{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T15:42:52Z","timestamp":1790091772229,"version":"4.0.1"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"2","funder":[{"DOI":"10.13039\/100020365","name":"Centers for Disease Control and Prevention Emerging Infections Program's","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020365","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Group A Streptococcus (GAS) infections are common in children, ranging from mild to life-threatening invasive disease. Large-scale descriptions of changes in pediatric invasive GAS infections in the United States, particularly during the coronavirus disease 2019 (COVID-19) pandemic, are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used the Centers for Disease Control and Prevention\u2019s (CDC's) Active Bacterial Core surveillance (ABCs), a multistate, population- and laboratory-based surveillance system, to assess changes in pediatric (&amp;lt;18 years old) invasive GAS incidence, clinical presentation, and bacterial strain characteristics from 2004 to 2023. Interrupted time series analysis was used to compare observed versus expected GAS incidence during 2020\u20132023, informed by trends before the COVID-19 pandemic (2004\u20132019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During 2004\u20132023, 2856 invasive GAS cases were identified. Incidence remained stable from 2004 to 2019 (mean incidence 1.9 per 100 000), decreased in 2020 (1.0) and 2021 (0.6), and rebounded in 2022 (1.5) and 2023 (4.4). ICU admission increased from 2011 to 2023; case fatality remained stable. Penicillin resistance was not detected. Clindamycin non-susceptibility doubled from 2011 (3.8%) to 2022 (7.5%), before slightly decreasing in 2023 (6.4%). Infections due to emm1, the most frequently identified emm type in children with severe disease, almost disappeared in 2021 but surged in late 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>After remaining stable for more than a decade, pediatric invasive GAS incidence declined during the COVID-19 pandemic and rebounded in 2022, more than doubling 2004\u20132019 incidence in 2023. Although case fatality remained low, intensive care unit (ICU) admissions increased over time, highlighting the need for effective preventive measures such as vaccines. Increasing clindamycin non-susceptibility bears continued monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag284","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T11:44:58Z","timestamp":1777031098000},"page":"e300-e309","source":"Crossref","is-referenced-by-count":1,"title":["Epidemiology of Pediatric Invasive Group A Streptococcal Infections in 10 US States, 2004\u20132023"],"prefix":"10.1093","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4028-8575","authenticated-orcid":false,"given":"Veena","family":"Ramachandran","sequence":"first","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]},{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0169-0966","authenticated-orcid":false,"given":"Jennifer","family":"Onukwube Okaro","sequence":"additional","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2268-279X","authenticated-orcid":false,"given":"Namrata","family":"Prasad","sequence":"additional","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1862-6370","authenticated-orcid":false,"given":"Soyoun","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley","family":"McGee","sequence":"additional","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8222-7353","authenticated-orcid":false,"given":"Sopio","family":"Chochua","sequence":"additional","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2331-2694","authenticated-orcid":false,"given":"Yuan","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1233-3780","authenticated-orcid":false,"given":"Bridget J","family":"Anderson","sequence":"additional","affiliation":[{"name":"NewYork State Department of Health , Albany, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari E","family":"Burzlaff","sequence":"additional","affiliation":[{"name":"NewYork State Department of Health , Albany, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3787-2705","authenticated-orcid":false,"given":"Lee H","family":"Harrison","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health Department of International Health, , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terresa","family":"Carter","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health Department of International Health, , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Houston","sequence":"additional","affiliation":[{"name":"New Mexico Emerging Infections Program, New Mexico Department of Health , Santa Fe, New Mexico ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M","family":"Sosin","sequence":"additional","affiliation":[{"name":"New