bluuebunny/crossref_metadata_2025 huggingface dataset:
1623. Implementation of Electronic Readmission Alert for Discharged Patients Reduces Risk of Secondary Measles Exposure Events
Authors: Boston Kelley M , Ostrosky-Zeichner Luis , Ellsworth Misti G , McInnis-Cole Tawanna A
Published: October 2019

Background

Measles is a highly infectious illness that is causing increased numbers of outbreaks in the United States. Patients involved in a healthcare measles exposure and who have been discharged before identification of exposure are at risk of becoming infectious in the community, and may seek healthcare within their infectious window, creating a secondary exposure risk for healthcare systems. A measles exposure in an integrated healthcare system occurred, resulting in patient exposures in multiple locations at three campuses, including two community-based emergency departments and three inpatient units. There were 159 patients who were included in the exposure group; 123 were exposed in an ED, and 36 were exposed in an inpatient setting. Ninety-four percent (149/159) of the patients had been discharged at the time of measles case identification and were in the pre-infectious phase of illness. Of those, 36 percent (54/149) presented back to the healthcare system within the potentially infectious window; these 54 patients had 97 individual healthcare contacts in the potentially infectious period following the exposure event. Sixty-one of the 97 return visits (63%) were within the window in which the exposed patients were potentially infectious. Return locations included the three exposure facilities and inpatient and outpatient locations at 10 other system campuses.

Methods

An alert system was developed within the electronic medical record that identified patients that were involved in the exposure, and guided clinicians to mask and place in airborne isolation until measles immunity was verified.

Results

The alert activated 13 days after the exposure was identified, and identified 100% of returns to healthcare at all sites within the system, representing 48% of all potential secondary exposure events (29 /61). No secondary exposures or transmission occurred.

Conclusion

Measles exposures are an enormous burden on healthcare organizations and public health systems. When exposures occur, healthcare organizations need systems to rapidly identify discharged patients who may return within the potentially infectious window. Rapid development of electronic readmission alerts can help standardize identification and reduce the risk of subsequent exposure.

Disclosures

All authors: No reported disclosures.
1630. Voluntary HIV Testing and Self-Realization of Risk of HIV Infection Among Young Men-Who-Have-Sex-with-Men in the Miami-Dade Area
Authors: Ocon Hampton , Sabbag Samir
Published: October 2019

Background

According to the Centers for Disease Control and Prevention, Miami-Dade County has the highest rate of new HIV diagnoses in the Nation. So far, a large focus of public health initiatives has been spreading awareness of HIV testing locations, but this form of voluntary testing relies on individuals realizing that they are at risk of HIV infection in the first place. Consequently, a major obstacle to encouraging young men-who-have-sex-with-men (YMSM) to test themselves for HIV is their own self-perceived risk of having an undetected infection.

Methods

In an effort to better understand the discordance between high-risk sexual behavior and HIV testing among this high-risk population, YMSM (18–24) were surveyed through smartphone applications that facilitate sexual encounters in the Miami-Dade area (eg Grindr, Scruff). Users were asked about their history of condomless anal intercourse (CAI), their HIV testing habits, and whether or not they believe it possible that they are currently infected with HIV. An analysis of the relationship between CAI and self-perception of possible HIV infection was performed using Cochran-Mantel–Haenszel testing.

Results

Of the 843 eligible responses, 667 reported a history of voluntary HIV testing while 176 had never voluntarily tested. 726 respondents reported a history of CAI and 131 of these have never voluntarily tested. Of the 843 total participants, 1.6% were in the highest HIV risk group, which is those who have engaged in CAI with an exchange/casual partner, have never voluntarily tested for HIV, and have no self-perceived risk of being currently infected. According to data analysis, YMSM who have engaged in CAI but have never been tested for HIV were not more likely to have a self-perceived possibility of infection when compared with those who have voluntarily tested (P < 0.595).

Conclusion

This suggests that many high-risk YMSM are not voluntarily testing themselves for HIV not because they do not have access to testing, but rather because they do not perceive themselves as being possibly infected in the first place. Therefore, in addition to increasing access to HIV testing, new public health initiatives must be designed to facilitate YMSM understanding their own personal HIV risk.

Disclosures

All authors: No reported disclosures.
1637. Antibiotic Use in Lower Respiratory Tract Infections: Insights From Patient Interviews in Sri Lanka
Authors: van Melle David T , ten Asbroek Guus H A , Vanderburg Sky , Abeysinghe Yohana W , Halloluwa Chathurangi , Zhang Helen L , Sheng Tianchen , Sewwandi Kanchana , Bodinayake Champica K , Nagahawatte Ajith , Woods Chris W , De Silva Vijitha , Tillekeratne L Gayani
Published: October 2019

Background

Antibiotic resistance is an emerging global public health threat with inappropriate use of antibiotics as one of the major drivers. In Sri Lanka, antibiotic consumption is increasing, while little is known about how patients perceive antibiotics. We conducted a qualitative study to better understand patients’ knowledge, perceptions, and attitudes toward antibiotics.

Methods

Semi-structured interviews were conducted in the local language (Sinhala) and audio recorded for 18 patients with lower respiratory tract infections (LRTI) admitted to a large, public tertiary care hospital in southern Sri Lanka. Interviews were transcribed and then translated into English. Translated interviews were analyzed for themes regarding care-seeking behavior, patients’ knowledge of disease etiology and treatment of LRTI.

