Clinical Infectious Diseases 'Under Review': What Each Status Means and When to Expect a Decision

Before the paper reaches external reviewers, the CID Editor-in-Chief or a deputy editor performs editorial review. If the paper is not a good fit for any IDSA journal, the editors will desk reject the paper prior to peer review, with a goal to make these desk rejection decisions within one week of submission. About 50 to 60 percent of submissions are desk-rejected at this stage.

A desk rejection most often means the editor concluded that the work would fit better at a sister IDSA journal (Open Forum Infectious Diseases for open-access cascade, The Journal of Infectious Diseases for basic-translational, IDSA practice guidelines for non-research) or that the clinical infectious-diseases priority bar is not met.

The CID editorial office initial quality check ensures that all necessary materials are present: manuscript with figures embedded, supplementary information separate, CONSORT checklist for clinical trials (required), reporting checklists where applicable (STROBE for observational studies, PRISMA for systematic reviews), cover letter directed to the editor, conflict-of-interest declarations, ethics-statement documentation, IRB approvals, trial-registration documentation, and data-availability statement.

The EIC or deputy editor reads the paper and evaluates clinical infectious-diseases priority, methodological rigor, IDSA family routing, and whether the paper warrants external peer review. The 1-week desk target reflects IDSA's commitment to rapid editorial response.

In parallel with the EIC or deputy editor's primary read, ambiguous-fit papers are discussed across the IDSA editorial team where peer deputy editors weigh in on whether the paper would fit better at CID flagship or at sister IDSA journals (Open Forum Infectious Diseases, The Journal of Infectious Diseases). This editorial-team discussion runs alongside the desk-screen and adds 3 to 7 days to the timeline that is invisible to the author in the portal.

Papers that are accepted for peer review are assigned to an associate editor or another appropriate editor who manages the external peer review process and invites reviewers whose expertise aligns with the focus of the manuscript.

CID associate editors typically invite 2 to 3 external reviewers, with reviewer recruitment typically taking 7 to 14 days. The recruitment window can take longer because reviewers with topic-matched infectious-disease subspecialty expertise (especially across antimicrobial resistance, HIV/AIDS, transplant ID, hospital-acquired infection, and tropical medicine boundaries) are scarce.

Once reviewers agree to review, the typical CID peer-review cycle lasts 2 to 6 weeks per reviewer. External peer review is a single-anonymous process at the journal, meaning that reviewers are anonymous to each other and to the paper's authors. Reviewers are asked to evaluate clinical infectious-diseases priority, methodological rigor, CONSORT/STROBE compliance, and reproducibility. Reviewer reports for CID tend to be thorough; 2000 to 4000 word reports are typical.

After reports return, the associate editor synthesizes them and recommends a decision to the EIC. The EIC reviews and issues the final decision.

• Rejection within 1 to 7 days: EIC or deputy editor desk rejection per the 1-week target.

• Still Under Review after 2 weeks: Strong signal. Paper passed the deputy editor desk screen and is in active review.

• Still Under Review after 10 weeks: Reviewer-recruitment or reviewer-report delay. A polite inquiry via the ScholarOne portal is appropriate.

• Status changes to "Decision Pending": Reports are in; expect a decision within 1 to 2 weeks.

This is the most common anxiety we hear from CID authors during the active editorial window. The honest answer: no, 6 weeks at Under Review puts you in the normal middle of CID's post-screen review distribution. Reports may already be in editorial synthesis with the associate editor preparing the recommendation for the EIC. Most reviewer-driven delays come from reviewer-recruitment timing for infectious-disease subspecialty experts rather than slow reviews.

If the portal still says Under Review at the 10-week mark, the most likely explanation is that one of the assigned reviewers asked for an extension and the associate editor granted it. This is normal practice at CID.

What you should NOT do during the 6-to-10-week window is email the editorial office. CID deputy editors and associate editors are working academic infectious-disease physicians managing 40+ active papers around their own clinical practice; an inquiry at 6 weeks adds friction without accelerating the timeline.

If your CID paper is rejected after review, the natural cascade depends on what the reviewers and associate editor cited:

Open Forum Infectious Diseases (OFID) is the natural IDSA open-access cascade for infectious-diseases papers where the priority bar of CID is not met but the rigor is high. IDSA supports manuscript-transfer with reviewer reports preserved.

The Journal of Infectious Diseases (JID) is the IDSA cascade for basic-translational infectious-diseases work. JID uses ScholarOne at ScholarOne submission portal; editorial contact jid.editorialoffice@oup.com.

Clinical Microbiology and Infection (CMI) is the external ESCMID cascade for European clinical microbiology and infectious-diseases papers.

JAMA is the external general-medicine cascade for top clinical infectious-diseases trials. JAMA uses ScholarOne at ScholarOne submission portal; editorial contact jama-editor@jamanetwork.org.

The Lancet Infectious Diseases is the Lancet specialty cascade for top global-impact infectious-diseases. The Lancet uses Editorial Manager at Editorial Manager submission portal; editorial contact editorial@lancet.com.

