Kevin C Ma, Diya Surie, Natalie Dean, Clinton R Paden, Natalie J Thornburg, Fatimah S Dawood
Background SARS-CoV-2 lineage-specific COVID-19 vaccine effectiveness (VE) studies can inform decision-making on whether vaccine composition updates are needed to maintain effectiveness against severe disease as SARS-CoV-2 continues to evolve. Lineage assignment methods in VE test-negative design (TND) studies include sequence-based (whole-genome sequencing), proxy-based (e.g., S-gene target failure during polymerase chain reaction), and time period-based (using variant predominance thresholds) approaches. Methods We first summarize benefits, challenges (including cost and timeliness), and methodologic considerations for estimating lineage-specific COVID-19 VE using these different assignment approaches. We then use a deterministic model to illustrate the potential impact of lineage misclassification error on VE estimates in a TND using period-based versus sequence-based lineage assignment across different variant emergence scenarios. Results Our model suggests period-based analyses may sometimes underestimate differences in VE between two lineages due to lineage misclassification error. This effect is most evident during prolonged variant co-circulation or in early time periods following new variant takeover. Using higher predominance thresholds can reduce VE estimate bias in period-based analyses but at the expense of sample size, reducing precision or outright precluding estimation under some scenarios. Period-based VE analyses should therefore consider including sensitivity analyses to characterize robustness of VE estimates to different predominance thresholds. Conclusions TND studies using sequence-, proxy-, and period-based lineage assignment have contributed substantially towards understanding SARS-CoV-2 variant-mediated vaccine escape, but biases that can affect each study design vary. Our results identify analytic considerations for robust estimation and suggest principles that may translate to other pathogens that undergo continuous antigenic drift.
{"title":"Integrating genomic data into test-negative designs for estimating lineage-specific COVID-19 vaccine effectiveness","authors":"Kevin C Ma, Diya Surie, Natalie Dean, Clinton R Paden, Natalie J Thornburg, Fatimah S Dawood","doi":"10.1093/cid/ciag059","DOIUrl":"https://doi.org/10.1093/cid/ciag059","url":null,"abstract":"Background SARS-CoV-2 lineage-specific COVID-19 vaccine effectiveness (VE) studies can inform decision-making on whether vaccine composition updates are needed to maintain effectiveness against severe disease as SARS-CoV-2 continues to evolve. Lineage assignment methods in VE test-negative design (TND) studies include sequence-based (whole-genome sequencing), proxy-based (e.g., S-gene target failure during polymerase chain reaction), and time period-based (using variant predominance thresholds) approaches. Methods We first summarize benefits, challenges (including cost and timeliness), and methodologic considerations for estimating lineage-specific COVID-19 VE using these different assignment approaches. We then use a deterministic model to illustrate the potential impact of lineage misclassification error on VE estimates in a TND using period-based versus sequence-based lineage assignment across different variant emergence scenarios. Results Our model suggests period-based analyses may sometimes underestimate differences in VE between two lineages due to lineage misclassification error. This effect is most evident during prolonged variant co-circulation or in early time periods following new variant takeover. Using higher predominance thresholds can reduce VE estimate bias in period-based analyses but at the expense of sample size, reducing precision or outright precluding estimation under some scenarios. Period-based VE analyses should therefore consider including sensitivity analyses to characterize robustness of VE estimates to different predominance thresholds. Conclusions TND studies using sequence-, proxy-, and period-based lineage assignment have contributed substantially towards understanding SARS-CoV-2 variant-mediated vaccine escape, but biases that can affect each study design vary. Our results identify analytic considerations for robust estimation and suggest principles that may translate to other pathogens that undergo continuous antigenic drift.