{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:44:52Z","timestamp":1792025092957,"version":"4.4.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004837","name":"Spanish Ministry of Science and Innovation","doi-asserted-by":"publisher","award":["PID2024-161570OB-I00"],"award-info":[{"award-number":["PID2024-161570OB-I00"]}],"id":[{"id":"10.13039\/501100004837","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI24CIII\/00045"],"award-info":[{"award-number":["PI24CIII\/00045"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","award":["MPY262\/25"],"award-info":[{"award-number":["MPY262\/25"]}],"id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","award":["FPU21\/01798"],"award-info":[{"award-number":["FPU21\/01798"]}],"id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The emergence of vaccine-covered serotypes causing invasive pneumococcal disease (IPD) is a serious concern worldwide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We characterized all national serotype 4 IPD isolates from children and adults received at the Spanish Pneumococcal Reference Laboratory (2009\u20132024).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We investigated the unexpected rise of serotype 4 causing IPD in young adults after the COVID-19 pandemic, affecting the elderly population in recent years. Epidemiological and genomic analysis confirmed that the rise started as an abrupt cluster of cases in Seville (Andalusia) in the year 2022 due to the ST15063 within the GPSC12 lineage. This outbreak initially affected nonvaccinated young individuals associated with high rates of tobacco smoking, alcohol, and inhaled drugs followed by a general distribution through the country in the following years that affected adults \u226565 years old. Moreover, ST15063 serotype 4 strains displayed enhanced infection rates of human lung cells that significantly increased in the presence of cigarette smoke exposure and by influenza A(H3N2) coinfection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings highlight the need for targeted vaccination strategies, molecular surveillance, and focused interventions in high-risk populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiag326","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T11:20:11Z","timestamp":1782127211000},"page":"e922-e934","source":"Crossref","is-referenced-by-count":1,"title":["Lineage Dynamics and Risk Factors Underlying Serotype 4 Invasive Pneumococcal Disease in Spain"],"prefix":"10.1093","volume":"234","author":[{"given":"Covadonga","family":"P\u00e9rez-Garc\u00eda","sequence":"first","affiliation":[{"name":"Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III , Madrid ,","place":["Spain"]},{"name":"CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquin","family":"Llorente","sequence":"additional","affiliation":[{"name":"Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Hospital Universitario Virgen del Roc\u00edo , Seville ,","place":["Spain"]},{"name":"Doctoral Program in Biomedical Sciences and Public Health, Spanish University of Distance Education , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Elena","family":"Aguirre Alastuey","sequence":"additional","affiliation":[{"name":"Internal Medicine Service, Hospital Universitario Virgen de Valme , Seville ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirella","family":"Llamos\u00ed","sequence":"additional","affiliation":[{"name":"Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III , Madrid ,","place":["Spain"]},{"name":"CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Gil-Prieto","sequence":"additional","affiliation":[{"name":"Department of Medical Specialties and Public Health, University Rey Juan Carlos, Alcorc\u00f3n , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7928-984X","authenticated-orcid":false,"given":"Gabriel","family":"Laghlali","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah","family":"El-Ayache","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3156-3132","authenticated-orcid":false,"given":"Michael","family":"Schotsaert","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"The Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Marc and Jennifer Lipschultz Institute for Precision Immunology, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Department of Immunology and Immunotherapy, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1737-8064","authenticated-orcid":false,"given":"Jorge","family":"del Diego-Salas","sequence":"additional","affiliation":[{"name":"Health and Consumption Department, General Directorate of Public