The Role of Nonpharmaceutical Interventions on Influenza Circulation During the COVID-19 Pandemic in Nine Tropical Asian Countries

Background: Low global influenza circulation was reported during the coronavirus-19 pandemic. We explored relationships between nonpharmaceutical interventions (NPIs) and influenza in tropical Asian countries.Methods: Using WHO surveillance data from 2015-2019 and the WHO shiny app, we constructed expected seasonal influenza epidemic curves from Mar 2020-Jun 2021 and compared the timing, and average percent positivity with observed data. We used multivariate regression to test associations between ordinal NPI data (from the Oxford Stringency Index) four weeks before the expected 2020/21 epidemics and present adjusted incidence rate ratio (IRR) or relative proportion ratio (RPR) and 95% confidence intervals (CI).Findings: Data from nine countries predicted 18 seasonal epidemics; seven were observed. Five started 6-24 weeks later, and all were 4-21 weeks shorter than expected. Five epidemics had lower maximum peak values (percent positivity), and all but one had lower average percent positivity than expected. All countries implemented NPIs. Each increased level of school closure reduced risk of an epidemic by 43% (IRR=0.57, CI: 0.34, 0.95). Each increased level of cancelling public events reduced the average percent positivity across the season by 44% (RPR=0.56, CI: 0.39, 0.82) and each increased level in restricting internal movements reduced it by 41% (RPR=0.59, CI: 0.36, 0.96). Other NPIs were not associated with changes.Interpretation: Although layered NPIs were difficult to tease apart, school closings, canceling public events, and restricting internal movements before influenza circulation seemed to reduce transmission.Funding Information: This study received no funding.Declaration of Interests: The authors have no conflicts of interest to disclose.