Mexico Emerging Infections Program, New Mexico Department of Health , Santa Fe, New Mexico ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7191-7824","authenticated-orcid":false,"given":"Kayla","family":"Fails","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health , St.Paul, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3450-5161","authenticated-orcid":false,"given":"Jennifer","family":"Zipprich","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health , St.Paul, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Petit","sequence":"additional","affiliation":[{"name":"Connecticut Department of Public Health , Hartford, Connecticut ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5948-6799","authenticated-orcid":false,"given":"Maria","family":"Rosales","sequence":"additional","affiliation":[{"name":"California Emerging Infections Program , Oakland, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2048-2871","authenticated-orcid":false,"given":"Shua J","family":"Chai","sequence":"additional","affiliation":[{"name":"California Emerging Infections Program , Oakland, California ,","place":["USA"]},{"name":"Career Epidemiology Field Officer, Division of State and Local Readiness, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1375-8078","authenticated-orcid":false,"given":"William","family":"Schaffner","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center Department of Health Policy, , Nashville, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8741-3729","authenticated-orcid":false,"given":"Tiffanie M","family":"Markus","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center Department of Health Policy, , Nashville, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Thomas","sequence":"additional","affiliation":[{"name":"Oregon Health Authority , Portland, Oregon ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasha","family":"Martin","sequence":"additional","affiliation":[{"name":"Oregon Health Authority , Portland, Oregon ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Tunali","sequence":"additional","affiliation":[{"name":"Georgia Emerging Infections Program , Atlanta, Georgia ,","place":["USA"]},{"name":"Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9924-0458","authenticated-orcid":false,"given":"Jessica","family":"Howard-Anderson","sequence":"additional","affiliation":[{"name":"Georgia Emerging Infections Program , Atlanta, Georgia ,","place":["USA"]},{"name":"Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0548-7247","authenticated-orcid":false,"given":"Meghan","family":"Barnes","sequence":"additional","affiliation":[{"name":"Colorado Department of Public Health and Environment , Denver, Colorado ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1775-5106","authenticated-orcid":false,"given":"Erin","family":"Youngkin","sequence":"additional","affiliation":[{"name":"Colorado Department of Public Health and Environment , Denver, Colorado ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8918-7988","authenticated-orcid":false,"given":"Christopher J","family":"Gregory","sequence":"additional","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"2026090211582471000_ciag284-B1","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1001\/jama.2025.0910","article-title":"Invasive group A streptococcal infections in 10 US states","volume":"333","author":"Gregory","year":"2025","journal-title":"JAMA"},{"key":"2026090211582471000_ciag284-B2","author":"Centers for Disease Control and Prevention"},{"key":"2026090211582471000_ciag284-B3","author":"Centers for Disease Control and Prevention"},{"key":"2026090211582471000_ciag284-B4","doi-asserted-by":"crossref","first-page":"e313","DOI":"10.1097\/INF.0000000000003195","article-title":"The indirect impact of the SARS-CoV-2 pandemic on invasive group A Streptococcus, Streptococcus pneumoniae and Staphylococcus aureus infections in Houston area children","volume":"40","author":"McNeil","year":"2021","journal-title":"Pediatr Infect Dis J"},{"key":"2026090211582471000_ciag284-B5","doi-asserted-by":"crossref","first-page":"3057","DOI":"10.1007\/s00431-023-04967-5","article-title":"Epidemiology and clinical features of Streptococcus pyogenes bloodstream infections in children in Madrid, Spain","volume":"182","author":"Cobo-V\u00e1zquez","year":"2023","journal-title":"Eur J Pediatr"},{"key":"2026090211582471000_ciag284-B6","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2025.2861","article-title":"Invasive group A streptococcal infection in children, 1992\u20132023","volume":"8","author":"Dabaja-Younis","year":"2025","journal-title":"JAMA Netw Open"},{"key":"2026090211582471000_ciag284-B7","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1097\/INF.0000000000004746","article-title":"Changes in epidemiology in