bluuebunny/crossref_metadata_2025 huggingface dataset:
1875. Continued demographic shifts in hospitalised COVID-19 patients from migrant workers to a vulnerable and more elderly local population at risk of severe disease
Authors: Nicholas Ngiam Jinghao , Chhabra Srishti , Goh Wilson , Sim Meng Ying , Liong Tze Sian , Chew Nicholas W S , Sia Ching Hui , Cross Gail Brenda , Tambyah Paul Anantharajah
Published: December 2022

Background

In the early months of the COVID-19 pandemic, the vast majority of infected persons were migrant workers living in dormitories who were young and with few medical co-morbidities. In 2021, this shifted to the more vulnerable and elderly population within the local community. We examined trends amongst the hospitalised cases, in order to demonstrate changes in disease severity in association with the evolving demographics.

Demographic shifts in hospitalised patients with COVID-19.

Proportion of hospitalised patients with COVID-19 requiring intensive care over time in Singapore

Methods

All patients with PCR-positive SARS-CoV-2 admitted from February 2020 to October 2021 were included, and subsequently stratified by their year of admission (2020 or 2021). Demographics were also classified by sex, ethnicity, as well as mode of transmission, namely i) imported cases, ii) locally-transmitted cases outside of migrant worker dormitories, and iii) migrant worker dormitory cases. We compared the baseline clinical characteristics, clinical presentation and outcomes.

Results

A majority of cases were seen in 2020 (n=1359), compared with 2021 (n=422), due to the large outbreaks in migrant worker dormitories. Nevertheless, the greater proportion of locally-transmitted cases outside of dormitories in 2021 (78.7% vs 12.3%) compared with 2020 meant a significantly older population with more medical co-morbidities were exposed to COVID-19. This led to an observably higher proportion of patients with severe disease, presenting with raised inflammatory markers, need for therapeutics, supplemental oxygenation and higher mortality.

Baseline characteristics of hospitalised patients with COVID-19 in Singapore over time.

Conclusion

Changing demographics and the characteristics of the exposed populations are associated with distinct differences in clinical presentation and outcomes. Understanding demographic shifts may be crucial in appropriate allocation of healthcare resources in managing hospitalised patients with COVID-19.

Disclosures

All Authors: No reported disclosures.
1880. Detection of Infectious SARS-CoV-2 in Specimens with High CT Values Is More Common for Omicron than for Delta Variants
Authors: Tassetto Michel , Garcia-Knight Miguel , Anglin Khamal , Kelly Dan , Lu Scott , Pineda-Ramirez Jesus , Saydah Sharon , Briggs-Hagen Melissa , Zhang Amethyst , Sanchez Ruth Diaz , Donohue Kevin , Romero Mariela , Peluso Michael J , Martin Jeffrey , Andino Raul , Midgley Claire
Published: December 2022

Background

Although not validated, cycle threshold (Ct) values from real-time (r)RT-PCR are sometimes used as a proxy for infectiousness to inform public health decision-making. A better understanding of variant-specific viral dynamics, including RNA and infectious virus relationships, is needed to clarify implications for diagnostics and transmission.

Methods

Non-hospitalized SARS-CoV-2-infected individuals were recruited ≤ 5 days post-onset and self-collected nasal swabs daily for two weeks. Sequencing was used to determine variant, an in-house quantitative rRT-PCR targeting N gene was used to produce Ct values and determine RNA load, and cytopathic effect was used to assess the presence or absence of infectious virus (binary outcome). We used a Ct threshold of 30 to define high-Ct (Ct > 30) or low-Ct (Ct ≤ 30) specimens and assessed the percentage of RNA-positive specimens that had infectious virus; variant-specific percentages were compared by Χ2 test.

Results

We included 113 and 200 RNA-positive specimens from 18 and 28 Omicron- and Delta-infected participants, respectively; timing of RNA-positive specimen collection was similar in both groups (median = 8d post-onset). Maximum observed RNA levels occurred at median of 5 days post-onset for both variants but were lower for participants with Omicron vs Delta [mean RNA copies/mL = 105.2 vs 107.9]. Despite lower RNA levels, infectious virus was frequently detected for both variants [Omicron: median duration = 4.5d; Delta: median = 6d; p = 0.13]. Omicron specimens with infectious virus had higher Cts vs Delta specimens [mean Ct = 29.9 vs 23.2, p < 0.001]. In high-Ct specimens (Ct > 30; Table), the percentage of specimens with infectious virus was typically higher for Omicron vs Delta, and was significantly higher in adults [27.3% vs 9.5%]. In low-Ct specimens (Ct ≤ 30), the percentage with infectious virus was similar or higher for Omicron vs Delta, and was significantly higher in children [87.5% vs 53.8%] and in those unvaccinated [94.1% vs 47.4%].

Conclusion

CDC does not recommend the use of Ct values as a proxy for infectiousness. These data further highlight that Ct values may not provide a reliable or consistent proxy for infectiousness across variants.

Disclosures

All Authors: No reported disclosures.
1890. Molecular Biology of SARS-CoV-2 and its Evolution within the Princeton University Campus Community
Authors: Brewer Jesse T , Yang Qiqi , Aranovich Irina , Wang Wei , Notterman Daniel , Daskalaki Irini
Published: December 2022

Background

SARS-CoV-2, a novel and highly pathogenic coronavirus, has caused unprecedented global disruption following its introduction into the human population. Beginning in January 2021, a NJ university invited all students to campus and initiated an asymptomatic testing protocol using weekly to twice-weekly PCR-based detection of human saliva samples. RNA extracted from PCR-positive human saliva samples was sequenced for surveillance purposes.