Results

Almost all patients mentioned multiple care visits and polypharmacy prior to admission. When seeking care, patients mainly focused on finding a quick cure, mostly by visiting several different private physicians. However, self-medication was also common. Patients reused prescriptions for antibiotics, kept antibiotics for later use after prematurely stopping their course of treatment and bought antibiotics over-the-counter. Patients’ knowledge of disease etiology and antibiotics was poor. Most patients described non-microbial causes such as exposure to dust and cold weather for their illness. Only a few patients were aware of antibiotic resistance. Despite the desire to receive more information regarding disease and treatment, transfer of information between patients and physicians was limited and mainly confined to prescription instructions.

Conclusion

This qualitative study in Sri Lanka suggests inappropriate use of antibiotics is a multifactorial problem. Patients’ poor knowledge of disease and treatment, poor information transfer between physicians and patients, high demand for medicines, overprescribing by physicians, and self-medication were found as possible obstructive factors to improve antibiotic usage. To improve antibiotic use, a multifaceted approach is needed with improvement of awareness by patients, public, and physicians regarding antibiotic use and antibiotic resistance.

Disclosures

All authors: No reported disclosures.
1638. Measles Outbreak Risk Assessment for Transplant Candidates and Recipients
Authors: Kreiger-Benson Elana , Gelb Bruce , Neumann Henry J , Sarah Hochman , Lighter Jennifer , Mehta Sapna A
Published: October 2019

Background

A measles outbreak began in 2018 with ongoing transmission in the New York City (NYC) area, affecting children and vulnerable adults. We developed a systematic 3-part approach to address measles risk in our solid-organ transplant program’s adult population by 1) identification of non-immune adults living in at-risk ZIP codes 2) education focused on risk reduction for all at-risk patients and families and 3) vaccination of non-immune waitlisted patients and consideration of prophylactic immunoglobulin G (IgG) for post-transplant non-immune patients at high risk for measles exposure.

Methods

All waitlisted and transplanted patients residing in any of 11 ZIP codes with recent measles cases in the NYC area as of April 4, 2019, were included. We also focused on the 4 ZIP codes in the NYC Health Commissioner’s vaccination order from April 9, 2019. We reviewed electronic medical records (EMR) of patients born after 1956 for measles immunity by serology or vaccine documentation. A 1-page measles patient education handout was created, reviewed for health literacy appropriateness and utilized in English and non-English language versions.

Results

118 waitlisted or previously transplanted patients resided in at-risk ZIP codes. Among the 118 patients, 56 (47.5%) were presumed immune based on birth year before 1957. Among 62 patients born in 1957 or later, 5 (8.1%) had preexisting positive measles IgG in the EMR and 1 patient had documentation of measles vaccination without measles IgG testing. Fifty-seven patients without EMR evidence of measles immunity were called to undergo measles IgG testing. 29 patients agreed to testing and an additional 19 patients had the test added to routine laboratories. Of these 48 patients, 1 was non-immune and 1 had equivocal immunity. Among transplanted patients identified as non-immune or with equivocal immune status, a recommendation for prophylactic IgG was made. All 118 patients received a measles informational handout by mail. Furthermore, we identified 21 patients born after 1956 living in the 4 zip codes targeted by the NYC health Commissioner’s order, and among those tested all were found to be immune.

Conclusion

A systematic risk assessment during a large measles outbreak identified at-risk transplant patients and provided timely education and screening for measles immunity.

Disclosures

All authors: No reported disclosures.
1639. Outbreak of Human Bartonellosis Due to Bartonella bacilliformis in the Ecuadorian Andes
Authors: Santiago Larreategui Romero David , Veronica Lafuente Cevallos Lizeth
Published: October 2019

Background

Bartonellosis affects small Andean communities in Peru, Colombia, and Ecuador. Research in this area has been limited; our study presents a continuous outbreak of cases that occurred in 2018 in areas near the cloud forest of the Ecuadorian Andes.

Methods

Retrospective review of 101 cases of human bartonellosis managed in Quito - Ecuador, during the last outbreak in our country in the last year (2018). The study focused upon the most recent outbreak in order to look at current manifestations of disease and existing practices in diagnosis and management, and how closely these followed the latest guidelines to manage this disease.

Results

Of the 101 patients reviewed, 52% were male and 48% were female. The mean age of cases was 24.3 years, (mean age of males = 23.7, mean age females = 25.3). The median age of patients was 20 years (min = 4 years, max = 71 years, IQR = 15). There was a peak in acute cases after the rainy season; mainly in moths march to June, chronic cases presented less constantly throughout the year. The sensitivity of blood smear against blood culture in acute disease was 35%. The most commonly used treatment for chronic disease was rifampicin; chloramphenicol and ciprofloxacin was used to treat most acute cases. Complications arose in 16.8% and the most frequent was anemia, and there were 2 deaths.

Conclusion

Recognize the physiopathological and microbiological characteristics of the disease, as well as improve the diagnostic and treatment algorithms for acute and chronic bartonellosis which have been developed without a strong evidence base. Preparation of ready-to-go operational research projects for future outbreaks would strengthen the evidence base for diagnostic and treatment strategies and enhance opportunities for control and prevent deaths.

