bluuebunny/crossref_metadata_2025 huggingface dataset:
2322. Challenges Faced by Perinatally-Infected Young People Living with HIV in Kenya During the COVID-19 Pandemic
Authors: Singh Manjot , Nyandiko Winstone , DeLong Allison , Ashimosi Celestine , Munyoro Dennis , Lidweye Janet , Nyagaya Jack , Biegon Whitney , Aluoch Josephine , Chory Ashley , Sang Edwin , Jepkemboi Eslyne , Orido Millicent , Novitsky Vladimir , Vreeman Rachel , Kantor Rami
Published: November 2023

Background

Understanding challenges experienced by young people living with HIV (YPLWH) during the COVID-19 pandemic could guide care during public health crises, particularly in resource-limited settings.

Methods

Surveys utilizing validated and self-reported measures were administered to perinatally-infected YPLWH receiving care at four clinics at the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya between February 2021 and July 2022. Reported psychological, physical, and socioeconomic challenges were summarized overall and across viral load (VL) thresholds (virologic failure VL >40 copies/mL; treatment failure VL >1000 copies/mL). COVID-19-related events, restrictions, and interventions in Kenya from the beginning of the pandemic through the entirety of the study period were compiled into a pandemic timeline and temporal patterns of the evaluated challenges within this timeline were assessed using generalized additive models.

Results

Among 442 participants (median age 17 years, IQR 14-19; 49% female), 89% reported any challenge (mean 2.92 of the 23 challenges estimated; SD=2.14); 48% psychological, 66% physical, and 62% socioeconomic. Major psychological challenges included moderate to severe depression (36%) and anxiety (29%) symptoms. Major physical challenges included recent illness (31%), and recent symptoms of cough (34%), congestion (25%), and fatigue (23%). Major socioeconomic challenges included food insecurity (31%), household income loss (27%), and departure from usual residence (20%). Participants with virologic or treatment failure experienced more challenges compared to those suppressed. Trends of challenges over time were stable for all but physical challenges, which decreased in parallel with the reduced incidence of respiratory infections as masking and social distancing measures were implemented.

Conclusion

The vast majority of Kenyan YPLWH experienced significant wellness challenges during the COVID-19 pandemic, conceivably due to pandemic-imposed travel restrictions and mitigation measures, and possibly impacting HIV care. This knowledge could guide intervention opportunities in this vulnerable population for current and future pandemics.

Disclosures

All Authors: No reported disclosures
2325. Five-day quarantine of patients exposed to SARS-CoV-2 within hospitals in the Omicron variant era
Authors: Choo Eun Ju
Published: November 2023

Background

Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be transmitted even in the absence of symptoms, it can be difficult to prevent its transmission within healthcare facilities. This study aimed to investigate whether initial screening tests and quarantine are still necessary for in-hospital close contact patients in the Omicron-dominant era.

Methods

This retrospective, observational study was performed at a tertiary hospital in South Korea, comprising mostly multi-bed rooms, with four or five beds each. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 was performed on the first and fourth day of quarantine, using a PowerChekTM 2019-nCoV Real-time PCR Kit (Kogenebiotech, Seoul, Korea) or an Allplex 2019-nCoV Assay (Seegene, Seoul, Korea). If relevant symptoms developed during quarantine, testing was promptly performed, regardless of the established schedule.

Results

Between June 15, 2022 and December 29, 2022, there were 179 events of COVID-19 within the hospital. Eighteen exposed patients were excluded because they were discharged during quarantine, and 705 patients were included in the final analysis. The median number of exposed inpatients was 4 (interquartile range, 2 – 5) for each event. Fifty-six (7.9%; 95% confidence interval [95%CI], 6.0 – 10.3%) exposed patients had positive initial screening tests. Among those with an initially negative test, positive conversion was identified in 31 patients (4.8%; 95%CI, 3.2 – 6.8%) during quarantine. In correlation with the number of confirmed COVID-19 cases in South Korea at that time, the number of in-hospital events and exposed patients peaked in August 2022. However, positive test rates at initial testing or during quarantine did not differ significantly according to the month (P = 0.095 and P = 0.104, respectively). This study showed that 12.3% of exposed patients had a positive PCR test, either at initial screening or during quarantine.

Conclusion

This study suggests that screening and quarantine are still necessary for close contact inpatients in the Omicron variant era. Testing intervals and the duration of quarantine may need adjustment considering the current shortage of isolation rooms, testing capacity, and healthcare personnel.

Disclosures

All Authors: No reported disclosures
2327. Masking without Mandates: Patient Preferences
Authors: Harris Matthew , Narvaez Joseph , Salvador Annabella , Farber Bruce
Published: November 2023

Background

Masking has been a foundational component of COVID-19 transmission reduction strategies; however, mask mandates have begun to sunset. The United States Center for Disease Control and Prevention has recommended curtailing mask use in healthcare settings and guiding decisions based on community transmission rates. There is little data describing patient perspectives on the continued use of masks in clinical settings.

Methods

Patient surveys were disseminated via email and SMS using census-sampling methodology to all patients with a clinical encounter within the past 3 months to gauge perceptions of the need for continued masking for patients, visitors, and medical staff in the clinical setting. Data analysis was performed using descriptive and inferential statistics. Thematic analysis was used to analyze qualitative data.

