bluuebunny/crossref_metadata_2025 huggingface dataset:
2310. Shifting COVID-19 admission screening practices- An Interrupted Time Series Analysis
Authors: Rosa Rossana M , Gilboa Mayan , Jimenez Adriana , Andrews David , Dinh Huy , Parra Katiuska , Martinez Octavio , Abbo Lilian M
Published: November 2023

Background

Screening of all patients admitted to hospitals for asymptomatic carriage of SARS-CoV-2 (SC2) using polymerase chain reaction (PCR) testing has been a widespread practice since the early months of the COVID-19 pandemic. Universal screening is an effective way of identifying carriers but can lead to delays in care and substantial financial burdens. Furthermore, hospital visitors are not screened by PCR and cannot be mandated to mask at healthcare facilities, and overall levels of COVID-19 activity community-wide have been decreasing. We describe our change in COVID-19 admission screening practices and their impact on the incidence rates of hospital-onset COVID-19 (HOC) infections.

Methods

Study conducted across adult and pediatric acute care and inpatient rehabilitation hospitals at a large integrated, university affiliated, public health system in Miami, Florida. More than half of the rooms across our hospitals are semi-private. The study period was December 1, 2021 to April 30, 2023. Testing criteria on admission and masking practices are presented in Table 1. There were no visitation restrictions throughout the study period. The outcome was rates of HOC per 10,000 patient-days (PD), defined as having a test positive for SC2 on or after day 4 of admission. An Interrupted Times Series Analysis (ITSA) was done to assess changes in level or trend of rates of COVID-19 after modifying admission screening practices.

Results

We identified 434 patients with HOC, with 23.5% of cases occurring in January 2022. The county-wide 7-day percent positivity was 8% when admission testing was modified, and later peaked at 22.4% in January 2023. Prior to the testing change, the HOC rate was 5.29 cases per 10,000 PD, and immediately after it was 2.74 cases per 10,000 PD. The ITSA did not show any immediate changes in level (IRR 1.50 [95% CI 0.36-6.17; p=0.57]) or in trend (IRR 1.03 [95% CI 0.73-1.46; p=0.86]) of HOC infection rates (Figure 1).

Conclusion

After modifying our COVID-19 screening on admission practices to target symptomatic and high-risk patient populations we did not observe increases in the rates of HOC infections and had improved patient flows in the Emergency Department. Individual facility-level and community-wide risk assessments may need to be performed before modifying testing practices.

Disclosures

Lilian M. Abbo, MD, MBA, Ferring: Advisor/Consultant|Pfizer: Advisor/Consultant|Regeneron: Grant/Research Support|Shionogi: Advisor/Consultant
2319. Trends in Health Services Utilization among Veterans with HIV Before and During the COVID-19 Pandemic
Authors: Adekunle Ruth O , Mohamed Ahmed , Pope Charlene , Gebregziabher Mulugeta , Axon Robert
Published: November 2023

Background

Public health efforts to curb the spread of COVID-19 required structural changes to healthcare delivery, necessitating the decrease of in-person visits and the transition to virtual visits. Without sustained adherence to antiretroviral therapy, Persons Living with HIV/AIDS (PLWH) experience increased morbidity and mortality. It is unknown how disruptions in access to healthcare as a result of the COVID-19 pandemic impacted care retention of Veterans with HIV (VWH). We aimed to compare visit volumes for HIV care before and during the ongoing COVID-19 pandemic.

Methods

VWH who receive their care in the Veteran Affairs Health Care System between January 1, 2019, and December 31, 2021, were included in the study. Outpatient visits and inpatient stays for all cohort members were extracted from the Corporate Data Warehouse. Interrupted time series analysis (ITSA) was used to test for healthcare interruption around the date of COVID-19 restriction implementation (end of March 2020 or on 2020 week 15). An additional interruption point was added on week 15 of 2021 based on the data distribution (around the time vaccination became available).

Results

Of the VWH, 34,531 had at least one inpatient or outpatient visit during the study period. The number of distinct patients was approximately similar through 2019 (N=32,391), 2020 (N=32,002), and 2021 (N=31,924). However, the number of total inpatient stays and outpatient visits decreased from 826,317 in 2019 to 728,206 in 2020. ITSA showed a statistically significant reduction (-1790.247; 95% CL [-2724, -854]) in the total number of outpatient visits and inpatient stays around the implementation of COVID-19 restriction around the end of March 2020 followed by an increasing trend (slope= 142, 95% CL [115, 170]) (Figure 1). The second interruption point (intercept= -1250; 95 CL [-2308, -191]) was at 2021 week 15 demonstrating a negative trend [slope =-149, 96; 95% CL [-198, -99]).

Interrupted time series analysis of inpatient stays and outpatient visits for Veterans with HIV prior to and during the ongoing COVID-19 pandemic

Conclusion

Health services for VWH decreased during the peak of the pandemic, though utilization trends demonstrated that the number of visits was decreasing even before the COVID-19 pandemic. Despite the loosening of restrictions, healthcare utilization has not fully rebounded to pre-pandemic rates.

Disclosures

All Authors: No reported disclosures
2321. Prevalence and determinants of depression among healthcare workers during the COVID-19 pandemic in Khujand, Tajikistan, 2022
Authors: Silemonshoeva Jamila , Horth Roberta , Tilloeva Zulfiya Haybullo , Jafarov Navruz , ZIKRIYAROVA S A N A M , Nabirova Dilyara
Published: November 2023

Background

Healthcare workers experienced substantial work overload and stress during the COVID-19 response. Increase in prevalence of mental health conditions among healthcare workers have been reported globally. Low-resource settings, such as Tajikistan, experienced additional challenges related to the COVID-19 pandemic and have scare resources to mitigate mental health consequences. To inform program planning, we aimed to determine prevalence of depression, associated factors, and care gap among healthcare workers.

