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Showing 1 - 200 of 396 Journals sorted alphabetically
ACS Symposium Series     Full-text available via subscription   (SJR: 0.189, CiteScore: 0)
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 5, SJR: 0.79, CiteScore: 2)
Adaptation     Hybrid Journal   (Followers: 8, SJR: 0.143, CiteScore: 0)
Advances in Nutrition     Hybrid Journal   (Followers: 44, SJR: 2.196, CiteScore: 5)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.434, CiteScore: 1)
African Affairs     Hybrid Journal   (Followers: 63, SJR: 1.869, CiteScore: 2)
Age and Ageing     Hybrid Journal   (Followers: 88, SJR: 1.989, CiteScore: 4)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 18, SJR: 1.376, CiteScore: 3)
American Entomologist     Full-text available via subscription   (Followers: 6)
American Historical Review     Hybrid Journal   (Followers: 148, SJR: 0.467, CiteScore: 1)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 40, SJR: 2.113, CiteScore: 3)
American J. of Clinical Nutrition     Hybrid Journal   (Followers: 144, SJR: 3.438, CiteScore: 6)
American J. of Epidemiology     Hybrid Journal   (Followers: 166, SJR: 2.713, CiteScore: 3)
American J. of Hypertension     Hybrid Journal   (Followers: 25, SJR: 1.322, CiteScore: 3)
American J. of Jurisprudence     Hybrid Journal   (Followers: 18, SJR: 0.281, CiteScore: 1)
American J. of Legal History     Full-text available via subscription   (Followers: 8, SJR: 0.116, CiteScore: 0)
American Law and Economics Review     Hybrid Journal   (Followers: 27, SJR: 1.053, CiteScore: 1)
American Literary History     Hybrid Journal   (Followers: 15, SJR: 0.391, CiteScore: 0)
Analysis     Hybrid Journal   (Followers: 21, SJR: 1.038, CiteScore: 1)
Animal Frontiers     Hybrid Journal  
Annals of Behavioral Medicine     Hybrid Journal   (Followers: 14, SJR: 1.423, CiteScore: 3)
Annals of Botany     Hybrid Journal   (Followers: 35, SJR: 1.721, CiteScore: 4)
Annals of Oncology     Hybrid Journal   (Followers: 42, SJR: 5.599, CiteScore: 9)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 9, SJR: 0.722, CiteScore: 1)
Annals of Work Exposures and Health     Hybrid Journal   (Followers: 33, SJR: 0.728, CiteScore: 2)
AoB Plants     Open Access   (Followers: 4, SJR: 1.28, CiteScore: 3)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 17, SJR: 0.858, CiteScore: 2)
Applied Linguistics     Hybrid Journal   (Followers: 56, SJR: 2.987, CiteScore: 3)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 1.241, CiteScore: 1)
Arbitration Intl.     Full-text available via subscription   (Followers: 20)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 14)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 30, SJR: 0.731, CiteScore: 2)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 3)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 42, SJR: 0.146, CiteScore: 0)
Behavioral Ecology     Hybrid Journal   (Followers: 52, SJR: 1.871, CiteScore: 3)
Bioinformatics     Hybrid Journal   (Followers: 294, SJR: 6.14, CiteScore: 8)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 10, SJR: 1.446, CiteScore: 3)
Biometrika     Hybrid Journal   (Followers: 20, SJR: 3.485, CiteScore: 2)
BioScience     Hybrid Journal   (Followers: 30, SJR: 2.754, CiteScore: 4)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.146, CiteScore: 0)
Biostatistics     Hybrid Journal   (Followers: 17, SJR: 1.553, CiteScore: 2)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 163, SJR: 2.115, CiteScore: 3)
BJA Education     Hybrid Journal   (Followers: 64)
Brain     Hybrid Journal   (Followers: 68, SJR: 5.858, CiteScore: 7)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 47, SJR: 2.505, CiteScore: 5)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 3, SJR: 2.15, CiteScore: 3)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 35, SJR: 2.161, CiteScore: 2)
British J. of Aesthetics     Hybrid Journal   (Followers: 26, SJR: 0.508, CiteScore: 1)
British J. of Criminology     Hybrid Journal   (Followers: 578, SJR: 1.828, CiteScore: 3)
British J. of Social Work     Hybrid Journal   (Followers: 87, SJR: 1.019, CiteScore: 2)
British Medical Bulletin     Hybrid Journal   (Followers: 7, SJR: 1.355, CiteScore: 3)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 31)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 4, SJR: 1.376, CiteScore: 1)
Cambridge J. of Economics     Hybrid Journal   (Followers: 61, SJR: 0.764, CiteScore: 2)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 10, SJR: 2.438, CiteScore: 4)
Cambridge Quarterly     Hybrid Journal   (Followers: 9, SJR: 0.104, CiteScore: 0)
Capital Markets Law J.     Hybrid Journal   (Followers: 2, SJR: 0.222, CiteScore: 0)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.135, CiteScore: 5)
Cardiovascular Research     Hybrid Journal   (Followers: 14, SJR: 3.002, CiteScore: 5)
Cerebral Cortex     Hybrid Journal   (Followers: 45, SJR: 3.892, CiteScore: 6)
CESifo Economic Studies     Hybrid Journal   (Followers: 17, SJR: 0.483, CiteScore: 1)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.42, CiteScore: 3)
Children and Schools     Hybrid Journal   (Followers: 5, SJR: 0.246, CiteScore: 0)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 4, SJR: 0.412, CiteScore: 0)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 22, SJR: 0.329, CiteScore: 0)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 9, SJR: 1.392, CiteScore: 2)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 10, SJR: 0.183, CiteScore: 0)
Classical Receptions J.     Hybrid Journal   (Followers: 25, SJR: 0.123, CiteScore: 0)
Clean Energy     Open Access   (Followers: 1)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 64, SJR: 5.051, CiteScore: 5)
Clinical Kidney J.     Open Access   (Followers: 3, SJR: 1.163, CiteScore: 2)
Communication Theory     Hybrid Journal   (Followers: 21, SJR: 2.424, CiteScore: 3)
Communication, Culture & Critique     Hybrid Journal   (Followers: 26, SJR: 0.222, CiteScore: 1)
Community Development J.     Hybrid Journal   (Followers: 27, SJR: 0.268, CiteScore: 1)
Computer J.     Hybrid Journal   (Followers: 9, SJR: 0.319, CiteScore: 1)
Conservation Physiology     Open Access   (Followers: 2, SJR: 1.818, CiteScore: 3)
Contemporary Women's Writing     Hybrid Journal   (Followers: 9, SJR: 0.121, CiteScore: 0)
Contributions to Political Economy     Hybrid Journal   (Followers: 5, SJR: 0.906, CiteScore: 1)
Critical Values     Full-text available via subscription  
Current Developments in Nutrition     Open Access  
Current Legal Problems     Hybrid Journal   (Followers: 27)
Current Zoology     Full-text available via subscription   (Followers: 2, SJR: 1.164, CiteScore: 2)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 8, SJR: 1.791, CiteScore: 3)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 13, SJR: 0.259, CiteScore: 1)
Diplomatic History     Hybrid Journal   (Followers: 20, SJR: 0.45, CiteScore: 1)
DNA Research     Open Access   (Followers: 5, SJR: 2.866, CiteScore: 6)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 3)
