Impact of the COVID-19 pandemic and associated non-pharmaceutical interventions on other notifiable infectious diseases in Germany: An analysis of national surveillance data during week 1-2016 - week 32-2020

Alexander Ullrich; Madlen Schranz; Ute Rexroth; Osamah Hamouda; Lars Schaade; Michaela Diercke; T Sonia Boender; Robert Koch's Infectious Disease Surveillance Group

doi:10.1016/j.lanepe.2021.100103

Impact of the COVID-19 pandemic and associated non-pharmaceutical interventions on other notifiable infectious diseases in Germany: An analysis of national surveillance data during week 1-2016 - week 32-2020

Lancet Reg Health Eur. 2021 Jun 19:6:100103. doi: 10.1016/j.lanepe.2021.100103. eCollection 2021 Jul.

Authors

Alexander Ullrich¹, Madlen Schranz¹, Ute Rexroth¹, Osamah Hamouda¹, Lars Schaade², Michaela Diercke¹, T Sonia Boender¹; Robert Koch's Infectious Disease Surveillance Group

Affiliations

¹ Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany.
² Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Nordufer 20, 13353 Berlin, Germany.

Abstract

Background: The COVID-19 pandemic and associated non-pharmaceutical interventions (NPIs) affect healthcare seeking behaviour, access to healthcare, test strategies, disease notification and workload at public health authorities, but may also lead to a true change in transmission dynamics. We aimed to assess the impact of the pandemic and NPIs on other notifiable infectious diseases under surveillance in Germany.

Methods: We included 32 nationally notifiable disease categories with case numbers >100/year in 2016-2019. We used quasi-Poisson regression analysis on a weekly aggregated time-series incorporating trend and seasonality, to compute the relative change in case numbers during week 2020-10 to 2020-32 (pandemic/NPIs), in comparison to week 2016-01 to 2020-09.

Findings: During week 2020-10 to 2020-32, 216,825 COVID-19 cases, and 162,942 (-35%) cases of other diseases, were notified. Case numbers decreased across all ages and notification categories (all p<0•05), except for tick-borne encephalitis, which increased (+58%). The number of cases decreased most for respiratory diseases (from -86% for measles, to -12% for tuberculosis), gastro-intestinal diseases (from -83% for rotavirus gastroenteritis, to -7% for yersiniosis) and imported vector-borne diseases (-75% dengue fever, -73% malaria). The less affected infections were healthcare associated pathogens (from -43% infection/colonisation with carbapenem-non-susceptible Acinetobacter, to -28% for Methicillin-resistant Staphylococcus aureus invasive infection) and sexually transmitted and blood-borne diseases (from -28% for hepatitis B, to -12% for syphilis).

Interpretation: During the COVID-19 pandemic a drastic decrease of notifications for most infectious diseases and pathogens was observed. Our findings suggest effects of NPIs on overall disease transmission that require further investigation.

Funding: The Robert Koch Institute is the National Public Health Institute of Germany, and is an institute within the portfolio of the Federal Ministry of Health.

Keywords: COVID-19; Cohort studies; Disease transmission, infectious; Epidemiology; General Practitioners; Pandemics; Public health surveillance.