Disclosures

All authors: No reported disclosures.
1646. Education Level is Associated with Tetanus Vaccine Coverage: Results from the 2016 BRFSS
Authors: Rencken Camerin , Amanullah Siraj , Gjelsvik Annie , Dunsiger Shira
Published: October 2019

Background

Vaccination coverage among US adults for tetanus, a potentially fatal disease, continues to be lower than the national goals. Education has been considered to have positive impact on vaccination coverage. However, recently there have been outbreaks of vaccine preventable conditions in areas with high college completion rates. This study aims to assess the relationship between education and vaccination coverage. Specifically, we looked at the association between education level and tetanus vaccination status of the US adults.

Methods

Data from the 2016 Behavioral Risk Factor Surveillance System, a self-reported annual survey for non-institutionalized adults in the United States from the Centers for Disease Control, were analyzed. The outcome was up-to-date tetanus coverage (within the last 10 years) defined by the response to: have you received tetanus vaccine since 2005? Education was stratified into four categories: (1) grade 11 or less, (2) grade 12/GED, 3) college 1–3 years, and (4) college 4 or more years. Bivariate analyses and multivariable logistic regression were conducted on the analytic sample (n = 417,473) using Stata 15, accounting for weighting and the complex survey design of the BRFSS.

Results

This study identified that 59.9% of US adults are up-to-date on the tetanus vaccine status (Table 1). Higher education level was found to be associated with increased odds of up to date tetanus vaccination. The highest odds were for those with 4 or more years of college education [aOR = 1.31; 95% CI: 1.26–1.35)] while the lowest odds were for those less than grade 11 education, when compared with those with a high school degree [aOR = 0.93; 95% CI: 0.88–0.98] (Figure 1). Other covariates identified as negatively associated with up-to-date tetanus status were race/ethnicity, female sex, unemployment, not being married, not having insurance or a personal healthcare provider, and being above 45 years of age (Figure 1).

Conclusion

This study identified a positive association between up-to-date tetanus status and higher education level. Introducing community-specific vaccination education programs for those without tertiary education, especially for those above age 45 and without insurance, may help increase the overall vaccination status in the United States.

Disclosures

All authors: No reported disclosures.
1648. Prevalence of Orientia tsutsugamushi, Anaplasma phagocytophilum, and Leptospira interrogans in Striped Field Mice in Gwangju, Republic of Korea
Authors: Kim Dong-Min , Seon Bang Mi , Kim Choon-Mee , Ra Yun Na , Seo Jun-won
Published: October 2019

Background

Scrub typhus, anaplasmosis, and leptospirosis are well-known diseases that are considered common, widespread rodent-borne infectious diseases

Methods

This study investigated the prevalence of Orientia tsutsugamushi, Anaplasma phagocytophilum, and Leptospira interrogans in wild rodents through molecular detection using organ samples and through serological assay using blood samples of mice collected from two distinct sites in Gwangju Metropolitan City, Republic of Korea (ROK).

Results

A total of 47 wild rodents, identified as Apodemus agrarius (A. agrarius), were captured from June to August 2016. The seroprevalence of antibodies against bacterial pathogens in A. agrarius sera was analyzed; 17.4% (8/46) were identified as O. tsutsugamushi through indirect immunofluorescence assay and 2.2% (1/46) were identified as Leptospira species through passive hemagglutination assay. Using polymerase chain reaction, the spleen, kidney and blood samples were investigated for the presence of O. tsutsugamushi, A. phagocytophilum, and L. interrogans. Out of the 47 A. agrarius, 19.1% (9/47) were positive for A. phagocytophilum and 6.4% (3/47) were positive for L. interrogans, while none were positive for O. tsutsugamushi. Four out of 46 (8.7%) blood samples, six out of 45 (13.3%) spleen samples, and one out of 47 (2.1%) kidney samples were positive for A. phagocytophilum. Three out of 47 (6.4%) kidney samples were positive for L. interrogans. The sequencing results of PCR positive samples demonstrated >99% similarity with A. phagocytophilum and L. interrogans sequences

Conclusion

A. phagocytophilum was mostly detected in the spleen, whereas L. interrogans was mostly detected in the kidneys. Notably, A. phagocytophilum and L. interrogans were detected in A. agrarius living in close proximity to humans in the metropolitan suburbans. The results of this study indicate that rodent-borne bacteria may be present in wild rodents in the metropolitan suburban areas of ROK

Disclosures

All authors: No reported disclosures.
1653. Strong Partnership and Effective Communication Between a Tertiary Hospital and a County Health Department Were Critical in Controlling a 2019 Measles Outbreak in Southeast Michigan (SEM)
Authors: Mathew Trini , Johnson Paul , Kamerer Diane , Jones Amber , Ditkoff Jeffrey , Ziadeh James , Carpenter Christopher
Published: October 2019

Background

Measles, declared eliminated in the US 2000, is a reemerging vaccine-preventable airborne disease. The 2019 case count (704 as of April 30, 2019) has surpassed the number of 2014 cases (667), the highest since 1994. Many healthcare personnel (HCP) have not seen a case of measles, and this lack of clinical experience may contribute to missed or delayed diagnoses leading to its spread. We describe the processes and measures implemented at Beaumont Hospital, Royal Oak (B-RO) Michigan in collaboration with the Oakland County Health Department (OCHD) to prevent secondary spread during an outbreak.