Early Music     Hybrid Journal   (Followers: 15, SJR: 0.139, CiteScore: 0)
Economic Policy     Hybrid Journal   (Followers: 39, SJR: 3.584, CiteScore: 3)
ELT J.     Hybrid Journal   (Followers: 24, SJR: 0.942, CiteScore: 1)
English Historical Review     Hybrid Journal   (Followers: 51, SJR: 0.612, CiteScore: 1)
English: J. of the English Association     Hybrid Journal   (Followers: 14, SJR: 0.1, CiteScore: 0)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.818, CiteScore: 2)
Environmental Epigenetics     Open Access   (Followers: 3)
Environmental History     Hybrid Journal   (Followers: 27, SJR: 0.408, CiteScore: 1)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.748, CiteScore: 4)
Epidemiologic Reviews     Hybrid Journal   (Followers: 9, SJR: 4.505, CiteScore: 8)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 16, SJR: 0.113, CiteScore: 0)
European Heart J.     Hybrid Journal   (Followers: 57, SJR: 9.315, CiteScore: 9)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 9, SJR: 3.625, CiteScore: 3)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 1)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. : Case Reports     Open Access  
European Heart J. Supplements     Hybrid Journal   (Followers: 8, SJR: 0.223, CiteScore: 0)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9, SJR: 1.681, CiteScore: 2)
European J. of Intl. Law     Hybrid Journal   (Followers: 180, SJR: 0.694, CiteScore: 1)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.279, CiteScore: 2)
European J. of Public Health     Hybrid Journal   (Followers: 20, SJR: 1.36, CiteScore: 2)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 10, SJR: 1.172, CiteScore: 2)
European Review of Economic History     Hybrid Journal   (Followers: 28, SJR: 0.702, CiteScore: 1)
European Sociological Review     Hybrid Journal   (Followers: 40, SJR: 2.728, CiteScore: 3)
Evolution, Medicine, and Public Health     Open Access   (Followers: 10)
Family Practice     Hybrid Journal   (Followers: 14, SJR: 1.018, CiteScore: 2)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 11, SJR: 1.492, CiteScore: 4)
Fems Microbiology Letters     Hybrid Journal   (Followers: 23, SJR: 0.79, CiteScore: 2)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 29, SJR: 7.063, CiteScore: 13)
Fems Yeast Research     Hybrid Journal   (Followers: 14, SJR: 1.308, CiteScore: 3)
Food Quality and Safety     Open Access   (Followers: 1)
Foreign Policy Analysis     Hybrid Journal   (Followers: 23, SJR: 1.425, CiteScore: 1)
Forest Science     Hybrid Journal   (Followers: 7, SJR: 0.89, CiteScore: 2)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 1.133, CiteScore: 3)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.104, CiteScore: 0)
French History     Hybrid Journal   (Followers: 32, SJR: 0.118, CiteScore: 0)
French Studies     Hybrid Journal   (Followers: 20, SJR: 0.148, CiteScore: 0)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.152, CiteScore: 0)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 12, SJR: 2.578, CiteScore: 4)
Geophysical J. Intl.     Hybrid Journal   (Followers: 35, SJR: 1.506, CiteScore: 3)
German History     Hybrid Journal   (Followers: 22, SJR: 0.161, CiteScore: 0)
GigaScience     Open Access   (Followers: 3, SJR: 5.022, CiteScore: 7)
Global Summitry     Hybrid Journal   (Followers: 1)
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.493, CiteScore: 3)
Health and Social Work     Hybrid Journal   (Followers: 56, SJR: 0.388, CiteScore: 1)
Health Education Research     Hybrid Journal   (Followers: 14, SJR: 0.854, CiteScore: 2)
Health Policy and Planning     Hybrid Journal   (Followers: 24, SJR: 1.512, CiteScore: 2)
Health Promotion Intl.     Hybrid Journal   (Followers: 22, SJR: 0.812, CiteScore: 2)
History Workshop J.     Hybrid Journal   (Followers: 29, SJR: 1.278, CiteScore: 1)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 26, SJR: 0.105, CiteScore: 0)
Human Communication Research     Hybrid Journal   (Followers: 13, SJR: 2.146, CiteScore: 3)
Human Molecular Genetics     Hybrid Journal   (Followers: 8, SJR: 3.555, CiteScore: 5)
Human Reproduction     Hybrid Journal   (Followers: 71, SJR: 2.643, CiteScore: 5)
Human Reproduction Open     Open Access  
Human Reproduction Update     Hybrid Journal   (Followers: 20, SJR: 5.317, CiteScore: 10)
Human Rights Law Review     Hybrid Journal   (Followers: 60, SJR: 0.756, CiteScore: 1)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 50, SJR: 1.591, CiteScore: 3)
ICSID Review     Hybrid Journal   (Followers: 10)
ILAR J.     Hybrid Journal   (Followers: 2, SJR: 1.732, CiteScore: 4)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.679, CiteScore: 1)
IMA J. of Management Mathematics     Hybrid Journal   (SJR: 0.538, CiteScore: 1)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.496, CiteScore: 1)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 1.987, CiteScore: 2)
Industrial and Corporate Change     Hybrid Journal   (Followers: 10, SJR: 1.792, CiteScore: 2)
Industrial Law J.     Hybrid Journal   (Followers: 35, SJR: 0.249, CiteScore: 1)
Inflammatory Bowel Diseases     Hybrid Journal   (Followers: 43, SJR: 2.511, CiteScore: 4)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 7, SJR: 1.319, CiteScore: 2)
Interacting with Computers     Hybrid Journal   (Followers: 11, SJR: 0.292, CiteScore: 1)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7, SJR: 0.762, CiteScore: 1)
Intl. Affairs     Hybrid Journal   (Followers: 58, SJR: 1.505, CiteScore: 3)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 31)
Intl. Health     Hybrid Journal   (Followers: 5, SJR: 0.851, CiteScore: 2)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 2.167, CiteScore: 4)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 34, SJR: 1.348, CiteScore: 2)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 63, SJR: 0.601, CiteScore: 1)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 212, SJR: 3.969, CiteScore: 5)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 5, SJR: 0.202, CiteScore: 1)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 31, SJR: 0.223, CiteScore: 1)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 10, SJR: 0.285, CiteScore: 1)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.403, CiteScore: 1)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.808, CiteScore: 4)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 9, SJR: 1.545, CiteScore: 1)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 35, SJR: 0.389, CiteScore: 1)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 12, SJR: 0.724, CiteScore: 2)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.168, CiteScore: 1)
Intl. Political Sociology     Hybrid Journal   (Followers: 36, SJR: 1.465, CiteScore: 3)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 23, SJR: 0.401, CiteScore: 1)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 9, SJR: 0.983, CiteScore: 1)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 44, SJR: 2.581, CiteScore: 2)