Methods

We conducted a cross-sectional study of all healthcare providers (physicians, nurses, and nurse assistants) working from July to August 2022 in three COVID-19 referral hospitals and three polyclinics in Khujand city, Tajikistan. We systematically sampled every fifth provider. Depression was assessed using the Hospital Anxiety and Depression Scale. We used multivariable logistic regression model adjusting for random effect of hospital to identify factors associated with depression.

Results

Among 400 healthcare workers, 277 (69%) had depression (Table 1). Half (44%) no longer enjoyed the things they used to (Figure 1). Prevalence of depression was significantly higher (p< 0.01) among females than males (71% vs 59%), nurses than physicians (77% vs 56%). Among providers with depression, 20% had received professional services, 32% had taken a vacation, 32% had severe COVID-19, and 53% experienced frequent respiratory issues, and 56% felt people avoided them because of work. In multivariable analysis depression was associated with being a nurse (adjusted odds ratio [aOR]=3.5; 95% confidence ratio [CI]: 1.7-7.2), having had severe COVID-19 disease (aOR=4.0; 95% CI: 1.4-11.8) and having felt that people avoided them because of work (aOR=1.6; 95% CI: 1.0-2.6) (Table 2). Providers who used respirators >3 hours had lower odds of depression (aOR=0.4; 95% CI: 0.2-0.9).

General characteristics of healthcare providers by depression, Tajikistan, 2022

External pressures, physical conditions and supportive services among and depression among healthcare workers, Tajikistan, 2021

Factors associated with depression among healthcare workers, Tajikistan, 2021

Conclusion

We found high prevalence of depression among healthcare workers in Khujand city, Tajikistan. Timely screening and increase in provision of supportive services for providers is needed. These services should be offered to all providers, and especially targeted towards those with prior severe COVID-19 disease and nurses.

Disclosures

All Authors: No reported disclosures
2326. SARS-CoV-2 PCR Cycle Threshold Trends in Immunocompromised Patients and Implications for Isolation Precautions
Authors: Harris Courtney E , Vaidya Vineeta , Klompas Michael , Rhee Chanu , Baden Lindsey R , Baker Meghan
Published: November 2023

Background

RT-PCR assays for SARS-CoV-2 produce a cycle threshold (Ct) value inversely proportional to the amount of virus detected. Ct values are sometimes used as proxies for infectivity to inform duration of precautions, but trends in Ct values vary between patient populations. We sought to better characterize the potential duration of infectivity using Ct values in immunocompromised patients and how it may vary between different kinds of immunocompromising conditions.

Methods

We performed a single-center, retrospective study of all inpatients or outpatients with solid or hematologic malignancies and a SARS-CoV-2 PCR test with available Ct counts between 12/1/2021 and 9/30/2022 (Omicron predominant period). Patient testing, immunocompromised status, and recent medications were analyzed. Patients with a positive PCR test with Ct value ≤33 were included if they had at least 2 tests within 30 days. PCR tests with Ct values of >33 were considered negative (non-infectious).

Results

398 patients with 399 episodes of SARS-CoV-2 infection were evaluated. 210 (53%) patients had a solid organ malignancy, and 189 (47%) had a hematologic malignancy; in the latter group, 138 (73%) had B-cell depleting therapy or Bruton tyrosine kinase inhibitor (BTKi) therapy in the 6 months preceding their first positive test. SARS-CoV-2 PCRs remained positive with Ct values ≤33 for ≥20 days after a first positive test in 46/189 (24%) patients with hematologic malignancies versus 15/210 (2%) with solid organ malignancies. In the subset who received B-cell depleting or BTKi therapy, 37/138 (27%) tested positive at ≥20 days compared to 9/51 (18%) of those who did not [Figure 1]. Testing remained positive for ≥30 days in 28/189 (15%) patients with hematologic malignancies vs 2/210 (1%) patients with solid organ malignancies [Table 1].

*Patients were included in the denominator of each window if they had a test performed during that time interval (excluding tests>30 days). Patients remained in the denominator once they tested negative.

A. All Immunocompromised Patients B. Patients with Hematologic Malignancy

Conclusion

Patients with hematologic malignancies, specifically those with B-cell depleting or BTKi therapy, were much more likely to test positive with Ct values in the potentially infectious range for prolonged periods compared to those with solid organ malignancy. Time-based strategies for discontinuing precautions should consider not only immunocompromised status but underlying conditions. Test-based clearance may be preferable for patients with hematologic malignancies.

Disclosures

Courtney E. Harris, MD, Dynamed: Advisor/Consultant Michael Klompas, MD, MPH, UpToDate, Inc.: Royalties for chapters on pneumonia Chanu Rhee, MD, MPH, Cytovale: Advisor/Consultant|Pfizer: Advisor/Consultant|UpToDate, Inc.: Honoraria
2354. Factors associated with COVID-19 booster vaccine hesitancy: a nation-wide, cross-sectional survey in Japan
Authors: Honda Hitoshi , Takamatsu Akane , Miwa Toshiki , Tokuda Yasuharu
Published: November 2023

Background

COVID-19 vaccine hesitancy and/or fatigue is increasing as the pandemic enters the endemic phase. The present study aimed to explore current perceptions about COVID-19 booster vaccination among the Japanese public.