Methods

Soon after the initial report of the index case in Oakland County in March, the B-RO epidemiology team connected with OCHD. As both exposed and suspected cases were expected to seek care at B-RO, a one-page informational document was sent to B-RO providers. This document detailed isolation precautions and testing methods, post-exposure prophylaxis (PEP), and contact information. During subsequent days, as measles cases increased, frequent calls between B-RO and OCHD addressed numerous issues, including: media notifications, contact of exposed persons, vaccine and immunoglobulin supply for PEP, safe referral of cases to the EC, and the process of measles specimen submission for testing. As needed, these communications occurred after business hours and during weekends. Serologic testing to confirm measles immunity was ramped up.

Results

As of April 30, 41 cases have been confirmed in MI associated with the index case. OCHD facilitated the exposure control for 40 patients, of which 6 came to B-RO during their infectious period (Figure 1). To date, there have been no secondary cases developing in B-RO patients, HCPs or visitors, which may be related to successful engineering controls, appropriate protective equipment, mandatory measles immunity confirmation as condition of Beaumont employment since the late 1980s, institution of furlough procedures, PEP for hospitalized patients, and widespread communications with patients, visitors and HCPs (Figure 2).

Conclusion

During an outbreak, close healthcare facility and local health department collaboration is essential in rapidly limiting an airborne disease outbreak.

Disclosures

All authors: No reported disclosures.
1654. Chickenpox Outbreak in a Tribal District Rayagada, Odisha, India: Warrants Need for Vaccination
Authors: Salomi. Kerketta Anna , Somalkar Nilam , Dwibedi Bhagirathi , Sabat Jyotsnamayee , Subudhi Pradeepta
Published: October 2019

Background

Chickenpox or varicella is caused by Varicella zoster virus. In India chickenpox outbreak is not uncommon as the vaccination against varicella is not included in the program. We report, chickenpox outbreak in a tribal district Rayagada, Odisha state of India a South Asian country. The outbreak investigation was undertaken to assess the characteristics and determinants of the outbreak and make appropriate recommendations for control and prevention of further transmission.

Methods

A door to door survey was made for case finding and line listing with detailed travel, exposure and vaccination history. Qualitative research tools including key informant’s interview and focus group discussion were undertaken to understand community behavior and practice. Intravenous blood samples were collected for serological test to detect antibody to varicella-zoster virus.

Results

A total of 59 individuals out of 767 residents were affected with chickenpox in this outbreak with an attack rate of 8.73 per 100 populations. Age distribution indicated 69.5% belonged to the age group less than 14 years. No severe complication was reported. Blood sample of 33 case-patients was tested for Varicella zoster virus IgM antibodies and 24 (72.7%) found seropositive. The primary case was an 11-year-old girl who contracted infection in her residential school. None of the community members had received vaccination against chickenpox. Qualitative research indicated traditional beliefs and remedies prevailing in the communities that prevented case isolation and the modern treatment.

Conclusion

The study highlights the need for regular training of peripheral health workers for an effective awareness campaign to change beliefs and traditional practice and vaccination against Varicella zoster virus for prevention of such outbreaks.

Disclosures

All authors: No reported disclosures.
1661. Using Social Media to Enhance an STI Screening Program in Wuhan, China
Authors: Newman McCort Margaret E , Feng Yanmeng , Huang Haojie , Lio Jonathan , Sherer Renslow
Published: October 2019

Background

357 million people between the ages of 19 and 49 are infected each year with a sexually transmitted infection (STI). Wuhan, China is a unique setting for STI intervention as it has over 900,000 college students, a population at high risk for contracting HIV. Cultural attitudes toward premarital sex and homosexuality and poor sexual education are barriers to lowering STI rates. Additionally, 90% of Chinese healthcare is provided at large public hospitals with minimal privacy. Anonymous STI screening outside of the public hospital setting is highly desired by young adults and MSM populations.

Methods

Study investigators partnered with dating app Blued to advertise a nontraditional testing site where high-risk individuals were offered anonymous STI/HIV screening. With the assistance of the regional CDC and a community-based organization (CBO), rapid STI results were provided in a convenient and nonjudgmental setting. Information on sexual behavior and knowledge of STIs was surveyed for future public health interventions.

Results

Of 200 individuals screened for HIV, syphilis, gonorrhea, and chlamydia, 51 (25.5%) had a positive test result. Over 10% of rectal and pharyngeal tests were positive, compared with 1% of urine tests. 3/200 (1.5%) of had positive rapid HIV test results; all were connected to treatment. Among 41 (20.5%) who learned about the study through Blued, STI prevalence was higher (31.7% vs. 23.9%, P = 0.3), compared with participants recruited through advertisement by the CBO. Most (67.5%) identified as MSM. Survey data confirmed low underlying knowledge of STI transmission and risk factors, especially regarding pre-exposure prophylaxis (PrEP).

Conclusion

A discreet screening service at a nontraditional site, facilitated through dating application and social media advertisement, was well received by young adult and MSM communities in Wuhan, China. Triple-site STI screening found a significant number of infections among this population and should be routinely offered by public health services. The use of real-time, convenient diagnostic testing presents an opportunity to lower HIV incidence in Wuhan, a city with a large at-risk population.