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"1 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catherine E Oldenburg, Boubacar Coulibaly, Ali Sié, Mamadou Ouattara, Mamadou Bountogo, Guillaume Compaoré, Dramane Kiemde, Adama Compaoré, Guillaume Zonou, Armin Hinterwirth, Lina Zhong, Cindi Chen, YuHeng Liu, Danny Yu, Thomas Abraham, Elodie Lebas, Huiyu Hu, Milan Hilde-Jones, Benjamin F Arnold, Thuy Doan, Thomas M Lietman
Background Biannual mass azithromycin distribution to children aged 1-59 months reduces all-cause child mortality but selects for antimicrobial resistance (AMR). The World Health Organization (WHO) recommends ongoing surveillance of AMR in the context of azithromycin distribution. We evaluated the impact of twice-yearly distribution of azithromycin compared to placebo on AMR in the gut of children in Burkina Faso. Methods The Community Health with Azithromycin Trial (CHAT) was a 1:1 cluster randomized placebo-controlled trial in Nouna District, Burkina Faso from 2019-2023. Communities were randomized in a 1:1 fashion to twice yearly azithromycin (20 mg/kg) or matching placebo. At 36 months, rectal swabs were collected from a random sample of 15 children per community in 48 communities participating in the trial and assessed for AMR genetic resistance determinants using next-generation DNA sequencing (DNA-seq). We assessed the fold-change in macrolide and non-macrolide resistance determinants between treatment groups after 36 months. Results 483 samples from 41 communities were analyzed at 36 months. There was no evidence of a difference in macrolide resistance determinants in the azithromycin group compared to the placebo group (fold-change 1.21, 95% confidence interval, CI, 0.96 to 1.52, P=0.62). There was no evidence of a difference in non-macrolide resistance genes, for example, beta-lactam resistance was similar between treatment groups (fold-change 1.05, 95% CI 0.79 to 1.40, P=0.81). Conclusions In this setting in Burkina Faso, twice-yearly azithromycin distributions to children aged 1-59 months did not lead to statistically significant differences in macrolide or non-macrolide genetic resistance determinants at 36 months. Trial Registration ClinicalTrials.gov NCT03676764
背景：1-59月龄儿童每年两次大规模分发阿奇霉素可降低全因儿童死亡率，但选择抗微生物药物耐药性（AMR）。世界卫生组织（世卫组织）建议对阿奇霉素分发情况下的抗菌素耐药性进行持续监测。我们评估了每年两次使用阿奇霉素与安慰剂对布基纳法索儿童肠道抗菌素耐药性的影响。方法2019-2023年在布基纳法索Nouna区开展阿奇霉素社区卫生试验（CHAT），采用1:1聚类随机安慰剂对照试验。社区以1:1的方式随机分配到每年两次的阿奇霉素（20mg /kg）或匹配的安慰剂。在36个月时，从48个参与试验的社区中每个社区随机抽取15名儿童的直肠拭子样本，并使用下一代DNA测序（DNA-seq）评估AMR遗传抗性决定因素。我们评估了36个月后各组大环内酯类和非大环内酯类耐药决定因素的倍增变化。结果36个月时对41个社区的483份样本进行了分析。与安慰剂组相比，没有证据表明阿奇霉素组大环内酯类耐药决定因素有差异（倍数变化1.21,95%可信区间，CI， 0.96至1.52，P=0.62）。无证据表明非大环内酯类耐药基因存在差异，例如，治疗组之间的β -内酰胺耐药相似（倍数变化1.05,95% CI 0.79 ~ 1.40， P=0.81）。结论在布基纳法索，1-59月龄儿童每年两次使用阿奇霉素，在36月龄时大环内酯类或非大环内酯类遗传耐药决定因素没有统计学上的显著差异。临床试验注册网站NCT03676764
{"title":"Macrolide and non-macrolide resistance after 36 months of mass azithromycin distribution in Burkina Faso: A cluster randomized trial","authors":"Catherine E Oldenburg, Boubacar Coulibaly, Ali Sié, Mamadou Ouattara, Mamadou Bountogo, Guillaume Compaoré, Dramane Kiemde, Adama Compaoré, Guillaume Zonou, Armin Hinterwirth, Lina Zhong, Cindi Chen, YuHeng Liu, Danny Yu, Thomas Abraham, Elodie Lebas, Huiyu Hu, Milan Hilde-Jones, Benjamin F Arnold, Thuy Doan, Thomas M Lietman","doi":"10.1093/cid/ciag051","DOIUrl":"https://doi.org/10.1093/cid/ciag051","url":null,"abstract":"Background Biannual mass azithromycin distribution to children aged 1-59 months reduces all-cause child mortality but selects for antimicrobial resistance (AMR). The World Health Organization (WHO) recommends