Results

10,964 (5.6%) of 196,424 surveys were completed. 5,418 (49%) of respondents were age 65 and older and 7,728 (70%) were female. Respondents prefer masking at all times in the inpatient setting (Med-surg, ICU, Oncology, Pediatrics, Mother/Baby, Emergency Dept) for clinical staff mean(m) 61.2% (range (r) 56.5%-71.3%), patients m = 56.9 (r 51.5-65.4), and visitors m = 58.5 (r 52.8-67.0). When local transmission rates are moderate to high, preference for masking increases by 36%, 45% and 42% for staff, patients, and visitors respectively. Patients hospitalized for COVID-19 in the past 365 days demonstrated a preference towards masking at all times, m = 63.5, (r 59.1-73.2) and when transmission rates are elevated, m= 86.6 (r 84.5-89.5), compared to those who were not hospitalized, m = 61.7 (r 57.1-71.6) and m = 76.0 (r 72.1 – 82.7). Respondents were less likely to prefer masking in non-clinical environments (∼25%). Approximately 40% preferred mask use in the ambulatory environment for all groups.

Conclusion

While mask utilization is becoming less ubiquitous in the current phase of the COVID-19 pandemic, the majority of patients prefer masks to be worn by staff, patients, and visitors in the inpatient setting. This is especially true for patients hospitalized for COVID-19 in the past year and during periods of moderate to high community transmission rates.

Disclosures

All Authors: No reported disclosures
2332. COVID-19 Primary Series and Booster Vaccination and Potential for Immune Imprinting
Authors: Chemaitelly Hiam , Ayoub Houssein H , Abu-Raddad Laith J
Published: November 2023

Background

Epidemiological evidence for immune imprinting was investigated in immune histories related to vaccination in Qatar from onset of the omicron wave, on December 19, 2021, through September 15, 2022.

Methods

Matched, retrospective, cohort studies were conducted to investigate differences in incidence of SARS-CoV-2 reinfection in the national cohort of persons who had a primary omicron infection, but different vaccination histories. History of primary-series (two-dose) vaccination was compared to that of no vaccination, history of booster (three-dose) vaccination was compared to that of two-dose vaccination, and history of booster vaccination was compared to that of no vaccination. Associations were estimated using Cox proportional-hazards regression models.

Results

The adjusted hazard ratio for incidence of reinfection, including also adjustment for differences in testing rate, in the two-dose cohort relative to that in the unvaccinated cohort was 0.43 (95% CI: 0.39-0.49). The adjusted hazard ratio comparing incidence of reinfection in the three-dose cohort to that in the two-dose cohort was 1.47 (95% CI: 1.23-1.76). The adjusted hazard ratio comparing incidence of reinfection in the three-dose cohort to that in the unvaccinated cohort was 0.57 (95% CI: 0.48-0.68). All adjusted hazard ratios appeared stable over 6 months of follow-up. Divergence in cumulative incidence curves in all comparisons increased markedly when incidence was dominated by BA.4/BA.5 and BA.2.75*. No reinfection in any cohort progressed to severe, critical, or fatal COVID-19.

Conclusion

History of primary-series vaccination enhanced immune protection against omicron reinfection, but history of booster vaccination compromised protection against omicron reinfection. These findings do not undermine the short-term public health utility of booster vaccination.

Disclosures

All Authors: No reported disclosures
2334. The effectiveness of bivalent COVID-19 booster among patients with hematologic malignancies
Authors: Aleissa Muneerah M , Davey Sonya , Rooks Rebecca , Izaguirre Natalie E , Yates Bridget , Kanwal Urwah , Baden Lindsey R , Issa Nicolas C , Sherman Amy C
Published: November 2023

Background

Patients with hematologic malignancies remain at higher risk for developing severe SARS-CoV-2 infections and have reduced immune responses to vaccines.

Methods

A prospective observational study was conducted at Brigham and Women’s Hospital and Dana-Farber Cancer Institute from January 2021 to May 2023. Adult participants were included if they had a history of lymphoid malignancy (LM) or had received hematopoietic stem cell transplantation (HSCT). SARS-CoV-2 antibodies were measured before vaccination and every 2-3 months thereafter. COVID-19 vaccination history and SARS-CoV-2 infections (by report or positive PCR) were recorded longitudinally. Our primary outcome for this study was to evaluate the incidence of breakthrough SARS-CoV-2 infections after receiving a bivalent COVID-19 vaccine booster (Omicron/wildtype).

Results

A total of 144 participants were included in the analysis. Of those, 98 (68%) received a bivalent COVID-19 booster. The median age was 68 (IQR 61 – 73) and 51 (52%) were male. The majority of participants 61 (62%) had LM and 37 (38%) underwent HSCT with a median time from transplant to first vaccine of 317 days (IQR 171 – 742). Overall, the incidence of breakthrough SARS-CoV-2 infections was 13 (13%) (Figure) with a median time from vaccination to breakthrough infection of 72 days (IQR 54 – 112). There were no SARS-CoV-2 related mortality or severe disease leading to hospitalization in our cohort.

Figure

Conclusion

Our analysis demonstrates a low incidence of breakthrough SARS-CoV-2 infections and no severe disease among those who received a bivalent mRNA vaccine, highlighting the potential protection of the bivalent booster against SARS-CoV-2 in patients with hematologic malignancies who had previously been vaccinated or boosted. Further studies are warranted to determine the optimal number and type of booster vaccinations needed to protect this vulnerable population.

Disclosures

Nicolas C. Issa, MD, AiCuris: Grant/Research Support|Astellas: Grant/Research Support|Boehringer Ingelheim: Advisor/Consultant|Fujifilm: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Moderna: Grant/Research Support
2336. General Safety Profile of mRNA-1273 (Moderna COVID-19 Vaccine) in the Elderly Population
Authors: Anteyi Kate , Urdaneta Veronica , Dharia Priyadarshani , Emile-Backer Magalie , Khamamkar Vaishali , Esposito Daina , Straus Walter
Published: November 2023

Background

Early in the pandemic, the elderly was recognized to be at high risk for COVID-19 related morbidity and mortality and then prioritized for vaccination. To provide further insight supporting the safety of mRNA-1273 in the elderly, we analyzed and characterized adverse events (AE) reported in the Moderna global safety database (GSDB) after mRNA-1273 administration in the elderly population.

