Changes in Invasive Neisseria meningitidis and Haemophilus influenzae Infections in France during the COVID-19 Pandemic

Abstract

BackgroundSince the appearance of COVID-19 in January 2020, invasive bacterial infections have decreased significantly worldwide. However, alterations in age and sex distributions, clinical forms, phenotypes, and genotypes of isolates have not been analyzed. Our goal is to present and discuss these data considering the current COVID-19 pandemic situation. Methods: The data of the national reference center for meningococci and Haemophilus influenzae in France were mined to examine the above aspects of invasive bacterial infection before (2018–2019) and after (2020–2021) the COVID-19 pandemic. Detailed epidemiological, clinical, and microbiological data were collected, and whole genome sequencing was carried out on meningococcal isolates (n = 1466). Results: In addition to the overall decline in the number of cases, various changes in age, sex, and phenotypes of isolates were also noted. As for N. meningitidis, more cases were observed in adults, as well as more invasive pneumopathies. Furthermore, fewer hyperinvasive meningococcal genotypes have circulated since COVID-19 emerged. The situation has been different for H. influenzae, as the number of invasive cases among adults decreased due to a reduction in non-typeable isolates. In contrast, cases due to serotypeable isolates, particularly serotypes a and b, increased in children <5 years-old. Conclusions: It is possible that measures implemented to stop COVID-19 may have reduced the circulation of N. meningitidis and H. influenzae isolates, but to a variable extent. This may be due to differences in circulation between these two species according to age groups. Vaccination schedules against these two species may have also influenced the evolution of these invasive bacterial infections since the emergence of the COVID-19 pandemic.

Haemophilus influenzae meningitis: A rare etiology of bacterial meningitis in adults! A case report

“…Asplenia, agammaglobulinemia and deficiencies of early complement components (e.g. C1-C3) are also related to the risk of invasive infections caused by H. influenzae [1]. In our case we did not detect such abnormalities.…”

“…Nevertheless, non-typeable strains of H. influenzae can lead to invasive infections [1]. A prospective cohort study of 80 adult cases of H. influenzae meningitis published in 2021 in the Netherlands has shown that in adult patients, the majority of H. influenzae meningitis occurs with non-typeable strains [2].…”

“…Clinical manifestations that are associated with meningitis include Kernig's sign and Brudzinski's sign. Cutaneous hyperesthesia may be associated with other signs such as tachycardia or bradycardia, respiratory disorders, and vasomotor disorders [1]. Other neurological complications of H. influenzae b meningitis may involve intracranial abscess, hydrocephalus, subdural effusion or empyema and ventriculitis.…”

“…According to the literature, H. influenzae b meningitis is associated with a mortality rate of 4-5% and severe neurological sequelae (deafness, epilepsy and intellectual impairment) of up to 8-11% [1]. Poor prognostic factors are the occurrence of systemic complications such as sepsis, pneumonia, convulsions impairment of consciousness (Glasgow Coma Scale <14) and immunodepression [2].…”

“…Invasive H. influenzae infections occur when the bacteria cross the nasopharynx, invade the bloodstream, and then proceed to normally sterile sites. Invasive H. influenzae infections can manifest as a sepsis, an invasive pneumonia, an epiglottitis, and an acute bacterial meningitis [1]. The H. influenzae meningitis represents roughly 4% of community-acquired bacterial meningitis in adults [2].…”