Impact of COVID-19 pandemic and the lockdown on invasive meningococcal disease
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RESEARCH NOTE
Impact of COVID‑19 pandemic and the lockdown on invasive meningococcal disease Muhamed‑Kheir Taha* and Ala‑Eddine Deghmane
Abstract Objective: Few data are available on the association between SARS-CoV-2 and secondary bacterial infections. Such an association was described for flu and invasive meningococcal disease (IMD). We aimed exploring such a correlation between COVID-19 and IMD as well as the impact of the lockdown on IMD. Results: We compared IMD cases received at the French National Reference Centre for meningococci and Haemophilus influenzae that are sent as part of the mandatory reporting of IMD. We compared these data during the period 01 January-15 May 2020 to those from the same period in 2018 and 2019. IMD cases that were associated with respira‑ tory presentations significantly increased in 2020 compared to 2018 (P = 0.029) and 2019 (P = 0.002), involved elderly and were due to unusual isolates. However, IMD cases due to hyperinvasive isolates decreased during the lockdown. Enhancing IMD surveillance and anti-meningococcal vaccination in elderly should be addressed. Keywords: Infection, Invasive meningococcal disease, Respiratory presentations, SARS-CoV-2, COVID-19, Typing Introduction Neisseria meningitidis (Nm) is a Gram negative bacterium with airborne inter-human transmission. Nm is carried asymptomatically in the nasopharynx with 10% carriers in the general population [1]. However, Nm is also responsible for invasive meningococcal disease (IMD) that is dominated by septicaemia and meningitis [2]. Nm is highly diverse due to frequent DNA transfer between isolates followed by recombination and allelic exchanges [3]. Genetic typing is crucial for epidemiological surveillance and is performed by DNA sequencing using multilocus sequence typing (MLST) and whole genome sequencing (WGS). The isolates are classified into genetic lineages called clonal complexes (CC) and those that are most frequently associated with IMD are referred to as hyperinvasive CC but other diverse CC *Correspondence: [email protected] Invasive Bacterial Infections Unit and the National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France
are more associated with carriage [1]. Risk factors to develop IMD include bacterial virulence factors, host factors such as complement deficiencies and environmental factors such as viral infections where IMD can be associated with respiratory manifestations such as bacteremic pneumonia [2, 4]. The association of viral infections and secondary bacterial infections has been described such as the association between flu and secondary bacterial infections including IMD [5, 6]. During the 1918 pandemic flu, fatality records suggested large impact of secondary bacterial infection [5]. Measures impacting airborne transmitted agents such as social and physical distancing are expected to reduce both flu and Nm transmissions and therefore to reduce the incidence of IMD. Indeed, it has been observed one century ago that bed distanc
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