Health and Pharmaceutical Management of Andalusia , Seville ,","place":["Spain"]},{"name":"Spanish Ministry of Health Health promotion and prevention, , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Miguel","family":"Cisneros","sequence":"additional","affiliation":[{"name":"Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Hospital Universitario Virgen del Roc\u00edo , Seville ,","place":["Spain"]},{"name":"CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6551-1827","authenticated-orcid":false,"given":"Adolfo","family":"Garc\u00eda-Sastre","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"The Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirian","family":"Domenech","sequence":"additional","affiliation":[{"name":"Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III , Madrid ,","place":["Spain"]},{"name":"CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9340-6867","authenticated-orcid":false,"given":"Julio","family":"Sempere","sequence":"additional","affiliation":[{"name":"Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III , Madrid ,","place":["Spain"]},{"name":"CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7996-0837","authenticated-orcid":false,"given":"Jose","family":"Yuste","sequence":"additional","affiliation":[{"name":"Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III , Madrid ,","place":["Spain"]},{"name":"CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"2026101419583362200_jiag326-B1","doi-asserted-by":"crossref","first-page":"5691","DOI":"10.1016\/j.vaccine.2015.08.009","article-title":"Secular trends (1990\u20132013) in serotypes and associated non-susceptibility of S. pneumoniae isolates causing invasive disease in the pre-\/post-era of pneumococcal conjugate vaccines in Spanish regions without universal paediatric pneumococcal vaccination","volume":"33","author":"Fenoll","year":"2015","journal-title":"Vaccine"},{"key":"2026101419583362200_jiag326-B2","doi-asserted-by":"crossref","first-page":"e3778","DOI":"10.1093\/cid\/ciaa1483","article-title":"Nationwide trends of invasive pneumococcal disease in Spain from 2009 through 2019 in children and adults during the pneumococcal conjugate vaccine era","volume":"73","author":"de Miguel","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2026101419583362200_jiag326-B3","doi-asserted-by":"crossref","first-page":"e744","DOI":"10.1016\/S2666-5247(22)00127-6","article-title":"Effect of pneumococcal conjugate vaccines and SARS-CoV-2 on antimicrobial resistance and the emergence of Streptococcus pneumoniae serotypes with reduced susceptibility in Spain, 2004\u201320: a national surveillance study","volume":"3","author":"Sempere","year":"2022","journal-title":"The Lancet Microbe"},{"key":"2026101419583362200_jiag326-B4","doi-asserted-by":"crossref","first-page":"e0153025","DOI":"10.1128\/aac.01530-25","article-title":"Emergence of antibiotic-resistant pneumococcal serotypes causing invasive pneumococcal disease in children, Spain","volume":"70","author":"Llorente","year":"2026","journal-title":"Antimicrob Agents Chemother"},{"key":"2026101419583362200_jiag326-B5","doi-asserted-by":"crossref","first-page":"106204","DOI":"10.1016\/j.jinf.2024.106204","article-title":"Surveillance of invasive pneumococcal disease in Spain exploring the impact of the COVID-19 pandemic (2019\u20132023)","volume":"89","author":"P\u00e9rez-Garc\u00eda","year":"2024","journal-title":"J Infect"},{"key":"2026101419583362200_jiag326-B6","doi-asserted-by":"crossref","first-page":"2521845","DOI":"10.1080\/22221751.2025.2521845","article-title":"The rise of serotype 8 is associated with lineages and mutations in the capsular operon with different potential to produce invasive pneumococcal disease","volume":"14","author":"P\u00e9rez-Garc\u00eda","year":"2025","journal-title":"Emerg Microbes Infect"},{"key":"2026101419583362200_jiag326-B7","doi-asserted-by":"publisher","first-page":"101365","DOI":"10.1016\/j.lanmic.2026.101365","article-title":"Upsurge of pneumococcal clade I-\u03b1\/CC180 serotype 3 and its association with a LytA mutation linked to enhanced evasion of the host immune response and disease potential: an observational and experimental study [manuscript published online ahead of print 27 May 2026]","author":"P\u00e9rez-Garc\u00eda","year":"2026","journal-title":"Lancet Microbe"},{"key":"2026101419583362200_jiag326-B8","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/S1473-3099(23)00706-5","article-title":"Invasive pneumococcal disease 3 years after introduction of a reduced 1 + 1 infant 13-valent pneumococcal conjugate vaccine immunisation