Methods

Positive samples were submitted for RNA-Seq analysis (ARTIC amplicon sequencing protocol, Illumina MiSeq) and analyzed using Nextclade and USHER (comparison data from GISAID). Using sequencing data, the evolution, transmission, and emergence of SARS-CoV-2 variants were monitored over time in the campus community. Using sequencing data from NY, PA, and NJ in combination with University data, we performed an IQ-TREE based phylogenetic analysis.

Results

Analyzing sequencing data of 1,011 University positive samples we demonstrate that SARS-CoV-2 variants Delta (B.1.617.2) and Omicron (BA.1 and BA.2) were first to emerge following widespread vaccination and, quickly, became predominant. These trends witnessed on campus preceded those same variants emerging in New Jersey, providing evidence of local campus spread distinct from the state-wide pandemic. The analysis of 2,359 total sequences from NY, PA, and NJ in combination with University data, provided evidence of the SARS-CoV-2 transmission chain on campus evolving from out-of-state (January 2021) to local (January 2022) spread over one year of the virus circulating within the community at large. Upon performing a Ct value analysis of 2,822 Princeton University sequences, no significant differences were discovered between N gene Ct values when grouped by age or vaccination status. However, there were significant differences in Ct values between strains.

The Emergence of SARS-CoV-2 Variants at Princeton University

This plot represents the emergence of SARS-CoV-2 clades at Princeton University, organized by Nextstrain clade and displayed as a proportion out of one. Dates of sample collection range from January 25, 2021, to March 1, 2022. X-axis represents SARS-CoV-2 sample test date (grouped by month); Y-axis represents the count per day organized by Nextstrain clade.

Conclusion

Sequencing of positive SARS-CoV-2 samples from population screening of a highly vaccinated University campus community allowed the detection of emergence of new variants that became predominant on campus irrespective of the circulation of variants in the surrounding area.

Disclosures

All Authors: No reported disclosures.
1892. Rise of COVID-19 Re-infections as Omicron Variant Prevailed: Implications on Monitoring the Course of the Pandemic
Authors: Mellou Kassiani , Gkolfinopoulou Kassiani , Tryfinopoulou Kyriaki , Panagoulias Ioannis , Psallida Panagiota , Gerolymatos Gerasimos , Tsiodras Sotirios , Panagiotakopoulos Georgios , Paraskevis Dimitrios , Zaoutis Theoklis
Published: December 2022

Background

The emergence of the highly infectious Omicron variant at the end of 2021 changed the pandemic dynamics, also causing an increase in COVID-19 re-infections. Our aim was to investigate suspected re-infections and the characteristics of individuals with multiple infections since the beginning of the pandemic until early April 2022.

Methods

Since the beginning of the pandemic, all COVID-19 positive tests (Rapid Antigen Tests - RAT and PCR) have been recorded in the COVID-19 National Electronic Registry. Cases were extracted and reported daily based on the first positive test for each individual (first episodes). Establishment of the Omicron variant, associated with a re-infection surge, triggered the decision for modifying case definition and applying a different methodology to include suspected re-infections in the number of daily reported cases after 3rd of April. Suspected re-infections were defined as “positive PCR or RAT sample ≥90 days following a previous positive PCR or RAT”. The number of re-infections were estimated retrospectively on the Registry’s data.

Results

Overall, 6,348 suspected re-infections were recorded up to 15/12/2021 (0.6% of the laboratory confirmed tests), whereas until 3/4/22 the number was increased at 115.201, raising the percentage to 4%. Distribution of the number of reinfections per ISO week is depicted in Figure 1, along with the number of first episodes. Suspected re-infections stand for 3.7% of the total number of first episodes recorded up to 3/4/22 (3,077,711), with their integration having a noticeable effect on case counting. Among them, 99.3% represent a second episode of infection and 0.7% multiple re-infections. Median age of suspected re-infections was 29 years (IQR: 19-44) (Figure 2). The median length of the time interval between two subsequent infections was 8 months (IQR: 5-12) (Figure 3).

Conclusion

Up until mid-December 2021, COVID-19 re-infection was uncommon, changing to higher rates after the emergence of Omicron variant, thus documenting the immune escape capacity of this variant. Besides the improvement in surveillance, knowledge about the re-infections and their characteristics provides a proxy of the immune protection from previous exposure to COVID-19, against circulating variants over time.

Disclosures

All Authors: No reported disclosures.
1893. Risk Categorization and Outcomes among Healthcare Workers Exposed to COVID-19: A Cohort Study from A Thai Tertiary-care Center
Authors: Khawcharoenporn Thana , Chancharoenrat Watcharee , Sajak Sirinporn , Phetsaen Suphannee , Hanchai Padcharadda , Thongphubeth Kanokporn , Pienthong Thanus
Published: December 2022

Background

A risk categorization tool for healthcare workers (HCWs) exposed to severe acute respiratory syndrome coronavirus-2 is crucial for preventing coronavirus disease 2019 (COVID-19) transmission and requires validation and modification according to local context. We conducted this study to evaluate the performance of the study risk categorization tool and COVID-19-related outcomes among HCWs.

Methods

From 1 January to 31 December 2021, a prospective cohort study was conducted among COVID-19 exposing HCWs at a Thai tertiary-care center. The study risk categorization tool was specifically created in this study and modified from the United States Centers for Disease Control and Prevention recommendations, which classified HCWs into low-risk (LR), intermediate-risk (IR), and high-risk (HR) groups based on types of activities, duration of exposure, and protective methods used during exposure. Subsequent measures were determined for the HCWs based on the risk categories. The primary outcome was the difference in rates of COVID-19 in the LR, IR and HR HCWs.