Methods

This cross-sectional study used data from the Japan COVID-19 and Society Internet Survey conducted in September 2021 and September 2022. The public’s perceptions of COVID-19 vaccination and factors associated with COVID-19 booster vaccine hesitancy were analyzed using multivariable logistic regression analysis.

Results

In total, 56,735 respondents were included. In the 2022 survey, 74.1% of the respondents (21,216/28,617) completed the primary series of vaccination with booster doses. Factors independently associated with booster vaccine hesitancy were young age (range: 18-29 years; adjusted odds ratio [aOR]: 6.56; 95% confidence interval [CI]: 5.07-8.47), history of COVID-19 (aOR: 1.82; 95% CI: 1.59-2.08), distrust of the Japanese government’s COVID-19 prevention measures (aOR: 1.55; 95% CI: 1.15-2.10), lack of confidence in COVID-19 vaccine efficacy (aOR: 1.30; 95% CI: 1.02-1.65), lack of confidence in COVID-19 vaccine safety (aOR: 1.62; 95% CI: 1.35-1.94), low reliance on the COVID-19 vaccine (aOR: 1.92; 95% CI: 1.35-2.73), and belief in COVID-19 conspiracy theories (aOR: 1.77; 95% CI: 1.17-2.67).

Respondents’ selection

Multivariate analysis of factors associated with COVID-19 booster vaccination hesitancy (n = 17,222)

Conclusion

Providing clear and trustworthy information is critically important to promoting COVID-19 booster vaccination. Policymakers should therefore develop consistent and transparent communication strategies and the ability to respond promptly and flexibly to mitigate the negative impact of COVID-19 on the public while preparing for the next pandemic.

Disclosures

Hitoshi Honda, MD, Moderna: Honoraria
2355. Incidence of Omicron Variant Reinfection and Reduction of Reinfection Risk After Coronavirus Disease 2019 Vaccination in Children
Authors: Ikuse Tatsuki , Aizawa Yuta , Hasegawa Satoshi , Takahashi Masashi , Hayashi Takanori , Kon Miyako , Tamura Tsutomu , Matsumoto Haruki , Saitoh Akihiko
Published: November 2023

Background

Reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become an important concern after the emergence of SARS-CoV-2 omicron variants (e.g., BA.1, BA.2, and BA.5). Reinfection by variants can occur in children; however, data are limited on the incidence of reinfection and the effectiveness of coronavirus disease 2019 (COVID-19) vaccines against reinfection.

Methods

This population-based cohort study collected clinical data for COVID-19 from children aged 15 years or younger who were diagnosed as having COVID-19 in Niigata, Japan, from January through August 2022, when omicron variants dominated. We analyzed three periods with different predominant variants (BA.1, BA.2, and BA.5). Reinfection was monitored during each period and observation was extended through November 2022. We calculated the incidence of reinfection and the hazard ratio (HR) for reinfection in relation to COVID-19 vaccination status.

Results

During the study period, 1338/48,099 children (2.8%) were reinfected by omicron variants; most reinfections occurred in the BA.5-predominant period (1265/1338, 94.5%). The median interval to reinfection was 169 days (interquartile range 120-207 days) (Table 1). Among children eligible for COVID-19 vaccination, the vaccine was effective in preventing reinfection: the HR for reinfection in children who completed vaccination was 0.29 (95% confidence interval, 0.20–0.40) (Figure 1).Table 1.Characteristics of children with primary coronavirus disease 2019 infection during periods of BA.1-, BA.2-, and BA.5-predominance in 2022 in Niigata, JapanFigure 1.Prevalence of pediatric COVID-19 reinfection after complete and incomplete vaccination

The prevalence of reinfection by omicron was analyzed by using Kaplan–Meier analysis. Children aged 5–15 years were classified on the basis of COVID-19 vaccination history before primary infection. The hazard ratio for reinfection among children aged 5–15 years with a history of complete COVID-19 vaccination before primary infection was 0.21 (95% confidential interval 0.16-0.29), as compared with those with a history of incomplete vaccination.

Conclusion

Reinfection in children was frequent when omicron variant BA.5 was predominant in Japan. Children who underwent COVID-19 vaccination had a significantly lower risk of omicron reinfection, which suggests that vaccination is important in preventing reinfection by SARS-CoV-2 omicron variants and preparing for outbreaks of new variants.

Disclosures

All Authors: No reported disclosures
2357. Descriptive Analyses of mRNA-1273 (Moderna COVID-19 vaccine) Spontaneous Reports by Geographic Regions
Authors: Emile-Backer Magalie , Khamamkar Vaishali , Dharia Priyadarshani , Laurent Samantha St , Zhou Cindy Ke , Esposito Daina , Martin David , Straus Walter
Published: November 2023

Background

Given global distribution of the mRNA-1273 vaccine in the pandemic, an understanding of regional differences in adverse event (AE) reporting is needed.

Methods

The Moderna global safety database (GSDB) contains mRNA-1273 associated AE reports directly submitted by health care providers and consumers, as well as from company supported trials and observational studies, reports received from regulators (80%), and identified in the literature. We evaluated AE reports by geographic region using a cross-sectional descriptive analysis.