Intl. Studies Review     Hybrid Journal   (Followers: 21, SJR: 1.201, CiteScore: 1)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 1, SJR: 0.15, CiteScore: 0)
ITNOW     Hybrid Journal   (Followers: 1, SJR: 0.103, CiteScore: 0)
J. of African Economies     Hybrid Journal   (Followers: 15, SJR: 0.533, CiteScore: 1)
J. of American History     Hybrid Journal   (Followers: 45, SJR: 0.297, CiteScore: 1)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 14, SJR: 1.065, CiteScore: 2)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 15, SJR: 2.419, CiteScore: 4)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 4, SJR: 0.585, CiteScore: 1)
J. of Biochemistry     Hybrid Journal   (Followers: 42, SJR: 1.226, CiteScore: 2)
J. of Burn Care & Research     Hybrid Journal   (Followers: 9, SJR: 0.768, CiteScore: 2)
J. of Chromatographic Science     Hybrid Journal   (Followers: 18, SJR: 0.36, CiteScore: 1)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.139, CiteScore: 0)
J. of Communication     Hybrid Journal   (Followers: 50, SJR: 4.411, CiteScore: 5)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 35, SJR: 0.33, CiteScore: 0)
J. of Complex Networks     Hybrid Journal   (Followers: 2, SJR: 1.05, CiteScore: 4)
J. of Computer-Mediated Communication     Open Access   (Followers: 26, SJR: 2.961, CiteScore: 6)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 12, SJR: 0.402, CiteScore: 0)
J. of Consumer Research     Full-text available via subscription   (Followers: 41, SJR: 5.856, CiteScore: 5)

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Journal Cover
Clinical Infectious Diseases
Journal Prestige (SJR): 5.051
Citation Impact (citeScore): 5
Number of Followers: 64  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1058-4838 - ISSN (Online) 1537-6591
Published by Oxford University Press Homepage  [396 journals]
  • In the Literature
    • PubDate: Wed, 18 Jul 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy520
      Issue No: Vol. 67, No. 3 (2018)
  • News
    • PubDate: Wed, 18 Jul 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy450
      Issue No: Vol. 67, No. 3 (2018)
  • Why Funding for Neglected Tropical Diseases Should Be a Global Priority
    • Authors: Reed S; McKerrow J.
      Pages: 323 - 326
      Abstract: Neglected tropical diseases affect >1 billion of the world’s poorest persons. Control programs range from near-elimination (dracunculiasis) to increasing prevalence (dengue and cutaneous leishmaniasis). These are some of the most cost-effective public health interventions and should be a global priority.
      PubDate: Tue, 24 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy349
      Issue No: Vol. 67, No. 3 (2018)
  • Poor Immunogenicity, Not Vaccine Strain Egg Adaptation, May Explain the
           Low H3N2 Influenza Vaccine Effectiveness in 2012–2013
    • Authors: Cobey S; Gouma S, Parkhouse K, et al.
      Pages: 327 - 333
      Abstract: BackgroundInfluenza vaccination aims to prevent infection by influenza virus and reduce associated morbidity and mortality; however, vaccine effectiveness (VE) can be modest, especially for subtype A(H3N2). Low VE has been attributed to mismatches between the vaccine and circulating influenza strains and to the vaccine’s elicitation of protective immunity in only a subset of the population. The low H3N2 VE in the 2012–2013 season was attributed to egg-adaptive mutations that created antigenic mismatch between the actual vaccine strain (IVR-165) and both the intended vaccine strain (A/Victoria/361/2011) and the predominant circulating strains (clades 3C.2 and 3C.3).MethodsWe investigated the basis of low VE in 2012–2013 by determining whether vaccinated and unvaccinated individuals were infected by different viral strains and by assessing the serologic responses to IVR-165, A/Victoria/361/2011, and 3C.2 and 3C.3 strains in an adult cohort before and after vaccination.ResultsWe found no significant genetic differences between the strains that infected vaccinated and unvaccinated individuals. Vaccination increased titers to A/Victoria/361/2011 and 3C.2 and 3C.3 representative strains as much as to IVR-165. These results are consistent with the hypothesis that vaccination boosted cross-reactive immune responses instead of specific responses against unique vaccine epitopes. Only approximately one-third of the cohort achieved a ≥4-fold increase in titer.ConclusionsIn contrast to analyses based on ferret studies, low H3N2 VE in 2012–2013 in adults does not appear to be due to egg adaptation of the vaccine strain. Instead, low VE might have been caused by low vaccine immunogenicity in a subset of the population.
      PubDate: Tue, 20 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy097
      Issue No: Vol. 67, No. 3 (2018)
  • Impact of Timing of Influenza Vaccination in Pregnancy on Transplacental
           Antibody Transfer, Influenza Incidence, and Birth Outcomes: A Randomized
           Trial in Rural Nepal
    • Authors: Katz J; Englund J, Steinhoff M, et al.
      Pages: 334 - 340
      Abstract: BackgroundMaternal influenza vaccination protects mothers and their infants in low resource settings, but little is known about whether the protection varies by gestational age at vaccination.MethodsWomen of childbearing age in rural southern Nepal were surveilled for pregnancy, consented and randomized to receive maternal influenza vaccination or placebo, with randomization stratified on gestational age (17–25 or 26–34 weeks). Enrollment occurred in 2 annual cohorts, and vaccinations occurred from April 2011 through September 2013.ResultsIn sum, 3693 women consented and enrolled, resulting in 3646 live births. Although cord blood antibody titers and the rise in maternal titers were generally greater when women were vaccinated later in pregnancy, this was not statistically significant. The incidence risk ratio (IRR) for maternal influenza in pregnancy through 6 months postpartum was 0.62 (95% confidence interval [CI]: 0.35, 1.10) for those vaccinated 17–25 weeks gestation and 0.89 (95% CI: 0.39, 2.00) for those 26–34 weeks. Infant influenza IRRs were 0.73 (95% CI: 0.51, 1.05) for those whose mothers were vaccinated earlier in gestation, and 0.63 (95% CI: 0.37, 1.08) for those later. Relative risks (RR) for low birthweight were 0.83 (95% CI: 0.71, 0.98) and 0.90 (95% CI: 0.72, 1.12) for 17–25 and 26–34 weeks gestation at vaccination, respectively. IRRs did not differ for small-for-gestational age or preterm. No RRs were statistically different by timing of vaccine receipt.ConclusionsVaccine efficacy did not vary by gestational age at vaccination, making maternal influenza immunization programs easier to implement where women present for care late in pregnancy.Clinical Trials RegistrationNCT01034254
      PubDate: Wed, 14 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy090
      Issue No: Vol. 67, No. 3 (2018)
  • Using Clinical Research Networks to Assess Severity of an Emerging
           Influenza Pandemic
    • Authors: Simonsen L; Higgs E, Taylor R, et al.
