Impact of COVID-19 social distancing measures on future incidence of invasive pneumococcal disease in England and Wales: a mathematical modelling study

Objectives In January 2020, the UK moved to a 1+1 schedule for the 13-valent pneumococcal conjugate vaccine (PCV13) with a single priming dose at 3-month and a 12-month booster. We modelled the impact on invasive pneumococcal disease (IPD) out to 2030/2031 of reductions in PCV13 coverage and population mixing associated with restrictions on non-essential healthcare visits and social distancing measures introduced in 2020/2021 to reduce SARS-CoV-2 transmission. Design Using an existing model of pneumococcal transmission in England and Wales, we simulated the impact of a 40% reduction in coverage and a 40% reduction in mixing between and within age groups during two lockdowns in spring 2020 and autumn/winter 2020/2021. More and less extreme reductions in coverage and mixing were explored in a sensitivity analysis. Main outcome measures Predicted annual numbers of IPD cases under different coverage and mixing reduction scenarios with uncertainty intervals (UIs) generated from minimum and maximum values of the model predictions using 500 parameter sets. Results The model predicted that any increase in IPD cases resulting from a reduction in PCV13 coverage would be more than offset by a reduction in pneumococcal transmission due to social distancing measures and that overall reductions in IPD cases will persist for a few years after resumption of normal mixing. The net reduction in cumulative IPD cases over the five epidemiological years from July 2019 was predicted to be 13 494 (UI 12 211, 14 676) all ages. Similar results were obtained in the sensitivity analysis. Conclusion COVID-19 lockdowns are predicted to have had a profound effect on pneumococcal transmission resulting in a reduction in pneumococcal carriage prevalence and IPD incidence for up to 5 years after the end of the lockdown period. Carriage studies will be informative in confirming the predicted impact of the lockdown measures after they have been lifted.