NEJM is the external top-tier general-medicine cascade for evidence-changes-practice infectious-diseases trials. NEJM uses ScholarOne at ScholarOne submission portal; editorial contact nejm@nejm.org.

IDSA asks reviewers at CID to evaluate four things specifically. The table below maps each to actionable preparation.

In our pre-submission work with CID-targeted manuscripts, three named patterns generate the most consistent reviewer concerns and the most common reasons papers miss the editorial bar or fail the desk screen.

Narrow-subspecialty framing flagged at EIC or deputy editor screen. When a Clinical Infectious Diseases introduction frames the work too narrowly within one infectious-diseases subspecialty without broader clinical priority, deputy editor desk rejection within the 1-week target is common. The strongest manuscripts make the patient-care, antimicrobial-stewardship, outbreak-response, transplant-ID, HIV, or hospital-epidemiology consequence visible in the abstract and first figure. A CID paper can be methodologically sound and still miss the journal if the clinical decision surface is buried in the discussion.

Check whether your CID clinical-priority framing is broad enough →

Reporting checklist gaps surface as reviewer concerns. When CONSORT, STROBE, or PRISMA checklists are incomplete or items say "see Methods" without actual Methods coverage, Clinical Infectious Diseases reviewers consistently request expanded reporting sections. We see this most often in cohort-selection language, missing denominator definitions, under-explained sensitivity analyses, and supplementary tables that do not match the abstract claim. The strongest manuscripts complete the relevant checklist fully before submission and make every checklist item traceable to methods, results, or supplement text.

Check your CID reporting-checklist coverage →

IDSA cascade offers from associate editor. When the Clinical Infectious Diseases associate editor concludes the work is rigorous but the CID priority bar is not met, transfer offers to Open Forum Infectious Diseases or The Journal of Infectious Diseases are common. Authors can also use the IDSA pathway for papers previously reviewed and rejected by high-impact medical journals outside the IDSA portfolio, which may see faster review times.

The practical distinction is whether the limitation is scope, clinical actionability, or basic-translational emphasis; each points to a different revision and routing plan.

Check whether CID, OFID, or JID is the better route →

We have reviewed 50+ manuscripts targeting Clinical Infectious Diseases, Open Forum Infectious Diseases, The Journal of Infectious Diseases, Lancet Infectious Diseases, and major general-medicine journals. This guide tells you what Clinical Infectious Diseases editors look for in the status window, while the review tells you whether your paper passes the same clinical-priority, methods, reporting-checklist, and IDSA-routing checks before the deputy editor or external reviewers see it. Full Manusights reviews include a 60-day money-back guarantee, and we do not train models on your manuscript.

We have found that the strongest CID revisions make the clinical decision point visible in the abstract and then prove it through complete checklist traceability in the methods, results tables, and supplement.

In our pre-submission review work across infectious-disease, clinical-epidemiology, and general-medicine targets, CID-bound drafts most often failed when the abstract promised a clinical decision point but the methods, results tables, and supplement did not make the decision usable. In our review work we see that mismatch as a recurring failure pattern, especially for observational studies with incomplete STROBE traceability.

Source limitation: official guidance explains IDSA editorial routing and review mechanics, but it cannot diagnose whether your specific evidence package is strong enough for CID rather than OFID or JID.

Use this guide when you need to separate normal CID review silence from a true follow-up moment before you submit, withdraw, or prepare an IDSA transfer plan.

This page was created from IDSA's public CID author guidelines at Oxford Academic author instructions, IDSA editorial documentation (1-week desk rejection target, initial quality check + EIC or deputy editor editorial review + associate editor external-peer-review management, single-anonymous peer review, IDSA transfer pathway for papers previously reviewed and rejected by high-impact medical journals outside the IDSA portfolio), and Manusights pre-submission review experience with CID-targeted manuscripts.

For the infectious-diseases landscape beyond CID, see Open Forum Infectious Diseases (IDSA open-access cascade), The Journal of Infectious Diseases (IDSA basic-translational), Clinical Microbiology and Infection (ESCMID), and external infectious-diseases alternatives (JAMA, Lancet Infectious Diseases, NEJM).

The choice across these titles depends on whether the central contribution is top IDSA clinical infectious-diseases (CID), IDSA open-access (Open Forum), basic-translational (JID), European clinical microbiology (CMI), top AMA general-medicine (JAMA), top global-impact infectious-diseases (Lancet Infectious Diseases), or top evidence-changes-practice (NEJM).

Reviewers at CID typically draw from 2 to 3 infectious-disease subspecialty experts under a single-anonymous model. Editors screen and triage manuscripts before any external reviewer sees them, and preparing a response template that addresses both clinical-infectious-diseases priority and reporting-checklist perspectives accelerates revision rounds substantially.

For a pre-upload check of your manuscript against the CID clinical-infectious-diseases-priority bar before submission, our Clinical Infectious Diseases pre-submission diagnostic flags the framing and checklist-compliance weaknesses most likely to surface in reviewer reports.