1. Marco Aurélio P. Sáfadi.
Santa Casa de São Paulo
Lessons and impact for meningitis in the
COVID-19 era:
Findings from the IRIS initiative, with a focus
on Brazil, and commenting on the situation in
Latin America

2. Disclosure Statement
Marco Aurélio Sáfadi MD, PhD
• Consultant for SAGE from the WHO
• Consultant AdHoc for ANVISA
• Member of the CEPI Scientific Committee.
• Member of the Brazilian NIP Advisory Committee for the Ministry of Health
• Research grants, speaker’s fee and participation in advisory boards from Pfizer, GSK and Sanofi.
• I don't own shares of any of these pharmaceutical companies.
• My prerequisites for participating in these activities are the autonomy of scientific thought, the
independence of opinions and freedom of expression.

3. Significant reductions in invasive bacterial infections
during the COVID-19 pandemic.
• All countries experienced a
significant, sustained reduction in
invasive diseases due to S
pneumoniae, H influenzae and N
meningitidis, but not S agalactiae, in
early 2020, coinciding with the
COVID-19 containment measures.
• There was no evidence of a specific
effect due to enforced school
closures.
Brueggmann et al. Lancet Digit Health 2021; 3: e360–70
Laboratories in 26 countries across six continents submitted data on cases of invasive disease due to
S pneumoniae, H influenzae and N meningitidis from 1 January 2018 to 31 May 2020

4. 2469 2663 2872 3006 2840 2556 2101 1615 1304 1117 1137 1131 1021 357
1.36
1.46 1.5
1.55
1.44
1.28
1.05
0.8
0.64
0.54 0.55 0,55
0.49
0.17
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
0
500
1000
1500
2000
2500
3000
3500
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Cases Incidence rates
Cases/100,000h
Number of cases and Incidence Rates of IMD.
Brazil, 2007-2020
SINAN, MS 2021. http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinannet/cnv/meninbr.def
MenACWY
Vaccination in
adolescents
MCC Vaccination
in infants
COVID-19
pandemic
Cases
Reductions of 66% in incidence rates of IMD in
2020 compared to 2017-2019

5. 5
Serogroup distribution of IMD. Brazil, 2008-2020.
Fonte: SIAPI/CGPNI
21.5
18
14
16 17
19 19
27
23
25
32
39 38
70
75
80
76 75
71 71
61
64 63
55
48 47
6.5 6 5 6 5
7 7
9 10 9 10
8
7
1 1 1 2 3 3 3 2 3 3 3
5
7
0
10
20
30
40
50
60
70
80
90
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
B C W Y
MenACWY
Vaccination in
adolescents
MCC Vaccination
in infants
COVID-19
pandemic
%
%
%
%
%

6. 6
Impact of the COVID-19 on incidende rates of IMD
according to age groups. Brazil.
http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sinannet/cnv/meninbr.def
4.3
1.6
0.75 0.75 0.8
0.46
0.3
0.2
1.4
0.5
0.18 0.09 0.16 0.14 0.09 0.05
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
< 1 y 1-4 y 5-9 y 10-14 y 15-19 y 20-39 y 40-59 y > 60 y
2017-2019 2020
Reductions of incidence rates in 2020 were observed in
all age groups in a similar proportion
Incidence
rates
(cases
/100,000
hab)
< 1 y 1-4 y 5-9 y 10 – 14 y 15 – 19 y 20 -39 y 40 -59 y > 60 y
67% 68% 75% 86% 80% 69% 70% 72%

7. 7
Incidence rates of bacterial meningitis. Sao Paulo,
2008-2021.
https://www.saude.sp.gov.br/cve-centro-de-vigilancia-epidemiologica-prof.-alexandre-vranjac/areas-de-vigilancia/doencas-de-transmissao-respiratoria/agravos/meningites/dados-estatisticos
1.3
1.04
1 1
0.9
0.36
0.04
1
0.9
1 1
0.8
0.15
0.04
0.1 0.11 0.1 0.1 0.1
0.04 0.01
0
0.2
0.4
0.6
0.8
1
1.2
1.4
2015 2016 2017 2018 2019 2020 2021
N meningitidis S pneumoniae Hib
COVID-19
pandemic

