ArticleThe Lancet. Digital health2023
Trends in invasive bacterial diseases during the first 2 years of the COVID-19 pandemic: analyses of prospective surveillance data from 30 countries and territories in the IRIS Consortium.
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94 citing papers in PubMed, 3 syntheses or guidelines pooled it, 151 citations in OpenAlex.
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- Rising incidence of invasive bacterial infections in Belgium following the COVID-19 pandemic.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
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- The impact of introducing meningococcal C/ACWY booster vaccination among adolescents in Germany: a dynamic transmission modelling study.BMC infectious diseases · 2026Article
34 more citing papers are in PubMed but not listed here.
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Authors and funding
99 authors at 20 institutions in 27 countries.
David ShawNuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK.
Raquel AbadNational Reference Laboratory for Meningococci, National Center of Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
Zahin Amin-ChowdhuryImmunisation and Countermeasures Division, UK Health Security Agency, London, UK.
Adriana BautistaInstituto Nacional de Salud, Bogotá, Colombia.
Desiree BennettIrish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland, Dublin, Ireland.
Karen BroughtonStaphylococcus and Streptococcus Reference Section, AMRHAI, UK Health Security Agency, London, UK.
Bin CaoDepartment of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Carlo CasanovaSwiss National Reference Center for Invasive Pneumococci, Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
Eun Hwa ChoiDepartment of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Yiu-Wai ChuDepartment of Health, Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Hong Kong Special Administrative Region, China.
Heike ClausUniversity of Würzburg, Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, Würzburg, Germany.
Juliana CoelhoStaphylococcus and Streptococcus Reference Section, AMRHAI, UK Health Security Agency, London, UK.
Mary CorcoranIrish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland, Dublin, Ireland; Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland.
Simon CottrellPublic Health Wales, Cardiff, Wales, UK.
Robert CunneyIrish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland, Dublin, Ireland; Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland.
Lize CuypersNational Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
Tine DalbyStatens Serum Institut, Department of Infectious Disease Epidemiology & Prevention, Copenhagen, Denmark.
Heather DaviesMeningococcal Reference Laboratory, Institute of Environmental Science and Research, Porirua, New Zealand.
Linda de GouveiaCentre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa.
Ala-Eddine DeghmaneInstitut Pasteur, Univeristé Paris Cité, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France.
Walter DemczukNational Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.
Stefanie DesmetNational Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
Mirian DomenechNational Center for Microbiology and CIBER of Respiratory Research, Instituto de Salud Carlos III, Madrid, Spain.
Richard DrewIrish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland, Dublin, Ireland; Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; Clinical Innovation Unit, Rotunda, Dublin, Ireland.
Mignon du PlessisCentre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa.
Carolina DuarteInstituto Nacional de Salud, Bogotá, Colombia.
Helga ErlendsdóttirDepartment of Clinical Microbiology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.
Norman K FryImmunisation and Vaccine Preventable Diseases Division and Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK.
Kurt FuurstedStatens Serum Institut, Department of Bacteria, Parasites & Fungi, Copenhagen, Denmark.
Thomas HaleBlavatnik School of Government, University of Oxford, Oxford, UK.
Desiree HenaresMicrobiology Department, Institut Recerca Sant Joan de Déu, Hospital Sant Joan de Deu, Barcelona, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain.
Birgitta Henriques-NormarkKarolinska Institutet, Karolinska University Hospital, Public Health Agency of Sweden, Stockholm, Sweden.
Markus HiltySwiss National Reference Center for Invasive Pneumococci, Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
Steen HoffmannStatens Serum Institut, Department of Bacteria, Parasites & Fungi, Copenhagen, Denmark.
Hilary HumphreysDepartment of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
Margaret IpDepartment of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
Susanne JacobssonNational Reference Laboratory for Neisseria meningitidis, Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Christopher JohnsonPublic Health Wales, Cardiff, Wales, UK.
Jillian JohnstonPublic Health Agency, Belfast, UK.
Keith A JolleyDepartment of Biology, University of Oxford, Oxford, UK.
Aníbal KawabataLaboratorio Central de Salud Pública, Asunción, Paraguay.
Jana KozakovaNational Reference Laboratory for Streptococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic.
Karl G KristinssonDepartment of Clinical Microbiology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.
Pavla KrizovaNational Reference Laboratory for Meningococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic.
Alicja KuchNational Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland.