Results

As of 17 Feb 2023, 1,654,338,053 doses of mRNA-1273 had been distributed. The greatest proportion of doses were in North America (40.2%), Europe (28.9%), and Asia (21.9%). Africa, Middle East, Latin America and Oceania represented < 10% of doses distributed. A total of 2,622,777 events (0.3%) were reported in 686,515 cases. Most cases were reported from Europe (52%) and North America (39.0%). The lowest proportion of reported cases were from Africa and the Middle East (< 0.01% and 0.03%, respectively) (Figure 1). In these regions, a higher proportion of cases were reported for children (74.0% and 44.0%, respectively) compared to the US (14.3%) and Europe (6.2%). The proportion of cases meeting the standard pharmacovigilance definition of ‘serious’ also varied (Figure 2). Across all regions, 49.0% of reported adverse events were indicative of reactogenicity, defined as commonly “expected” vaccine-related reactions (e.g., headache, pyrexia, fatigue). This proportion was highest in Europe (57.0%) and Latin America (59.0%) and lowest in Africa (6.1%). Across all regions, 59.0% of cases did not document medical history, and this was most common ( > 85%) for reports from Africa, Latin America, Asia and Oceania.

Conclusion

Regional differences in frequency and data quality for spontaneous reporting of adverse events was evident. Differences in reporting may be attributable to variability in local reporting infrastructure. Where appropriate, active surveillance studies may supplement spontaneous data to allow for more robust vaccine safety monitoring across regions.

Disclosures

Magalie Emile-Backer, PharmD, CCRP, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Vaishali Khamamkar, MS, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Priyadarshani Dharia, PhD, MD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Samantha St Laurent, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Cindy Ke Zhou, PhD, MBBS, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Daina Esposito, PhD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds David Martin, MD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Walter Straus, MD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds
2358. Safety Profiles of Three Major Types of COVID-19 Vaccine among Two Cohorts of People Living with HIV
Authors: Khawcharoenporn Thana , Hanvivattanakul Sirashat
Published: November 2023

Background

Existing data on adverse effects (AEs) of COVID-19 vaccines among people living with human immunodeficiency virus (PLHIV) are currently limited.

Methods

A cohort study was conducted among PLHIV receiving care at two clinics during COVID-19 epidemics in Thailand (2021-2022). The PLHIV received various types and regimens of COVID-19 vaccines based on vaccine availability and the national policies. Data on vaccine types and AEs were collected and assessed using the online survey system.

Results

Of the 398 vaccinated PLHIV, 365 (92%) had CD4 count at enrollment ≥ 200 cells/µL, 382 (96%) were virologic suppressed, 153 received two doses and 245 received three doses of COVID-19 vaccines. Inactivated and viral vector were the most common vaccine types received by the PLHIV as the first and second doses (47% and 56%, respectively), while mRNA vaccine was the most commonly used as a booster dose (57%). For the first and second vaccine doses, the most common AEs were fever (15% and 11%) and injection site pain (11% and 11%). The mRNA vaccine significantly caused more overall AEs, injection pain, fatigue, and rashes than the other two types, while the mRNA and viral vector vaccines significantly caused more fever than the inactivated vaccine. For a booster dose, viral vector vaccine significantly caused more injection site pain and headache than the other two types. Most of the PLHIV reported that the AE intensity was similar between the first and second doses (49%) and was more for a booster dose compared to the first dose (50%). The majority of all AEs of the first, second and booster doses spontaneously recovered without treatment (55%, 59%, and 59%) or required symptomatic treatment without hospitalization (44%, 40% and 40%). By multivariable analysis, receipt of viral vector or mRNA vaccine and age less than 40 years were independently associated with any AEs of the primary series vaccines, while having AEs from the previous dose and female sex were factors associated with any AEs of a booster vaccine.

Conclusion

The three types of COVID-19 vaccines were generally safe among PLHIV. Most of the AEs were non-severe and did not require hospitalization. PLHIV who were elderly, female or had AEs from the previous vaccine dose should be closely monitored for AEs of the vaccines.

Disclosures

All Authors: No reported disclosures
2365. Effectiveness of COVID-19 Vaccines Against Medically Attended COVID-19 in Pregnant Persons Within the VISION Network, December 2021 - April 2023
Authors: Ciesla Allison Avrich , Link-Gelles Ruth , Fleming-Dutra Katherine E , Lazariu Victoria , Dascomb Kristin K , Grannis Shaun J , Ong Toan , Embi Peter J , Ball Sarah W , Gaglani Manjusha , Kharbanda Anupam , Natarajan Karthik , Zerbo Ousseny , Vazquez-Benitez Gabriela , Irving Stephanie
Published: November 2023

Background

Pregnant people have an increased risk of severe COVID-19, including hospitalization and critical illness. Currently, pregnant people are recommended to receive the same vaccinations as non-pregnant people of the same age and underlying health status (i.e., with or without immunocompromising conditions); however, additional data are needed to inform policy decisions around the potential need for an extra dose during pregnancy to protect mother and infant. Our goal was to estimate effectiveness of COVID-19 vaccination against medically attended COVID-19 among pregnant people, during predominance of the Omicron variant.

Methods

The VISION Network conducted a test-negative, case-control study including emergency department/urgent care (ED/UC) encounters December 2021–April 2023 among immunocompetent pregnant people between the ages of 18-45 years. Encounters were included if COVID-19-like illness (CLI) was documented, and the pregnant person underwent SARS-CoV-2 testing within 14 days prior to the encounter. We compared the odds of vaccination among pregnant persons who tested positive with the odds of vaccination among those who tested negative. Monovalent vaccine effectiveness (VE) was calculated as 1-adjusted odds ratio multiplied by 100.

Results

Among 10,631 eligible CLI-associated ED/UC encounters, 2,022 (19%) were SARS-CoV-2 positive (Table). Of these, 52% of cases and 44% of controls were unvaccinated and 14% of cases and 23% of controls had received a primary series with at least 1 booster. VE of a complete monovalent primary series was 19% (95% CI: 8-29%); VE of a primary series plus a monovalent booster was 39% (95% CI: 27-50%). Median time since last dose was 349 and 219 days, respectively (Figure). VE of bivalent doses and time since last dose within the VISION Network will be available in the coming months.