Results

There were 1,892 HCWs included; 52%, 25% and 23% were LR, IR, and HR, respectively. The median age was 30 years (IQR, 26-36 years). The majority was female (79%) and nurses (33%). The most common risk activities were being in the same room with closed space without wearing a mask with COVID-19 cases (75%). COVID-19 was diagnosed in 157 HCWs and 27%, 5% and 1% of HR, IR and LR HCWs, respectively (P< 0.001). By multivariable analysis, factors associated with COVID-19 included household or community exposure [adjusted odds ratio (aOR), 1588.68; P< 0.001], being HR group (aOR, 11.94; P< 0.001), working at outpatient departments (aOR, 2.54; P< 0.001), and no history of COVID-19 vaccination (aOR, 2.05; P=0.01). The monthly rates of COVID-19 among LR, IR, and HR HCWs significantly decreased after the incremental rate of full vaccination. In-hospital transmission between HCWs occurred in 8% and was mainly due to eating at the same table (58%).

Conclusion

The study risk categorization tool can differentiate risks of COVID-19 among the HCWs. Prevention of COVID-19 should be focused on HCWs with the identified risk factors and behaviors associated with COVID-19 development and encouraging receipt of full vaccination.

Disclosures

All Authors: No reported disclosures.
1909. Steak with a Side of Omicron? Efficacy of Coordinated Outbreak Response during an early COVID-19 Omicron Outbreak amongst Restaurant Workers in Riverside County, CA
Authors: Tsang Shunling , Hetherington Wendy , Hetherington Wendy , Landeros-Tavera Juan , Chevinsky Jennifer , Penny Marshare
Published: December 2022

Background

On Dec 9, 2021, Riverside University Health System-Public Health (RUHSPH) identified a large outbreak of COVID-19 with staff at an upscale restaurant. Omicron was emerging as a Variant of Concern (VOC) and not well understood within the county. This study offers safe reopening strategies during a VOC outbreak.

Methods

RUHSPH worked with county supervisors, counsel, environmental health, and California Department of Public Health outbreak consultation team. Collaboration with corporate restaurant leaders resulted in voluntary closure of operations on Dec 21, 2021. RUHSPH teams were deployed to test and interview 33 staff over 2 days. Specimens were sent to RUHSPH lab for rapid processing. Positive samples were sent to California Viral and Rickettsial Disease Laboratory for whole genomic sequencing (WGS). Outbreak mitigation measures were agreed upon with restaurant leaders. Demographics of cases were summarized using descriptive statistics. Differences by vaccination status and Omicron VOC confirmation were tested with Pearson's Chi-Square.

Results

Between Nov 18-Dec 28, 2021, 31 cases were identified with a mean age of 34.9 years, including 4 positives during the 2-day outbreak investigation. (Table 1) Staff were demographically diverse with no significant differences among those who completed their primary vaccine series. 7 Omicron BA.1 cases were detected amongst staff who completed their primary vaccine series. (Figure 1) Significantly more Omicron cases were observed among females (p< 0.05). Phylogenetic analysis of the Omicron specimens showed three distinct introductions with one clear cluster of 4 cases.

A framework of staff clearance was detailed with restaurant leaders. Clearance criteria allowed for reopening the next day. Contact tracing occurred for 79 total staff. No additional cases were identified amongst restaurant staff and the outbreak was closed on Jan 2, 2022. Table 1.Characteristics of the 31 employees that tested positive, including those tested during the 2-day investigation.Figure 1.Employees Infected with COVID-19 by Date of Symptom Onset or Specimen Collection

Conclusion

This response highlights the importance of collaboration between state, local, and workplaces to develop a concise approach in an emerging VOC outbreak. WGS provided evidence of distinct introductions and workplace transmission amongst restaurant staff. This approach will be imperative to evaluate and contain future VOC outbreaks.

Disclosures

All Authors: No reported disclosures.
1922. Outbreak and Management of COVID-19 and Infection Prevention Control Practices at a Community Living Center in Veterans Administration Hospital, North Texas
Authors: Hanna John J , Silva-Rodriguez Denisse , Christie-Smith Angela , Psenicka Andrew O , Reid Sherry R , Oboho Ikwo K
Published: December 2022

Background

The increase in SARS-CoV-2 cases due to the omicron wave led to significant utilization of healthcare resources and reduced acute care hospital beds at the Veterans Administration Hospital, North Texas Health Care System (VANTHCS). As a result, veterans with non-severe disease were managed at a VANTHCS community living center (CLC) during a COVID-19 outbreak.

Methods

Veterans residing at the CLC with laboratory-confirmed cases of SARS-CoV-2 (the virus that causes COVID-19) by polymerase chain reaction diagnosed from January 1 to February 15, 2022, were included in the descriptive analysis. We described resident characteristics and outcomes and infection control practices (IPC) implemented to control the outbreak. Resident data was ascertained from the COVID-19 facility dashboard and medical record system.

