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The Increase in Invasive Bacterial Infections With Respiratory Transmission in Germany, 2022/2023
Regina Singer1, Muna Abu Sin, Tobias Tenenbaum
1Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin; Postgraduate Training in Applied Epidemiology, Robert Koch Institute, Berlin; European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; Department of Pediatrics, Sana Hospital Lichtenberg, Academic Teaching Hospital of the Charité, Berlin; Department of Pediatrics, Carl Gustav Carus University Hospital and Faculty of Medicine, Technical University of Dresden; Institute for Medical Microbiology, University Hospital, RWTH Aachen University, Aachen; National Reference Center for Meningococci and H. influenzae, Institute for Hygiene and Microbiology, University of Würzburg.
Background:
In late 2022, health care institutions in Germany reported an unusual number of severe, invasive bacterial infections in association with a high incidence of viral respiratory infections.
Methods:
We analyzed routine data on invasive infections due to Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes (2017-2023) from a voluntary, laboratory-based surveillance system involving continuously participating facilities providing diagnostic routine data that cover approximately one-third of the German population.
Results:
In the first quarter (Q1) of 2023, the number of invasive S. pyogenes isolates rose by 142% (n = 837 vs. mean Q1/2017-2019 = 346, 95% CI [258; 434]), while the number of H. influenzae isolates rose by 90% (n = 209 in Q1/2023 vs. mean Q1/2017-2019 = 110, 95% CI [79; 142]), compared to pre-pandemic seasonal peak values. The number of invasive S. pneumoniae isolates was high in two quarters (n = 1732 in Q4/2022 und Q1/2023). Adults aged 55 and older and children younger than 5 years were most affected by invasive H. influenzae, S. pneumoniae, and S. pyogenes infections. N. meningitidis was most commonly found in children under age 5.
Conclusion:
The reason for the marked rise in invasive bacterial infections may be an increased circulation of respiratory pathogens and elevated susceptibility in the population after relaxation of the measures taken to prevent COVID-19 infection. Coinfections with respiratory viruses may have reinforced this effect. We recommend continuous surveillance, preventive measures such as raising awareness about invasive bacterial diseases, and vaccination as recommended by the German Standing Committee on Vaccinations (STIKO).
Insights
Severe bacterial infections, including Streptococcus pyogenes and Haemophilus influenzae, surged in Germany following COVID-19 measure relaxations. Increased pathogen circulation and population susceptibility likely contributed to this rise.
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- Germany observed a notable increase in severe bacterial infections in late 2022.
- This rise coincided with a high incidence of viral respiratory infections.
Purpose of the Study:
- To analyze trends in invasive bacterial infections in Germany from 2017 to 2023.
- To identify specific bacterial pathogens and demographic groups affected.
Main Methods:
- Utilized routine diagnostic data from a voluntary, laboratory-based surveillance system.
- Data covered invasive infections by Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes.
- Analysis spanned from 2017 to 2023, encompassing approximately one-third of the German population.
Main Results:
- Invasive Streptococcus pyogenes cases increased by 142% and Haemophilus influenzae by 90% in Q1 2023 compared to pre-pandemic levels.
- Streptococcus pneumoniae infections were also elevated in late 2022 and early 2023.
- Invasive infections predominantly affected adults over 55 and children under 5, with Neisseria meningitidis primarily seen in the youngest age group.
Conclusions:
- The rise in bacterial infections is potentially linked to increased respiratory pathogen circulation and heightened population susceptibility post-COVID-19 restrictions.
- Coinfections with respiratory viruses may have exacerbated the situation.
- Continuous surveillance, public awareness campaigns, and adherence to vaccination recommendations are advised.
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