ongoing surveillance of AMR in the context of azithromycin distribution. We evaluated the impact of twice-yearly distribution of azithromycin compared to placebo on AMR in the gut of children in Burkina Faso. Methods The Community Health with Azithromycin Trial (CHAT) was a 1:1 cluster randomized placebo-controlled trial in Nouna District, Burkina Faso from 2019-2023. Communities were randomized in a 1:1 fashion to twice yearly azithromycin (20 mg/kg) or matching placebo. At 36 months, rectal swabs were collected from a random sample of 15 children per community in 48 communities participating in the trial and assessed for AMR genetic resistance determinants using next-generation DNA sequencing (DNA-seq). We assessed the fold-change in macrolide and non-macrolide resistance determinants between treatment groups after 36 months. Results 483 samples from 41 communities were analyzed at 36 months. There was no evidence of a difference in macrolide resistance determinants in the azithromycin group compared to the placebo group (fold-change 1.21, 95% confidence interval, CI, 0.96 to 1.52, P=0.62). There was no evidence of a difference in non-macrolide resistance genes, for example, beta-lactam resistance was similar between treatment groups (fold-change 1.05, 95% CI 0.79 to 1.40, P=0.81). Conclusions In this setting in Burkina Faso, twice-yearly azithromycin distributions to children aged 1-59 months did not lead to statistically significant differences in macrolide or non-macrolide genetic resistance determinants at 36 months. Trial Registration ClinicalTrials.gov NCT03676764","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"10 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Edwin J Asturias,Robert Schechter,H Keipp Talbot,Julie Boom,Oliver T Brooks,Lin H Chen,Helen Y Chu,Sybil Cineas,Dana J Hawkinson,Mini Kamboj,Jamie Loehr,Karyn L Lyons,Yvonne A Maldonado,Charlotte A Moser,Mysheika W Roberts,Albert C Shaw,Zanthia Wiley,Jane R Zucker,Noel T Brewer
Since June 2025, the restructuring of the U.S. Advisory Committee on Immunization Practices (ACIP)-including the abrupt replacement of all voting members and leadership-marked a significant departure from its longstanding norms of continuity and governance. Subsequent deviations from evidence-based policymaking raise concerns about the independence, transparency, and scientific rigor of vaccine policies under the new Department of Health and Human Services (DHHS) administration. The politicization of deliberations, selective use of questionable evidence, and disregard for established methodological standards threaten to undermine vaccine development, access, and public trust. Potential consequences include diminished credibility of federal vaccine recommendations, reduced advisory capacity for advancing key and new vaccines (e.g., cytomegalovirus, Lyme disease), and disruption of critical and leading research infrastructure. Safeguarding ACIP's integrity through legislative and structural reforms is essential to restoring its credibility, preserving U.S. leadership in global vaccine science, and maintaining population protection through robust, evidence-based immunization policy.
{"title":"The Erosion of a Pillar of Public Health: ACIP's Role and the Future of U.S. Vaccine Policy Post-June 2025.","authors":"Edwin J Asturias,Robert Schechter,H Keipp Talbot,Julie Boom,Oliver T Brooks,Lin H Chen,Helen Y Chu,Sybil Cineas,Dana J Hawkinson,Mini Kamboj,Jamie Loehr,Karyn L Lyons,Yvonne A Maldonado,Charlotte A Moser,Mysheika W Roberts,Albert C Shaw,Zanthia Wiley,Jane R Zucker,Noel T Brewer","doi":"10.1093/cid/ciag042","DOIUrl":"https://doi.org/10.1093/cid/ciag042","url":null,"abstract":"Since June 2025, the restructuring of the U.S. Advisory Committee on Immunization Practices (ACIP)-including the abrupt replacement of all voting members and leadership-marked a significant departure from its longstanding norms of continuity and governance. Subsequent deviations from evidence-based policymaking raise concerns