Results

From January 1–February 15, 2022, 33 adults residing at the CLC were diagnosed COVID-19. Most infections (93.9%) occurred between January 12–24 (figure 1). The median age was 76 years [interquartile range, 71–80 years] and 30 (90.9%) were men and 25 (75.8%) were white and 5 (15.2%) African American (table 1). Among the total cases, 9 (27.3%) resided in the dementia unit. Nineteen of 33 (57.6%) were asymptomatic. Overall, 28 (84.8%) were documented to be fully vaccinated against SARS-CoV-2 and 24 (72.7%) were boosted. Obesity, ischemic heart disease, chronic obstructive pulmonary disease, and stroke were the most common comorbidities. Residents were cohorted based on COVID-19 results. A multidisciplinary team was convened, and staff were fit tested for appropriate personal protective equipment (PPE) and received refresher training on hand hygiene, donning and doffing of PPE. Most residents were determined to have mild or moderate COVID-19 and managed at the CLC while 7 (21.2%) were hospitalized in the acute care hospital. For management of COVID-19, 11 (33.3%) received dexamethasone and 25 (75.8%) received remdesivir. Overall, 32 (97%) residents survived while one hospice resident was transferred to acute care and died; only 1 resident required ICU admission.

Epidemic curve of laboratory-confirmed coronavirus disease 2019 (COVID-19) disease at a Community Living Center, Veterans Administration Hospital, North Texas Health Care System, January–February 2022. Table 1Epidemiological Characteristics, and Outcomes of Laboratory-confirmed COVID-19 cases (N=33)Abbreviation: BMI, body mass index; COPD, Chronic Obstructive Pulmonary Disease; ESRD, end stage renal disease1Other comorbidity (asthma n=1 and chronic liver disease n=2)

Conclusion

It is feasible to administer COVID-19 therapies to high-risk residents with mild-moderate disease in a CLC with a multidisciplinary team and IPC strategies.

Disclosures

All Authors: No reported disclosures.
1932. Antibody Response to SARS-CoV-2 Vaccination in US Veterans Living with HIV
Authors: Njoroge Alexander , Ford Florence M , Psevdos George
Published: December 2022

Background

COVID-19 (C-19) vaccines have demonstrated effectiveness in reducing SARS-CoV-2 related morbidity/mortality. The duration of protection in the general population is showing a waning immunity over time. Variable antibody responses to C-19 vaccines have been shown in persons living with HIV. We followed the anti-SARS-CoV-2 receptor biding domain (RBD) antibody titers, after 2 and 3 (booster) C-19 vaccinations, in US Veterans living with HIV (USVLH).

Methods

Retrospective chart review of USVLH who had received C-19 vaccinations at Northport VAMC. Testing was done with the © Beckman Coulter enzyme immunoassay measuring total IgG antibody to the RBD, a critical target of neutralizing antibodies within the spike protein encoded in the mRNA vaccines. Titers were drawn after the 2nd and 3rd doses C-19 vaccines in variable timing. Demographic data, CD4+ T cell counts nadir and current, HIV viral load, comorbid conditions were reviewed.

Results

We analyzed the SARS CoV-2 RBD IgG titers in 50 vaccinated USVLH. The median age is 65 years (range 36-75). 50% were Black, Caucasian 40%, Hispanic 10%. Risk factor for HIV infection, Heterosexual 52%, IVDU 18%, MSM 26%, needle stick 2%, blood transfusion 2%. The median CD4 nadir was 200/µL (5- 600), median current CD4 656 (174-1529). All USVLH were on HAART, 92% on INSTI-based therapy. 45 had undetectable HIV viral load (< 20), 5 had viremia from 22 to 563 copies. Medical conditions: diabetes 30%, CAD 18%, HTN 60%, COPD 8%, HLD 66%, smokers 18%. Six USV had C-19 prior to vaccination, and six had C-19 after vaccination with median 102 days (90-148) from last vaccine dose. Vaccines given: Janssen in 3 USVLH: Moderna (MOD)- 2 doses: 4; MOD-3 doses:5; Pfizer (PFZ)-2: 6; PFZ-3: 32. IgG titers decrease with time after 2nd vaccine dose and increase after booster dose. IgG titers checked after 2nd dose median days 120 (11-392) {titers: median 4.63 S/CO [0.17 – 53.66]}, 91 days (5-181) after 3rd dose {titers: median 16.22 [1.15-73.92]}. Titers were higher in MOD-2 vs. PFZ-2, median 25.7 vs. 4.63, P: 0.039, MOD-3 vs. PFZ-3 33.89 vs. 15.5, P: 0.117. No death due to C-19 was seen.

SARS-CoV-2 RBD IgG titers in US Veterans living with HIV after 2nd dose of COVID vaccine.

COVID-19 VACCINATED IN US VETERANS LIVING WITH HIV N=50

Conclusion

In a cohort of USVLH, well controlled on HAART, C-19 vaccinations produced a serologic response that decayed over time and increased after booster dose. MOD vaccine may have achieved higher titers than PFZ.

Disclosures

All Authors: No reported disclosures.
2349. Elucidating the Pathogenesis of Staphylococcus aureus During Hyperglycemic Osteomyelitis
Authors: Butrico Casey E , Eichelberger Kara R , Good Christopher J , Neumann Elizabeth K , Spraggins Jeffrey M , Cassat James E
Published: December 2022

Background

Staphylococcus aureus is a leading cause of antibiotic-resistant bacterial infections and can infect nearly every organ of the human body. One common manifestation of S. aureus disease is invasive bone infection, or osteomyelitis. Osteomyelitis is one of the most difficult to treat infections, often necessitating prolonged antibiotic treatment and surgical interventions. Hyperglycemia, or elevated blood glucose concentration, increases the risk for developing osteomyelitis. We hypothesized that S. aureus adapts specifically to the altered host environment during hyperglycemic osteomyelitis, thereby contributing to the increased infection severity.

