Florentia Kaguelidou (France)
Assistance Publique–Hôpitaux de Paris - Robert Debré University Hospital ECEVE INSERM UMR 1123Author Of 1 Presentation
UNRAVELLING THE FUNDAMENTAL LINK BETWEEN PNEUMOCOCCAL CARRIAGE, RESPIRATORY VIRAL INFECTION, AND PEDIATRIC INVASIVE PNEUMOCOCCAL DISEASES: A TIME SERIES ANALYSIS BASED ON MULTIPLE NATIONAL SURVEILLANCE SYSTEMS
Abstract
Backgrounds:
An unbreakable relationship has been established between pneumococcal carriage and invasive pneumococcal disease (IPD), with IPD supposed to be the direct consequence of carriage dynamics. We aimed to assess the role of pneumococcal carriage dynamics and the viral epidemiology in the unprecedented IPD epidemiology related to non-pharmaceutical interventions (NPIs) implemented during the COVID-19 pandemic.
Methods
We performed a quasi-experimental interrupted time series analysis based on multiple national surveillance systems of pneumococcal carriage, respiratory syncytial virus (RSV) and influenza-related diseases, and IPD in children <15 years old in France. We estimated the fraction of IPD change after NPIs that was attributable to RSV, influenza and pneumococcal carriage dynamics, analyzed by a quasi-Poisson regression model.
Results:
Between November 2006 and April 2021, 5113 IPD cases were included and 6831 healthy children had a swab test. After NPI implementation, the IPD incidence decreased 63% (95%CI, -82% to -43%, P<.001, Figure) while the overall pneumococcal carriage rate did not significantly change (-12%, 95%CI, -37% to 12%, P=.32). We estimated that 53% (95%CI, 28% to 78%, P<.001) and 40% (95%CI, 15% to 65%, P=.002) of the decrease in IPD in the NPI period was attributable to the change in influenza and RSV epidemiology, respectively. Only 4% (95%CI, -7% to 15%, P=.49) was attributable to a change in pneumococcal carriage. We found similar results when analyzing only high and low-disease potential serotypes.
Conclusions/Learning Points:
The major decrease in pediatric IPD incidence after NPIs was related to a change in viral dynamics rather than pneumococcal carriage. The fundamental link between pneumococcal carriage and IPD is highly affected by viral epidemiology. Interventions targeting respiratory viruses, such as immunoprophylaxis or vaccines against RSV and influenza, may prevent a large part of pediatric IPD.