Background Streptococcus pneumoniae coinfection with influenza results in synergistic lethality, but there are limited data on pneumococcal coinfection with SARS-CoV-2. Methods Public Health England conducts invasive pneumococcal disease (IPD) and SARS-CoV-2 surveillance in England. IPD trends during 2000/01-2019/20 were analysed and cases between during February-June 2020 were linked with laboratory-confirmed SARS-CoV-2 infections. Multivariable logistic regression was used to assess risk factors for death. Results IPD incidence in 2019/20 (7.6/100,000; n=3,964) was 30% (IRR 0.70, 95%CI, 0.18-2.67) lower compared to 2018/19 (10.9/100,000; n=5,666) with large reductions observed across all age-groups during March-June 2020. The serotypes responsible for IPD during 2019/20 were similar to previous years. There were 160,886 SARS-CoV-2 and 1,137 IPD cases during February-June 2020, including 40 IPD/COVID-19 (0.025% [95%sCI, 0.018-0.034] of SARS-CoV-2 infections; 3.5% [95%CI, 2.5-4.8] of IPD cases), 21 with COVID-19 diagnosed 3-27 days after IPD and 27 who developed COVID-19 ≥28 days after IPD. Case-fatality rates (CFR) were 63.2% (25/40), 47.6% (10/21) and 33.3% (9/27), respectively (p<0.001). In addition to an independent association with increasing age and pneumococcal serotype group, CFR was 7.8-fold (95% CI, 3.8-15.8) higher in those with IPD/COVID-19 co-infection and 3.9-fold (95% CI, 1.4-10.7) higher in patients who developed COVID-19 3-27 days after IPD compared to patients with IPD only. Conclusions Large declines in IPD were observed following COVID-19 lockdown in England. IPD/COVID-19 confections were rare but associated with high CFR, mainly in older adults. The rarity, age distribution and serotype distribution of IPD/SARS-CoV-2 coinfections does not support wider extension of pneumococcal vaccination.

Introduction The reopening of schools during the COVID-19 pandemic has raised concern for the safety of staff and students, their families and the wider community. We monitored SARS-CoV-2 infection rates in school-aged children and compared them with adult infection rates before and after schools reopened in England. Methods Public Health England receives daily electronic reports of all SARS-CoV-2 tests nationally. SARS-CoV-2 infection rates by school year from July to December 2020 were analysed, including the effect of a national month-long lockdown whilst keeping schools open in November 2020 Results SARS-CoV-2 infections rates were low during early summer but started increasing in mid-August, initially in young adults followed by secondary and then primary school-aged children prior to schools reopening in September 2020. Cases in school-aged children lagged behind and followed adult trends after schools reopened, with a strong age gradient in weekly infection rates. There was a strong (P<0.001) correlation in regional infection rates between adults and secondary (R 2 =0.96-0.98), primary (R 2 =0.93-0.94) and preschool-aged (R 2 =0.62-0.85) children. The November lockdown was associated with declines in adult infection rates, followed a week later, by declines in student cases. From 23 November 2020, cases in adults and children increased rapidly following the emergence of a more transmissible novel variant of concern (VUI-202012/01; VOC B.1.1.7). Conclusions In school-aged children, SARS-CoV-2 infections followed the same trajectory as adult cases and only declined after national lockdown was implemented whilst keeping schools open. Maintaining low community infection rates is critical for keeping schools open during the pandemic.

Objective We aimed to look at the burden of disease caused by SARS-COV-2 reinfections and identified potential risk factors for disease severity. Methods We used national surveillance data to collect information on all SARS-CoV-2 primary infection and suspected reinfection cases between January 2020 until early May 2021. Reinfection cases were positive COVID-19 PCR or antigen test, 90 days after their first COVID-19 positive test. We collected information on case demographics, hospital and ICU admission, immunisation status and if individuals were at risk of complication for COVID-19. Results Deaths reported within 28 days of testing positive were 61% (95% confidence interval: 56% to 65%) lower in suspected COVID-19 reinfection than primary infection cases. In the unvaccinated cohort, reinfections were associated with 49% (37% to 58%) lower odds of hospital admission in cases aged 50 to 65 years in the population not identified at risk of complication for COVID-19, and 34% (17% to 48%) in those at risk. ICU admission at reinfection compared to primary infection decreased 76% (55% to 87%). Individuals at risk and those aged below 50 years, who received at least 1 dose of vaccine against COVID-19, were 62% (39% to 74%) and 58% (24% to 77%) less likely to get admitted to hospital at reinfection, respectively. Conclusion Prior SARS-CoV-2 infection was associated with lower odds of dying, and both prior infection and immunisation showed a protective effect against severe disease in selected populations. Older age, sex and underlying comorbidities appeared as principal risk factors for illness severity at reinfection. Funding PHE/UKHSA

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Background The full reopening of schools in September 2020 was associated with an increase in COVID-19 cases and outbreaks in educational settings across England. Methods Primary and secondary schools reporting an outbreak (≥2 laboratory-confirmed cases within 14 days) to Public Health England (PHE) between 31 August and 18 October 2020 were contacted in November 2020 to complete an online questionnaire. Interpretation There were 969 school outbreaks reported to PHE, comprising 2% ( n = 450) of primary schools and 10% ( n = 519) of secondary schools in England. Of the 369 geographically-representative schools contacted, 179 completed the questionnaire (100 primary schools, 79 secondary schools) and 2,314 cases were reported. Outbreaks were larger and across more year groups in secondary schools than in primary schools. Teaching staff were more likely to be the index case in primary (48/100, 48%) than secondary (25/79, 32%) school outbreaks ( P = 0.027). When an outbreak occurred, attack rates were higher in staff (881/17,362; 5.07; 95%CI, 4.75–5.41) than students, especially primary school teaching staff (378/3852; 9.81%; 95%CI, 8.90–10.82%) compared to secondary school teaching staff (284/7146; 3.97%; 95%CI, 3.79–5.69%). Secondary school students (1105/91,919; 1.20%; 95%CI, 1.13–1.28%) had higher attack rates than primary school students (328/39,027; 0.84%; 95%CI, 0.75–0.94%). Conclusions A higher proportion of secondary schools than primary schools reported a COVID-19 outbreak and experienced larger outbreaks across multiple school year groups. The higher attack rate among teaching staff during an outbreak, especially in primary schools, suggests that additional protective measures may be needed. Funding PHE