Impact of non-pharmaceutical interventions on the incidence of respiratory infections during the COVID-19 outbreak in Korea: a nationwide surveillance study

Clin Infect Dis. 2020 Nov 5;ciaa1682. doi: 10.1093/cid/ciaa1682. Online ahead of print.


Background: Many countries have implemented non-pharmaceutical interventions (NPIs) to slow the spread of coronavirus disease 2019 (COVID-19). We aimed to determine whether NPIs led to the decline in the incidences of respiratory infections.

Methods: We conducted a retrospective, ecological study using a nationwide notifiable diseases database and a respiratory virus sample surveillance collected from January 2016 through July 2020 in the Republic of Korea. Intervention period was defined as February-July 2020, when the government implemented NPIs nationwide. Observed incidences in the intervention period were compared to the predicted incidences by autoregressive integrated moving average model and the 4-year mean cumulative incidences (CuIs) in the same months of the pre-intervention period.

Results: Five infectious diseases met the inclusion criteria: chickenpox, mumps, invasive pneumococcal disease, scarlet fever, and pertussis. The incidences of chickenpox and mumps during the intervention period were significantly lower than the prediction model. The CuIs of chickenpox and mumps were 36.4% (95% CI, 23.9-76.3) and 63.4% (95% CI, 48.0-93.3) of the predicted values. Subgroup analysis showed that the decrease in the incidence was universal for chickenpox, while mumps showed a marginal reduction among those aged <18 years, but not in adults. The incidence of respiratory viruses was significantly lower than both the predicted incidence (19.5%; 95% CI, 11.8-55.4%) and the 4-year mean CuIs in the pre-intervention period (24.5%; P<0.001).

Conclusions: The implementation of NPIs was associated with a significant reduction in the incidences of several respiratory infections in Korea.

Keywords: COVID-19; South Korea; non-pharmaceutical intervention; respiratory infection; social distancing.