Disclosures

All authors: No reported disclosures.
1662. Pushing the Dose: Miltefosine Treatment for a Supersized American with Cutaneous Leishmaniasis
Authors: Aronson Naomi E , Roseboom Ignace , Digby Michael , Bravos Christina , Selig Daniel , Farmer Aaron , AM van Thiel Pieter-Paul , Dorlo Thomas
Published: October 2019

Background

Miltefosine (Profounda, FL) is an oral alkylphospholipid drug which is approved by the Food and Drug Administration for the treatment of some species of New World cutaneous leishmaniasis. The maximal daily recommended dosage is 50 mg t.i.d for 28 days; yet there is some evidence that doses <2.5 mg/kg/day may be associated with lesser efficacy. We treated a healthy 30-year-old, 117 kg, 78 inches (low body fat) male with cutaneous Leishmania tropica infection with miltefosine after multiple unsuccessful treatment regimens. This presentation will provide the background considerations and the outcome of our approach of using higher daily dosages of miltefosine.

Methods

We used a miltefosine dose escalation of 50 mg t.i.d (1.28 mg/kg/day) for days 1–5 with fatty food, increasing to 50 mg. q.i.d. (1.71 mg/kg/day) for days 6–15. For days 16–28, the patient received 250 mg daily (2.13 mg/kg/day). Weekly blood testing was done for complete blood count, metabolic panel, and miltefosine pharmacokinetics. Plasma concentrations were assayed using a validated liquid chromatography coupled to tandem mass spectrometry methodology.

Results

The patient experienced a good clinical result with his two ulcerative lesions on the left leg healing with full epithelialization by day 28. He tolerated miltefosine well until he escalated to 250 mg daily when he noted 2 hours of fatigue and dizziness after the dose, nausea and after the fourth day he developed epididymitis. His serum creatinine was elevated (1.4 mg/dL). The epididymitis resolved after approximately a week, his other symptoms resolved soon after completing the day 28 dose. Serial miltefosine plasma levels accumulated during treatment to 30, 34, 44, and 53 μg/mL on days 7, 14, 21, and 27 after the start of treatment (dropping to 27 μg/mL 8 days post), with an apparent distribution half-life of 7 days.

Conclusion

Miltefosine yielded healing of recalcitrant L. tropica infection but was associated with adverse effects at the 250 mg daily dose that severely limited the activity of the patient for the final 8 days of therapy; however, they were not dose-limiting. Miltefosine accumulation appeared to be dose-proportional compared with reported concentrations with a median 1.8 mg/kg/day dose in Dutch cutaneous leishmaniasis patients (median weight 85 kg).

Disclosures

All authors: No reported disclosures.
1667. Influenza A and B Co-Circulation and Burden: A 2018–2019 Influenza Season Analysis Using the National Active Surveillance Database in Mexico
Authors: Guzman Holst Adriana , Gilberto Gomez Luis , Yolanda Cervantes Apolinar Maria , Huerta Gloria
Published: October 2019

Background

Seasonal influenza is a prevalent respiratory infection for children and adults in Mexico. Influenza A and B viruses co-circulate and there is a need to better understand local epidemiology to inform vaccination recommendations (tri- vs. quadrivalent vaccines). We describe the 2018–2019 influenza season to estimate influenza burden, virus co-circulation and understand the vaccine match in Mexico.

Methods

We reviewed preliminary sentinel surveillance data for the influenza season (October 2018–May 2019) from the Mexican Health Secretariat and World Health Organization’s (WHO) FluNet databases. We performed a descriptive analysis of cases and deaths due to influenza-like illness (ILI), severe acute respiratory infections (SARI) and lab-confirmed influenza to estimate the prevalence of influenza A and B circulating strains, per state and age group, and determine B strain vaccine match.

Results

During the 2018–2019 season in Mexico, there were 52,525 reported cases of ILI/SARI with 6,997 lab-confirmed influenza cases (28% positivity rate among ILI/SARI) and 787 (11%) deaths (Figures 1 and 2). The states with 36% of cases were Mexico City, State of Mexico, Hidalgo, Tlaxcala, and Guanajuato. More than half of the Mexican states had a high (10–14.9%) to intense (≥15%) accumulated case positivity rate of confirmed influenza in relation to ILI/SARI cases (Figure 3). Most cases were reported among the 1–9 and > 60-year-old groups. 45% of deaths occurred in State of Mexico, Hidalgo, Mexico City, Puebla, and Guanajuato. The seasonal viral profile was dominated by A/H1N1 (68%), followed by B (16%) and A/H3N2 (12%), with 90% of deaths attributed to A/H1N1. FluNet’s influenza B data show Yamagata (55%) and Victoria (27%) co-circulation (Figure 1).

Conclusion

The 2018–2019 seasonal co-circulation of influenza A and B viruses in Mexico showed significant nation-wide morbi-mortality burden, with A/H1N1 and B/Yamagata dominance. Stronger B lineage determination is needed in Mexico to understand associated burden and prevent vaccine mismatch, considering the trivalent vaccine does not contain both B strains. Given the circulation of both influenza B lineages and the recommendation of the WHO, Mexico could enhance quadrivalent vaccine use in coming seasons to optimize protection.