      Pages: 341 - 349
      Abstract: BackgroundEarly clinical severity assessments during the 2009 influenza A H1N1 pandemic (pH1N1) overestimated clinical severity due to selection bias and other factors. We retrospectively investigated how to use data from the International Network for Strategic Initiatives in Global HIV Trials, a global clinical influenza research network, to make more accurate case fatality ratio (CFR) estimates early in a future pandemic, an essential part of pandemic response.MethodsWe estimated the CFR of medically attended influenza (CFRMA) as the product of probability of hospitalization given confirmed outpatient influenza and the probability of death given hospitalization with confirmed influenza for the pandemic (2009–2011) and post-pandemic (2012–2015) periods. We used literature survey results on health-seeking behavior to convert that estimate to CFR among all infected persons (CFRAR).ResultsDuring the pandemic period, 5.0% (3.1%–6.9%) of 561 pH1N1-positive outpatients were hospitalized. Of 282 pH1N1-positive inpatients, 8.5% (5.7%–12.6%) died. CFRMA for pH1N1 was 0.4% (0.2%–0.6%) in the pandemic period 2009–2011 but declined 5-fold in young adults during the post-pandemic period compared to the level of seasonal influenza in the post-pandemic period 2012–2015. CFR for influenza-negative patients did not change over time. We estimated the 2009 pandemic CFRAR to be 0.025%, 16-fold lower than CFRMA.ConclusionsData from a clinical research network yielded accurate pandemic severity estimates, including increased severity among younger people. Going forward, clinical research networks with a global presence and standardized protocols would substantially aid rapid assessment of clinical severity.Clinical Trials RegistrationNCT01056354 and NCT010561.
      PubDate: Tue, 08 May 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy088
      Issue No: Vol. 67, No. 3 (2018)
  • Age-Related Clinical Spectrum of Plasmodium knowlesi Malaria and
           Predictors of Severity
    • Authors: Grigg M; William T, Barber B, et al.
      Pages: 350 - 359
      Abstract: BackgroundPlasmodium knowlesi is increasingly reported in Southeast Asia, but prospective studies of its clinical spectrum in children and comparison with autochthonous human-only Plasmodium species are lacking.MethodsOver 3.5 years, we prospectively assessed patients of any age with molecularly–confirmed Plasmodium monoinfection presenting to 3 district hospitals in Sabah, Malaysia.ResultsOf 481 knowlesi, 172 vivax, and 96 falciparum malaria cases enrolled, 44 (9%), 71 (41%), and 31 (32%) children aged ≤12 years. Median parasitemia was lower in knowlesi malaria (2480/μL [interquartile range, 538–8481/μL]) than in falciparum (9600/μL; P < .001) and vivax malaria. In P. knowlesi, World Health Organization–defined anemia was present in 82% (95% confidence interval [CI], 67%–92%) of children vs 36% (95% CI, 31%–41%) of adults. Severe knowlesi malaria occurred in 6.4% (95% CI, 3.9%–8.3%) of adults but not in children; the commenst severity criterion was acute kideny injury. No patient had coma. Age, parasitemia, schizont proportion, abdominal pain, and dyspnea were independently associated with severe knowlesi malaria, with parasitemia >15000/μL the best predictor (adjusted odds ratio, 16.1; negative predictive value, 98.5%; P < .001). Two knowlesi-related adult deaths occurred (fatality rate: 4.2/1000 adults).ConclusionsAge distribution and parasitemia differed markedly in knowlesi malaria compared to human-only species, with both uncomplicated and severe disease occurring at low parasitemia. Severe knowlesi malaria occurred only in adults; however, anemia was more common in children despite lower parasitemia. Parasitemia independently predicted knowlesi disease severity: Intravenous artesunate is warranted initially for those with parasitemia >15000/μL.
      PubDate: Mon, 05 Mar 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy065
      Issue No: Vol. 67, No. 3 (2018)
  • Should Acute Q-Fever Patients be Screened for Valvulopathy to Prevent
    • Authors: de Lange M; Gijsen L, Wielders C, et al.
      Pages: 360 - 366
      Abstract: BackgroundEchocardiographic screening of acute Q-fever patients and antibiotic prophylaxis for patients with cardiac valvulopathy is considered an important approach to prevent chronic Q-fever-related endocarditis. During a large Q-fever epidemic in the Netherlands, routine screening echocardiography was discontinued, raising controversy in the international literature. We followed a cohort of acute Q-fever patients to estimate the risk for developing chronic Q-fever, and we evaluated the impact of screening in patients who were not yet known to have a valvulopathy.MethodsThe study population consisted of patients diagnosed with acute Q-fever in 2007 and 2008. We retrospectively reviewed all screening echocardiographs and checked for development of chronic Q-fever 8 years after the acute episode. Risks of developing chronic Q-fever in relation to the presence or absence of valvulopathy were analyzed with logistic regression.ResultsThe cohort included 509 patients, of whom 306 received echocardiographic screening. There was no significant difference (P-value = .22) in occurrence of chronic Q-fever between patients with a newly detected valvulopathy (2/84, 2.4%) and those with no valvulopathy (12/202, 5.9%). Two patients with a newly detected valvulopathy, who did not receive antibiotic prophylaxis, developed chronic Q-fever at a later stage.ConclusionsWe found no difference in outcome between patients with and without a valvulopathy newly detected by echocardiographic screening. In retrospect, the 2 above-mentioned patients could have benefitted from antibiotic prophylaxis, but its omission must be weighed against the unnecessary large-scale and long-term use of antibiotics that would have resulted from universal echocardiographic screening.
      PubDate: Tue, 20 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy128
      Issue No: Vol. 67, No. 3 (2018)
  • Effectiveness of 7- and 13-Valent Pneumococcal Conjugate Vaccines in a
           Schedule Without a Booster Dose: A 10-Year Observational Study
    • Authors: Jayasinghe S; Chiu C, Quinn H, et al.