Methods

We conducted a descriptive analysis of cumulative data (18 Dec 2020 -17 Dec 2022) from recipients of the mRNA-1273 vaccine, aged >65 years, in the GSDB. Data were aggregated and assessed to search for patterns and variations. Findings were summarized using frequency distributions.

Results

As of 17 Dec 2022, an estimated 773 million doses of mRNA-1273 had been administered, with 658,519 case reports collected in the GSDB. Of these 133,303 cases (20.2%) were in the elderly, 25% were “serious cases”; most reports involved females (65.6%).

Most AE (49.0%) were associated with reactogenicity (including pain, redness, swelling or induration at the injection site, headache, fever, myalgia) similar to results from clinical trials. The most frequently reported events in the elderly were pyrexia, headache, fatigue, chills, and myalgia (Table). Fatal outcomes were reported in 3.3% of the cases. Review of these cases showed they were frequently confounded by common comorbidities of the elderly, including hypertension (42.6%), diabetes mellitus (28.2%), atrial fibrillation (12.6%) and chronic obstructive pulmonary disease (12.2%). These comorbidities provided alternate etiologies for the fatal outcomes.

Conclusion

The pattern of adverse events identified in the elderly population was generally consistent with the known safety profile of mRNA-1273 vaccine. This review provides supporting evidence for the favorable safety profile of mRNA-1273 in the elderly population.

Disclosures

Kate Anteyi, MD, MPH, MBA, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Veronica Urdaneta, MD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Priyadarshani Dharia, PhD, MD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Magalie Emile-Backer, PharmD, CCRP, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Vaishali Khamamkar, MS, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Daina Esposito, PhD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Walter Straus, MD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds
2339. COVID-19 Vaccination in Adults and Children. Cross-Sectional Study of Adults', Pediatricians' and Parents' perceptions and Acceptance of COVID-19 Vaccine in Colombia
Authors: Cortés Margarita , Puentes Andrea , Arenas Mónica , Arango Carlos , Brea José , Beltran Claudia , Debbag Roberto
Published: November 2023

Background

COVID-19 (C-19) immunization started in Colombia in February 2021 for adults; in October 2021 for children over 3 years old (yo), and since January 2023 the recommendation was extended to children 6 m - 3 yo.

At the time of this study, C-19 vaccine (C-19V) coverage rates were still low in Colombia: adults, first booster: 43.7%; children over 3 yo 67.8% first dose, 47.9% second dose.

The objective of this study was to assess C-19V acceptance in Colombia, among pediatricians, parents of children up to 18 yo and adults.

Methods

In January 2023 we carried out 3 online surveys on C-19V among adults, parents and pediatricians in Colombia.

Results

Adults

655 adults over 18 yo participated in the study: 80% lived in an urban area, 80% had completed high school, 93% had received C-19V (50% complete primary schedule, 35% first booster); 83% had been contacted by their social security to be reminded about the importance of vaccination. Among the non-vaccinated, 71% did not want to receive C-19V; over 41% said they did not want or did not need it. In the vaccinated group, 66% reported confidence in the vaccines and 55% said they willed would complete their C-19V schedule.

Pediatricians

767 pediatricians answered the survey, 52.1% work in private practice. Perception of C-19V risks among pediatricians was low for both adults and children; vaccine acceptance was lower for healthy children than for adults (69.4 vs 96.4%). The main causes for vaccine hesitancy were the lack of scientific information, fear of immediate and long-term side effects, and non-severity of the disease in children (57.3%, 20.8% and 33.3%, and 21.8%, respectively).

Parents

Of the 646 parents, 86.2% were mothers, 57.7% had postgraduate degrees, 89.4% had vaccinated their children against C-19. The main cause for vaccine hesitancy was vaccine safety (36.6%); 71.2% were informed about how vaccines work, and 64.8% regarding the risks of C-19 in children.

Conclusion

These results show a high acceptance of C-19V in Colombia. However, coverage rates for were low at the time of the study. This might suggest that besides vaccine confidence, other factors impacting coverage rates should be evaluated, as vaccine access.

Disclosures

All Authors: No reported disclosures
2341. Response to Vaccination Against COVID-19 in a Community Oncology Practice: a Rational for Antibody Testing
Authors: Egoryan Goar , Rodriguez-Nava Guillermo
Published: November 2023

Background

Patients with cancer are at increased risk of morbidity and mortality from COVID-19. Vaccination is crucial to prevent this potentially fatal infection. The aim of this study was to evaluate the seroconversion rate in response to 3 different COVID-19 vaccines in patients with cancer in a community setting.

Methods

In this retrospective cohort study, we included 136 patients of a community oncology clinic with solid and hematological malignancies, fully vaccinated against SARS-CoV-2 and without a history of COVID-19. We evaluated qualitative seroconversion rates against the SARS-CoV-2 spike protein after 2 doses and after a booster dose, and the factors associated with increased risk for lack of seroconversion.