about the independence, transparency, and scientific rigor of vaccine policies under the new Department of Health and Human Services (DHHS) administration. The politicization of deliberations, selective use of questionable evidence, and disregard for established methodological standards threaten to undermine vaccine development, access, and public trust. Potential consequences include diminished credibility of federal vaccine recommendations, reduced advisory capacity for advancing key and new vaccines (e.g., cytomegalovirus, Lyme disease), and disruption of critical and leading research infrastructure. Safeguarding ACIP's integrity through legislative and structural reforms is essential to restoring its credibility, preserving U.S. leadership in global vaccine science, and maintaining population protection through robust, evidence-based immunization policy.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"71 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preventing Long COVID With Metformin.","authors":"Carolyn T Bramante, David R Boulware","doi":"10.1093/cid/ciaf700","DOIUrl":"https://doi.org/10.1093/cid/ciaf700","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":7.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Portia Mira, Ruben Dyrhovden, Marit Gjerde Tellevik, Tomas Mikal Eagan, Abigail Krause, Oscar Lopez-Martinez, Matthew Wolf, Kaiser G Lim, Ryan M Kern, Eva Carmona Porquera, Oyvind Kommedal, Robin Patel
Objective New insights into community acquired pleural infection microbiology may enable development of more rapid and accessible diagnostics that can streamline treatment. This study systematically compared molecular approaches for pathogen detection in pleural fluid from patients with such infections. Considering the need for rapid results with minimum hands-on time and test complexity, off-label use of the cassette-based, random-access BIOFIRE® Joint Infection (JI) Panel (bioMérieux) with and without supplementary in-house PCRs was evaluated. Methods Pleural fluids from 162 subjects from the Mayo Clinic (Rochester, Minnesota) and Haukeland University Hospital (Bergen, Norway), where molecular tests are routinely used for analyzing pleural fluid, were studied. The performance of the BIOFIRE JI Panel was compared to 16S ribosomal RNA gene PCR followed by Sanger and next-generation sequencing (16S rRNA gene PCR/sequencing), an in-house PCR panel specifically designed for pleural space infections, and culture. Main Results The BIOFIRE JI Panel supplemented with three in-house PCRs targeting Fusobacterium nucleatum group, Streptococcus intermedius/constellatus and Aggregatibacter aphrophilus detected 96.8% of pleural infections, providing complete microbial profiles in 70.8%. In comparison, the detection rate of 16S rRNA gene PCR/sequencing was 92.2%, providing complete microbial profiles in 87.0%. Culture detected bacteria in only 31.9% of pleural fluids, providing complete microbial profiles in 15.3%. Conclusions These results underscore the importance of molecular approaches in diagnosing pleural space infections and demonstrate the feasibility of panel-based PCR-based diagnostics for these sometimes-complex infections. The BIOFIRE JI Panel, designed for testing synovial fluid, could be modified to provide a useful diagnostic for testing pleural fluid.
目的对社区获得性胸膜感染的微生物学研究有新的认识，有助于开发更快速、更便捷的诊断方法，简化治疗。本研究系统地比较了分子方法在此类感染患者胸膜液中的病原体检测。考虑到需要以最少的操作时间和测试复杂性获得快速结果，我们评估了在标签外使用基于卡带的随机访问BIOFIRE®联合感染（JI）面板（biomrieux），并评估了是否使用补充的内部pcr。方法对来自梅奥诊所（明尼苏达州罗彻斯特）和豪克兰大学医院（挪威卑尔根）的162名受试者的胸膜液进行研究，分子测试是常规用于分析胸膜液的方法。将BIOFIRE JI面板的性能与16S核糖体RNA基因PCR进行比较，然后进行Sanger和下一代测序（16S rRNA基因PCR/测序），这是一种专门为胸膜腔感染设计的内部PCR面板，并进行培养。BIOFIRE JI Panel补充了3种针对核梭杆菌群、中间/星座链球菌和嗜aphrophilus聚集杆菌的内部pcr，检测出96.8%的胸膜感染，70.8%的胸膜感染提供了完整的微生物谱。相比之下，16S rRNA基因PCR/测序的检出率为92.2%，提供完整微生物图谱的比例为87.0%。培养仅在31.9%的胸膜液中检测到细菌，在15.3%的胸膜液中提供完整的微生物谱。结论这些结果强调了分子方法在诊断胸膜腔感染中的重要性，并证明了基于pcr的小组诊断这些有时复杂的感染的可行性。BIOFIRE JI面板，设计用于测试滑液，可以修改为提供一个有用的诊断测试胸膜液。
