NEJM Journal Watch Infectious Diseases Top Stories of 2021

Dear Readers,

As we did in 2020, we have again assembled two Top Ten story lists — COVID-19 and non–COVID-19 — for Journal Watch Infectious Diseases in 2021. The COVID-19 list begins with the landmark reports of the Pfizer-BioNTech and Moderna COVID-19 mRNA vaccines, followed by two subsequent studies on the effectiveness of the Pfizer-BioNTech vaccine in pregnant women and the impact of this vaccine on SARS-CoV-2 viral load in breakthrough cases. We also included three major studies demonstrating the effectiveness of a monoclonal antibody cocktail, the interleukin-6 inhibitor tocilizumab, and the Jak inhibitor baricitinib. Finally, we selected studies on mortality in patients with influenza compared with COVID-19, the impact of COVID-19 on persons living with HIV, and the safety of transplantation using donor organs of individuals who had succumbed to COVID-19.

The top COVID-19 stories are as follows:

• The Pfizer-BioNTech COVID-19 Vaccine: Remarkably Effective

• The Moderna COVID-19 Vaccine: Noteworthy Efficacy to Date

• Effectiveness of BNT162b2 COVID-19 Vaccine in Pregnant Women

• Viral Load in Breakthrough Infection After Receiving the Pfizer-BioNTech COVID-19 Vaccine

• Casirivimab and Imdevimab: Phase 3 Trial of the Cocktail

• Largest Randomized Tocilizumab Trial Shows Mortality Reduction

• Baricitinib for Management of Severe COVID-19

• COVID-19: Five Times More Deadly Than Seasonal Influenza

• Certain Categories of Persons Living with HIV Have Worse Covid-19 Outcomes

• Can Organs from SARS-CoV-2–Positive Donors Be Safely Transplanted?

Our list encompassing non–COVID-19 stories leads off with two studies on the effectiveness of cabotegravir for HIV therapy as well as pre-exposure prevention. A third HIV paper describes two phase 3 studies on the efficacy of the broadly neutralizing VRC01 antibody in preventing HIV acquisition. We selected three papers addressing vaccines, including the conjugate typhoid vaccine, early encouraging progress toward a universal influenza vaccine, and the optimal approach for pneumococcal immunization of non-compromised adults. We also chose studies on the efficacy of posaconazole for aspergillosis, the adjunctive use of clindamycin for severe group A streptococcal infections, and the emergence of penicillin- and ciprofloxacin-resistant Neisseria meningitidis. Finally, we included the updated recommendations on management of Lyme disease, the only U.S. medical guideline ever to have undergone a legal challenge. This document has set a standard for guideline development regarding management of conflicts of interest, inclusion of patient representation, and use of a public comment period.

The top non–COVID-19 stories are as follows:

• Long-Acting Cabotegravir plus Rilpivirine: A Viable Option for Management of HIV Infection?

• Long-Acting PrEP Is Here to Stay

• Neutralizing Antibodies to Prevent HIV Acquisition: A Foot in the Door

• Conjugate Vaccine Can Protect Infants and Children Against Typhoid Fever

• On the Path Toward a Universal Influenza Vaccine

• Rethinking Pneumococcal Vaccine Recommendations for Adults

• For Treatment of Invasive Aspergillosis, Posaconazole Was Noninferior to Voriconazole

• Adjunctive Clindamycin Improves Outcomes of Invasive Group A Streptococcal Infection: Best Evidence to Date

• Emergence of Dual Resistance to Penicillin and Ciprofloxacin in Neisseria meningitidis

• Management of Lyme Disease: An Update

Wishing all of you a joyous and safe holiday season.