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Editorial

Abstract

We are pleased that the International Journal of Infectious Diseases (IJID) has been indexed in MEDLINE and Index Medicus. It is a tribute to those of you who have submitted excellent papers, case reports, and reviews and to those who have contributed thoughtful editorials. We expect that heightened exposure both online and in libraries will result in increased submissions and that this will soon warrant publication at bimonthly and eventually monthly intervals. Increased frequency of publication depends on members of the International Society for Infectious Diseases (ISID) and other colleagues and their submission of more manuscripts of the highest scientific merit. We also welcome more letters and encourage critical and spirited commentaries. We urge you to tell your libraries about the IJID and to suggest that they subscribe. Likewise, colleagues who could not attend our biannual meeting should be asked to subscribe as well as to submit the results of their observations and investigations. Much of the credit for the success of IJID goes to its editors and reviewers. The peer review process works because of the expertise, diligence, and timeliness of the reviewers and the experience and judgment of the editors. The editors select reviewers, consider their comments, and determine how to respond to potential contributors. The overall objective is to present information about infectious diseases that has international significance. Since these data frequently originate from regions where English is not the primary language, our staff will provide assistance in editing manuscripts to improve grammar and usage. Command of the English language is not a criterion for acceptance or rejection of a manuscript. However, it does make it easier for the reviewers if a native English speaker has read and revised the manuscript. The recent meeting of the ISID in Boston was clearly a huge success, and the presentations were outstanding. We trust that many of you who participated in this meeting will submit articles to the IJID. Suggestions for supplements from this meeting or from other meetings also are welcomed. Our second issue comprised the proceedings at the Jenner Symposium of the 7th International Congress for Infectious Diseases in Hong Kong, June 10-13, 1996. An independent supplement on fungal infections came from a symposium at the meeting of the International Immunocompromised Host Society, June 23-26, 1996, Assisi, Italy.

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BibTeXRIS

D Armstrong, EM Bernard. 1998. Editorial. https://doi.org/10.1016/s1201-9712(98)90048-0

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Effectiveness of high-dose versus standard-dose influenza vaccines against hospitalisation according to frailty risk: a prespecified analysis of the randomised trial DANFLU-2.

BACKGROUND: Frailty is a major risk factor for influenza-related complications and can influence vaccine effectiveness. We aimed to assess the relative vaccine effectiveness (rVE) of high-dose (HD-IIV) versus standard-dose inactivated influenza vaccine (SD-IIV) in older adults aged 65 years or older according to frailty risk. METHODS: This study was a prespecified analysis of DANFLU-2, an open-label, individually randomised trial, conducted in Denmark during three consecutive influenza seasons (2022-23, 2023-24, and 2024-25). Adults aged 65 years or older were randomised (1:1) to the HD-IIV or SD-IIV group. The primary endpoint was hospitalisation for influenza or pneumonia. Frailty was defined according to the validated Hospital Frailty Risk Score (HFRS) based on ICD-10 codes within 10 years before randomisation. Participants were stratified into three HFRS categories, namely low (<5 points), intermediate (5-15 points), and high (>15 points) frailty risk. The rVE of HD-IIV versus SD-IIV against the primary endpoint was assessed across prespecified HFRS categories and treating HFRS as a continuous variable. Pearson's chi-square test was used to compare safety events across frailty risk groups and randomisation groups. FINDINGS: Among 332&#x2009;438 randomised participants (mean age 73&#xb7;7 years [SD 5&#xb7;8]; 161&#x2009;538 [48&#xb7;6%] were female), 276&#x2009;173 (83&#xb7;1%) had low frailty risk, 52&#x2009;395 (15&#xb7;8%) had intermediate frailty risk, and 3861 (1&#xb7;2%) had high frailty risk. The primary endpoint of hospitalisation for influenza or pneumonia occurred in 1424 (0&#xb7;5%) of 276&#x2009;173 participants with low frailty risk, 761 (1&#xb7;5%) of 52&#x2009;395 with intermediate frailty risk, and 163 (4&#xb7;2%) of 3861 with high frailty risk (relative risk [RR] for intermediate vs low frailty risk 2&#xb7;8 [95% CI 2&#xb7;6-3&#xb7;1]; RR for high vs low frailty risk 8&#xb7;2 [7&#xb7;0-9&#xb7;6]). HFRS as a continuous variable significantly modified the effect of HD-IIV versus SD-IIV against the primary endpoint with higher rVE estimates with increasing HFRS (pinteraction=0&#xb7;020). The rVE was 0&#xb7;2% (95% CI -10&#xb7;8 to 10&#xb7;2) among those with low frailty risk, 13&#xb7;1% (-0&#xb7;4 to 24&#xb7;8) among those with intermediate frailty risk, and 19&#xb7;9% (-10&#xb7;3 to 42&#xb7;1) among those with high frailty risk. No significant interaction was observed when HFRS was assessed according to the prespecified categorical frailty groups (pinteraction=0&#xb7;17). The proportion of participants with at least one serious adverse event increased across frailty risk groups (13&#x2009;366 [4&#xb7;8%] of 275&#x2009;795 for low frailty risk, 5475 [10&#xb7;5%] of 52&#x2009;315 for intermediate frailty risk, and 777 [20&#xb7;2%] of 3850 for high frailty risk; p<0&#xb7;0001), with similar proportions of serious adverse events in the HD-IIV and SD-IIV groups for each frailty risk group. INTERPRETATION: Among adults aged 65 years or older in Denmark, frailty risk might modify the effects of HD-IIV versus SD-IIV against hospitalisation for influenza or pneumonia, with higher rVE estimates with increasing frailty risk. These findings might support considering high-dose influenza vaccines for frail older adults. However, effect modification was not evident when frailty was assessed using prespecified categorical subgroups, and subgroup-specific estimates were imprecise, with 95% CIs crossing the null. These results should be considered exploratory, warranting further investigation. FUNDING: The DANFLU-2 trial was funded by Sanofi.

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