Methods

To model hyperglycemic osteomyelitis, we treated mice with streptozotocin prior to infection with S. aureus in a post-traumatic osteomyelitis model. We analyzed bacterial burdens in homogenized tissues and bone parameters with microcomputed tomography. To identify changes in the spatial molecular architecture of infected, hyperglycemic femurs, we utilized imaging mass spectrometry. Finally, to obtain a comprehensive understanding of S. aureus metabolic and virulence changes and identify genes essential for staphylococcal growth in vivo in hyperglycemic mice, we performed a transposon sequencing experiment.

Results

We discovered that hyperglycemic mice sustained increased bacterial burdens within infected femurs and greater dissemination to other organs. We also found that hyperglycemic infected mice experienced increased rates of bone destruction and loss of trabecular bone volume, suggesting that hyperglycemia exacerbates infection-associated bone loss. Finally, we identified 71 genes as uniquely essential for S. aureus growth during hyperglycemic infection compared to euglycemic infection.

Conclusion

Hyperglycemia results in increased osteomyelitis infection severity. Multiple S. aureus genes involved in metabolism with roles in bacterial fitness in acidic environments were uniquely essential for bacterial fitness during comorbid infection. By identifying genes contributing to S. aureus survival during hyperglycemic osteomyelitis, we have the potential to inform targeted therapeutic development for treatment of exacerbated infections in patients with comorbid hyperglycemia.

Disclosures

All Authors: No reported disclosures.
1938. COVID-19 Vaccine Hesitancy among Adults Who Rely on Social Media for Health Care Information in Cameroon, Africa
Authors: Baecher Kendall , Boutwell Alexander , Gunawardhana Nuwan , Gunawardhana Nuwan , Tebit Denis M , Dionne Jodie
Published: December 2022

Background

In Africa, uptake of effective COVID-19 vaccines has been limited by accessibility and vaccine hesitancy (VH). VH is multifactorial but influences include disinformation through social media with Whats App being the most popular form in Cameroon. The aim of this study was to test our hypothesis that frequent users of social media would have higher vaccine hesitancy due to exposure to disinformation in Cameroon in Central Africa.

Methods

A survey study was conducted at urban and suburban hospital facilities in four of the ten regions of Cameroon. Participants were asked to self-report socio-demographics, perceptions of COVID-19 infection, and interest in vaccination. They were also asked to rank their top two sources of health care information, including social media. Bivariate analysis was used to explore the perceptions of infection and vaccination stratified by social media preference with statistical significance set at p< 0.05.

Results

We found that 18% (151/835) of participants cited social media (SM) as a top source of health care information. Health care professionals were cited by 82% as the most trusted source for health information (n=681). Fewer than one-third of survey participants were interested in receiving the COVID-19 vaccine (31%, 257/835) and rates did not differ by SM preferences. More people in the social media group, 53% vs 38% (p=0.046) stated that more information about vaccine safety may help reduce hesitancy. Perceived risks of COVID-19 vaccination ranged from death (33%) to fetal harm (31%) to supernatural reactions (1.4%). The SM group was not more likely to site perceived risks of the vaccine (p=0.244).

Participant Characteristics.

Conclusion

Although vaccine hesitancy in Cameroon was high at the time of the survey, adults who prefer to get health information from social media were not more likely to express vaccine hesitancy. Public education campaigns led by healthcare professionals may have the greatest impact on vaccine acceptability based on trusted information sources cited by participants.

Disclosures

All Authors: No reported disclosures.
1940. COVID-19 Vaccines and Related Adverse Effects among Health Sciences and Non-Health Sciences Students from Two Large Public Universities in Thailand
Authors: Jongmekwamsuk Kanathip , Hanvivattanakul Sirashat , Vanichanan Jakapat , Khawcharoenporn Thana
Published: December 2022

Background

Existing data on vaccine regimens received by university students and related adverse effects are limited.

Methods

An online survey study was conducted among students from 12 Health Sciences faculties (HS), including Faculty of Medicine and from 16 non-Health Sciences faculties (NHS) of two large urban Thai universities from October 2021 to January 2022. Types, doses and adverse effects (AEs) of COVID-19 vaccines received by HS and NHS were assessed.

Results

There were 1,439 participating students who had received two doses of COVID-19 vaccines. Of these 1,439 students, 522 (36%) were HS (208 were medical students), 393 (27%) were from faculties of Sciences, and 524 (37%) were from faculties of Social Sciences. The types of the first dose vaccine received were inactivated (49%), viral vector (46%) and mRNA (5%), while the types of the second dose vaccine received were viral vector (53%), inactivated (40%) and mRNA (7%). For the first dose vaccines, the most common AE of inactivated, viral vector and mRNA vaccines were muscle pain (47%, 82%, 58%, respectively). For the second dose vaccines, the most common AE were cough (47%) for inactivated vaccines and muscle pain (49% for viral vector and 56% for mRNA vaccines). Viral vector vaccines were more likely to cause fever, muscle pain, diarrhea, headache and rashes while inactivated vaccines were more likely to cause cough. The mRNA vaccines caused injection site pain more than inactivated vaccines. Tables 1 and 2 demonstrate the type and onset of AEs by types of the vaccines. Overall, the majority of AEs occurred at 24-48 hours after vaccination (57-68%), were more severe with the first dose compared to the second dose (59%) and resolved spontaneously or with symptomatic treatment without the need for hospitalization (98%). The AEs experienced by HS and NHS were different according to the types of vaccine they received. Table 1Adverse effects of the first dose of COVID-19 vaccine, stratified by type, of those who had received two doses of the vaccinesTable 2Adverse effects of the second dose of COVID-19 vaccine, stratified by type, of those who had received two doses of the vaccines.