Cancer types in studied population

Results

The median age was 71.5 years (IQR, 64 – 79.75 years), 67 (49.3%) were receiving active treatment; 94 (69.1%) patients had a hematological malignancy, 38 (27.9%) had a solid malignancy, and 4 (2.9%) had both. Only 90 (66.2%) patients developed antibodies against the SARS-CoV-2 spike protein after initial vaccination. 53.8% of those who did not initially develop antibodies, converted after a booster dose. In a multivariable binary logistic regression, patients with hematologic malignancies were nine times more likely to not develop antibodies compared to patients with a solid malignancy or both, when controlling for age, type of COVID-19 vaccine, and cancer therapy (odds ratio [OR] 9.57; 95% confidence interval [CI] 2.65 – 34.60, p=.001). Older age was also associated with an increased risk for not developing antibodies (OR 1.07; 95% CI 1.03 – 1.11, p < .001).

Antibody response after initial vaccination in each therapy group

The rate of antibody production per each vaccine group (initial vaccination)

The rate of antibody production in response to booster per each hematologic malignancy type

Conclusion

In this population of patients from a community oncology clinic, older patients and patients with a hematological malignancy had an increased risk for not developing antibodies against the SARS-CoV-2 spike protein. A booster dose induced a response in a significant number of patients.

Disclosures

All Authors: No reported disclosures
2342. Evaluation of mRNA-LNP and adjuvanted protein SARS-CoV-2 vaccines in a maternal antibody mouse model
Authors: England Ross N , Drapeau Elizabeth , Hosseinzadeh Reihaneh , Weissman Drew , Hensley Scott
Published: November 2023

Background

Maternal antibodies (matAbs) protect against a myriad of pathogens early in life; however, these antibodies can also inhibit de novo immune responses against some vaccine platforms. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) matAbs are efficiently transferred during pregnancy and protect infants against subsequent SARS-CoV-2 infections. It is unknown if matAbs inhibit immune responses elicited by different types of SARS-CoV-2 vaccines.

Methods

We established a mouse model to determine if SARS-CoV-2 spike (S)-specific matAbs inhibit immune responses elicited by recombinant protein and nucleoside-modified mRNA-lipid nanoparticle (mRNA-LNP) vaccines. Mouse dams were vaccinated with SARS-CoV-2 S protein-encoding mRNA-LNP vaccine (or vehicle) in early pregnancy and pups were born and matAbs quantitated in pup serum by ELISA. Pups with and without matAbs were vaccinated at weaning with recombinant S protein (adjuvanted with Addavax or empty LNP) or mRNA-LNP and serum S-specific IgG quantitated over time.

Results

S-specific matAbs were transferred to pups and decayed over time as expected. We found that SARS-CoV-2 mRNA-LNP vaccines elicited robust de novo antibody responses in mouse pups in the presence of matAbs. Recombinant protein vaccines were also able to circumvent the inhibitory effects of matAbs when co-administered with Addavax or empty LNP as adjuvants.

Conclusion

While additional studies need to be completed in humans, our results raise the possibility that mRNA-LNP-based and adjuvanted protein-based SARS-CoV-2 vaccines have the potential to be effective when delivered in the presence of matAbs.

Disclosures

Reihaneh Hosseinzadeh, MASc, Acuitas Therapeutics: Employee Drew Weissman, MD, PhD, Intellectual Property/Patents: D.W. is named on the first patent describing nucleoside-modified mRNA and on patents describing its use as a treatment and vaccine platform. Scott Hensley, PhD, Intellectual Property/Patents: SEH is named on patents that describe the use of nucleoside-modified mRNA as a platform to deliver therapeutic proteins and as a vaccine platform
2344. Clinical Profile and Immunologic Response from COVID-19 Vaccine Among People Living with HIV Enrolled in a Treatment Hub in the Philippines
Authors: Festin Mark John , Berba Regina , Ramos Christine P , Lim Jodor
Published: November 2023

Background

SARS-CoV-2 has caused more than 1 million deaths worldwide. Several studies showed that People with HIV had higher rates of hospitalization and mortality with COVID-19 compared with people without HIV but data on serologic response to COVID-19 vaccine among People Living with HIV (PLHIV) is still limited.

Methods

A prospective cohort study on determination of serologic response to COVID-19 vaccine among completely vaccinated PLHIV enrolled in a treatment hub in the Philippines until December 31, 2021 was done. Baseline demographics were collected via chart review. History of COVID-19 infection was also asked during enrollment, on follow-up and at the end of 6 months after the 2nd dose of vaccination.

Blood Extraction were done on enrollment and on follow-up visit to the treatment hub. All the specimen were processed using the SARS-CoV2 ( RocheElecsys Anti-SARS-CoV2 spike (S) protein assays.

Results

A total of 261 PLHIV who received vaccination from February 11, 2021 to December 29, 2021 were enrolled in the study. The participants received any of the following vaccine brands: CoronoVac/Sinovac (41%), Oxford-AstraZeneca (20.7%), Pfizer-BioNTech (21.5%), Moderna (14.2% and Janseen (2.7%). Univariate analysis showed that presence of opportunistic infection, HIV Viral load , Antiretroviral(ARV) Status, COVID-19 Vaccine brand were all significant predictors of antibody response. On multiple regression analysis, only the Vaccine Brand and Viral load remained significant. Sinovac gave a lower median antibody level and seroconversion rate as compared to other vaccine brands. HIV Viral load > 1000 copies/ml was predictive of lower antibody response.

Conclusion

In this study among PLHIV, the type of vaccine and HIV viral load were significant predictors of antibody response to COVID-19 Vaccine. Specifically, Sinovac COVID-19 Vaccine gave a lower Median SARS-CoV-2 IgG(S) Antibody and Seroconversion rate as compared to other Vaccine brands. HIV Viral load > 1000 copies/ml was predictive of lower antibody response to COVID-19 Vaccine . Overall, the antibody response peaked at 2-4 weeks after vaccination and decreases thereafter.