schedule in England: a prospective national observational surveillance study","volume":"24","author":"Bertran","year":"2024","journal-title":"Lancet Infect Dis"},{"key":"2026101419583362200_jiag326-B9","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.3390\/microorganisms11051333","article-title":"Changes in the incidence of invasive pneumococcal disease in Calgary, Canada, during the SARS-CoV-2 pandemic 2020\u20132022","volume":"11","author":"Ricketson","year":"2023","journal-title":"Microorganisms"},{"key":"2026101419583362200_jiag326-B10","doi-asserted-by":"crossref","first-page":"36","DOI":"10.14745\/ccdr.v52i0102a05","article-title":"Invasive pneumococcal disease surveillance in Canada, 2023","volume":"52","author":"Golden","year":"2026","journal-title":"Can Commun Dis Rep"},{"key":"2026101419583362200_jiag326-B11","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1093\/infdis\/jiae453","article-title":"Increased proportions of invasive pneumococcal disease cases among adults experiencing homelessness sets the stage for new serotype 4 capsular-switch recombinants","volume":"231","author":"Beall","year":"2025","journal-title":"J Infect Dis"},{"key":"2026101419583362200_jiag326-B12","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1093\/infdis\/jiaa501","article-title":"Upsurge of conjugate vaccine serotype 4 invasive pneumococcal disease clusters among adults experiencing homelessness in California, Colorado, and New Mexico","volume":"223","author":"Beall","year":"2021","journal-title":"J Infect Dis"},{"key":"2026101419583362200_jiag326-B13","doi-asserted-by":"crossref","first-page":"108216","DOI":"10.1016\/j.ijid.2025.108216","article-title":"Rapid increase in serotype 4 invasive pneumococcal disease among vulnerable young male adults in Belgium (2020\u20132024)","volume":"163","author":"Cuypers","year":"2026","journal-title":"Int J Infect Dis"},{"key":"2026101419583362200_jiag326-B14","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/j.vaccine.2021.10.046","article-title":"International links between Streptococcus pneumoniae vaccine serotype 4 sequence type (ST) 801 in Northern European shipyard outbreaks of invasive pneumococcal disease","volume":"40","author":"Gladstone","year":"2022","journal-title":"Vaccine"},{"key":"2026101419583362200_jiag326-B15","doi-asserted-by":"crossref","first-page":"e32","DOI":"10.1017\/S0950268824001870","article-title":"Second reported outbreak of pneumococcal pneumonia among shipyard employees in Turku, Finland, August-October 2023: a case-control study","volume":"153","author":"Kitowska","year":"2025","journal-title":"Epidemiol Infect"},{"key":"2026101419583362200_jiag326-B16","doi-asserted-by":"crossref","first-page":"2500758","DOI":"10.2807\/1560-7917.ES.2025.30.41.2500758","article-title":"Third Streptococcus pneumoniae disease outbreak involving serotype 4-ST801 in a shipyard, Finland, May to June 2025","volume":"30","author":"Manca","year":"2025","journal-title":"Euro Surveill"},{"key":"2026101419583362200_jiag326-B17","doi-asserted-by":"crossref","first-page":"1900681","DOI":"10.2807\/1560-7917.ES.2019.24.49.1900681","article-title":"Outbreak of invasive pneumococcal disease among shipyard workers, Turku, Finland, May to November 2019","volume":"24","author":"Linkevicius","year":"2019","journal-title":"Euro Surveill"},{"key":"2026101419583362200_jiag326-B18","doi-asserted-by":"crossref","first-page":"e00190-20","DOI":"10.1128\/mSystems.00190-20","article-title":"Bactopia: a flexible pipeline for complete analysis of bacterial genomes","volume":"5","author":"Petit","year":"2020","journal-title":"mSystems"},{"key":"2026101419583362200_jiag326-B19","doi-asserted-by":"crossref","first-page":"775402","DOI":"10.3389\/fcimb.2021.775402","article-title":"Streptococcus pneumoniae: a plethora of temperate bacteriophages with a role in host genome rearrangement","volume":"11","author":"Martin-Galiano","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"key":"2026101419583362200_jiag326-B20","doi-asserted-by":"crossref","first-page":"827","DOI":"10.3390\/microorganisms13040827","article-title":"Structure, function, and regulation of LytA: the N-acetylmuramoyl-l-alanine amidase driving the \u201csuicidal tendencies\u201d of Streptococcus pneumoniae\u2014a review","volume":"13","author":"Garcia","year":"2025","journal-title":"Microorganisms"},{"key":"2026101419583362200_jiag326-B21","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1128\/JCM.01454-08","article-title":"Temporal trends of invasive Streptococcus pneumoniae serotypes and antimicrobial resistance patterns