Conclusion

The AEs experienced by the students were different according to the type and number of doses of COVID-19 vaccines. The AEs were mostly non-severe and occurred less for the second dose compared to the first dose. The study findings could serve as information provided to university students for decision making regarding COVID-19 vaccination.

Disclosures

All Authors: No reported disclosures.
1941. Describing the immune response kinetics to mRNA COVID-19 vaccines among previously SARS-CoV-2–infected and –uninfected nursing home residents, a prospective longitudinal observational cohort evaluation—Georgia, October 2020 – September 2021
Authors: Chisty Zeshan A , Haile Melia , DaSilva Juliana , Biology M A , Houston Hollis , Le Shoshona , Li Deana , Overton Rahsaan , Arons Melissa , Schuh Amy J , Tsang Clarisse A , Selenic Dejana , Clemente Jacob , Bugrysheva Julia , Branch Alicia , Thornburg Natalie J , Epperson Monica , Rasheed Mohammed A , Bohannon Caitlin D , Stuckey Matthew J , McDonald L C , Brown Allison C , Kutty Preeta K
Published: December 2022

Background

To describe post-COVID-19 vaccination [fully vaccinated (FV) and first booster] immune response and occurrence of reinfection ( >90 days from prior infection) in nursing home residents (NHr) with/without evidence of prior SARS-CoV-2 infection.

Methods

In a longitudinal prospective cohort of 36 NHr from 3 NHs, interviews, chart abstractions, and specimens [blood and anterior nasal swabs (ANs)] were collected at baseline and monthly visits. ANs underwent molecular and BinaxNOW™ antigen testing. Quantitative Meso Scale Discovery platform tested blood specimens for anti-spike (S) protein and anti-nucleocapsid (N) antibodies. In addition, in a subset (n=13), S-specific memory B cells (MBCs) were tested with ELISpot assays.

Results

The cohort's median age was 72 years; 46% male, 64% White Non-Hispanic, 80% had ≥3 comorbidities, and 29 (81%) had prior SARS-CoV-2 infection. Of 36, 76% received Pfizer-BioNTech and 24% Moderna homologous vaccine. The median distribution of anti-S IgG concentrations among those with prior infection increased 15‒30 days post-FV, remained stable for 90 days, and declined by 120 days. The anti-S IgG remained above the estimated vaccine effectiveness (VE) thresholds published [Pfizer-BioNTech (95% VE: 530 BAU/ml), Moderna (90% VE: 298 BAU/ml)]. Among those without previous infection, anti-S IgG declined after 60 days and stayed near the VE thresholds until a recent infection/booster. Age, sex, and comorbidities had no appreciable impact on anti-S IgG. From enrollment to November 2021, 1of 29 had reinfection. From December 2021 to January 2022, 2 of 7 had a new infection, and 4 of 29 had reinfection, as shown by anti-N IgG rise. Persistently low numbers of total and anti-S MBC were seen across the evaluation, even with post-booster anti-S MBC rise. There was an immediate rise in anti-S IgG concentrations in all participants post-booster, irrespective of recent infection.

Conclusion

These findings from a NH convenience cohort suggest that prior SARS-CoV-2 infection has a pronounced immunomodulatory enhancing effect on the magnitude and duration of FV immune response. The decline of anti-S antibodies post-FV and rise after booster supported the booster recommendation in this cohort. The low MBC counts indicate immunosenescence in this high-risk population.

Disclosures

Hollis Houston, BA, Fidelity: Stocks/Bonds.
1947. Evaluating the Relationship Between Obesity and the Humoral Immune Response to COVID-19 Vaccines
Authors: Tables LaKesha , Ali Fatima , Gaines Eric , Sim Yul Eum , Johnson Erica L , Immergluck Lilly
Published: December 2022

Background

The pro-inflammatory state associated with obesity leads to B- and T-lymphocyte dysfunction that may lead to an inadequate immune response to natural infection and vaccination. Preliminary studies, conducted outside of the US, involving multiple COVID-19 vaccines indicate that obesity may impact antibody response. The objective of this study was to evaluate the role of inflammatory status as a mediator in the relationship between obesity and COVID-19 vaccine immune response in a predominantly African-American population.

Methods

This cross-sectional analysis involved 54 participants ≧ 18 years of age who had completed the primary dosing schedule and booster for Novavax’s recombinant COVID-19 vaccine, NVX-CoV2373. Weight, height, and waist circumference (WC) measurements were taken. Medical history including COVID-19 vaccination and known COVID-19 infection were obtained. Blood samples were taken for measurement of c-reactive protein (CRP) and anti-SARS-CoV-2 spike protein IgG levels. Spearman correlation coefficient was used to assess the presence of a relationship between BMI and CRP, WC and CRP, CRP and spike protein IgG, BMI and spike protein IgG, and finally, WC and spike protein IgG. Mediation analysis was used to evaluate the moderating effect of plasma CRP on the relationship between WC and spike protein IgG while adjusting for suspected confounders. Statistical significance was defined as p < .05.

Results

There was an expected positive relationship between WC and CRP, (ρ = 0.37, p< .05). CRP and spike protein IgG trended towards a weak, negative relationship (ρ= -0.13, p > .05). WC and BMI both trended towards a positive relationship with anti-SARS-CoV-2 spike protein IgG (ρ = 0.29 and 0.15, respectively, p >.05). The mediation analysis showed that WC positively influenced spike protein IgG (p< .05), and this effect was not mediated by CRP.

