bluuebunny/crossref_metadata_2025 huggingface dataset:
1177. Vaccinate Lurie (VaLu) a QI Project to Improve Pediatric Pre-Transplant Immunization Rates
Authors: Heald-Sargent Taylor , John Jordan D , Toia Jacquie , Newman Alexander , Vo Truc , Semp Melissa , Le Kevin , Rowley Anne H , Thush Philip , Joong Anna , Panek Natalia , Jhaveri Ravi
Published: December 2021

Background

Immunization prior to transplantation is important due to post-transplant immunosuppression. According to a national study, 15% of pediatric solid organ transplant recipients were hospitalized within 5 years post-transplant for a vaccine preventable illness or RSV. At our large academic pediatric hospital approximately 53% of heart and liver transplant recipients in 2016 -2018 were up to date with tetanus and pneumococcal vaccinations. This QI project was designed to improve our pre-transplant vaccination rates to minimize post-transplant infections.

Methods

An interdisciplinary team was convened including pharmacists, nurses, nurse practitioners, and physicians from cardiology, hepatology, and infectious diseases. After evaluating our current processes and key drivers, we selected interventions to implement via the PDSA model. Our first intervention was to have team members gain access to our statewide vaccine database (ICARE). Our second cycle was to link ICARE to our electronic medical record system (EPIC) for automatic immunization record integration.

Process Map

Key Driver Diagram

Results

Our outcome measure was up to date tetanus and pneumococcal vaccines per the CDC recommendations by age at transplant, as documented in the medical record. We saw an improvement in immunization rates to 100% during the third quarter of 2020 with an overall rate of over 80% for late 2019 - mid 2020. With the understanding that our average wait time for a heart and liver transplant was 2.4 and 3.8 months, respectively, the initiation of our QI project and obtaining access to ICARE by our team members was likely related to the improved vaccination rates. Unfortunately, after the team stopped meeting during the pandemic our immunization completion rates have decreased in 2021, despite implementing institutional access to ICARE.

Control Chart

Conclusion

It is possible to obtain optimal immunization rates for pneumococcal and tetanus vaccines in pediatric heart and liver transplant recipients. Our future interventions include improving vaccinations after catch-up recommendations have been made and sustaining our interventions. Additionally, we look to expand our analysis to include outcomes related to vaccine-preventable diseases after transplantation.

Disclosures

Jacquie Toia, DNP, RN, APN, QarTek (Board Member) Ravi Jhaveri, MD, AstraZeneca (Consultant)Dynavax (Consultant)Elsevier (Other Financial or Material Support, Editorial Stipend as Co-editor in Chief, Clinical Therapeutics)Seqirus (Consultant)
1179. PCV13 Pediatric Routine Schedule Completion and Adherence Before and During the COVID-19 Pandemic in the US
Authors: Huang Liping , Nguyen Jennifer L , Perdrizet Johnna , Alfred Tamuno , Arguedas Adriano
Published: December 2021

Background

Coronavirus Disease 2019 (COVID) mitigation measures may have unintended consequences, such as reduced or delayed access to routine immunizations. This study examined (1) PCV13 routine vaccination completion and adherence (C&A) among US infants before and during the COVID pandemic and (2) the relationship between primary dose C&A and booster dose C&A.

Methods

Retrospective data from the Optum’s de-identified Clinformatics Data Mart Database were used to create 3 cohorts: C1, Pre-COVID; C2, During COVID; C3, Cross-COVID (Figure 1). The completion was defined as number of PCV13 doses received within 8 months of birth, and the adherence was defined number of doses received at ACIP recommended time (@2, 4, 6 months, +/- 5 days). Univariable logistic regression was used to compare the odds of primary dose C&A in cohorts C1 and C3 vs C2 and descriptive analyses were used to explore primary dose C&A in relation to booster dose C&A.