in Spain from 1979 to 2007","volume":"47","author":"Fenoll","year":"2009","journal-title":"J Clin Microbiol"},{"key":"2026101419583362200_jiag326-B22","doi-asserted-by":"crossref","first-page":"3447","DOI":"10.1128\/JCM.36.12.3447-3454.1998","article-title":"Evolution of Streptococcus pneumoniae serotypes and antibiotic resistance in Spain: update (1990 to 1996)","volume":"36","author":"Fenoll","year":"1998","journal-title":"J Clin Microbiol"},{"key":"2026101419583362200_jiag326-B23","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/S1473-3099(17)30654-0","article-title":"Pneumococcal conjugate vaccine 13 delivered as one primary and one booster dose (1 + 1) compared with two primary doses and a booster (2 + 1) in UK infants: a multicentre, parallel group randomised controlled trial","volume":"18","author":"Goldblatt","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2026101419583362200_jiag326-B24","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.3201\/eid2707.204403","article-title":"Whole-genome analysis of Streptococcus pneumoniae serotype 4 causing outbreak of invasive pneumococcal disease, Alberta, Canada","volume":"27","author":"Kellner","year":"2021","journal-title":"Emerg Infect Dis"},{"key":"2026101419583362200_jiag326-B25","doi-asserted-by":"crossref","first-page":"570","DOI":"10.3390\/vaccines13060570","article-title":"Two outbreaks of invasive pneumococcal disease in nursing homes in Gipuzkoa, northern Spain","volume":"13","author":"Marimon","year":"2025","journal-title":"Vaccines"},{"key":"2026101419583362200_jiag326-B26","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.jinf.2019.10.009","article-title":"Outbreaks of severe pneumococcal disease in closed settings in the conjugate vaccines era, 2010\u20132018: a systematic review to inform national guidance in the UK","volume":"79","author":"Amin-Chowdhury","year":"2019","journal-title":"J Infect"},{"key":"2026101419583362200_jiag326-B27","doi-asserted-by":"crossref","first-page":"3945","DOI":"10.1016\/j.vaccine.2017.06.010","article-title":"Serious pneumococcal disease outbreak in men exposed to metal fume\u2014detection, response and future prevention through pneumococcal vaccination","volume":"35","author":"Ewing","year":"2017","journal-title":"Vaccine"},{"key":"2026101419583362200_jiag326-B28","doi-asserted-by":"crossref","first-page":"1270848","DOI":"10.3389\/fcimb.2023.1270848","article-title":"Pilus of Streptococcus pneumoniae: structure, function and vaccine potential","volume":"13","author":"Miao","year":"2023","journal-title":"Front Cell Infect Microbiol"},{"key":"2026101419583362200_jiag326-B29","doi-asserted-by":"crossref","first-page":"2510005","DOI":"10.1080\/21645515.2025.2510005","article-title":"Serotype 3 invasive pneumococcal disease in Tuscany across the eras of conjugate vaccines (2005\u20132024) and anthropic-driven respiratory virus fluctuations","volume":"21","author":"Lodi","year":"2025","journal-title":"Hum Vaccin Immunother"},{"key":"2026101419583362200_jiag326-B30","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1186\/s12879-016-1648-2","article-title":"Epidemiology of invasive pneumococcal infections: manifestations, incidence and case fatality rate correlated to age, gender and risk factors","volume":"16","author":"Backhaus","year":"2016","journal-title":"BMC Infect Dis"},{"key":"2026101419583362200_jiag326-B31","doi-asserted-by":"crossref","first-page":"164","DOI":"10.2471\/BLT.20.273052","article-title":"Smoking and epidemics of respiratory infections","volume":"99","author":"Sitas","year":"2021","journal-title":"Bull World Health Organ"}],"container-title":["The Journal of Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jid\/advance-article-pdf\/doi\/10.1093\/infdis\/jiag326\/68626786\/jiag326.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jid\/article-pdf\/234\/4\/e922\/68626786\/jiag326.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jid\/article-pdf\/234\/4\/e922\/68626786\/jiag326.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:58:44Z","timestamp":1792022324000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jid\/article\/234\/4\/e922\/8718922"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":31,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,6,30]]},"published-print":{"date-parts":[[2026,10,15]]}},"URL":"https:\/\/doi.org\/10.1093\/infdis\/jiag326","relation":{},"ISSN":["0022-1899","1537-6613"],"issn-type":[{"value":"0022-1899","type":"print"},{"value":"1537-6613","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10,15]]},"published":{"date-parts":[[2026,6,30]]}}}