8. Coverage rates of vaccines. Brazil 2014-2020
100 96 93 93 94 96 100
73
78 80 77 77 76 79
45
0
10
20
30
40
50
60
70
80
90
100
BCG MenC PCV10 Rotavirus PENTA IPV SCR dTpa
pregnancy
2014 2015 2016 2017 2018 2019 2020
Fonte:http://pni.datasus.gov.br*Dados acessados em15/07/2019.Destaqueemvermelhopara CV<meta (90%BCGe Rotavirus;95%demais vacinas
%

9. IMD cases by serogroup in Chile, 2011-2021
Number
of
IMD
cases
•https://www.ispch.cl/andid/gestion-de-la-informacion/vigilancia-laboratorios-de-agentes-infecciosos/
32 38
46
32
40
31 27 32 32
3 8
22
60
85
102
69
69
48 38
30
2
2
13
19
5 5
11
6
7
6
7
1
2
0
20
40
60
80
100
120
140
160
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Other MenW MenB
ACWY vaccination
(1-5 Years)
• REDUCTION IN IMD
CASES IN 2020 AND 2021.
• SIMILAR SEROGROUP
DISTRIBUTION
Covid-19

10. 10
Informe Ministerio de Salud Pública 2001-2020
Meningococcal Disease in Uruguay. 2001-2020
A 72% reduction was observed in 2020
comparing to the period between 2013-2019
Number of annual confirmed cases of IMD Serogroup distribution of IMD
MenB, the predominant serogroup causing IMD,
was responsible for all identified cases in 2020

11. others/NG*
Y
W
C
B
Year
Number of samples
Serogroup
distribution
Serogroup distribution of IMD cases in Argentina
Adaptado del Informe Regional de SIREVA II, 2000-2015. Washington, DC: Organización Panamericana de la Salud. https://www.paho.org/hq/index.php?option=com_content&view=article&id=5536:2011-sireva-
ii&Itemid=3966&lang=es (acceso Octubre 2019); . Adaptado de Antimicrobianos. SIREVA-Argentina. Informe Argentina 2016-2019. SIREVA II. Servicio Antimicrobianos. Dpto. Bacteriología, Instituto Nacional de
Enfermedades Infecciosas (INEI) - ANLIS “Dr. Carlos G. Malbrán. http://antimicrobianos.com.ar/category/resistencia/sireva/ (acceso Enero 2021).
Only 17 isolates of N
meningitidis in 2020,
against an average of
76 [63-149] in the
period between 2014-
2019.
No changes in the
serogroup distribution.

12. Measles case distribution by month and WHO Region (2017-2021*)
Based on data received 2021-03 - Data Source: IVB Database.
Reported annual cases
in 2019 were the
highest number since
1996:
2017: 173,457
2018: 360,296
2019: 872,872
2020: 87,992
COVID-19
pandemic
In 2020, the notification of suspected measles and rubella cases in the Americas
region decreased in 73% in comparison with 2019. The low notification trend
continues, with a median of 132 cases for the first semester of 2021.
*Data as of epidemiological week26,2021 (endingon3 July2021). Source:SurveillancecountryreportssenttoPAHO.
2017 2018 2019 2020 2021

13. Changes in Influenza and Other Respiratory Virus Activity During
the COVID-19 Pandemic — United States, 2020–2021
MMWR / July 23, 2021 / Vol. 70 / No. 29/
Number of specimens tested and the percentage of positive tests for influenza, RSV, common human
coronaviruses, parainfluenza viruses, HMP, respiratory adenoviruses, and rhinoviruses/enteroviruses

14. Hospitalizations and deaths from Severe Acute Respiratory
Syndrome. Brazil, 2020 to 2021, until SE 37
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15. • A dramatic reduction in incidence rates of invasive diseases caused
by pathogens of respiratory transmission
• Despite a unique opportunity to further control of IMD, Vaccination
coverage rates are dramatically decreased representing a potential
risk not only of a rebound in the IMD rates, but also of resurgence of
diseases that were reduced, controlled, or even eliminated in the
region.
• IMD was not eliminated from these regions, highlighting the need of
maintaining surveillance system to inform health authorities on the
current burden of these invasive diseases, including data on carriage
rates.
Key Learnings

16. Obrigado!
Thank You!