Disclosures

All Authors: No reported disclosures
2345. Factors associated with COVID-19 vaccination refusal among U.S. Immigration and Customs Enforcement detainees
Authors: Palacios Carlo Foppiano , Travassos Mark
Published: November 2023

Background

COVID-19 has disproportionately affected migrant detainees, leading to SARS-CoV-2 test positivity rates exceeding 50% among migrants in U.S. Immigration and Customs Enforcement (ICE) detainment facilities. The federal government started vaccinating migrants in detention centers in January 2021 for SARS-CoV-2, but little data on vaccine uptake is available. We sought to identify ICE facility characteristics and particular vaccines associated with vaccination refusal in migrant detention centers.

Methods

As result of Freedom of Information Act request, we acquired a comprehensive dataset of SARS-CoV-2 immunization efforts across ICE facilities from January, 2021 to July, 2022. Data included number of vaccines offered and refused, brand of vaccine (Janssen, Moderna, or Pfizer), vaccination date, detention facility name, and whether ICE Health Service Corps (IHSC) staffed the vaccine delivery. We incorporated data from ICE website on each detention center’s ownership, management of operations, detainee capacity, and COVID-19 burden (as of January 11th, 2021). Descriptive statistics, chi-square, Welch’s ANOVA, and multivariate logistic regression were performed.

Results

Of 129,046 vaccines offered, 65,015 (50.4%) were refused across 103 detention centers across 29 states on 506 vaccination dates. Factors associated with higher refusal included facilities not operated by IHSC (p< 0.001), local government operation (p=0.03), private operations (p=0.02), and vaccinations during the 2nd (p< 0.001) and 3rd quarters (p< 0.001) of 2022. Factors associated with lower refusal included ownership by local or state government, other public association, or private company; combination private/public operations; any COVID-19 death within ICE facility; and vaccination with Moderna and Pfizer (all p< 0.005).

Figure 1. Numbers of SARS-CoV-2 vaccinations administered (blue) and vaccine refusals (orange) in United States Immigration and Customs Enforcement facilities.

Conclusion

Half of ICE detainees refused vaccination against SARS-CoV-2. Refusal rates were lower among vaccination campaigns utilizing mRNA vaccines and among facilities with documented COVID-19 death. Addressing refusal rates may involve detainee education on the efficacy and safety of different SARS-CoV-2 vaccines.

Disclosures

All Authors: No reported disclosures
2347. Factors Associated with COVID-19 and Influenza Vaccine Coadministration in Rhode Island
Authors: Gargano Lisa M , Dumont Dora M
Published: November 2023

Background

Co-administration of COVID-19 and influenza vaccines has several advantages, has been advocated by various public health authorities, and should be seen as an opportunity to increase the uptake of both vaccines. Co-administration of vaccines has a substantial role to play in decreasing the number of consultations or provider visits and hence missed opportunities and can increase timeliness of vaccination. The objective of this analysis was to examine factors associated with COVID-19 and influenza vaccine co-administration in Rhode Island (RI).

Methods

Data were from the RI Child and Adult Immunization Registry (RICAIR), which maintains records of all vaccinations administered in the state. Dates of vaccination were from September 1, 2022-March 30, 2023, corresponding with the availability of influenza vaccine in RI. Co-administration was defined as receipt of COVID-19 and influenza vaccine on the same day. Logistic regression was used to examine the association between selected factors and location of co-administration.

Results

There were 473,872 individuals who received either a COVID-19 and/or influenza vaccine during the study period. Of those, 205,486 received both vaccines, of whom 95,599 received both vaccines on the same day. Adults 19-64 years were less likely to receive both vaccines compared to adults 65+ years (42.8% vs. 59.0%), but of those who did, a greater proportion (52.1% vs. 39.8%; p-value < 0.0001) received them on the same day. Compared to other race/ethnicity groups, Hispanic/Latinos were the least likely to get both vaccines (24.9%), but they were the most likely to get them co-administered (53.4%). Of those who received both COVID-19 and influenza vaccines in the same day, 70.0% were vaccinated at a pharmacy, compared to 22.2% at a primary care provider (PCP). Non-Hispanic Blacks and Hispanic/Latinos had higher odds of receiving same day vaccines from their PCP versus a pharmacy than non-Hispanic Whites (AOR 2.7 [95% CI 2.5-2.9] and 5.0 [95% CI: 4.7-5.3], respectively).

Conclusion

These data demonstrate a willingness to co-administer vaccines among adults. Identifying groups that are less likely to co-administer vaccines and understanding behaviors around where people are getting co-administered will aid in outreach and education efforts.

Disclosures

All Authors: No reported disclosures
2361. Prevalence of Zoster Infection Post mRNA COVID-19 Vaccination Compared to Influenza Vaccination
Authors: Lazbin Mark S , Kaelber David C
Published: November 2023

Background

Introduction: Varicella-zoster virus (VZV) reactivation was not listed as a side effect of any vaccine until introduction of COVID-19 vaccines. Since COVID-19 vaccines were introduced, several case reports described the link between COVID-19 vaccination and VZV reactivation. In our study we aimed to investigate how often patients developed VZV reactivation after mRNA COVID-19 vaccine compared to influenza vaccine.

Methods

We used the TriNetX platform and its global health research network containing aggregated de-identified information of electronic health records on over 100 million patients from scores of healthcare organizations. Three patient groups were identified:

Patients receiving their 1st mRNA COVID-19 vaccine 12/20/2020-12/20/2022

Patients receiving their 2nd mRNA COVID-19 vaccine 12/20/2020-12/20/2022

Patients receiving influenza vaccine 12/20/2018-12/20/2022

Propensity Score Matching was used for age, gender, and Zoster vaccine status.

