Lifting non-pharmaceutical interventions following the COVID-19 pandemic – the quiet before the storm?

Figures & data

Figure 1. Challenges and opportunities of the COVID-19 pandemic.

COVID-19, coronavirus disease 2019; NPIs, non-pharmaceutical interventions; VPD, vaccine-preventable disease.

Figure 2. Drops in burden caused by vaccine-preventable and non-vaccine preventable diseases due to the implementation of NPIs. a) VPDs; b) Non-VPDs; c) Etiology not determined.

GII, gastrointestinal infections, ILI, influenza-like illness; IPD, invasive pneumococcal disease; LRTI, lower respiratory tract infections; NPIs, non-pharmaceutical interventions; Ref, reference; RSV, respiratory syncytial virus; SRI, severe respiratory illness; VPD, vaccine-preventable disease; YOA, years of age; US, United States; URTI, upper respiratory tract infections.

Figure 2. (Continued).

Figure 3. Drops in vaccination during the early phases of the COVID-19 pandemic.

BCG, Bacillus Calmette–Guérin; COVID-19, coronavirus disease; D, diphtheria; HI, Haemophilus influenzae type B; M, measles/mumps; Polio, poliovirus; PT, pertussis; R, rubella; Ref, refence; T, tetanus; Tdap, tetanus-diphtheria-acellular pertussis; TT, tetanus toxoid; US, United States; V, varicella; MenC, group C Neisseria meningitidis.

Table 1. Evolution of different infectious diseases during the COVID-19 pandemic.

Disease (country/region)	Observations during NPIs (2020–2021)	First signals following lifting of NPIs (2021–2022)	Future considerations
VPDs
Influenza (Australia, EU)	54%–100% drop in notifications/hospitalized cases [12,15,20]	Australia: no increase in detections [36] EU: circulation slightly higher than in the 2020/2021 season, but substantially lower than in pre-pandemic influenza seasons [103]	Countries in the Southern hemisphere may experience a more intense 2022 influenza season compared to pre-pandemic seasons, as lifting of restrictions will coincide with the debut of the influenza season
Pertussis (Australia)	87% drop in notifications [15]	No rebound reported [104]	Increased social contact between susceptible age groups and healthy carriers from different age groups may promote transmission
Rotavirus gastroenteritis (Australia)	91% drop in notifications [15]	Rebound to pre-pandemic levels or higher [105,108]	Most cases likely to originate from childcare centers. Impact may be higher in countries where vaccination was disrupted, especially since the time period for catch-up vaccination is very limited.
Invasive meningococcal disease (England)	90% drop in cases [27]	Number of cases still low in infants, toddlers and young children but higher than pre-pandemic levels in adolescents and young adults aged 15–19 years [27,109]	Social contact may have reverted to pre-pandemic levels in adolescents and young adults (college students) first; a similar trend could be seen in younger vulnerable age groups as well, as all restrictions are lifted
Invasive pneumococcal disease (IPD) (England)	lowest number of cases due to strains covered by PCV13 in all age groups [106]	Number of cases similar to pre-pandemic levels in children <5 years of age, but still low in persons aged ≥5 years [106]	Increased social contact between children and the elderly, as well as the resumed circulation of respiratory viruses could eventually lead to an increase in cases in older susceptible individuals
Measles (EU)	86% drop in notifications (Germany) [18]	No rebound reported in the EU [103]; however, 79% more measles cases were reported worldwide in Jan–Feb 2022 vs. the same period in 2021 [82]	High likelihood of outbreaks, especially in countries/communities where measles vaccination has been impacted by the COVID-19 pandemic
Non-VPDs
RSV (Australia, EU, South Africa, US)	Initial drop in cases (34%–99%), followed by out-of-season outbreaks, sometimes of higher intensity than regular seasonal peaks in the pre-pandemic years [12,32,36–39]	Cases reached an all-time record in the fall of 2021 (Germany) [12]	Seasonal patterns of RSV transmission might continue to be affected, negatively impacting the planning of prophylactic palivizumab treatments. Regular seasons could be more intense and affect a broader age range than typical [110]
Norovirus gastroenteritis (UK)	Substantial drop in activity until the second part of 2021 [107]	Activity higher or comparable to pre-pandemic seasons [107]	An important part of the outbreaks originated from educational settings (nurseries and childcare facilities), as opposed to care homes (as in pre-pandemic years). Educational settings will likely continue to play in important role in disease transmission.
Rhino-/Enterovirus infection (Germany)	Almost no cases among children up to August 2020, rebound first observed in children in the last quarter of 2020 [12]	Marked increase in the number of cases between Jun–Oct 2021 [34]	Rebound could be associated with an increase in exacerbations of recurrent viral induced wheeze and asthma in children.

COVID-19, coronavirus disease 2019; EU, European Union; IPD, invasive pneumococcal disease; NPIs, non-pharmaceutical interventions; PCV13, 13-valent pneumococcal conjugate vaccine; RSV, respiratory syncytial virus; US, United States; UK, United Kingdom; VPD, vaccine-preventable disease.

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