Similar trends were observed across most countries and territories despite differing stringency in COVID-19 control policies. The incidence of reported S pneumoniae infections decreased by 68% at 4 weeks (incidence rate ratio 0•32 [95% CI 0•27-0•37]) and 82% at 8 weeks (0•18 [0•14-0•23]) following the week in which significant changes in population movements were recorded. Interpretation The introduction of COVID-19 containment policies and public information campaigns likely reduced transmission of S pneumoniae, H influenzae, and N meningitidis, leading to a significant reduction in life-threatening invasive diseases in many countries worldwide.

The predominant serotypes were III (n=258, 60%) and Ia (n=73, 17%); five serotypes (Ia, Ib, II, III, V) comprised 94% (n=377) of serotyped isolates (n=402). Interpretation: The incidence of invasive infant GBS disease in the UK and Ireland has increased since 2000-2001. The burden of EOD incidence has not declined despite the introduction of national prevention guidelines. New strategies for prevention are required.

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AimsTo define the burden of group B Streptococcal disease in infants younger than 90 days in 2014–2015; their clinical presentation; the frequency of established risk factors; the mortality and short-term complication rates (at hospital discharge); the responsible serotypes and their distribution. In addition, to compare these parameters to those of the previous national surveillance in 2000–2001.MethodsProspective, enhanced, active surveillance was undertaken through the British Paediatric Surveillance Unit (BPSU), microbiology reference laboratories and national public health agencies.Cases were identified by paediatricians and microbiologists. Paediatricians reporting a case were asked to complete a questionnaire. Microbiologists were encouraged to report cases through established routine laboratory reporting systems, and to submit all invasive GBS isolates to the relevant Reference Units. Surveillance was then enhanced by reconciling data from the clinicians and laboratory reports with referred isolates. Referral of isolates was further optimised through direct contact with all microbiology departments.ResultsIn the 13 months from April 2014 817 cases were identified (incidence 0.89/1000 live births, 95% CI; 0.87–0.91). The incidence for early-onset (EO) disease was 0.54/1000 (0.51–0.57), and for late-onset (LO) disease 0.36/1000 (0.33–0.39).Clinical information is currently available for 77% of cases. Serotype information is available for 46% of cases. Of those cases where gestation is available, 21% of EO cases and 40% of LO cases were in infants born prematurely.36% of EO cases where information is available had one or more risk factors present at or before delivery.There were 147 meningitis cases (55 EO, 92 LO).38 infants died (4.7%); 16 were EO cases and 22 were LO.ConclusionSince the national surveillance of 2000–2001 there has been a significant increase in the incidence of invasive GBS disease in all five British Isles countries. There has been a proportionately greater increase in the incidence of LO disease; however the increase was also evident for EO incidence, despite the presence of national prevention guidelines. New strategies for preventing GBS in this age group are urgently required.

Group B Streptococcus (GBS) is a common intestinal colonizer during the neonatal period, but also may cause late-onset sepsis or meningitis in up to 0.5% of otherwise healthy colonized infants after day 3 of life. Transmission routes and risk factors of this late-onset form of invasive GBS disease (iGBS) are not fully understood. Cases of iGBS with recurrence (n=25) and those occurring in parallel in twins/triplets (n=32) from the UK and Ireland (national surveillance study 2014/15) and from Germany and Switzerland (retrospective case collection) were analyzed to unravel shared (in affected multiples) or fixed (in recurrent disease) risk factors for GBS disease. The risk of iGBS among infants from multiple births was high (17%), if one infant had already developed GBS disease. The interval of onset of iGBS between siblings was 4.5 days and in recurrent cases 12.5 days. Disturbances of the individual microbiome, including persistence of infectious foci are suggested e.g. by high usage of perinatal antibiotics in mothers of affected multiples, and by the association of an increased risk of recurrence with a short term of antibiotics [aOR 4.2 (1.3-14.2), P=0.02]. Identical GBS serotypes in both recurrent infections and concurrently infected multiples might indicate a failed microbiome integration of GBS strains that are generally regarded as commensals in healthy infants. The dynamics of recurrent GBS infections or concurrent infections in multiples suggest individual patterns of exposure and fluctuations in host immunity, causing failure of natural niche occupation.