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In This Issue of JAMA
October 8, 2014


Author Affiliations

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2014;312(14):1373-1375. doi:10.1001/jama.2013.279767
Infectious Disease

Edited by Preeti Malani, MD, MSJ, MS


Developing a vaccine against avian influenza A/H7N9 has been hampered by poor immunogenicity of the H7 surface hemagglutinin. In a randomized trial involving 700 adults, Mulligan and colleagues assessed the safety and immunogenicity of point-of-use mixing and immunization with H7N9 antigen and MF59—a vaccine adjuvant. The authors report that administration of 2 doses of adjuvanted H7N9 vaccine at the lowest tested antigen dose produced seroconversion in 59% of participants. In an Editorial, Treanor discusses options for confronting pandemic influenza.

Editorial and Related Article

In a multicenter clinical trial, Belshe and colleagues investigated the effect of immunologic priming and vaccine adjuvant on immunogenicity of an avian influenza H5N1 variant (A/Anhui/01/2005 [Anhui]) vaccine. The authors report that previous receipt of a single dose of the H5N1 Vietnam vaccine was associated with sufficient immunologic priming to facilitate antibody response to a different H5N1 antigen in the Anhui vaccine. In H5N1 vaccine–naive participants, low dose Anhui vaccine with adjuvant was more immunogenic than higher doses of unadjuvanted vaccine.

Editorial and Related Article

In a cluster-randomized crossover trial conducted in 16 intensive care units (ICUs), Oostdijk and colleagues compared the effects of selective digestive tract decontamination with selective oropharyngeal decontamination—applied as unit-wide interventions—on antibiotic resistance and patient outcomes. The authors found that both strategies were associated with low levels of antibiotic resistance and no difference in 28-day mortality. In an Editorial, Kollef and Micek discuss rational use of antibiotics in the ICU.


In an analysis of cross-sectional data from 1-day prevalence surveys conducted in 183 US acute care hospitals in 10 states between May and September 2011, Magill and colleagues found the prevalence of antimicrobial drug use was 49.9% and use of broad-spectrum drugs was common.

Author Video Interview and Continuing Medical Education

Epstein and colleagues report results of a 2013 investigation of a New Delhi metallo-β-lactamase–producing carbapenem-resistant Escherichia coli (NDM-producing CRE) outbreak at 1 hospital. Thirty-nine case patients were identified. Exposure to duodenoscopes was associated with apparent transmission of the NDM-producing E coli isolate. In an Editorial, Rutala and Weber discuss decontamination of gastrointestinal endoscopes.


Clinical Review & Education

An article in JAMA Neurology described a model to differentiate central from infectious fever in critically ill neurology patients. In this From the JAMA Network article, Vespa discusses diagnosis and treatment of noninfectious fever in patients with critical neurologic illnesses.

A patient presents with an intensely pruritic eruption on his ankle and the sole of his foot, which began 1 week after travel to Puerto Rico. Examination reveals red serpiginous lesions—some with vesicles. What would you do next?

This JAMA Diagnostic Test Interpretation article presents the case of a female student from India who has a positive tuberculin skin test, a history of BCG vaccination, and a negative chest radiograph result. An interferon-γ release assay is ordered. How would you interpret the results?