Disclosures

All authors: No reported disclosures.
1671. Impact of Zika Syndrome on Brazilian Infant Mortality Rate
Authors: Nogueira Mendes Neto Nilson , da S. Maia Jessika T , Zacarkim Marcelo , Queiroz Igor T , Rosa Gleyson , Labeaud A Desiree , Aronoff David
Published: October 2019

Background

Infant mortality in Brazil has increased for the first time in 26 years. This study aimed to define the Zika Syndrome (ZS) perinatal case fatality rate (PCF) since the 2015 Zika outbreak in a Brazilian northeast state highly impacted by the virus.

Methods

Cross-sectional study conducted using data obtained through the State Health Department for cases of microcephaly (MCP) and congenital abnormalities (CA) in Rio Grande do Norte State (RN) from April 2015 to March 2, 2019. Perinatal period: commencing at 22 completed weeks (154 days) of gestation until 7 days after birth. PCF was defined as the number of deaths as a fraction of the number of sick persons with the specific disease (×100).

Results

There were 535 reported cases of MCP and others CA notified in RN during this period: 4 in 2014, 337 in 2015, 157 in 2016, 21 in 2017, 14 in 2018, and 2 in 2019. Of these, 151 were confirmed and 135 remain under investigation. The remaining 247 cases were ruled out by normal physical exams or due to noninfectious cause of MCP. Of the total confirmed cases, 35.8% (54/151) died after birth or during pregnancy. Zika virus infection during pregnancy was confirmed in 55.5% (30/54) of deaths and 1.8% (01/54) had a positive TORCH blood test. The odds ratio for the Zika PCF was found to be 1.57 (95% CI: 0.7940–3.1398; P = 0.1928). Deaths related to Zika were confirmed using a combination of clinical and epidemiological findings paired with either radiological information or molecular/serological data (RT–PCR and/or IgM/IgG antibodies against Zika). Twelve cases remain under investigation and 7 were ruled out as MCP. The highest number of confirmed MCP cases occurred between August 2015 and February 2016. The prevalence increased in September, with a peak in November 2015 (20.1 cases per 1,000 live births).

Conclusion

Before the recent Brazilian Zika outbreak, the incidence of MCP in RN between 2010 and 2014 was 1.8 cases/year. The real incidence and prevalence might be higher due to the underreporting and lack of resources for confirmatory diagnostic tests (laboratory and imaging). This study indicates that Zika virus accounted for a substantial proportion of MCP cases seen during the years studied, and suggests that ZS contributed to an increase in infant mortality in Brazil.

Disclosures

All authors: No reported disclosures.
1676. Incidence and Outcomes of Pulmonary Involvement in Patients with Scrub Typhus: A Clinical Study from India
Authors: Nangia Vivek , Mobashir Amina
Published: October 2019

Background

Scrub typhus is a tropical fever caused by orrientia tsutsugamushi and is probably the most under-recognized of all the febrile illnesses leading to hospitalization, especially in India. Although the most common presenting symptoms are fever, myalgia, lymphadenopathy and rash, a significant percentage of patients also present with respiratory complaints.

Methods

December 2018 at a tertiary care center, in Delhi, India. The primary objective was to determine the incidence of respiratory involvement in patients with scrub typhus on the basis of radiological findings. Secondary objective was to compare the length of hospital stay, clinical presentation, and severity of illness as indicated by transaminitis, thrombocytopenia, inotropic requirement, and lactate levels. Also compared was the difference in mortality between the two groups.

Results

Pulmonary involvement was seen in 28.9% (22/76) patients which included varied radiological pictures. 5 patients required mechanical and 2 noninvasive ventilation. Eschar was seen in 44.7% out of which 20 had pulmonary involvement. Patients with pulmonary involvement had a significantly greater length of hospital stay (5.82 days vs. 2.56, P < 0.001), more severe transaminitis (P < 0.001), thrombocytopenia (P < 0.001), hyperlactatemia (P < 0.001), higher ionotropic requirement (P < 0.001) and mortality (P = 0.006).

Conclusion

Pulmonary involvement was seen in almost one-third of the patients with scrub typhus and was associated with higher morbidity and mortality. These patients were sicker, often required intensive care admissions, inotropic support, noninvasive and invasive mechanical ventilation and a significantly prolonged hospitalization. Chest radiographs should be a part of routine evaluation of all patients suspected to have scrub typhus. With such high pulmonary involvement, scrub typhus forms an important differential diagnosis in patients with lung infection residing in endemic areas and in those with a history of travel to such areas

Disclosures

All authors: No reported disclosures.
1683. Empathy Scale Validation Among Expectant Seroconcordant Couples Enrolled in HIV Care and Treatment in Zambézia Province, Mozambique
Authors: Sack Daniel , DeSchacht Caroline , Erin Graves , Aaron Kipp , Barreto Ezequiel , Van Rompaey Sara , Audet Carolyn
Published: October 2019

Background

Among patients enrolled in HIV care and treatment in rural Mozambique, 30% abandon treatment within a year. A cluster randomized controlled trial assessing the impact of couple-based vs. individual treatment for concordant couples on viral suppression (the HoPS+ trial) hypothesizes that harnessing family support will improve patient outcomes. Individuals with high levels of empathy will likely provide greater social support for treatment retention and adherence. This study validates a locally tailored version of the interpersonal reactivity index (IRI)—cognitive empathy (CE) and affective empathy (AE)—among expectant parents living with HIV in Zambézia province, Mozambique.

