Impact of COVID-19 pandemic may exacerbate antibiotic resistance, says new report

In a new report published in the Journal of Infection, the Global Meningococcal Initiative (GMI) – an international group of expert scientists, doctors and public health officials - has reported that in addition to the COVID-19 pandemic disrupting the surveillance, diagnosis and prevention of invasive meningococcal disease (IMD), the effects of the pandemic may even exacerbate antibiotic resistance; which is a particular cause for concern given the increasing prevalence of antibiotic resistant meningococcal strains. 

The COVID-19 pandemic has brought significant changes to society, from efforts to control the spread of the virus including masks, social distancing, and quarantine, to the re-structuring of healthcare systems.  Despite such challenges, IMD cases appeared to decline throughout 2020 in multiple countries, likely due to strict infection control and lockdown measures minimising close contacts and limiting social gatherings that would normally facilitate transmission of meningococcal bacteria. However, the reduction in childhood vaccination may lead to future resurgence of bacterial diseases. 

Disruption due to the COVID-19 pandemic of vaccination implementation and uptake has been widely publicised, with many countries temporarily stopping programmes in the early stages of the pandemic to minimise the risk of COVID-19 transmission. Uptake was also reduced due to containment measures or parental fear of exposure to COVID-19.  A recent online survey revealed that around 50% of parents delayed or cancelled a scheduled meningococcal vaccination appointment for their child during the pandemic – citing lockdown regulations and concerns surrounding COVID-19 as the main reasons for the disruption.  

The report highlights more recent concerns about increasing antibiotic resistance as a result of the pandemic potentially compromising future successful treatment of meningococcal disease. Some strains of meningococcal bacteria have already been shown to be resistant to two types of antibiotics. In the United States, this has led to the recommendation for health professionals to find out whether meningococcal infections are susceptible to antibiotics in order to ensure effective treatment of cases of meningitis and septicaemia. 

Professor Ray Borrow, Chair of the GMI said: “Each year, antibiotic-resistant diseases are responsible for at least 700,000 deaths globally; a figure that is set to increase. A sustained effort is required to contain this global public health crisis. However, the COVID-19 pandemic is an unprecedented global challenge that has understandably dominated healthcare systems and economies over the past two years.” 

“COVID-19 may have additional impact on existing public health threats. The pandemic may be exacerbating antibiotic resistance, which is alarming in the case of meningitis, given growing concerns about the increased prevalence of antibiotic-resistant meningococcal strains, particularly in the Asia-Pacific Region.” 

The report explains that broad-spectrum antibiotics are frequently and pre-emptively prescribed for patients with COVID-19 to limit bacterial co-infection or secondary infection. However, such practices may lead to antibiotic overuse and promote resistance. The experts highlight the importance of tracking the impact of antibiotic resistance on treatments for life-threatening diseases, including IMD. 

Linda Glennie, Director of Research, Evidence and Policy said: “Antibiotic resistant strains of meningococcal bacteria could present an increasing threat to the treatment of meningitis. This makes the prevention of meningococcal disease ever important. It is therefore encouraging to see that despite the significant challenges brought about by the COVID-19 pandemic, progress in the development of new vaccines has continued; with vaccines against meningococcal ABCWY and ACWYX now in late stage clinical trials.”