We examined the prevalence of VZV reactivation in each group during the first 21 days following vaccination.

Results

Out of 444,016 patients in each matched group receiving either their 1st mRNA COVID-19 vaccine or the Influenza vaccine, 0.04% in the COVID-19 vaccine group and 0.15% in the influenza group, odds ratio (OR) 0.24 (95% CI 0.20-0.29), were diagnosed with VZV reactivation within 21 days. Among 445,382 patients in each matched group receiving either their 2nd mRNA COVID-19 vaccine or their influenza vaccine, 0.04% in the COVID-19 vaccine group and 0.13% in the Influenza group, OR 0.27 (95% CI 0.22-0.32), were diagnosed with VZV reactivation within 21 days. There was a lower risk of VZV reactivation after 1st or 2nd dose of mRNA COVID-19 vaccine than influenza vaccine.

Conclusion

The risk of VZV reactivation after the 1st or 2nd dose of mRNA COVID-19 vaccination is smaller than VZX reactivation after influenza vaccine. The risk of VZV reactivation after mRNA COVID-19 vaccine is very low and hesitance to receive COVID-19 vaccine due to concern of VZV reactivation is not substantiated.

Disclosures

David C. Kaelber, MD, PhD, MPH, FAAP, FACP, FACMI, FAMIA, Becton, Dickinson and Company: Advisor/Consultant|Dynavax Technologies Corporation: Advisor/Consultant|Merck Sharp & Dohme Corporation: Advisor/Consultant
2368. SARS-CoV-2 mRNA vaccination induces B cell immunity in the tonsils and adenoids of children
Authors: Xu Qin , Mudd Pamela , Behzadpour Hengameh , Bellusci Lorenza , Grubbs Gabrielle , Pourhashemi Sara , Tang Juanjie , Liu Can , Newman Daniel , Shi Lihong , Milanez-Almeida Pedro , Kardava Lela , Tsang John , Moir Susan , Khurana Surender , Schwartzberg Pamela , Manthiram Kalpana
Published: November 2023

Background

We recently reported that SARS-CoV-2 infection triggered robust adaptive immune responses in the tonsils and adenoids of children. However, whether intramuscular mRNA vaccination induces immunity in these tissues is unknown.

Methods

We collected peripheral blood, tonsils, and adenoids from 21 children undergoing tonsillectomy/adenoidectomy in 2022 who had previously received a COVID-19 mRNA vaccination. From questionnaires and serology, we identified 10 vaccinated subjects who had not been infected; the remaining 11 were both infected and vaccinated. We characterized SARS-CoV-2-specific B cells that bound fluorescently-labelled spike proteins (S1 and RBD) in the blood and tissues of these participants using high dimensional flow cytometry, and compared them to SARS-CoV-2-specific B cells from 24 COVID-19 convalescent children recruited in 2020-2021.

Results

We identified SARS-CoV-2-specific B cells (S1+RBD+) in the blood, tonsils, and adenoids of nearly all infected and vaccinated subjects. Tonsils and adenoids post-infection had a higher percentage of S1+RBD+ memory B cells than post-vaccination, but differences in the percentage of S1+RBD+ cells were not noted in the peripheral blood. Furthermore, we found that only 20% of vaccinated only subjects had SARS-CoV-2-specific germinal center B cells in their tissues compared to over 70% of infected subjects and subjects with hybrid immunity. Unsupervised analyses of the high dimensional flow cytometry data revealed differences in the characteristics of SARS-CoV-2-specific B cells post-vaccination and post-infection; S1+RBD+ B cells from infected subjects had a higher portion of CXCR3+ and IgA+ memory B cells, while those from vaccinated subjects had a greater proportion of CD21lo memory B cells in the blood and tissues, implying a greater extrafollicular response post-vaccination but stronger mucosal IgA and IFN-γ-induced B cell responses post-infection.

Conclusion

We found tissue-specific immunity to SARS-CoV-2 in the upper respiratory tract lymphoid tissue after mRNA vaccination, but vaccination induced B cell phenotypes distinct from that of natural infection which may affect the quality and duration of immunity in the blood and at the mucosal surface.

Disclosures

Pedro Milanez-Almeida, PhD, Novartis: Salary
2960. A Gut Pathobiont Triggers Neuroinflammation and Neurocognitive Impairment via Breaching the Gut-Brain Axis in a Preclinical Model of Alzheimer’s Disease: From Microbial Pathogenesis to Neuropathogenesis
Authors: Park Gwoncheol , Kadyan Saurabh , Nagpal Ravinder
Published: November 2023

Background

Klebsiella pneumoniae (Kpn) is notorious for causing nosocomial infections and is commonly found in elderly patients in hospitals with Alzheimer's disease (AD). This bacterium can cause bloodstream infection, which may worsen AD pathophysiology, but there are no studies demonstrating the mechanistic role of this pathogen in AD.

Methods

We infected APP/PS mice intestinally with Kpn with (Kpn+Ab) and without antibiotics (Kpn) for a week and then fecal and serum samples were collected 1 and 3 weeks afterwards. Neurocognitive function and motor coordination were tested followed by collection of intestinal and brain tissues at 5 weeks. Microbiome profiles were measured using 16S rRNA amplicon sequencing.