      Pages: 367 - 374
      Abstract: BackgroundUnique among high-income countries, Australia has used a 3 + 0 schedule (3 primary doses, no booster) for infant pneumococcal conjugate vaccine (PCV) since January 2005, initially 7 valent (PCV7) then 13 valent (PCV13) from July 2011. We measured vaccine effectiveness (VE) of both PCVs against invasive pneumococcal disease (IPD) using 2 methods.MethodsCases were IPD notifications to the national surveillance system of children eligible for respective PCVs. For case-control method, up to 10 age-matched controls were derived from the Australian Childhood Immunisation Register. For indirect cohort method, controls were IPD cases due to serotypes not in PCVs. VE was calculated as (1 − odds ratio [OR]) × 100 by logistic regression. VE waning was estimated as odds of vaccine type (VT) IPD in consecutive 12-month periods post-dose 3.ResultsBetween 2005 and 2014, there were 1209 and 308 IPD cases in PCV7-eligible and PCV13-eligible cohorts, respectively. Both methods gave comparable VE estimates. In infants, VE for 3 doses against VT IPD was 92.9% (95% confidence interval [CI], 27.7% to 99.3%) for PCV7 and 86.5% (95% CI, 11.7% to 97.9%) for PCV13. From 12 months post-dose 3, the odds of VT IPD by 24–36 months increased significantly for PCV7 (5.6, 95% CI, 1.2–25.4) and PCV13 (5.9, 95% CI, 1.0–35.2).ConclusionsFor both PCVs in a 3 + 0 schedule, despite similar VE, progressive increase in breakthrough cases only occurred post-PCV13. This supports the importance of a booster dose of PCV13 in the second year of life to maintain protection.
      PubDate: Sat, 17 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy129
      Issue No: Vol. 67, No. 3 (2018)
  • Examining Duration of Protection: Should a Booster Dose Be Part of All
           Infant Pneumococcal Conjugate Vaccine Programs'
    • Authors: Whitney C.
      Pages: 375 - 377
      Abstract: pneumococcal vaccinebooster dosevaccine scheduleinfant
      PubDate: Sat, 17 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy135
      Issue No: Vol. 67, No. 3 (2018)
  • Statin Use and Risks of Influenza-Related Outcomes Among Older Adults
           Receiving Standard-Dose or High-Dose Influenza Vaccines Through Medicare
           During 2010–2015
    • Authors: Izurieta H; Chillarige Y, Kelman J, et al.
      Pages: 378 - 387
      Abstract: BackgroundStatins are used to reduce cardiovascular disease risk. Recent studies suggest that statin use may be associated with an increased influenza risk among influenza vaccinees. We used Medicare data to evaluate associations between statins and risks of influenza-related encounters among vaccinees.MethodsIn this retrospective cohort study, we identified Medicare beneficiaries aged > 65 years who received high-dose (HD) or standard-dose (SD) influenza vaccines at pharmacies from 2010–2011 through 2014–2015. Statin users were matched to nonusers by vaccine type, demographics, prior medical encounters, and comorbidities. We used multivariable Poisson models to estimate associations between statin use around the time of vaccination and risk of influenza-related encounters. Study outcomes included influenza-related office visits with a rapid test followed by dispensing of oseltamivir and influenza-related hospitalizations (including emergency room visits) during high influenza circulation periods.ResultsThe study included 1403651 statin users matched to nonusers. Cohorts were well balanced, with standardized mean differences ≤0.03 for all measured covariates. For statin users compared to nonusers, the adjusted relative risk was 1.086 (95% confidence interval [CI], 1.025–1.150) for influenza-related visits and 1.096 (95% CI, 1.013–1.185) for influenza-related hospitalizations. The risk difference ranged from ‒0.02 to 0.23 for influenza-related visits and from ‒0.04 to 0.13 for hospitalizations, depending on season severity. Results were similar for HD and SD vaccinees and for nonsynthetic and synthetic statin users.ConclusionsAmong 2.8 million Medicare beneficiaries, these results suggest that statin use around the time of vaccination does not substantially affect the risk of influenza-related medical encounters among older adults.
      PubDate: Fri, 09 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy100
      Issue No: Vol. 67, No. 3 (2018)
  • A Smartphone-Driven Thermometer Application for Real-time Population- and
           Individual-Level Influenza Surveillance
    • Authors: Miller A; Singh I, Koehler E, et al.
      Pages: 388 - 397
      Abstract: BackgroundSmartphone-based sensors may enable real-time surveillance of infectious diseases at population and household levels. This study evaluates the use of data from commercially available “smart thermometers,” connected to a mobile phone application, for surveillance of influenza-like illness (ILI).MethodsAt a population level, we analyzed the correlation between thermometer recordings and Centers for Disease Control and Prevention–reported ILI activity nationally and by age group and region. We developed time-series models to forecast ILI activity in real time and up to 3 weeks in advance. We analyzed the ability of thermometer readings to track the duration of fevers and identify biphasic fever patterns. We also investigated potential transmission of febrile illness within households among device users.ResultsThermometer readings were highly correlated with national ILI activity (r > 0.95) and activity patterns across regions and age groups. Thermometer readings also significantly improved forecasts of ILI activity in real time and up to 3 weeks in advance. We found that fevers lasting between 3 and 6 days and biphasic fever episodes occurred more frequently during the influenza season. In addition, potential cases of in-household transmission of febrile illness originated more frequently from children than adults.ConclusionsSmart thermometers represent a novel source of information for influenza surveillance and forecasting. Thermometer readings capture real-time ILI activity at a population level, and they can also be used to generate improved forecasts. Moreover, the widespread deployment of these smart thermometers may also allow for more rapid and efficient surveillance at the household level.
      PubDate: Thu, 08 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy073
      Issue No: Vol. 67, No. 3 (2018)
  • Clonal Emergence of Invasive Multidrug-Resistant Staphylococcus
           epidermidis Deconvoluted via a Combination of Whole-Genome Sequencing and
           Microbiome Analyses
    • Authors: Li X; Arias C, Aitken S, et al.
      Pages: 398 - 406
      Abstract: BackgroundPathobionts, bacteria that are typically human commensals but can cause disease, contribute significantly to antimicrobial resistance. Staphylococcus epidermidis is a prototypical pathobiont as it is a ubiquitous human commensal but also a leading cause of healthcare-associated bacteremia. We sought to determine the etiology of a recent increase in invasive S. epidermidis isolates resistant to linezolid.MethodsWhole-genome sequencing (WGS) was performed on 176 S. epidermidis bloodstream isolates collected at the MD Anderson Cancer Center in Houston, Texas, between 2013 and 2016. Molecular relationships were assessed via complementary phylogenomic approaches. Abundance of the linezolid resistance determinant cfr was determined in stool samples via reverse-transcription quantitative polymerase chain reaction.ResultsThirty-nine of the 176 strains were linezolid resistant (22%). Thirty-one of the 39 linezolid-resistant S. epidermidis infections were caused by a particular clone resistant to multiple antimicrobials that spread among leukemia patients and carried cfr on a 49-kb plasmid (herein called pMB151a). The 6 kb of pMB151a surrounding the cfr gene was nearly 100% identical to a cfr-containing plasmid isolated from livestock-associated staphylococci in China. Analysis of serial stool samples from leukemia patients revealed progressive staphylococcal domination of the intestinal microflora and an increase in cfr abundance following linezolid use.ConclusionsThe combination of linezolid use plus transmission of a multidrug-resistant clone drove expansion of invasive, linezolid-resistant S. epidermidis. Our results lend support to the notion that a combination of antibiotic stewardship plus infection control measures may help to control the spread of a multidrug-resistant pathobiont.