{"title":"Microbial Detection in Community Acquired Pleural Space Infection Using the BioFire Joint Infection Panel and Individual PCR Assays","authors":"Portia Mira, Ruben Dyrhovden, Marit Gjerde Tellevik, Tomas Mikal Eagan, Abigail Krause, Oscar Lopez-Martinez, Matthew Wolf, Kaiser G Lim, Ryan M Kern, Eva Carmona Porquera, Oyvind Kommedal, Robin Patel","doi":"10.1093/cid/ciag050","DOIUrl":"https://doi.org/10.1093/cid/ciag050","url":null,"abstract":"Objective New insights into community acquired pleural infection microbiology may enable development of more rapid and accessible diagnostics that can streamline treatment. This study systematically compared molecular approaches for pathogen detection in pleural fluid from patients with such infections. Considering the need for rapid results with minimum hands-on time and test complexity, off-label use of the cassette-based, random-access BIOFIRE® Joint Infection (JI) Panel (bioMérieux) with and without supplementary in-house PCRs was evaluated. Methods Pleural fluids from 162 subjects from the Mayo Clinic (Rochester, Minnesota) and Haukeland University Hospital (Bergen, Norway), where molecular tests are routinely used for analyzing pleural fluid, were studied. The performance of the BIOFIRE JI Panel was compared to 16S ribosomal RNA gene PCR followed by Sanger and next-generation sequencing (16S rRNA gene PCR/sequencing), an in-house PCR panel specifically designed for pleural space infections, and culture. Main Results The BIOFIRE JI Panel supplemented with three in-house PCRs targeting Fusobacterium nucleatum group, Streptococcus intermedius/constellatus and Aggregatibacter aphrophilus detected 96.8% of pleural infections, providing complete microbial profiles in 70.8%. In comparison, the detection rate of 16S rRNA gene PCR/sequencing was 92.2%, providing complete microbial profiles in 87.0%. Culture detected bacteria in only 31.9% of pleural fluids, providing complete microbial profiles in 15.3%. Conclusions These results underscore the importance of molecular approaches in diagnosing pleural space infections and demonstrate the feasibility of panel-based PCR-based diagnostics for these sometimes-complex infections. The BIOFIRE JI Panel, designed for testing synovial fluid, could be modified to provide a useful diagnostic for testing pleural fluid.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"29 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Changing Course.","authors":"Koray K Demir, Matthew P Cheng, Joanna Nelson","doi":"10.1093/cid/ciaf720","DOIUrl":"https://doi.org/10.1093/cid/ciaf720","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":7.3,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146060502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Methodology Misrepresented: Correcting the Record on the ATS Community-acquired Pneumonia Guideline Process.","authors":"Kevin C Wilson,Eyal Oren","doi":"10.1093/cid/ciag040","DOIUrl":"https://doi.org/10.1093/cid/ciag040","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"30 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coccidioidomycosis continues to shape life across California's southern San Joaquin Valley, where thousands fall ill each year. Yet for many, diagnosis marks not the end of uncertainty but the start of another challenge, staying in care. In communities already strained by clinician shortages, distance, and limited insurance coverage, the year-long follow-up recommended after Valley Fever is rarely feasible. Lessons from other rural Latino populations show that continuity can be rebuilt through community-rooted approaches: trusted health workers, mobile clinics, peer education, and simple digital tools that meet patients where they are. Bringing these models into existing county and safety-net systems will require dedicated funding and shared commitment across institutions. Strengthening continuity of care, not only diagnostic capacity, offers the most realistic path to better outcomes for those living in the heart of California's Valley Fever region.
