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Background.Because there may be substantial hidden mortality caused by common seasonal pathogens, we estimated the number of deaths in elderly persons attributable to viruses and bacteria for which robust weekly laboratory surveillance data were available.Methods.On weekly time series (1999–2007) we used regression models to associate total death counts in individuals aged 65–74, 75–84, and ≥85 years (a population of 2.5 million) with pathogen circulation—influenza A (season-specific), influenza B, respiratory syncytial virus (RSV), parainfluenza, enterovirus, rotavirus, norovirus, Campylobacter, and Salmonella—adjusted for extreme outdoor temperatures.Results.Influenza A and RSV were significantly (P < .05) associated with mortality in all studied age groups; influenza B and parainfluenza were additionallyassociated in those aged ≥75 years, and norovirus was additionally associated in those aged ≥85 years. The proportions of deaths attributable to seasonal viruses were 6.8% (≥85 years), 4.4% (75–84 years), and 1.4% (65–74 years), but with great variations between years. Influenza occasionally showed lower impact than some of the other viruses.Conclusions.The number of different pathogens associated with mortality in the older population increases with increasing age. Besides influenza A and RSV, influenza B, parainfluenza and norovirus may also contribute substantially to elderly mortality. [ABSTRACT FROM AUTHOR]

Phylogenetic reconstructions of transmission events from individuals with acute human immunodeficiency virus (HIV) infection are conducted to illustrate this group's heightened infectivity. Varied definitions of acute infection and assumptions about observed phylogenetic clusters may produce misleading results. We conducted a phylogenetic analysis of HIV pol sequences from 165 European patients with estimated infection dates and calculated the difference between dates within clusters. Nine phylogenetic clusters were observed. Comparison of dates within clusters revealed that only 2 could have been generated during acute infection. Previous analyses may have incorrectly assigned transmission events to the acutely HIV infected when they were more likely to have occurred during chronic infection. [ABSTRACT FROM AUTHOR]

Background. Currently, there are no comparable estimates of the short-term risk of disease progression in the absence of effective antiretroviral therapy for human immunodeficiency virus (HIV)-infected adults and children. Methods. A joint analysis of 2 large studies of children with vertically acquired HIV infection (the HIV Paediatric Prognostic Markers Collaborative Study) and adults with seroconversion (the CASCADE [Concerted Action on Sero-Conversion to AIDS and Death in Europel collaboration) was conducted. Follow-up was censored at the end of 1995, before the introduction of combination antiretroviral therapy. The incidence rates of death and AIDS or death (AIDS/death) were estimated on the basis of age and current CD4 cell count. Results. A total of 1260 deaths (over 20,500 person-years of follow-up) and 1894 initial AIDS events (over 17,200 person-years of follow-up) were observed among 6741 patients (3244 children [i.e., patients ⩽15 years of age] and 3497 adults). Young children (age, <5 years) experienced high morbidity and mortality rates. After adjustment for the CD4 cell count, the effect of age on disease progression was not significant among older children, whereas the risk increased markedly in association with increasing age among adults. Death rates were similar among older children and adults aged ~20 years, as were the rates of progression to AIDS/death when cases of serious recurrent bacterial infection, which has a more restrictive case definition in adults, were excluded. Conclusions. Similar CD4 cell count criteria for initiation of antiretroviral therapy can be applied to adults and children ⩾5 years of age. [ABSTRACT FROM AUTHOR]

Objective. To determine whether early postseroconversion CD4 cell counts and human immunodeficiency virus (HIV) loads have changed over time. Methods. Our analysis was based on 22 cohorts of people with known dates of seroconversion from Europe, Australia, and Canada (Concerted Action on Seroconversion to AIDS and Death in Europe Collaboration). We focused on individuals seroconverting between 1985 and 2002 who had the first CD4 cell count ( n = 3687) or HIV load (n = 1584) measured within 2 years of seroconversion and before antiretroviral use. Linear regression models were used to assess time trends in postseroconversion CD4 cell count and HIV load. Trends in time to key thresholds were also assessed, using survival analysis. Results. The overall median initial CD4 cell count was 570 cells/μL (interquartile range [IQR], 413-780 cells/ μL). The median initial HIV load was 35,542 copies/mL (IQR, 7600-153,050 copies/mL; on log10 scale, 3.9-5.2 log10 copies/mL). The postseroconversion CD4 cell count changed by an average of -6.33 cells/μL/year (95% confidence interval [CI], -8.47 to -4.20 cells/μL/year; ), whereas an increase was observed in log10 HIV P < .001 load (+0.044 log10 copies/mL/year; 95% CI, +0.034 to +0.053 log10 copies/mL/year). These trends remained after adjusting for potential confounders. The probability of progressing to a CD4 cell count of <500 cells/μL by 24 months from seroconversion increased from 0.66 (95% CI, 0.63-0.69) for individuals who seroconverted before 1991 to 0.80 (95% CI, 0.75-0.84) for those who seroconverted during 1999-2002. Conclusion. These data suggest that, in Europe, there has been a trend of decrease in the early CD4 cell count and of increase in the early HIV load. Additional research will be necessary to determine whether similar trends exist in other geographical areas. [ABSTRACT FROM AUTHOR]

To describe the spread of hepatitis C virus (HCV) among HCV/human immunodeficiency virus (HIV)-coinfected injection drug users (IDUs), the molecular epidemiology of HCV was studied among 108 IDUs from 7 European countries. Phylogenetic analysis based on the NS5B region showed great sequence variation of HCV within each country and no clear phylogenetic clustering by geographic region. The most prevalent subtypes were la and 3a, but the percentage of genotype 4 was also relatively high, ranging from 7% in northern Europe to 24% in southern Europe. Genotype 4 consisted mainly of subtype 4d and has entered the majority of the IDU populations studied. The significantly lower evolutionary distances within subtype 4d suggest that this subtype may have entered the European IDU population relatively recently. In conclusion, HCV exchange between European IDU populations has occurred on a large scale, and, overall, country-specific clustering for HCV was less than that shown for HIV. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to a letter by Matthias Schröter to a letter to the editor published in previous issue of "The Journal of Infectious Disease."

Presents a letter to the editor about the spread of hepatitis C virus genotypes among injection drug users.

The table of contents for the September 2012 issue of "The Journal of Infectious Diseases" is presented.