      PubDate: Mon, 12 Mar 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy089
      Issue No: Vol. 67, No. 3 (2018)
  • Regional Spread of an Outbreak of Carbapenem-Resistant Enterobacteriaceae
           Through an Ego Network of Healthcare Facilities
    • Authors: Ray M; Lin M, Tang A, et al.
      Pages: 407 - 410
      Abstract: BackgroundIn 2013, New Delhi metallo-β-lactamase (NDM)–producing Escherichia coli, a type of carbapenem-resistant Enterobacteriaceae uncommon in the United States, was identified in a tertiary care hospital (hospital A) in northeastern Illinois. The outbreak was traced to a contaminated duodenoscope. Patient-sharing patterns can be described through social network analysis and ego networks, which could be used to identify hospitals most likely to accept patients from a hospital with an outbreak.MethodsUsing Illinois’ hospital discharge data and the Illinois extensively drug-resistant organism (XDRO) registry, we constructed an ego network around hospital A. We identified which facilities NDM outbreak patients subsequently visited and whether the facilities reported NDM cases.ResultsOf the 31 outbreak cases entered into the XDRO registry who visited hospital A, 19 (61%) were subsequently admitted to 13 other hospitals during the following 12 months. Of the 13 hospitals, the majority (n = 9; 69%) were in our defined ego network, and 5 of those 9 hospitals consequently reported at least 1 additional NDM case. Ego network facilities were more likely to identify cases compared to a geographically defined group of facilities (9/22 vs 10/66; P = .01); only 1 reported case fell outside of the ego network.ConclusionsThe outbreak hospital’s ego network accurately predicted which hospitals the outbreak patients would visit. Many of these hospitals reported additional NDM cases. Prior knowledge of this ego network could have efficiently focused public health resources on these high-risk facilities.
      PubDate: Sat, 03 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy084
      Issue No: Vol. 67, No. 3 (2018)
  • Metabolic Effects of Preexposure Prophylaxis With Coformulated Tenofovir
           Disoproxil Fumarate and Emtricitabine
    • Authors: Glidden D; Mulligan K, McMahan V, et al.
      Pages: 411 - 419
      Abstract: BackgroundAntiretroviral drugs have been associated with changes in lipids, fat mass and dat distribution. Tenofovir disoproxil fumarate (TDF) has been shown to have a more favorable metabolic profile than other drugs in its class. However, the metabolic effects of TDF in preexposure prophylaxis (PrEP) are unknown.MethodsWe evaluated the effects of TDF/emtricitabine (FTC) on lipids and body composition in a blinded, placebo-controlled PrEP trial. Participants enrolled in a metabolic subcohort (N = 251, TDF/FTC; N = 247, placebo) consented to fasting lipid panels, dual-energy X-ray absorptiometry scans for body composition, and pharmacologic testing of drug metabolites at baseline and every 24 weeks thereafter.ResultsLean body mass was stable and unaffected by TDF/FTC. Body weight increased in both groups but was lower on TDF/FTC through week 72. This difference was explained by lower fat accumulation on TDF/FTC. The net median percent difference (standard error, P value) for TDF/FTC vs placebo at week 24 was −0.8% (0.4%, P = .02), +0.3% (0.4%, P = .46), and −3.8% (1.4%, P = .009) for total, lean, and fat mass, respectively. There was no apparent differential regional fat accumulation on TDF/FTC. Decreases in cholesterol, but not triglycerides, were seen in TDF/FTC participants, with detectable drug levels compared to placebo.ConclusionsTDF/FTC for PrEP showed cholesterol reductions and appeared to transiently suppress the accumulation of weight and body fat compared to placebo. There was no evidence of altered fat distribution or lipodystrophy during daily oral TDF/FTC PrEP.Clinical Trials RegistrationNCT00458393.
      PubDate: Sat, 03 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy083
      Issue No: Vol. 67, No. 3 (2018)
  • Risk of Suicidal Behavior With Use of Efavirenz: Results from the
           Strategic Timing of Antiretroviral Treatment Trial
    • Authors: Arenas-Pinto A; Grund B, Sharma S, et al.
      Pages: 420 - 429
      Abstract: BackgroundRandomized trials have shown increased risk of suicidality associated with efavirenz (EFV). The START (Strategic Timing of Antiretroviral Treatment) trial randomized treatment-naive human immunodeficiency virus (HIV)–positive adults with high CD4 cell counts to immediate vs deferred antiretroviral therapy (ART).MethodsThe initial ART regimen was selected prior to randomization (prespecified). We compared the incidence of suicidal and self-injurious behaviours (suicidal behavior) between the immediate vs deferred ART groups using proportional hazards models, separately for those with EFV and other prespecified regimens, by intention to treat, and after censoring participants in the deferred arm at ART initiation.ResultsOf 4684 participants, 271 (5.8%) had a prior psychiatric diagnosis. EFV was prespecified for 3515 participants (75%), less often in those with psychiatric diagnoses (40%) than without (77%). While the overall intention-to-treat comparison showed no difference in suicidal behavior between arms (hazard ratio [HR], 1.07, P = .81), subgroup analyses suggest that initiation of EFV, but not other ART, is associated with increased risk of suicidal behavior. When censoring follow-up at ART initiation in the deferred group, the immediate vs deferred HR among those who were prespecified EFV was 3.31 (P = .03) and 1.04 (P = .93) among those with other prespecified ART; (P = .07 for interaction). In the immediate group, the risk was higher among those with prior psychiatric diagnoses, regardless of prespecified treatment group.ConclusionsParticipants who used EFV in the immediate ART group had increased risk of suicidal behavior compared with ART-naive controls. Those with prior psychiatric diagnoses were at higher risk.
      PubDate: Mon, 12 Mar 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy051
      Issue No: Vol. 67, No. 3 (2018)
  • Incidence and Clinical Profile of Norovirus Disease in Guatemala,
    • Authors: Bierhoff M; Arvelo W, Estevez A, et al.