pediatric invasive group A streptococcal infections in Ireland during the 2022\u20132023 outbreak","volume":"44","author":"Foley","year":"2025","journal-title":"Pediatr Infect Dis J"},{"key":"2026090211582471000_ciag284-B8","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/S2352-4642(23)00295-X","article-title":"Invasive group A streptococcal infections in children and adolescents in Denmark during 2022\u201323 compared with 2016\u201317 to 2021\u201322: a nationwide, multicentre, population-based cohort study","volume":"8","author":"Nygaard","year":"2024","journal-title":"Lancet Child Adolesc Health"},{"key":"2026090211582471000_ciag284-B9","doi-asserted-by":"crossref","first-page":"2400242","DOI":"10.2807\/1560-7917.ES.2024.29.20.2400242","article-title":"Increase in invasive group A streptococcal infections (iGAS) in children and older adults, Norway, 2022 to 2024","volume":"29","author":"Valcarcel Salamanca","year":"2024","journal-title":"Euro Surveill"},{"key":"2026090211582471000_ciag284-B10","doi-asserted-by":"crossref","first-page":"e122","DOI":"10.1097\/INF.0000000000003810","article-title":"Increase in invasive group a streptococcal infections in children in The Netherlands, A survey among 7 hospitals in 2022","volume":"42","author":"van Kempen","year":"2023","journal-title":"Pediatr Infect Dis J"},{"key":"2026090211582471000_ciag284-B11","doi-asserted-by":"crossref","first-page":"2200942","DOI":"10.2807\/1560-7917.ES.2023.28.1.2200942","article-title":"Increase in invasive group A streptococcal infection notifications, England, 2022","volume":"28","author":"Guy","year":"2023","journal-title":"Euro Surveill"},{"key":"2026090211582471000_ciag284-B12","first-page":"100873","article-title":"Increase in invasive group A streptococcal disease among Australian children coinciding with northern hemisphere surges","volume":"41","author":"Abo","year":"2023","journal-title":"Lancet Reg Health West Pac"},{"key":"2026090211582471000_ciag284-B13","doi-asserted-by":"crossref","first-page":"265","DOI":"10.15585\/mmwr.mm7210a4","article-title":"Notes from the field: increase in pediatric invasive group A Streptococcus infections - Colorado and Minnesota, October\u2013December 2022","volume":"72","author":"Barnes","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026090211582471000_ciag284-B14","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.3201\/eid2109.141333","article-title":"Twenty years of active bacterial core surveillance","volume":"21","author":"Langley","year":"2015","journal-title":"Emerg Infect Dis"},{"key":"2026090211582471000_ciag284-B15","author":"Centers for Disease Control and Prevention"},{"key":"2026090211582471000_ciag284-B16","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1093\/cid\/ciw248","article-title":"Epidemiology of invasive group A streptococcal infections in the United States, 2005\u20132012","volume":"63","author":"Nelson","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2026090211582471000_ciag284-B17","doi-asserted-by":"crossref","DOI":"10.1128\/mBio.01422-17","article-title":"Population and whole genome sequence based characterization of invasive group A streptococci recovered in the United States during 2015","volume":"8","author":"Chochua","year":"2017","journal-title":"mBio"},{"key":"2026090211582471000_ciag284-B18","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1093\/cid\/ciab575","article-title":"Patterns of antibiotic nonsusceptibility among invasive group A Streptococcus infections-United States, 2006\u20132017","volume":"73","author":"Fay","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2026090211582471000_ciag284-B19","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/S1473-3099(20)30523-5","article-title":"Effectiveness of adjunctive clindamycin in \u03b2-lactam antibiotic-treated patients with invasive \u03b2-haemolytic streptococcal infections in US hospitals: a retrospective multicentre cohort study","volume":"21","author":"Babiker","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"2026090211582471000_ciag284-B20","author":"Centers for Disease Control and Prevention"},{"key":"2026090211582471000_ciag284-B21","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s12874-021-01235-8","article-title":"Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: a guide for evaluating large-scale health interventions","volume":"21","author":"Schaffer","year":"2021","journal-title":"BMC Med Res Methodol"},{"key":"2026090211582471000_ciag284-B22","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1093\/infdis\/jiad028","article-title":"Changes in the incidence of invasive bacterial disease during the COVID-19 pandemic in the United States, 2014\u20132020","volume":"227","author":"Prasad","year":"2023","journal-title":"J Infect