Conclusion

Inflammation may be negatively associated with antibody response to COVID-19 vaccines. WC and antibody response may be positively related in NVX-CoV2373 recipients, in spite of chronic low-grade inflammation. Further research is needed to fully characterize the impact of obesity on COVID-19 vaccine immunogenic responses.

Disclosures

Lilly Immergluck, MD, MS, GSK: Clinical Trial- PI|Merck: Vaccine Trial Site- serve as PI|Moderna: Board Member|Novavax: Part of CoVID-19 Phase 3 Trial through US Covid Prevention Network.
1955. Immunogenicity And Safety of a Virus-Like Particle (VLP) Protein Subunit SARS-CoV-2 Vaccine in Adults: a Phase 1/2 Study
Authors: Scott Robert , Thackwray Susan , Hourguettes Nicholas , Gelderblom Huub , Kanesa-thasan Niranjan
Published: December 2022

Background

COVID-19 continues to cause substantial morbidity and mortality globally. It is likely that booster vaccinations will be needed in future years to protect older adults and those with chronic medical conditions. We present interim topline results of a phase 1/2 study of IVX-411 [ACTRN12621000738820.; ACTRN12621000882820], an investigational VLP protein subunit SARS-CoV-2 vaccine, in adults aged 18–69 years (Figure 1).

Methods

In Part 1, 84 SARS-CoV-2-naïve adults were randomized to receive two doses on Days 0 and 28 of either IVX-411 (5, 25, or 125µg) ± adjuvant, or placebo (Figure 2a). In Part 2, 84 subjects received a single dose of either IVX-411 ± adjuvant or placebo 3–6 months after completion of a primary licensed vaccine regimen (Figure 2b). Solicited adverse events (AEs) were collected for 7 days after each dose, with immunogenicity assessed on Days 0, 28, and 49 [(Part 1) and on Days 0, 7 and 28 (Part 2). Primary outcomes in both parts were solicited and unsolicited AEs, neutralizing antibody titers, and spike protein-specific IgG antibody titers.

Results

Demographics were similar in the IVX-411 groups vs placebo. In Part 1 and Part 2, local reactogenicity was mild-to-moderate, with higher rates of AEs with increasing doses and addition of adjuvant (Figure 3a). Rates of systemic AEs were similar to placebo across groups (Figure 3b). No vaccine-related severe or serious AEs were noted. IVX-411 was immunogenic in both primary and booster vaccination: in SARS-CoV-2-naïve subjects, a limited dose effect was seen, with significantly higher antibody titers in the groups receiving adjuvanted IVX-411 vaccine (p< 0.01; Figure 4a). The magnitude of antibody responses was similar to, or below, Human Convalescent Sera levels. In previously vaccinated subjects, IVX-411 boosted baseline antibody titers, with no conclusive dose or adjuvant effect (Figure 4b). Immunogenicity was observed across all variants of concern (beta, delta, and omicron) in both parts, with up to 7- fold rises from baseline (Figure 5).

Conclusion

The study met all primary safety and immunogenicity objectives, with acceptable tolerability profiles in primary and booster vaccination. A clear adjuvant effect was observed in SARS-CoV-2-naïve subjects.

Disclosures

All Authors: No reported disclosures.
1956. Impact of an Implementation Science-Based Project to Address COVID-19 Vaccine Hesitancy
Authors: Ratzan Scott C , Hultgren Erin , Carter Jeffrey D , Rodriguez Melissa , Simone Laura , Molloy Leah
Published: December 2022

Background

COVID-19 vaccine uptake remains suboptimal. This project aimed to identify and mitigate reasons for vaccine hesitancy.

Baseline patient knowledge and attitudes about COVID-19 vaccination

Methods

Between 9/2021 and 1/2022, 16 live in-person and/or virtual patient education programs were held in community centers/clinics in NC and GA. Surveys were administered before/after each session, and longitudinal outcomes 3 weeks later.

Results

Surveys were conducted amongst the 1381 participating patients. 64% were already fully vaccinated against COVID-19, 19% had received 1 of 2 doses, and 17% were either unvaccinated (14%) or unsure of their status (3%). Baseline vaccine knowledge was higher among fully vaccinated patients, with patient attitudes varied per vaccination status (Figure). Patients not planning to get vaccinated cited concern for long-term (21%) and short-term (18%) side effects, thinking the vaccines were developed too quickly (16%), not feeling the vaccine would protect them (10%), and not feeling at risk for serious illness (10%). When asked what they thought would increase patient interest in vaccination, providers (n = 28) identified a strong recommendation (39%) or more information (36%) from a patient’s own doctor, while patients prioritized transportation (28%) , vaccine availability in their doctor’s office (23%), and information from their doctor (23%). Provider confidence in counseling patients improved after the program; more providers felt confident discussing vaccine safety (69%) and efficacy (69%) after the program than at baseline (33% and 41%, respectively). More patients felt confident sharing COVID-19 vaccine information with family and friends after the program (73%) than before (53%). Gains in patient views about COVID-19 vaccination were greatest among those who were unvaccinated/unsure; among this group, more patients agreed that vaccines are safe (72%), effective (76%), and important (78%) after the education, compared to 42%, 46%, and 52% at baseline, respectively. In the longitudinal patient follow-up survey 86% of unvaccinated patients got vaccinated after completing the education session.

Conclusion

Patient knowledge and attitudes varied based on vaccine experience, as did patient and provider perceptions about improving vaccine acceptance. Vaccine uptake was high following the program.