Figure 1: Study population and inclusion criteria

Results

A total of 172,916, 70,049, and 34,854 infants were included in C1, C2, and C3. Among infants with > 8 months of follow-up from birth (N=132,183 for C1&C3, 16,522 for C3), 3-primary dose completion was statistically significantly higher before COVID than during COVID (crude OR = 1.10, 95% CI: 1.06-1.15). The 3-primary dose adherence was also higher before COVID than during COVID (crude OR = 1.10, 95% CI: 1.05-1.15). Among infants with ≥2, 4 and 6 months of follow-up, adherence of each individual dose was consistently higher before COVID than during COVID (1st dose: OR = 1.03, 95% CI: 1.01–1.04; 2nd dose: OR = 1.04, 95% CI: 1.01 – 1.06; 3rd dose: OR = 1.12, 95% CI: 1.08 – 1.15) (Table 1). Booster dose completion was higher in infants who completed or adhered to 3 primary doses than infants who completed or adhered to only 1 or 2 primary doses (Figure 2, Overall) and booster dose C&A was generally higher before COVID than during COVID (Figure 2, Cohort 1 vs. Cohort 3).

Table 1. Comparison of completion and adherence of primary dosing series per-COVID vs. during-COVID era

Figure 2: Booster dose completion and adherence in relation to primary dosing completion (A) and adherence (B)

Conclusion

These results indicated that PCV13 full completion was statistically lower during COVID, but the magnitude of the difference in infants was not extensive. Infants who completed or adhered to all three primary doses were more likely to complete or adhere to the booster dose. Further research is warranted as structured datasets mature to capture the full time span of COVID-19 mitigation measures.

Disclosures

Liping Huang, MD, MA, MS, Pfizer Inc (Employee) Jennifer L Nguyen, ScD, MPH, Pfizer Inc. (Employee) Johnna Perdrizet, MPH, Pfizer Inc (Employee) Tamuno Alfred, PhD, Pfizer Inc. (Employee) Adriano Arguedas, MD, Pfizer (Employee)
1180. Comparing Changes in Pneumococcal Meningitis Incidence to all Invasive Pneumococcal Disease Following Introduction of PCV10 and PCV13: The PSERENADE Project
Authors: Yang Yangyupei , Knoll Maria Deloria
Published: December 2021

Background

The introduction of higher valency pneumococcal conjugate vaccines (PCV10 and PCV13) has reduced invasive pneumococcal disease (IPD) incidence. It is unknown whether the degree of reduction differs for pneumococcal meningitis, a small subset of pneumococcal disease but a major cause of severe childhood morbidity and mortality globally. We compared the impact of PCV10/13 on pneumococcal meningitis and all IPD by estimating the changes in incidence following the introduction of PCV10/13 among children < 5 years of age.

Methods

Data on confirmed positive cases for pneumococcus in cerebrospinal fluid (CSF) were obtained directly from surveillance sites. PCV10/13 impact on all-serotype pneumococcal meningitis and all IPD were estimated using site-specific incidence rate ratios (IRRs) at each post-PCV10/13 year relative to the pre-PCV period, using Bayesian multi-level, mixed effects Poisson regression. All-site weighted average IRRs were estimated using linear mixed-effects regression. Results were stratified by product (PCV10 vs. PCV13) and amount of prior PCV7 use (none; some (1-3 years or 4-5 years with < 70% uptake); or many (≥ 4 years with ≥ 70% uptake).

Results

40 surveillance sites (9 PCV10, 31 PCV13) in 28 countries, primarily high-income (82%) that had both CSF and IPD data were included in analyses. CSF+ accounted for 9.0% of IPD cases (IQR across sites: 6.2%-15.6%). The rate and amount of decline was generally similar between meningitis and IPD across all strata. At 5 years after PCV10/13 introduction, the IRRs across PCV7-use strata were 0.28-0.32 for pneumococcal meningitis and 0.22-0.43 for all IPD at PCV10-using sites, and 0.27-0.41 and 0.21-0.32, respectively, for PCV13-using sites. Only one site from the African meningitis belt contributed eligible data, which lacked pre-PCV data to estimate IRRs, but incidence rate of both IPD and meningitis decreased following PCV introduction.