      Pages: 430 - 436
      Abstract: BackgroundAcute gastroenteritis (AGE) is a leading infectious cause of morbidity worldwide, particularly among children in developing countries. With the decline of rotavirus disease rates following introduction of rotavirus vaccines, the relative importance of norovirus will likely increase. Our objectives in this study were to determine the incidence and clinical profile of norovirus disease in Guatemala.MethodsWe analyzed data from a population-based surveillance study conducted in Guatemala from 2008 through 2013. Demographic information, clinical data, and stool samples were collected from patients who presented with AGE (≥3 liquid stools within 24 hours that initiated 7 days before presentation). Estimated incidence of hospitalized, outpatient, and total community norovirus disease was calculated using surveillance data and household surveys of healthcare use.ResultsWe included 999 AGE hospitalizations and 3189 AGE outpatient visits at facilities, of which 164 (16%) and 370 (12%), respectively, were positive for norovirus. Severity of norovirus was milder than of rotavirus. Community incidence of norovirus ranged from 2068 to 4954 per 100000 person-years (py) in children aged<5 years. Children aged <5 years also had higher incidence of norovirus-associated hospitalization (51–105 per 100000 py) compared with patients aged ≥5 years (0–1.6 per 100000 py and 49–80 per 100000 py, respectively).ConclusionsThis study highlights the burden of norovirus disease in Guatemala, especially among young children. These data can help prioritize development of control strategies, including the potential use of vaccines, and provide a baseline to evaluate the impact of such interventions.
      PubDate: Tue, 06 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy091
      Issue No: Vol. 67, No. 3 (2018)
  • Emergence of Polyfunctional Cytotoxic CD4+ T Cells in Mycobacterium avium
           Immune Reconstitution Inflammatory Syndrome in Human Immunodeficiency
           Virus-Infected Patients
    • Authors: Hsu D; Breglio K, Pei L, et al.
      Pages: 437 - 446
      Abstract: BackgroundImmune reconstitution inflammatory syndrome (IRIS) is an aberrant inflammatory response in individuals with advanced human immunodeficiency virus (HIV) infection, after antiretroviral therapy (ART) initiation. The pathogenesis of Mycobacterium avium complex (MAC)–associated IRIS has not been fully elucidated.MethodsWe investigated monocyte and CD4+ T-cell responses in vitro, tumor necrosis factor (TNF) expression in tissues, and plasma cytokines and inflammatory markers, in 13 HIV-infected patients with MAC-IRIS and 14 HIV-uninfected patients with pulmonary MAC infection.ResultsPrior to ART, HIV-infected compared with HIV-uninfected patients, had reduced TNF+ monocytes (P = .013), although similar cytokine (interferon gamma [IFN-γ], TNF, interleukin 2 [IL-2], and interleukin 17 [IL-17])–expressing CD4+ T cells. During IRIS, monocyte cytokine production was restored. IFN-γ+ (P = .027), TNF+ (P = .004), and polyfunctional CD4+ T cells (P = 0.03) also increased. These effectors were T-betlow, and some expressed markers of degranulation and cytotoxic potential. Blockade of cytotoxic T-lymphocyte associated protein 4 and lymphocyte activation gene-3 further increased CD4+ T-cell cytokine production. Tissue immunofluorescence showed higher proportions of CD4+ and CD68+ (monocyte/macrophage) cells expressed TNF during IRIS compared with HIV-uninfected patients. Plasma IFN-γ (P = .048), C-reactive protein (P = .008), and myeloperoxidase (P < .001) levels also increased, whereas interleukin 10 decreased (P = .008) during IRIS.ConclusionsAdvanced HIV infection was associated with impaired MAC responses. Restoration of monocyte responses and expansion of polyfunctional MAC-specific T-betlow CD4+ T cells with cytotoxic potential after ART initiation may overwhelm existing regulatory and inhibitory mechanisms, leading to MAC-IRIS.
      PubDate: Sat, 10 Mar 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy016
      Issue No: Vol. 67, No. 3 (2018)
  • Sleep Apnea and Heart Failure With a Reduced Ejection Fraction Among
           Persons Living With Human Immunodeficiency Virus
    • Authors: Alvi R; Tariq N, Malhotra A, et al.
      Pages: 447 - 455
      Abstract: BackgroundSleep apnea (SA) is common and has prognostic significance among broad groups of patients with heart failure (HF). There are no data characterizing the presence, associations, and prognostic significance of SA among persons living with human immunodeficiency virus (PLHIV) with HF.MethodsWe conducted a single-center study of PLHIV with HF with reduced ejection fraction (HFrEF; left ventricular ejection fraction [LVEF] <50%) and analyzed the relationship of SA with 30-day HF hospital readmission rate.ResultsOur cohort included 1124 individuals admitted with HFrEF; 15% were PLHIV, and 92% were on antiretroviral therapy. SA was noted in 28% of PLHIV and 26% of uninfected controls. Compared to uninfected controls with HFrEF and SA, PLHIV with HFrEF and SA had a lower body mass index, lower LVEF, a higher pulmonary artery systolic pressure (PASP), were more likely to have obstructive rather than central SA (P < .05 for all). In a multivariable model, PASP, low CD4 count, high viral load (VL), and SA parameters (apnea–hypopnea index, CPAP use and duration) were predictors of 30-day HF readmission rate. Each 1-hour increase in CPAP use was associated with a 14% decreased risk of 30-day HF readmission among PLHIV.ConclusionsCompared to uninfected controls, PLHIV were more likely to have obstructive SA than central SA. Apnea severity, low CD4 count, high VL, and cocaine use were positively associated with 30-day HF hospital readmission rate, whereas CPAP use and increased duration of CPAP use conferred protection.
      PubDate: Fri, 09 Mar 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy216
      Issue No: Vol. 67, No. 3 (2018)
  • IKBKG (NEMO) 5′ Untranslated Splice Mutations Lead to Severe, Chronic
           Disseminated Mycobacterial Infections
    • Authors: Hsu A; Zerbe C, Foruraghi L, et al.
      Pages: 456 - 459
      Abstract: Four patients with adult-onset, disseminated mycobacterial infection had 5′ UTR mutations in IKBKG without clear physical stigmata of NEMO deficiency. These mutations caused decreased levels of NEMO protein and Toll-like receptor driven cytokine production. Three patients died from disseminated disease. These mutations may be missed by whole exome sequencing.
      PubDate: Fri, 09 Mar 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy186
      Issue No: Vol. 67, No. 3 (2018)
  • Demonstration of Near-Elimination of Hepatitis C Virus Among a Prison
           Population: The Lotus Glen Correctional Centre Hepatitis C Treatment
    • Authors: Bartlett S; Fox P, Cabatingan H, et al.
      Pages: 460 - 463
      Abstract: Micro-elimination of hepatitis C virus (HCV) infection through rapid uptake of government-funded direct-acting antiviral therapy within an Australian prison setting is demonstrated. During a 22-month period, 119 patients initiated treatment for chronic HCV infection, with HCV in-prison viremic prevalence declining from 12% to 1%.
      PubDate: Mon, 12 Mar 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy210
      Issue No: Vol. 67, No. 3 (2018)
  • Protecting the Community Through Child Vaccination
    • Authors: Anderson E; Daugherty M, Pickering L, et al.