Conclusion

Monovalent COVID-19 vaccines helped provide protection against medically attended COVID-19 among pregnant people. Pregnant people should stay up to date with all recommended vaccinations.

Disclosures

Gabriela Vazquez-Benitez, PhD, MSc, Abbvie: Grant/Research Support|Sanofi Pasteur: Grant/Research Support
2369. kinetics of total and neutralizing SARS-CoV-2 spike antibodies after the 2nd and 3rd dose of the BNT162b2 covid-19 vaccine and association with epidemiological characteristics and breakthrough infection
Authors: Michos Athanasios , Tatsi Elizabeth-Barbara , Filippatos Filippos , Dellis Charilaos , Syriopoulou Vasiliki
Published: November 2023

Background

Evidence regarding the kinetics of antibody levels after the 2nd and 3rd doses of the BNT162b2 mRNA COVID-19 vaccine with epidemiological parameters and breakthrough infection is limited.

Methods

We prospectively measured total (TAbs) and neutralizing (NAbs) antibodies against the receptor binding domain of SARS-CoV-2 spike protein in healthcare workers (HCWs) 4 and 8 months after the 2nd and 1 and 8 months after the 3rd dose of the BNT162b2 vaccine. Serum samples from HCWs were tested for TAbs using the Elecsys Anti-SARS-CoV-2 S reagent, while NAbs against wild type SARS-CoV-2 and Omicron variant in non-infected HCWs were measured using the blocking ELISA cPass SARS-CoV-2 neutralization antibody detection kit.

Results

A cohort of 486 vaccinated HCWs with BNT162b2 vaccine with median age (IQR): 49 years (38-56) and 377 (77.6%) females were included in the study. A significant increase in breakthrough infections were observed over time. Specifically, 4 and 8 months after the 2nd dose breakthrough infection happened in 8/486 (1.6%) [median time 3 (IQR:0.75) months] and 11/486 (2.3%) [median time 6 (IQR:6)], respectively. One and 8 months after the 3rd dose breakthrough infection happened in 35/486 (7.2%) [median time 1 (IQR:0) month] and 188/486 (38.7%) [median time 4 (IQR:2) months], respectively. No significant differences in vaccinated HCWs 1 month after the 3rd dose were detected among those who got infected or did not have a breakthrough infection during the next 7 month regarding TAbs [median (IQR): 16611 (13011) vs 17572.5 (14501.0), p=0.529] and NAbs [median (IQR): 96.5 (1.7) vs 96.7 (1.9), p=0.555], respectively. After infection, HCWs had significantly increased TAbs levels in all time points compared to non-infected vaccinated HCWs (Table 1). In non-infected HCWs, a negative association of TAbs and NAbs levels with age was detected after the 2nd and 3rd vaccine dose (p< 0.05). No association was found in 8 months after the 3rd dose between antibody levels and demographic and clinical parameters.

Median values of total antibodies (TAbs, U/ml) and neutralizing antibodies (NAbs, %) SARS-CoV-2 spike antibodies after 4 months and 8 months from the 2nd dose, 1 month and 8 months from the 3rd dose of BNT162b2 vaccine. Values refer to median ± interquartile range, P-value1 of Mann-Whitney U test or Kruskall-Wallis H test, P-value2 of two-way analysis of variance (ANOVA). Statistically significant values are marked in bold.

Conclusion

Findings of the present study indicate that levels of TAbs and NAbs after 3 doses of the BNT162b2 vaccine are not directly associated with the possibility of a breakthrough infection.

Disclosures

All Authors: No reported disclosures
2371. A study to describe the pattern of cutaneous adverse effects of COVID-19 vaccines (Covishield and Covaxin )
Authors: Mitra Debdeep , Saraswat Neerja
Published: November 2023

Background

Vigorous administration of Covid-19 vaccines to tackle the ongoing pandemic has led to increasing research on adverse effects including both systemic and cutaneous.

A prospective observational study to delineate cutaneous adverse effects of two vaccines namely Covishield and Covaxin administered in two doses in northern India.

Methods

The study was conducted in a tertiary hospital in northern India wherein patients were asked to report voluntarily any cutaneous adverse effects after covid-19 vaccination to the dermatology department. The data was collected using excel sheets and later analysed taking into consideration the age, vaccine types, and duration of onset of adverse effects.

Results

Out of the 19672 vaccination jabs, 296 (1.5%) developed cutaneous adverse effects out of which the incidence was higher in Covishield vaccinees compared to Covaxin vaccinee group. The incidence of side effects was more with the first dose of either vaccine compared to the second dose. All the side effects were benign and were managed symptomatically or were self-limiting.

Conclusion

Rampant administration of vaccines along with widespread advertisement of vaccine-induced side effects via social media has created apprehension in the general population. This warrants studies improving awareness about the most vital preventive measure available to halt and eventually end the Covid-19 pandemic.

Disclosures

All Authors: No reported disclosures
2374. Predicting the Public Health Impact of Bivalent Vaccines and Nirmatrelvir-Ritonavir against COVID-19
Authors: Park Hailey J , Tan Sophia T , León Tomás M , Jain Seema , Schechter Robert , Lo Nathan C
Published: November 2023

Background

Uptake of COVID-19 bivalent vaccines and nirmatrelvir-ritonavir (Paxlovid) remains low across the United States. The goal of this study is to predict the public health impact of increasing uptake of bivalent vaccines and nirmatrelvir-ritonavir in key risk groups on COVID-19 cases, hospitalizations, and deaths.

