Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Invasive Pneumococcal Disease and Risk of Pneumococcal Coinfection With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Prospective National Cohort Study, England
Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Invasive Pneumococcal Disease and Risk of Pneumococcal Coinfection With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Prospective National Cohort Study, England
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DOI：
10.1093/cid/ciaa1728
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发表时间：
2021-01-25
影响因子：
11.8
通讯作者：
Ladhani, Shamez N.
中科院分区：
文献类型：
--
作者：
Amin-Chowdhury, Zahin;Aiano, Felicity;Ladhani, Shamez N.
背景。肺炎链球菌合并流感可导致协同致死，但肺炎球菌合并严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）的数据有限。英国公共卫生部在英格兰开展侵袭性肺炎球菌病（IPD）和SARS-CoV-2监测。分析了2000/2001-2019/2020流行病学年IPD趋势，并将2020年2月至6月的病例与实验室确诊的SARS-CoV-2感染联系起来。采用多变量logistic回归评估死亡危险因素。与2018/2019年（10.9/10万，n = 5666）相比，2019/2020年IPD发病率（7.6/10万，n = 3964）降低了30% (IRR, 0.70; 95% CI, 0.18 -2.67)， 2020年3月至6月期间，所有年龄组的IPD发病率均大幅下降。2020年2 - 6月，全国共发生SARS-CoV-2病例160886例，IPD病例1137例，其中IPD/ COVID-19合并感染病例40例。0.25% [95% CI, 0.018 ~ 0.034]的SARS-CoV-2感染；3.5% [2.5-4.8] IPD病例)，21例在IPD后3-27天诊断为COVID-19, 27例在IPD后28天出现COVID-19。病死率（CFRs）分别为62.5%（25/40）、47.6%（10/21）和33.3% (9/27)（P < 0.001）。除了与年龄和血清型组的增加独立相关外，IPD/COVID-19合并感染患者的CFR比单纯IPD患者高7.8倍（95% CI, 3.8-15.8）， IPD后3-27天发生COVID-19的患者CFR比单纯IPD患者高3.9倍（95% CI, 1.4-10.7）。COVID-19封锁后，IPD大幅下降。IPD/COVID-19合并感染罕见，但与高CFR相关，主要发生在老年人中。IPD/COVID-19合并感染的罕见性、年龄和血清型分布不支持更广泛地推广肺炎球菌疫苗接种。
Background. Streptococcus pneumoniae coinfection with influenza results in synergistic lethality, but there are limited data on pneumococcal coinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Methods. Public Health England conducts invasive pneumococcal disease (IPD) and SARS-CoV-2 surveillance in England. IPD trends during 2000/2001-2019/2020 epidemiological years were analyzed and cases during February-June 2020 linked with laboratory-confirmed SARS-CoV-2 infections. Multivariable logistic regression was used to assess risk factors for death.Results. IPD incidence in 2019/2020 (7.6/100 000; n = 3964) was 30% (IRR, .70; 95% CI, .18-2.67) lower compared with 2018/2019 (10.9/100 000; n = 5666), with large reductions observed across all age groups during March-June 2020. There were 160 886 SARS-CoV-2 and 1137 IPD cases during February-June 2020, including 40 IPD/coronavirus disease 2019 (COVID-19) co-infections (.025% [95% CI, .018-.034] of SARS-CoV-2 infections; 3.5% [2.5-4.8] of IPD cases), 21 with COVID-19 diagnosed 3-27 days after IPD, and 27 who developed COVID-19 >28 days after IPD. Case-fatality rates (CFRs) were 62.5 (25/40), 47.6% (10/21), and 33.3% (9/27), respectively (P < .001). In addition to an independent association with increasing age and serotype group, CFR was 7.8-fold (95% CI, 3.8-15.8) higher in those with IPD/COVID-19 coinfection and 3.9-fold (95% CI, 1.4-10.7) higher in patients who developed COVID-19 3-27 days after IPD compared with patients with IPD only.Conclusions. Large declines in IPD were observed following COVID-19 lockdown. IPD/COVID-19 coinfections were rare but associated with high CFR, mainly in older adults. The rarity, age and serotype distribution of IPD/COVID-19 coinfections do not support wider extension of pneumococcal vaccination.