Shamez LadhaniImmunisation and Countermeasures Division, UK Health Security Agency, London, UK.
Thiên-Trí LâmUniversity of Würzburg, Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, Würzburg, Germany.
María Eugenia LeónLaboratorio Central de Salud Pública, Asunción, Paraguay.
Laura LindholmFinnish Institute for Health and Welfare, Helsinki, Finland.
David LittRespiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK.
Martin C J MaidenDepartment of Biology, University of Oxford, Oxford, UK.
Irene MartinNational Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.
Delphine MartinyNational Belgian Reference Centre for Haemophilus influenzae, Laboratoire des Hôpitaux Universitaires de Bruxelles-Universitair Laboratorium van Brussel, Brussels, Belgium; Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium.
Wesley MattheusMeningococcal National Reference Centre, Sciensano, Belgium.
Noel D McCarthyPopulation Health Medicine, Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland.
Mary MeehanIrish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland, Dublin, Ireland.
Susan MeiringDivision of Public Health Surveillance and Response, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa.
Paula MöllingNational Reference Laboratory for Neisseria meningitidis, Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Eva MorfeldtPublic Health Agency of Sweden, Solna, Sweden.
Julie MorganStreptococcal Reference Laboratory, Institute of Environmental Science and Research Limited, Porirua, New Zealand.
Robert MulhallIrish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland, Dublin, Ireland.
Carmen Muñoz-AlmagroMicrobiology Department, Institut Recerca Sant Joan de Déu, Hospital Sant Joan de Deu, Barcelona, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain; Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain.
David MurdochUniversity of Otago, Christchurch, New Zealand.
Joy MurphyPublic Health Agency, Belfast, UK.
Martin MusilekNational Reference Laboratory for Meningococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic.
Alexandre MzabiMinistère de la Santé - Direction de la santé, Luxembourg, Luxembourg.
Ludmila NovakovaNational Reference Laboratory for Haemophilus Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic.
Shahin OftadehNSW Pneumococcal Reference Laboratory, Institute of Clinical Pathology and Medical Research - NSW Health Pathology, Sydney, NSW, Australia.
Amaresh Perez-ArgüelloMicrobiology Department, Institut Recerca Sant Joan de Déu, Hospital Sant Joan de Deu, Barcelona, Spain.
Maria Pérez-VázquezLaboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
Monique PerrinLaboratoire National de Sante, Dudelange, Luxembourg.
Malorie PerryPublic Health Wales, Cardiff, Wales, UK.
Benoit PrevostNational Belgian Reference Centre for Haemophilus influenzae, Laboratoire des Hôpitaux Universitaires de Bruxelles-Universitair Laboratorium van Brussel, Brussels, Belgium.
Maria RobertsPublic Health Wales, Cardiff, Wales, UK.
Assaf RokneyPublic Health Laboratories-Jerusalem, Public Health Services, Ministry of Health, Jerusalem, Israel.
Merav RonPublic Health Laboratories-Jerusalem, Public Health Services, Ministry of Health, Jerusalem, Israel.
Olga Marina SanabriaInstituto Nacional de Salud, Bogotá, Colombia.
Kevin J ScottBacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratories, Glasgow Royal Infirmary, Glasgow, UK.
Carmen SheppardRespiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK.
Lotta SiiraFinnish Institute for Health and Welfare, Helsinki, Finland.
Vitali SintchenkoNSW Pneumococcal Reference Laboratory, Institute of Clinical Pathology and Medical Research - NSW Health Pathology, Sydney, NSW, Australia; Sydney Institute for Infectious Diseases, University of Sydney, NSW, Australia.
Anna SkoczyńskaNational Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland.
Monica SloanPublic Health Agency, Belfast, UK.
Hans-Christian SlotvedStatens Serum Institut, Department of Bacteria, Parasites & Fungi, Copenhagen, Denmark.
Andrew J SmithBacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratories, Glasgow Royal Infirmary, Glasgow, UK; College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
Anneke SteensCentre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
Muhamed-Kheir TahaInstitut Pasteur, Univeristé Paris Cité, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France.
Maija ToropainenFinnish Institute for Health and Welfare, Helsinki, Finland.
Georgina TzanakakiNational Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece.
Anni VainioFinnish Institute for Health and Welfare, Helsinki, Finland.
Mark P G van der LindenDepartment of Medical Microbiology, German National Reference Centre for Streptococci, University Hospital RWTH Aachen, Aachen, Germany.