Methods

We used a statistical model that was calibrated to person-level COVID-19 outcome data (cases, hospitalizations, deaths) from the California Department of Public Health, to predict the cumulative number of COVID-19 outcomes over the next six months. We modeled the impact of perfect uptake of these interventions in different risk groups defined by age (50+ years, 65+ years, 75+ years) and vaccination status (everyone, primary series only, previously vaccinated). We predicted the number of averted COVID-19 outcomes with each strategy by applying published estimates of vaccine and nirmatrelvir-ritonavir effectiveness; we computed number needed to treat (NNT).

Results

The most efficient strategy (based on NNT) for averting severe COVID-19 was targeting interventions to the 75+ years age group. In the California population, perfect coverage of bivalent boosters in the 75+ years age group averted 3,920 hospitalizations (95% UI: 2,491-4,882; 7.8% total averted; NNT 387) and 1,074 deaths (95% UI: 774-1,355; 16.2% total averted; NNT 1,410). Perfect uptake of bivalent boosters in those 50+ years averted 7,778 hospitalizations (95% UI: 4,858-9,763; 15.4% total averted; NNT 1,144) and 1,630 deaths (95% UI: 1,134-2,122; 24.6% total averted; NNT 5,458). Perfect uptake of nirmatrelvir-ritonavir in the 75+ years age group averted 5,644 hospitalizations (95% UI: 3,947-6,826; 11.2% total averted; NNT 11) and 1,669 deaths (95% UI: 1,053-2,038; 25.2% total averted; NNT 35), while perfect uptake in the 50+ years age group averted 9,699 hospitalizations (95% UI: 6,882-11,611; 19.2% total averted; NNT 19) and 2,323 deaths (95% UI: 1,458-2,866; 35.0% total averted; NNT 79).

Conclusion

Prioritizing uptake of bivalent boosters and nirmatrelvir-ritonavir based on age group (65+ years and older) rather than vaccine status would be efficient and have substantial public health impact, but would not address the entire burden of severe COVID-19.

Disclosures

All Authors: No reported disclosures
2393. Factors Associated with Time to COVID-19 Vaccination among People with HIV
Authors: Paz Aasith Villavicencio , Sanchez-Covarrubias Alex P , Ghadimi Fatemeh , Nkwihoreze Hervette , Zelada Raymond , Koenig Helen , Momplaisir Florence
Published: November 2023

Background

The COVID-19 pandemic has significantly impacted at-risk populations, including people with HIV/AIDS (PWHA). Several reports indicate a higher risk of SARS-CoV-2 infection and mortality in PWHA compared to the general population. Despite an effective vaccine, PWHA with low CD4 count develop a weak immune response and are at risk of severe breakthrough infections. Vaccination gaps have been identified amongst PWHA, but factors associated with time to mRNA COVID-19 vaccine initiation and first booster have not been studied.

Methods

PWHA age ≥ 18 years, in HIV care at an urban clinic, and who completed the primary series of COVID-19 vaccines were invited to complete an online survey. Socio-demographic and clinical characteristics and COVID-19 vaccination motivators were assessed and complemented by a review of medical records. Statements on motivators to vaccination were rated on a 5-point Likert scale treated as ordinal data (minimum score 19, maximum 95). Factors associated with time to first COVID-19 vaccine and first booster were analyzed by the Kaplan-Meier method.

Results

A total of 129 patients enrolled; 83% (108/129) received the COVID-19 booster. Mean age was 50.3 (±10.9) years; 26.4% were female; 54.3% were Black, and 34.1% were White; 91.5% were non-Hispanic. The mean nadir CD4 count throughout their care was 309.4 (±245.6) cells/mm3. The mean time to first COVID-19 vaccine dose was 2.8 (±1.8) months from December 2020 (Pfizer-BioNTech vaccine approval), and time to first booster was 9.9 (±3.8) months from the date of the first vaccine. Factors associated with quicker uptake of the first dose included being ≥ 51 years of age (p=0.001), White race (p=0.027), male sex (p=0.023), and gay/lesbian identity (p=0.014) (Fig 1). Factors associated with quicker uptake of the first booster included being ≥ 51 years of age (p < 0.000) and a COVID-19 motivators’ survey score > 69 (p=0.017) (Fig 2).

Figure 1.

Kaplan-Meier Curves for Time to COVID-19 First Dose Vaccination Among People Living with HIV/AIDS Receiving HIV Care through Penn Medicine.

Figure 2.

Kaplan-Meier Curves for Time to COVID-19 First Booster Vaccination Among People Living with HIV/AIDS Receiving HIV Care through Penn Medicine.

Conclusion

We found high rates of COVID-19 booster vaccination among PWHA. White and male patients got vaccinated quicker in the early phase of the pandemic; however, race and age-based inequities resolved in the later phase of the pandemic. Motivation to vaccination emerged as a facilitator for uptake of booster vaccines.

Disclosures

All Authors: No reported disclosures
2394. Comparative Analysis of Behavior Change and Vaccine Uptake Beliefs
Authors: Walsh Tyler , Lavalas Bright Monique A , Liu Jingxia , Newland Jason
Published: November 2023

Background

COVID-19 vaccination rates have been wide-ranging among age groups, specifically among the pediatric population. Children under the age of 4 currently representing 12% with at least one dose, while children aged 5-11 represent 39% with at least one dose. We hypothesize that understanding and teaching children and caregivers will cause an increase in capability, opportunity and motivation (COM-B Model) towards the COVID-19 vaccine.