Methods

Using baseline data from 558 participants from the HOPS+ trial, we used a maximum likelihood exploratory factor analysis with a promax oblique rotation to assess the culturally relevant questions from the IRI. We examined discriminant and construct validity through analysis of subscale relationships by sex, age, education, and depression and intra-person reliability over time with an interclass correlation model (n = 119).

Results

Our participants live in 6 districts and receive health care at 24 health facilities. The median age was 25 (IQR: 22 to 30), 50% were female, and 44% were single. Participants had a median of 5 years of formal education (IQR: 2–7). Half of them report their occupation as “farmer” and 17% screened positive for depression. On a scale of 0–4, the median baseline CE score was 2.6 (IQR: 1.9–3.2) and the median baseline AE score was 1.9 (IQR: 1–2.6). Males (2.6 vs. 2.4, P < 0.01), participants who finished primary school (2.7 vs. 2.5, P < 0.01), and older participants (2.6 vs. 2.5, P = 0.04) had higher CE scores, while depressed participants had higher AE scores (2.3 vs. 1.8, P < 0.01). We found moderate stability over time (CE ICC: 0.63, AE ICC: 0.54) in a subset of 119 study participants.

Conclusion

While depression is associated with 12.5% higher AE scores, older participants, males, and those high levels of education had higher scores on the CS scale. This preliminary work will inform future work on the HoPS+ trial and guide future interventions aimed at increasing retention in and adherence to treatment in people living with HIV.

Disclosures

All authors: No reported disclosures.
1685. Retrospective Analysis of Strongyloides Hyperinfection-Dissemination Syndrome Risk Factors in a County Hospital
Authors: Xu Teena H , Onyewuenyi Chinma , Woc-Colburn Laila , Weatherhead Jill
Published: October 2019

Background

Strongyloides stercoralis is a parasitic infection endemic to tropic, subtropic, and temperate regions globally, affecting nearly 100 million people. Clinical disease ranges from asymptomatic strongyloidiasis (AS) to hyperinfection-dissemination syndromes (HDS), a syndrome of accelerated autoinfection and fulminant illness. This study aims to identify risk factors for HDS in a county hospital.

Methods

Subjects admitted to Ben Taub Hospital in Houston, TX, a safety net facility providing care to uninsured and underinsured Harris County residents, from 2012–2016 were identified by ICD-9 and -10 codes. Charts were retrospectively reviewed, and statistical analysis was completed using chi-square with R-software.

Results

15 subjects with strongyloidiasis were identified, 9 (60%) with AS and 6 (40%) with HDS. There was no statistical demographic difference between the groups in terms of age, country of origin, or presence of co-morbidities, including chronic T-cell-mediated immunosuppressed states, such as HIV, diabetes mellitus, chronic kidney disease, malignancy, and malnutrition. When compared with patients with AS, patients with HDS were more likely to have acutely received immunosuppressant medications, such as corticosteroids or chemotherapy, prior to admission (P = 0.009). Common presenting symptoms, including abdominal pain, diarrhea, cough/dyspnea, and rash, were similar between the groups. Subjects with HDS were more likely to present with hypotension (P = 0.017) and have concurrent severe infections (P = 0.0361) at the time of presentation, reflecting the subjects’ underlying immunosuppressed status. Additionally, there was no difference in levels of peripheral eosinophils in subjects with AS vs. HDS. However, subjects with AS were more likely to have a positive serum S. stercoralis IgG (P = 0.002).

Conclusion

HDS should be considered in all individuals from endemic regions who have acutely received immunosuppressive medications presenting with hypotension, irrespective of chronic underlying co-morbidities. Recognizing the high likelihood of co-infection with virulent pathogens is of particular importance in subjects with HDS. As diagnostic tests are unreliable in subjects with HDS, empiric treatment is imperative.

Disclosures

All authors: No reported disclosures.
1698. Epidemiology and Antifungal Susceptibility of Candidemia Among Adult Patients at a Tertiary Care Hospital in South Korea During an 8-Year Period
Authors: Hun Kim Jong , Woong Suh Jin , Yeon Kim Jeong , Lee Hojin , Bean Kim Sun , Wook Sohn Jang , Ja Kim Min
Published: October 2019

Background

Candidemia continues to contribute to significant morbidity and mortality in the hospital. This study aimed to evaluate the epidemiology and antifungal susceptibility at a tertiary care hospital in South Korea during an 8-year period.

Methods

Adult patients ≥19 years with candidemia at a tertiary care hospital in South Korea from 2006 to 2018 were reviewed, and cases of candidemia with antifungal susceptibility data were included for the analysis.

Results

There were 270 cases of candidemia with fluconazole susceptibility data from 2011 to 2018. Overall, fluconazole resistance rate of candidemia was 8.5%. Between period 1 (2011–2015) and period 2 (2016–2018), fluconazole resistance rate was significantly higher in the period 2 (14.3%) than in the period 1 (0.9%), P < 0.001. Among candidemia caused by different Candida spp., a significant increase of fluconazole-resistant C. parapsilosis candidemia was noted in the period 2 (12 out of 34 cases; 35.3%) when compared with the period 1 (0 out of 17 cases; 0.0%), P = 0.004. Although there was a trend of higher fluconazole resistance rate for candidemia caused by C. albicans (9.1% vs. 1.8%), C. tropicalis (2.7% vs. 0.0%), and C. glabrata (11.1% vs. 0.0%) in the period 2 than in the period 1, no statistical significance was observed. Echinocandin (caspofungin and micafungin) susceptibility data were available for 211 cases of candidemia from 2013 to 2018. There were no cases of caspofungin-resistant candidemia except for 2 cases of C. utilis candidemia. However, there were 9 cases of micafungin-resistant candidemia (1 case of C. tropicalis candidemia out of 51 cases [2.0%], 6 cases of C. glabrata candidemia out of 18 cases [33.3%], and 2 cases of C. utilis candidemia out of 2 cases [100.0%]). Micafungin-resistant C. tropicalis and C. glabrata candidemia cases were susceptible to caspofungin.