Nina M van SorgeDepartment of Medical Microbiology and Infection Prevention, and Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands.
Emmanuelle VaronLaboratory of Medical Biology and National Reference Centre for Pneumococci, Intercommunal Hospital of Créteil, Créteil, France.
Sandra VohrnovaNational Reference Laboratory for Streptococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic.
Anne von GottbergCentre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa.
Jose YusteNational Center for Microbiology and CIBER of Respiratory Research, Instituto de Salud Carlos III, Madrid, Spain.
Rosemeire ZanellaNational Laboratory for Meningitis and Pneumococcal Infections, Center of Bacteriology, Institute Adolfo Lutz, São Paulo, Brazil.
Fei ZhouDepartment of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Angela B BrueggemannNuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK. Electronic address: angela.brueggemann@ndph.ox.ac.uk.
UK Health Security Agency · GBNational Institute of Public Health · CZUniversity of Oxford · GBChildren's Health Ireland at Crumlin · IEFinnish Institute for Health and Welfare · FINational Health Laboratory Service · ZAPublic Health Wales · GBStatens Serum Institut · DKInstituto de Salud Carlos III · ESInstituto Nacional de Salud · COPublic Health Agency · GBRoyal College of Surgeons in Ireland · IEChinese Academy of Medical Sciences & Peking Union Medical College · CNGlasgow Royal Infirmary · GBHospital Sant Joan de Déu Barcelona · ESIsrael Ministry of Health · ILKU Leuven · BEMinisterio de Salud Pública y Bienestar Social · PYNarodowy Instytut Leków · PLNational University Hospital of Iceland · IS
Funding
Department of HealthWellcome Trust 203141/Z/16/ZWellcome Trust 206394Wellcome Trust 206394/Z/17/ZWellcome Trust 218205Wellcome Trust 218205/Z/19/Z
Abstract
backgroundThe Invasive Respiratory Infection Surveillance (IRIS) Consortium was established to assess the impact of the COVID-19 pandemic on invasive diseases caused by Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Streptococcus agalactiae. We aimed to analyse the incidence and distribution of these diseases during the first 2 years of the COVID-19 pandemic compared to the 2 years preceding the pandemic.
methodsFor this prospective analysis, laboratories in 30 countries and territories representing five continents submitted surveillance data from Jan 1, 2018, to Jan 2, 2022, to private projects within databases in PubMLST. The impact of COVID-19 containment measures on the overall number of cases was analysed, and changes in disease distributions by patient age and serotype or group were examined. Interrupted time-series analyses were done to quantify the impact of pandemic response measures and their relaxation on disease rates, and autoregressive integrated moving average models were used to estimate effect sizes and forecast counterfactual trends by hemisphere.
findingsOverall, 116 841 cases were analysed: 76 481 in 2018-19, before the pandemic, and 40 360 in 2020-21, during the pandemic. During the pandemic there was a significant reduction in the risk of disease caused by S pneumoniae (risk ratio 0·47; 95% CI 0·40-0·55), H influenzae (0·51; 0·40-0·66) and N meningitidis (0·26; 0·21-0·31), while no significant changes were observed for S agalactiae (1·02; 0·75-1·40), which is not transmitted via the respiratory route. No major changes in the distribution of cases were observed when stratified by patient age or serotype or group. An estimated 36 289 (95% prediction interval 17 145-55 434) cases of invasive bacterial disease were averted during the first 2 years of the pandemic among IRIS-participating countries and territories.
interpretationCOVID-19 containment measures were associated with a sustained decrease in the incidence of invasive disease caused by S pneumoniae, H influenzae, and N meningitidis during the first 2 years of the pandemic, but cases began to increase in some countries towards the end of 2021 as pandemic restrictions were lifted. These IRIS data provide a better understanding of microbial transmission, will inform vaccine development and implementation, and can contribute to health-care service planning and provision of policies.
fundingWellcome Trust, NIHR Oxford Biomedical Research Centre, Spanish Ministry of Science and Innovation, Korea Disease Control and Prevention Agency, Torsten Söderberg Foundation, Stockholm County Council, Swedish Research Council, German Federal Ministry of Health, Robert Koch Institute, Pfizer, Merck, and the Greek National Public Health Organization.
Indexed as
Bacterial InfectionsCOVID-19Neisseria meningitidisHaemophilus influenzaeHumansPandemicsStreptococcus pneumoniae
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