Methods

The study was conducted within St. Louis City and County School Districts. Participants were randomized to one of two interventions, re-randomized after 2 weeks if the participant was not vaccinated, and received follow up assessment surveys. The interventions entail the participant receiving a text message containing information and resources on vaccination or a phone call with a study team member, to further discuss beliefs around the vaccine. The primary outcome is behavioral measures toward vaccine, defined as the average of capability, opportunity and motivation scores. It was collected at three time points: baseline, first follow up and second follow up. A mixed regression model with autoregressive correlation structure, was used to assess the intervention’s effect on the primary outcome.

Questionnaire survey scores relating to health behavior at baseline and following each intervention

Results

One hundred and forty-four (144) participants met the eligibility criteria and received both randomizations for this study. Participant agreement of capability (54%) and opportunity (49%) toward the COVID-19 vaccine improved, while motivation (30%) remained disagreed or neither agree nor disagree toward the vaccine. The mixed regression model showed the group intervention was a significant factor across the time points, p-value < 0.001. Specific improvement in LSM for the Call, Text intervention group with significant effect on primary outcome across the time points [baseline LSM: 3.133, (95% CI: 2.865, 3.402); and first follow up LSM: 3.3222 (95% CI: 3.0671, 3.5774)]

Percentage of questionnaire survey scores selected relating to health behavior at baseline and following each intervention

Conclusion

Participant survey scores improved the most in capability and opportunity of behavior change towards the vaccine, while motivation did not have an improvement. The use of mixed intervention, Call, Text, leads to the most effective behavior towards the vaccine.

Disclosures

Jason Newland, MD, Moderna: Grant/Research Support|Pfizer: Grant/Research Support
2402. Evaluating Clinical Outcomes of Adjunctive Beta-Lactam Use in Vancomycin-Resistant Enterococcus Infective Endocarditis
Authors: Khan Ebrahim H , Yetmar Zachary A , Abu Saleh Omar M , Mahmood Maryam
Published: November 2023

Background

Vancomycin resistant enterococcus (VRE) infective endocarditis (IE) is associated with poor outcomes. There are limited data to guide the antimicrobial choice and duration of therapy. Several in vitro and limited clinical studies demonstrate the synergistic effect of β-lactams with other agents, particularly daptomycin, in this setting. We sought to compare clinical outcomes in patients with VRE IE treated with adjunctive β-lactam therapy.

Methods

This was an IRB-approved, retrospective, single-center cohort study. The study included patients ≥18 years of age diagnosed with VRE IE via modified Duke criteria from 2011-2021. Data were collected by electronic medical record review. Descriptive statistics were obtained. The primary outcome was 90-day treatment failure compared between those receiving and not receiving adjunctive β-lactams. Treatment failure was defined as recurrence of bloodstream infection (BSI) or death within 90 days of diagnosis. Failure-free survival was analyzed by Kaplan-Meier curve with log-rank test.

Results

A total of 32 cases were identified. 12 received adjunctive β-lactams. Mean age was 67 years, and 71% were male. 13 (41%) had a prosthetic valve and 6 (19%) had a CIED (Table 1). A majority (78%) had E. faecium IE. Mean duration of bacteremia was 9 days (Table 2). About one-third had treatment failure with 7 deaths and 4 BSI recurrences. Adjunctive β-lactams included ampicillin (3), cefepime (1), ceftaroline (6) and ceftriaxone (2). There was no statistical difference in failure-free survival in patients treated with adjunctive β-lactam therapy (Figure 1). The results were similar when restricted only to those who received daptomycin with or without adjunctive β-lactam therapy.Table 1.Patient CharacteristicsTable 2.Disease characteristics

Figure 1.

Kaplan-Meier curve comparing failure-free survival between patients who were primary treated with adjunctive β-lactams versus non-adjunctive therapy. The p-value is calculated via the log-rank test.

Conclusion

VRE IE is associated with poor prognosis, including high rates of mortality and relapses. In our experience, adjunctive B-lactam use did not result in improved outcome. Limitations include small sample size, and heterogenous antibiotic use. More prospective randomized data are needed.

Disclosures

All Authors: No reported disclosures
2406. A Changing Landscape: Trends in Infective Endocarditis in Western India - A Single Centre Retrospective Analysis
Authors: Naguthevar Santhanam , Ravindra Akshatha , Bohra Gopal Krishana , Kumar Deepak , Meena Durga Shankar , Tak Vibhor , Samantaray Subhashree , Sharma Shivang , Garg M K
Published: November 2023

Background

Infective endocarditis (IE) is a life-threatening infection that poses a significant risk to morbidity and mortality. Traditionally, IE has been associated with pre-existing cardiac diseases such as congenital heart disease (CHD) or rheumatic heart disease (RHD). This study aims to describe the changing epidemiology of IE in patients admitted to a tertiary care centre in Western India.

Methods

We conducted a prospective view of cases of definite IE using the Modified Duke Criteria. Our study analysed patient records from April 2021 to March 2023, and we collected demographic data, clinical manifestations, laboratory findings, microbiological data, treatment modalities, and outcomes.

Results

A total of 50 cases of definite IE were identified according to the modified Duke’s criteria. The patients had a mean age of 36±17 years, with males being more affected (75%). Prior heart diseases were identified as a predisposing factor in 50% of cases, with rheumatic heart disease (60%) and congenital heart disease (40%) being the most common. Notably, two patients had IE secondary to coronary stent infection.

Among the 74% culture-positive cases, Staphylococcus aureus (24.3%) was the most frequently isolated organism, with methicillin-resistant S. aureus (44.4%) and Pseudomonas aeruginosa (13.5%) being the predominant pathogens. Other organisms isolated included Enterococcus spp. (n=4), MSCONS (n=4), Candida albicans (n=3), Mycobacterium abscessus (n=1), and Brucella melitensis (n=1).