Dis"},{"key":"2026090211582471000_ciag284-B23","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1086\/521264","article-title":"The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000\u20132004","volume":"45","author":"O'Loughlin","year":"2007","journal-title":"Clin Infect Dis"},{"key":"2026090211582471000_ciag284-B24","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1093\/infdis\/173.4.896","article-title":"Genetic correlates of throat and skin isolates of group A streptococci","volume":"173","author":"Bessen","year":"1996","journal-title":"J Infect Dis"},{"key":"2026090211582471000_ciag284-B25","first-page":"001615","article-title":"The rise and spread of invasive emm49 Streptococcus pyogenes in the USA","volume":"12","author":"Metcalf","year":"2026","journal-title":"Microb Genom"},{"key":"2026090211582471000_ciag284-B26","doi-asserted-by":"crossref","first-page":"ofad563","DOI":"10.1093\/ofid\/ofad563","article-title":"Invasive community-onset gram-positive infections from July 2018 through December 2022 at 2 children's hospitals","volume":"10","author":"Engstrom","year":"2023","journal-title":"Open Forum Infect Dis"},{"key":"2026090211582471000_ciag284-B27","doi-asserted-by":"crossref","first-page":"e91","DOI":"10.1016\/S1473-3099(25)00343-3","article-title":"Invasive group A streptococcal infections: lessons learned from the 2022\u201323 upsurge","volume":"26","author":"Flamant","year":"2026","journal-title":"Lancet Infect Dis"},{"key":"2026090211582471000_ciag284-B28","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1093\/cid\/ciae493","article-title":"Cycles of susceptibility: immunity debt explains altered infectious disease dynamics post -pandemic","volume":"81","author":"Munro","year":"2026","journal-title":"Clin Infect Dis"},{"key":"2026090211582471000_ciag284-B29","doi-asserted-by":"crossref","first-page":"e77","DOI":"10.1093\/infdis\/jiae611","article-title":"Decline of antibodies to major viral and bacterial respiratory pathogens during the COVID-19 pandemic","volume":"231","author":"Lorenz","year":"2025","journal-title":"J Infect Dis"},{"key":"2026090211582471000_ciag284-B30","doi-asserted-by":"crossref","first-page":"342","DOI":"10.3389\/fmicb.2016.00342","article-title":"The association between invasive group A streptococcal diseases and viral respiratory tract infections","volume":"7","author":"Herrera","year":"2016","journal-title":"Front Microbiol"},{"key":"2026090211582471000_ciag284-B31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1542\/pedsos.2024-000284","article-title":"Temporal association between respiratory viruses and invasive streptococcal disease","volume":"1","author":"Teoh","year":"2025","journal-title":"Pediatr Open Sci"},{"key":"2026090211582471000_ciag284-B32","doi-asserted-by":"crossref","first-page":"101497","DOI":"10.1016\/j.lanepe.2025.101497","article-title":"Paediatric invasive group A streptococcal infections and associations with viral infections in 15 European countries after lifting non-pharmaceutical interventions against SARS-CoV-2: an interrupted time-series analysis","volume":"59","author":"Lenglart","year":"2025","journal-title":"Lancet Reg Health Eur"},{"key":"2026090211582471000_ciag284-B33","doi-asserted-by":"crossref","DOI":"10.1542\/peds.105.5.e60","article-title":"Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario group A streptococcal study group","volume":"105","author":"Laupland","year":"2000","journal-title":"Pediatrics"},{"key":"2026090211582471000_ciag284-B34","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1086\/599344","article-title":"Seven-year surveillance of north American pediatric group a streptococcal pharyngitis isolates","volume":"49","author":"Shulman","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2026090211582471000_ciag284-B35","doi-asserted-by":"crossref","first-page":"e582","DOI":"10.1016\/S2589-7500(23)00108-5","article-title":"Trends in invasive bacterial diseases during the first 2 years of the COVID-19 pandemic: analyses of prospective surveillance data from 30 countries and territories in the IRIS consortium","volume":"5","author":"Shaw","year":"2023","journal-title":"Lancet Digit Health"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciag284\/68168560\/ciag284.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/83\/2\/e300\/68168560\/ciag284.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/83\/2\/e300\/68168560\/ciag284.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T15:58:33Z","timestamp":1788364713000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/83\/2\/e300\/8663174"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4,27]]},"published-print":{"date-parts":[[2026,9,2]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciag284","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8,15]]},"published":{"date-parts":[[2026,4,27]]}}}