Study design

Results

Kpn was found to have explosively increased in the gut of all mice that received antibiotics and negatively correlated with microbial diversity. Conversely, Kpn was barely detected in the mice that did not receive antibiotics. This underscores the role of antibiotic-induced gut dysbiosis in instigating a ‘pathobiome’ signature. Notably, after five weeks post-infection, Kpn was found to be more abundantly colonized in the small intestine than large colon. Importantly, in the Kpn+Ab group, Kpn was detected not only in the blood but also in the brain, indicating the translocation of Kpn from the intestine to the brain via circulation. In mice in which Kpn was found in the brain, a substantial amount of neuroinflammation caused by bacterial infection was observed. Subsequent neurocognitive and behavioral tests revealed that mice infected with Kpn, especially those in the Kpn+Ab group, had impaired memory function and motor coordination.

Effects of Klebsiella pneumoniae colonization.

A. Changes in microbial composition before and after K. pn colonization, B. Correlation between microbial diversity (Shannon entropy) and abundance of Kpn of Kpn+Ab group C. Assessment of motor coordination (incline screen and hanging wire test) and memory function (T-maze) test. D. Neuroinflammation after K.pn translocation from gut to brain, E. Abundance of K.pn in the three parts of small intestine, colon, blood, and brain.

Conclusion

These results corroborate the emerging notion of the implicating role of the gut dysbiosis and consequent gut-brain axis impairment in Alzheimer’s neuropathology. Our findings suggest that Alzheimer's patients who are hospitalized and treated with antibiotics are at a higher risk of contracting multi-drug resistant Kpn. Further, these data also hint that gut pathobiome may increase the host’s predisposition to AD by breaching the gut-brain axis thereby triggering neuroinflammation and impairing neurocognitive function. Our ongoing studies are anticipated to reveal underlying mechanisms and will be presented at the conference.

Disclosures

All Authors: No reported disclosures
2370. Characterizing Predictors of COVID-19 Vaccine Refusal in an Urban Southern California Jail
Authors: Qureshi Nazia , Miller Loren G , Judge Stephen , Tran Ngoc Dung , Henderson Sean O
Published: November 2023

Background

Correctional populations have been disproportionately affected by COVID-19, with majority of the largest single-site outbreaks being linked to jails and prisons. Vaccination is a key strategy to reduce the transmission of SARS-CoV-2 in carceral settings but can be challenging to implement due to vaccine hesitancy and medical mistrust. We sought to identify factors associated with COVID-19 vaccine refusal in the largest urban jail system in the Unites States.

Methods

We retrospectively analyzed electronic health record data for individuals who were offered COVID-19 vaccination at the Los Angeles County Jail between January 19, 2021 and January 31, 2023 and used multivariable logistic regression to determine predictors of COVID-19 vaccine refusal.

Results

Of the 21,424 individuals offered, 2,060 (9.6%) refused vaccination. Refusal was associated with being male ([aOR] = 2.3, 95% CI (1.9, 2.8)), age 18-34 ([aOR] = 1.2, 95% CI (1.1, 1.4), referent group: age 45-54), Black/African American race ([aOR] = 1.2, 95% CI (1.1, 1.4)), reporting ever being houseless ([aOR] = 1.2, 95% CI (1.1, 1.3)), and having a history of not receiving influenza vaccination while incarcerated ([aOR] = 2.4, 95% CI (2.0, 2.8)). When analyzing the male and female populations separately, the male-specific trends reflected those seen in the overall population, whereas the only significant predictor of vaccine refusal in the female population was not receiving influenza vaccination while in custody ([aOR] = 6.5, 95% CI (2.4, 17.6)).

Conclusion

Identifying predictors of vaccine refusal in correctional populations is an essential first step in the development and implementation of targeted interventions to mitigate vaccine hesitancy.

Disclosures

Loren G. Miller, MD MPH, ContraFect: Grant/Research Support|GSK: Grant/Research Support|Medline: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support
2375. Contemporary Patterns and Predictors of Influenza and COVID-19 Vaccination Among US Adults During the COVID-19 Pandemic
Authors: Bush Christopher , Mues Katherine E , Desai Shaina , Arakaki Brent , Dharia Priyadarshani , Ghaswalla Parinaz , Park Yoonyoung
Published: November 2023

Background

With the development of combined influenza and COVID-19 vaccines, there is a need to understand contemporary patterns of both COVID-19 and influenza vaccine administration in the real world. This study aimed to describe patterns and assess predictors of COVID-19 and influenza vaccine administration among insured, influenza-vaccinated adults in the US from 2020 to 2022.Figure 1.Study SchemaFigure 2.Multivariable Odds Ratios for Factors Associated With Observed Vaccine Pattern in Follow-up

Methods

A cohort of adults ≥18 years with evidence of an influenza vaccination administered between August 1, 2020, and July 31, 2021 (index date) was generated using open and closed administrative claims sourced from HealthVerity. Fig 1 includes additional inclusion and exclusion criteria, subject characteristics, and follow-up windows. Baseline characteristics and time-to-subsequent vaccine administration after index date were assessed via descriptive statistics. Multinomial logistic regression was used to assess the association between subject characteristics and receipt of subsequent influenza and COVID-19 vaccines.

Results

Of 3,043,095 influenza vaccinated adults, 13.7% had a subsequent influenza vaccination, 21.1% had a subsequent COVID-19 vaccination, and 50.7% had both through July 31, 2022. Following the index date, the median (IQR) time to a subsequent influenza vaccine was 373 (353, 396) days and 185 (144, 383) days for a subsequent COVID-19 vaccine. Among those who received both vaccines, most (64.1%) received a COVID-19 vaccine followed by influenza. Prior influenza vaccine was associated with subsequent receipt of both vaccines vs influenza only (OR, 95% CI: 1.18, 1.18-1.19). Adults ≥65 years and those considered high-risk for serious complications were slightly less likely to receive both vaccines compared to influenza only (Fig 2; OR, 95% CI, ≥65 years: 0.93, 0.92-0.94; high-risk: 0.91, 0.90-0.92). Outcome misclassification could be driving these results.