Conclusion

A significant increase of fluconazole-resistant candidemia in recent years was noted, particularly among C. parapsilosis candidemia cases. Echinocandin resistance among candidemia cases is rare. However, close monitoring needs to be considered for the possible emergence of differential echinocandin resistance.

Disclosures

All authors: No reported disclosures.
1710. Profiling Patients with Rare Mucormycosis Infections Using Real-world Data
Authors: Sung Anita H , Rubinstein Emily , Benigno Michael , Chambers Richard , Aram Jalal A
Published: October 2019

Background

Invasive mucormycosis (IM) is universally fatal if untreated and is a challenge to assess due to its rarity. Diagnosis is difficult and can be missed due to a low index for suspicion. IM prevalence may be increasing with medical advances, especially in neutropenia management, leading to improved survival and expansion of the at-risk patient group. Large administrative databases contain patient-level chart information and may offer a way to describe IM patients in a representative sample of the population.

Methods

A retrospective observational study was conducted using US data from the deidentified Optum Electronic Health Record database between January 2007 and June 2018. Patients with any fungal infection and IM specifically were defined by ICD9 (110–119, 117.7) or ICD10 (B35-49, B46) codes. Descriptive statistics were used to assess demographics, comorbidities, and antifungal agents (AF) prescribed among IM patients with an underlying diagnosis of hematologic malignancy (HM). Restricting to an at-risk population minimized possible false IM coding in the sample.

Results

Of the approximately 97 million patients in the database, about 5 million had a fungal infection diagnosis and 5,208 had an IM diagnosis (0.005% overall, 0.11% of fungal infection). Among those with underlying HM (n = 698,187), 641 IM cases were observed (0.09%); of whom, 46% were male, 82% were over 40 years of age, and 77% were in the Midwest region of the United States. They were 83% Caucasian, 7% African American, 2% Asian, and 8% other/unknown race or ethnicity. The mean Charlson Comorbidity Index score was 3 ± 2 and the top comorbidities, aside from malignancy, were diabetes (24%, n = 151), chronic pulmonary disease (22%, n = 141), and renal disease (11%, n = 69). Not all IM patients were treated. There were 376 AF prescriptions, of which 35% were for fluconazole, 28% for posaconazole, and 14% for voriconazole, followed by 7–8% each for isavuconazole and amphotericin formulations.

Conclusion

A sizable number of IM patients were identified from a large US electronic medical records database. More work is needed to understand the data. Given the significant challenges in prospectively identifying IM patients, a large database may allow for a broader insight into patients at risk and potential predictors of IM.

Disclosures

All authors: No reported disclosures.
1711. Histoplasmosis-Associated Hemophagocytic Lymphohistiocytosis: A Case Series and Review of the Literature
Authors: Jabr Ra’ed , El Atrouni Wissam , Male Heather , Hammoud Kassem
Published: October 2019

Background

Histoplasmosis is an endemic fungal disease with a spectrum of presentations from asymptomatic, mild to disseminated infections. Histoplasmosis-associated hemophagocytic lymphohistiocytosis (HLH) is a rare disorder with limited data regarding treatment and outcome. We described the clinical features, treatment, and outcomes of five patients. This review also summarized the current literature about presentation, treatment, and outcome of this infection-related HLH entity.

Methods

We searched the electronic medical records for patients with histoplasmosis-associated HLH at our institution from January 1, 2006 to September 30, 2017. Diagnosis of HLH was confirmed and by chart review according to HLH-04 criteria. We also searched the current literature for case reports and case series of this entity.

Results

We reported five cases of histoplasmosis-associated HLH during this period. All patients were diagnosed after 2010, this may be explained in part by increased awareness of this entity. The literature review yielded 60 cases of histoplasmosis-associated HLH. Among all patients (65 patients), the most common underlying condition was HIV in 61% of all patients. The majority of histoplasmosis patients were treated with amphotericin B formulation in 81%. The specific treatment for HLH was as follows: nine patients received steroids only, six patients received intravenous immunoglobulin (IVIG) only, three patients received dexamethasone and etoposide, two patients received etoposide, dexamethasone, and cyclosporine, two patients received steroids and IVIG, and one patient received Anakinra and IVIG. The inpatient mortality rate was 31% with most of the deaths occurring within 2 weeks of hospital admission.

Conclusion

Histoplasmosis-associated HLH among adults is an uncommon but aggressive disease with multiorgan involvement. Early antifungal therapy with a lipid formulation amphotericin B is the most important part of the management. Initial HLH-specific immunosuppressive therapy with regimens such as the HLH-94 protocol is usually individualized.

Disclosures

All authors: No reported disclosures.