In the culture-negative endocarditis group (26%), 15.4% were diagnosed with non-bacterial thrombotic endocarditis (NBTE). The mitral valve (66%) was the most commonly affected valve, with the majority (58%) showing large vegetation (≥10mm). Complications such as central nervous system embolization were frequently observed (40%), and mortality occurred in 20% of cases

Conclusion

Although pre-existing heart disease, including rheumatic heart disease and congenital heart disease, remains the most common risk factor for IE, there has been a noticeable trend of increasing IE in prosthetic devices. In recent years also Staphylococcus aureus only the leading organism for IE.

Disclosures

All Authors: No reported disclosures
2411. Association between Causative Pathogen and Occurrence of Infection-Related Glomerulonephritis in Infective Endocarditis
Authors: Shrestha Nabin K , Kanyo Emese , Nakhoul Georges , Herlitz Leal , Gordon Steven M
Published: November 2023

Background

Infection-related glomerulonephritis (IRGN) is an uncommon complication of infective endocarditis (IE). We have noticed that this complication occurs unusually frequently among patients with IE caused by Bartonella spp. The purpose of this study was to investigate the association between causative pathogen and the occurrence of IRGN in patients with IE.

Methods

This was a retrospective case-control study. Episodes of pathologically-proven IE with a single causative pathogen, among patients admitted from July 1, 2007, through Jan 1, 2022 were identified from the Cleveland Clinic Infective Endocarditis Registry. Those with definite IRGN (proven by renal biopsy) or probable IRGN (hematuria, proteinuria, elevated creatinine, and depleted serum complement levels) were considered case subjects. Four control subjects were selected for each case subject from patients without definite, probable, or possible IRGN (hematuria, proteinuria, elevated creatinine, or hematuria, proteinuria, depleted serum complement levels), by propensity score matching on age, gender, admission year, and IE category (native or prosthetic), using the nearest neighbor method. The association between pathogen and occurrence of IRGN was examined using logistic regression.

Results

Forty-eight case subjects (IE with IRGN) were matched to 192 control subjects (IE without IRGN). Of the 48 case subjects with IRGN, 17 (35%) had definite IRGN and 13 (27%) had prosthetic valve endocarditis. Bartonella was the causative pathogen in 9 (3.75%) subjects and of these, 8 had IRGN. There was a very strong association between Bartonella being the causative pathogen in IE and the occurrence of IRGN (OR 47.8, 95% C.I. 11.5 – 323.9, p-value < 0.001). A significant association with IRGN was not found for Staphylococcus aureus, viridans group streptococci, Enterococcus, coagulase-negative staphylococci, or fungi.

Conclusion

Bartonella being the causative pathogen in IE is very strongly associated with the occurrence of IRGN. Acute glomerulonephritis in a person with clinical or echocardiographic features suspicious for IE, and negative blood cultures, should prompt specific testing for the presence of Bartonella infection by blood PCR or serology.

Disclosures

Leal Herlitz, MD, Chemocentryx: Advisor/Consultant|Novartis: Advisor/Consultant
2415. Health Outcome Disparities in Device-Associated Healthcare Infections Before and During the COVID-19 Pandemic
Authors: Bischoff Werner , Evans Joni , Passaretti Catherine , Fernandez Andrea
Published: November 2023

Background

The COVID-19 pandemic has led to a considerable increase in Central-Line Associated Bloodstream Infections (CLABSI) and Catheter Associated Urinary Tract Infections (CAUTI). However, it remains unclear how this affected different population groups.

Methods

This retrospective observational cohort study included CLABSI and CAUTI in a tertiary care facility. Information was collected on patient demographics, hospitalization, comorbidities, and COVID-19 status. Chi-square and Wilcoxon rank-sum tests were used for categorical and continuous variable comparisons. GEE models compared pre- and pandemic periods by interrupted time series analysis.

Results

From 1/1/2018 to 5/31/2022 98,791 patients had 151,550 hospital admissions. Of those, 17,796 patients had 29,483 central lines placed and 45,180 patients had 65,422 Foleys. 314 patients developed 338 CLABSI and 216 patients had 217 CAUTI. 1,552 patients tested positive for COVID-19 with 22 developing CLABSI and 14 CAUTI. The pre-pandemic downward trend in CLABSI and CAUTI was reversed during COVID-19 (p< 0.05).

Black patients and those with other/unknown race had higher CLABSI per patient with central lines (p< 0.02) and higher device days (p< 0.0001) compared to white patients. Hispanic/Latino patients acquired more CLABSI per patient compared to non-Hispanic/non-Latino patients (p=0.04). During COVID-19 the already higher device days in Hispanic/Latino patients further increased compared to non-Hispanic/non-Latino patients (p< 0.0001).

Black patients had higher CAUTI infection rates per patient with Foleys compared to white and other/unknown patients (p< 0.05). CAUTI per device days were also higher in black patients compared to white patients (p=0.02). No difference in CAUTI burden was detected for ethnic groups throughout the study period. Black and non-Hispanic/non-Latino patients had higher Foley usage days than other patients (p< 0.0001). Foley days decreased during COVID-19 (p=0.01).

Conclusion

We detected health outcome disparities affecting black (CLABSI and CAUTI) and Hispanic/Latino (CLABSI) patients. Infections increased during the pandemic without altering race/ethnicity differences. Device utilization was significantly higher in affected groups.

Disclosures

All Authors: No reported disclosures