Conclusion

During influenza seasons impacted by the COVID-19 pandemic, evidence of prior preventive services and immunizations were associated with subsequent influenza and COVID-19 vaccine administration. As the pandemic subsides, there will be a continued need to assess COVID-19 and influenza vaccination patterns to inform future vaccination campaigns, including combination influenza and COVID-19 vaccines.

Disclosures

Christopher Bush, MPH, Aetion, Inc.: Employee|Aetion, Inc.: Stocks/Bonds Katherine E. Mues, PhD, Aetion, Inc.: Employee Shaina Desai, MPH, Aetion, Inc.: Employee Brent Arakaki, BS, Aetion, Inc.: Employee Priyadarshani Dharia, PhD, MD, MPH, Moderna, Inc.: Salary|Moderna, Inc.: Stocks/Bonds Parinaz Ghaswalla, PhD, Moderna, Inc: Employee|Moderna, Inc: Stocks/Bonds Yoonyoung Park, ScD, Moderna, Inc.: Employee|Moderna, Inc.: Stocks/Bonds
2379. An Urban Detroit Clinic’s Experience in Bivalent COVID-19 Booster Uptake in People Living with HIV
Authors: Ramakrishna Jahanavi M , Yesilyaprak Abdullah , Monday Lea M , Newman Gretchen Snoeyenbos
Published: November 2023

Background

Both HIV and COVID-19 disproportionately affect vulnerable communities. People living with HIV (PLWH) are a priority population for COVID-19 vaccination. Bivalent COVID-19 boosters (BCB) were granted emergency use authorization on August 31, 2022. We assessed onsite BCB uptake amongst PLWH enrolled at our HIV clinic in Detroit, Michigan.

Methods

HIV care data was obtained from CareWare collected as part of Ryan White program quality initiatives. BCB (Pfizer/BioNTech and Moderna) administration data from September 1, 2022 to March 20, 2023 was pulled using Current Procedural Terminology codes from our Athena electronic medical record. We excluded patients < 18 years old. A deterministic match was done using name and date of birth. Of 2268 PLWH, 1,921 (84.7%) had complete care data. The outcome of interest was the percentage of patients who received the BCB. Covariates examined were gender, age (years), race, CDC transmission risk factor, year of HIV diagnosis, insurance type, HIV viral load measurement after Sep. 1, 2022, and most recent HIV viral load value (< or > 200 copies/mL). Bivariate analysis was done using Wilcoxon rank sum test and Pearson's Chi-squared test. Statistical significance was defined as P < 0.05. We used R 4.3.0 for all analyses.

Results

Of 1,921 PLHW, 519 (27%) received the BCB. Compared to PLWH 18-29, those 50 years and older were more likely to receive the BCB (P < 0.001). Although not statistically significant, Black PLWH (26%) were less likely to have been vaccinated with the BCB compared to white PLWH (32%, P < 0.30). BCB uptake was higher in PLWH diagnosed with HIV prior to 2010 (P < 0.001). PLWH enrolled in Medicare were more likely to receive the BCB than those with other or no insurance (P < 0.001). No statistically significant trends were found based on CDC HIV transmission risk factor. Only 5% of PLWH who underwent HIV viral load testing before Sep. 1, 2022 received the BCB compared to 33% with testing after Sep. 1, 2022 (P < 0.001). Patients with viral load < 200 copies/mL (28%) had a higher BCB vaccination rate compared to those with viral load > 200 copies/mL (16%, P < 0.001).

Conclusion

Vaccine surveillance studies such as this one are critical to equitable vaccine distribution to PLWH by identifying subpopulations that may benefit from more intensive outreach.

Disclosures

All Authors: No reported disclosures
2380. Menstrual changes after COVID vaccine in the Dominican Republic
Authors: Roque Yori A , De Luna David
Published: November 2023

Background

Women around the world began reporting menstrual disorders after receiving COVID vaccines. Numerous studies were launched evaluating a possible causal relationship between vaccines and these disorders. To date, it has not been possible to establish causality between the different vaccine compounds and these disorders. Here we identify the main self-reported menstrual disorders in vaccinated women the Dominican Republic.

Methods

We elaborated a multiple-choice self-questionnaire shared through a link on social networks. Sociodemographic factors, type of vaccine received, number of doses, and symptoms or disorders related to the menstrual cycle that occurred after its administration were addressed.

Results

200 participants completed the questionnaire. The ages were mainly between 18 to 28 years (40.5%), 29 to 38 years (39%), 39 to 49 years (18.5%). 74% defined their menstrual cycle as regular (between 21 and 29 days). Most of the vaccines reported were Coronavac (63%), Astra Zeneca (23%) and Pfizer (7%). 81.5% received two doses of the vaccine, while 13.5% had received 3 doses. Most of the disorders reported occurred after the second dose (60%), the most frequent being dysmenorrhea (33%), menorrhagia (31.5%) delayed menstrual bleeding (31%), and heavy bleeding (30.5%). 59.5% considered these symptoms as moderate and 44.5% reported that they were maintained for 2 to 3 months. 65.5% of women reported that they would get vaccinated against COVID again despite these events.

Conclusion

Dysmenorrhea, menorrhagia, delayed menstrual bleeding, and heavy bleeding were the most reported disorders in our cohort. Although causality has not been confirmed, health personnel should be aware of these findings and offer the relevant recommendations to women who are going to be vaccinated.

Disclosures

All Authors: No reported disclosures