Disclosures

Scott C. Ratzan, MD, MPA, Abbvie: Stocks/Bonds|Astra Zeneca: Stocks/Bonds|baxter: Stocks/Bonds|Bristol Myers Squibb: Stocks/Bonds|Merck: Grant/Research Support|Quest Diagnostics: Stocks/Bonds|United Health Group: Stocks/Bonds|Usana Health. Services: Stocks/Bonds|vertex: Stocks/Bonds.
1962. Perceptions of the COVID-19 Vaccine within the Sudanese-American Community
Authors: Freese Jonathan R , Sayles Harlan R , Ahmed Fatima , Abdellatif Mujtaba , Fadul Nada
Published: December 2022

Background

One of the primary issues affecting COVID-19 vaccine uptake in high-income countries is vaccine hesitancy, which is prevalent in people from different countries of origin. Characterizing vaccine uptake in immigrant and refugee populations in the US could provide a unique window into both local and global health behaviors. The goal of this project is to characterize Sudanese American perspectives on the COVID-19 vaccine.

Methods

We conducted an anonymous, online, anonymous, cross-sectional survey directed toward Sudanese Americans, with survey development guided by principles from the Vaccine Examination Scale. The survey was distributed in both English and Arabic and included questions about vaccination history, motives for getting the vaccination, reasons for vaccine hesitancy, and barriers to vaccination. Fisher’s exact tests were used to analyze evaluate possible associations between vaccine uptake and sources of information on the vaccine and social media use, respectively. Data analysis was conducted using STATA SE v17.0 (StataCorp, College Station, TX).

Results

A total of 108 survey responses were received; 4 were excluded for failing to meet inclusion criteria. A total of 92% received at least one dose of COVID-19 vaccine, with the primary motivation being to protect oneself (62%). Only 8 had not been vaccinated and, of those, 2 were willing to take the vaccine. Of the 6 unwilling to take the vaccine, the most cited reason was a belief that it had not been studied enough. Of the 14 possible hesitancy responses, 9 were selected at least once.

When asked about their primary source of information on COVID-19, 44% used government websites, followed by mass media (22%), social media (12%) and health personnel (11%). Using Fisher’s exact tests, no statistically significant conclusions were drawn between vaccine uptake and primary source of information (P = .097) or specific types of social media.

Conclusion

Vaccine uptake among our survey population (92%) was much higher than that of the US (77%) or Sudanese population (11%). Overall motivators for vaccine hesitancy and vaccine uptake varied and no specific correlations were found to be associated to vaccine uptake. Future research should evaluate high levels of vaccine uptake in this community.

Disclosures

All Authors: No reported disclosures.
1963. Peripartum Outcomes Associated With COVID-19 Vaccination during Pregnancy: A Systematic Review and Meta-analysis
Authors: Watanabe Atsuyuki , Yasuhara Jun , Iwagami Masao , Miyamoto Yoshihisa , Yamada Yuji , Suzuki Yukio , Takagi Hisato , Kuno Toshiki
Published: December 2022

Background

The risk and benefits of coronavirus disease 2019 (COVID-19) vaccination during pregnancy are under investigation. Pooled evidence regarding neonatal and maternal outcomes in relation to COVID-19 vaccination during pregnancy is scarce.

Methods

We searched PubMed and EMBASE databases in April 2022 without language restrictions. We included Prospective trials and observational studies comparing the women who received at least one COVID-19 vaccination during pregnancy with those who did not and reporting neonatal outcomes. Two independent investigators extracted relevant data from each study. Odds ratios (ORs) were calculated using random-effects models. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.

The primary outcomes were the neonatal outcomes, including preterm birth, small-for-gestational-age (SGA), low Apgar score (< 7 at 5 min), neonatal intensive care units (NICU) admission, and intrauterine fetal death (IFD). The secondary outcomes were maternal outcomes, including maternal SARS-CoV-2 infection, cesarean delivery, postpartum hemorrhage, and chorioamnionitis.

Results

Nine observational studies involving 81,349 vaccinated (mean age, 32.0±4.6 years) and 255,346 unvaccinated women during pregnancy (mean age, 30.5±5.1 years) were included. COVID-19 vaccination during pregnancy was associated with lower risk of NICU admission (OR, 0.88; 95% confidence intervals [CI], 0.80-0.97) and IFD (OR, 0.73; 95% CI, 0.57-0.94), whereas it was not associated with preterm birth (OR, 0.89; 95% CI, 0.76-1.04), SGA (OR, 0.99; 95% CI, 0.94-1.04), and low Apgar score (OR, 0.94; 95% CI, 0.87-1.02). COVID-19 vaccination during pregnancy was associated with a lower risk of maternal SARS-CoV-2 infection (OR, 0.46; 95% CI, 0.22-0.93), but not associated with increased risk of cesarean delivery (OR, 1.05; 95% CI, 0.93-1.20), postpartum hemorrhage (OR, 0.95; 95% CI, 0.83-1.07), and chorioamnionitis (OR, 0.95; 95% CI, 0.83-1.07).

Flowchart of study selection

Forest plots showing the odds ratio of neonatal outcomes

a: neonatal intensive care units admission, b: intrauterine fetal death, c: preterm birth, d: small for gestational age, e: low Apgar score

Forest plots showing the odds ratio of maternal outcomes

a: maternal SARS-CoV-2 infection, b: cesarean delivery, c: postpartum hemorrhage, d: chorioamnionitis

Conclusion

COVID-19 vaccination during pregnancy did not increase the risk of peripartum outcomes but decreased the risk of NICU admission, IFD, and maternal COVID-19 infection. COVID-19 vaccination should be encouraged for pregnant women.

Disclosures

All Authors: No reported disclosures.