      Pages: 464 - 471
      Abstract: The direct impact of vaccines on children is well described, but the major public health impact of indirect protection provided to the community by vaccines is underappreciated. Community protection occurs when vaccinated persons block the chain of transmission, protecting undervaccinated or unvaccinated susceptible community members by preventing exposure and limiting the spread of the pathogen through the community. Substantial declines in disease incidence have occurred shortly after implementing new childhood vaccines, including declines among vaccine-ineligible children, adolescents, and adults. Protection of susceptible community members depends on maintaining high vaccination rates. Improved recognition of community protection will strengthen childhood vaccination strategies that will protect our communities into the future.
      PubDate: Sat, 17 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy142
      Issue No: Vol. 67, No. 3 (2018)
  • A Wake-up Call for Human Immunodeficiency Virus (HIV) Providers:
           Obstructive Sleep Apnea in People Living With HIV
    • Authors: Owens R; Hicks C.
      Pages: 472 - 476
      Abstract: Obstructive sleep apnea (OSA) is defined by repetitive collapse of the upper airway during sleep leading to transient hypoxemia and arousals from sleep. Surges in sympathetic activity, repeated oxygen desaturation, and sleep fragmentation can lead to cardiovascular (eg, myocardial infarction) and neurocognitive (eg, excessive daytime sleepiness) consequences. Emerging data suggest that OSA is common in people living with human immunodeficiency virus (PLWH) and that traditional risk factors for OSA, such as obesity, are not highly predictive of OSA in PLWH. Untreated OSA is associated with increased fatigue and levels of inflammation. Despite these data, most PLWH with OSA remain undiagnosed and untreated. Improved awareness of OSA among healthcare providers and greater use of OSA diagnostic approaches have the potential to substantially improve quality of life and outcomes in PLWH.
      PubDate: Wed, 09 May 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy217
      Issue No: Vol. 67, No. 3 (2018)
  • Rapid Onset of a Painful, Ulcerated Facial Lesion in a 58-Year-Old Woman
    • Pages: 477 - 477
      Abstract: (See pages 478–9 for the Answer to the Photo Quiz.)
      PubDate: Wed, 18 Jul 2018 00:00:00 GMT
      DOI: 10.1093/cid/cix1134
      Issue No: Vol. 67, No. 3 (2018)
  • Rapid Onset of a Painful, Ulcerated Facial Lesion in a 58-Year-Old Woman
    • Authors: Kravitz A; Schorer A, Kravitz G.
      Pages: 478 - 479
      Abstract: (See page 477 for the Photo Quiz.)
      PubDate: Wed, 18 Jul 2018 00:00:00 GMT
      DOI: 10.1093/cid/cix1136
      Issue No: Vol. 67, No. 3 (2018)
  • Why Are Patients With Giardiasis Not Treated Earlier' Two Sides of the
           Same Coin
    • Authors: Escobedo A; Almirall P, Rodríguez-Morales A, et al.
      Pages: 480 - 480
      Abstract: giardiasisGiardiadelaydiagnosisprevalence
      PubDate: Tue, 27 Mar 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy122
      Issue No: Vol. 67, No. 3 (2018)
  • Response to Escobedo et al
    • Authors: Beer K; Collier S, Du F, et al.
      Pages: 481 - 481
      Abstract: To the Editor—We were pleased to receive the response from Escobedo et al [1] to our recent article describing giardiasis diagnosis and treatment patterns in the United States. They shared a summary of similar diagnosis and treatment patterns among patients with giardiasis in Cuba—notably, that diagnoses are often delayed. They offer a framework for understanding and addressing these patterns based on surveys conducted among Cuban patients, caregivers and physicians. We wish to thank them for their insights and highlight opportunities for US clinical and public health professionals to explore and address factors underlying delayed diagnoses and ineffective treatment in this country.
      PubDate: Tue, 27 Mar 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy125
      Issue No: Vol. 67, No. 3 (2018)
  • Reconsidering Treatment of Community-Acquired Pneumonia: Are Macrolides
           Plus β-Lactams Essential'
    • Authors: Horowitz H.
      Pages: 481 - 482
      Abstract: To the Editor—The letter from Musher et al [1] regarding the evolving role of Streptococcus pneumoniae as a cause of pneumonia in adults raises a question regarding the treatment of community-acquired pneumonia (CAP) that deserves attention. In their review of data reporting the causes of CAP since 2010 in the United States, there is a remarkably low incidence of Legionella, Mycoplasma, and Chlamydia causing CAP (1%–2% total reported from 3 separate studies [1], table 3). The percentage of pneumonias due to these “atypical” organisms in the United States is markedly lower than in prior years as well as lower than that reported from Europe.
      PubDate: Fri, 09 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy123
      Issue No: Vol. 67, No. 3 (2018)
  • Efficacy and Safety of short courses of antibiotic therapy for bacteremia
           caused by Enterobacteriaceae
    • Authors: Chou A; Trautner B.
      Pages: 482 - 483
      Abstract: To the Editor—The findings by Chotiprasitsakul and colleagues [1] support the efficacy and safety of short courses of antibiotic therapy for bacteremia caused by Enterobacteriaceae. We applaud their work on this very important subject where studies are needed.
      PubDate: Thu, 29 Mar 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy117
      Issue No: Vol. 67, No. 3 (2018)
  • Reply to Horowitz
    • Authors: Musher D; Abers M, Bartlett J.
      Pages: 482 - 482
      Abstract: To the Editor—Horowitz [1] is entirely on target in questioning whether macrolides should be recommended routinely to treat patients who are hospitalized in the United States for community-acquired pneumonia (CAP). With some geographic exceptions, it is quite clear that only a very small proportion are infected with Mycoplasma, Chlamydia, Legionella, or Coxiella burnetii [2]. The routine inclusion of a macrolide in treating all patients hospitalized for CAP can be justified only if a clear benefit is demonstrable, and that benefit would presumably result from the anti-inflammatory effects of the macrolide. Results of observational studies suggest that macrolides might be associated with reduced mortality [3, 4], particularly in cases of severe CAP [4]. However, a mortality benefit has not been demonstrated in randomized prospective trials [2, 5].
      PubDate: Fri, 09 Feb 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy124
      Issue No: Vol. 67, No. 3 (2018)
  • Reply to Chou and Trautner
    • Authors: Chotiprasitakul D; Han J, Lautenbach E, et al.
      Pages: 483 - 483
      Abstract: To the Editor—We thank Chou and Trautner for their letter [1]. As they correctly point out, clinicians may be more likely to prescribe therapy that is more “aggressive” when their patients are infected with highly drug-resistant organisms. This may consist of combination regimens, higher antibiotic dosages, extended infusions, shorter intervals, and/or prolonged durations of therapy. The authors raise the concern that in a study comparing short and prolonged courses of therapy for Enterobacteriaceae bacteremia [2], patients in the prolonged-course group may have been infected with drug- resistant organisms at a higher frequency than those in the short-course group.
      PubDate: Thu, 29 Mar 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy118
      Issue No: Vol. 67, No. 3 (2018)
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