{"title":"Valley Fever in Central California: Diagnosis is Not the Finish Line, the Real Gap is Longitudinal Care.","authors":"Geetha Sivasubramanian","doi":"10.1093/cid/ciaf728","DOIUrl":"https://doi.org/10.1093/cid/ciaf728","url":null,"abstract":"Coccidioidomycosis continues to shape life across California's southern San Joaquin Valley, where thousands fall ill each year. Yet for many, diagnosis marks not the end of uncertainty but the start of another challenge, staying in care. In communities already strained by clinician shortages, distance, and limited insurance coverage, the year-long follow-up recommended after Valley Fever is rarely feasible. Lessons from other rural Latino populations show that continuity can be rebuilt through community-rooted approaches: trusted health workers, mobile clinics, peer education, and simple digital tools that meet patients where they are. Bringing these models into existing county and safety-net systems will require dedicated funding and shared commitment across institutions. Strengthening continuity of care, not only diagnostic capacity, offers the most realistic path to better outcomes for those living in the heart of California's Valley Fever region.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"95 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marian Loveday,Emma Clarence,Sindisiwe Hlangu,Nalini Singh,Sunitha Chotoo,James C M Brust,Catriona Waitt,Richard Court,Jennifer Furin
BACKGROUNDThere is limited experience of the all-oral 6-month regimens containing bedaquiline, delamanid, linezolid and levofloxacin/clofazimine (BDLLfx/BDLCfz) in pregnant women with MDR/RR-TB. We report maternal treatment, pregnancy, and infant outcomes to 12 months of age in a cohort of pregnant women treated with these regimens.METHODSWe included pregnant women treated for MDR/RR-TB from September 2023 to January 2025 in KwaZulu-Natal, South Africa in a prospective observational study. Outcomes were collected through ongoing record reviews. Infant clinical assessments were conducted at six weeks, six and 12 months.RESULTSOf 25 pregnant women with MDR/RR-TB, 21 received BDLLfx/BDLCfz; 12 (57%) were living with HIV. Although 10/21 (48%) of the women developed anaemia, 18 (86%) had favourable treatment outcomes. All 21 infants were born alive; median gestational age 39 weeks (interquartile range [IQR]:38-40) and median birth weight 3160g (IQR: 2818-3308). Three women had unfavourable pregnancy outcomes, with infants born prematurely, two with low birth weight, one of whom developed respiratory distress syndrome. Of the 18 infants evaluated at 12 months, ten (56%) had possible or confirmed unfavourable outcomes. Two infants had confirmed congenital anomalies and three possible congenital anomalies, but only one had first-trimester drug exposure. One infant died, another was diagnosed with MDR/RR-TB and started on treatment, and three infants had signs/symptoms of TB necessitating referral for care.CONCLUSIONSThese limited data suggests that in pregnant women, the BDLLfx/BDLCfz regimens have improved treatment and pregnancy outcomes compared to prior regimens. However, there is a high prevalence of unfavourable infant outcomes.
{"title":"Pregnant women with MDR/RR-TB and the all-oral 6-month regimen: experiences from a patient series in South Africa.","authors":"Marian Loveday,Emma Clarence,Sindisiwe Hlangu,Nalini Singh,Sunitha Chotoo,James C M Brust,Catriona Waitt,Richard Court,Jennifer Furin","doi":"10.1093/cid/ciag032","DOIUrl":"https://doi.org/10.1093/cid/ciag032","url":null,"abstract":"BACKGROUNDThere is limited experience of the all-oral 6-month regimens containing bedaquiline, delamanid, linezolid and levofloxacin/clofazimine (BDLLfx/BDLCfz) in pregnant women with MDR/RR-TB. We report maternal treatment, pregnancy, and infant outcomes to 12 months of age in a cohort of pregnant women treated with these regimens.METHODSWe included pregnant women treated for MDR/RR-TB from September 2023 to January 2025 in KwaZulu-Natal, South Africa in a prospective observational study. Outcomes were collected through ongoing record reviews. Infant clinical assessments were conducted at six weeks, six and 12 months.RESULTSOf 25 pregnant women with MDR/RR-TB, 21 received BDLLfx/BDLCfz; 12 (57%) were living with HIV. Although 10/21 (48%) of the women developed anaemia, 18 (86%) had favourable treatment outcomes. All 21 infants were born alive; median gestational age 39 weeks (interquartile range [IQR]:38-40) and median birth weight 3160g (IQR: 2818-3308). Three women had unfavourable pregnancy outcomes, with infants born prematurely, two with low birth weight, one of whom developed respiratory distress syndrome. Of the 18 infants evaluated at 12 months, ten (56%) had possible or confirmed unfavourable outcomes. Two infants had confirmed congenital anomalies and three possible congenital anomalies, but only one had first-trimester drug exposure. One infant died, another was diagnosed with MDR/RR-TB and started on treatment, and three infants had signs/symptoms of TB necessitating referral for care.CONCLUSIONSThese limited data suggests that in pregnant women, the BDLLfx/BDLCfz regimens have improved treatment and pregnancy outcomes compared to prior regimens. However, there is a high prevalence of unfavourable infant outcomes.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"4 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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