Figure 1. All-Site Weighted Average Incidence Rate Ratios, Children < 5 years

* Total sites indicate the number of sites with incidence rate data included and pre/post sites indicate the number of sites with both pre− and post−PCV data to estimate site−specific IRRs for each outcome. The size of point estimates is relative to the number of sites with both pre− and post− data. ** Year 0 indicates the year of PCV10/13 introduction and year −1 indicates the last year of PCV7 use prior to PCV10/13 introduction.

Conclusion

Net declines in all-serotype IPD and CSF+ meningitis in children < 5 years were similar on average for both PCV10 and PCV13. Data from low-income, high-burden, and meningitis-belt regions were limited.

Disclosures

Maria Deloria Knoll, PhD, Merck (Research Grant or Support)Pfizer (Research Grant or Support)
1186. Increased Respiratory Syncytial Virus (RSV) Viral Replication Leads to Increased Cytokine Production and Polarized Interferon Response in Infant Mucosal Epithelium
Authors: Glowinski Rebecca M , Yun Ki Wook , Mejias Asuncion , Ramilo Octavio
Published: December 2021

Background

RSV is the most frequent etiology of pediatric lower respiratory tract infection. Most children hospitalized for RSV are previously healthy without known risk factors. Children with mild disease managed as outpatients (OP) have higher viral loads than those hospitalized with severe disease. OP children have higher concentrations of the mucosal interferon (IFN), IFNλ2/3, and IP-10, but no differences in IFNλ1. We examined how RSV replication impacts cytokine production kinetics in the nasal mucosa.

Methods

Primary infant human nasal epithelial (iHNE) cells were collected from nasopharyngeal swabs and cultured on an air-liquid interface. Cultures were infected with 0.1 or 0.001 multiplicity of infection (MOI) of RSV-A, or mock infected. Concentrations of IFN-related (IFNα2, β, γ, λ1, λ2/3, and IP-10) and inflammatory (IL-1β, -6, -12, and TNFα) cytokines secreted to the apical and basolateral surfaces were quantified via immunoassay. Kinetics according to viral inocula were compared by ANOVA with Dunn post-hoc testing of the area under the curve (AUC) for each cytokine. Peak concentrations were compared according to MOI and secretion surface by 2-way ANOVA.

Results

AUC of IFNs in both surfaces of RSV infected cells were significantly higher than those of mock infected. The 0.1 MOI RSV inoculum resulted in significantly higher AUCs for all IFN cytokines on both surfaces than the 0.001 MOI. Peak IFNλ1 concentrations were higher on the apical than basolateral side; peak IFNλ2/3 concentrations were higher on the basolateral side than apical. AUCs of inflammatory cytokines in RSV infection were significantly higher on the basolateral, but not apical, surfaces than mock; all basolateral inflammatory cytokines were higher in the 0.1 MOI than the 0.001 MOI.

Conclusion

Higher RSV inoculum induces higher concentrations of IFN-related cytokines on both sides of epithelial cells, and higher concentrations of inflammatory cytokines on the basolateral side. Differential secretion of IFNλ1 and IFNλ2/3 to the apical and basolateral surfaces suggests they may play different roles in immune response during RSV infection. These data support viral replication as an important factor influencing RSV pathogenesis and severity through cytokine production.

Disclosures

Asuncion Mejias, MD, PhD, MsCS, Janssen (Grant/Research Support, Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Roche (Advisor or Review Panel member)Sanofi (Advisor or Review Panel member) Octavio Ramilo, MD, Adagio (Consultant)Bill & Melinda Gates Foundation (Grant/Research Support)Janssen (Grant/Research Support)Lilly (Consultant)Merck (Consultant, Grant/Research Support)NIH (Grant/Research Support)Pfizer (Consultant)SANOFI (Board Member)
1187. Neurodevelopmental Outcomes of Children with Congenital Cytomegalovirus (cCMV) Infection: Does Antiviral Treatment Matter?
Authors: Jia Margaret R , Medoro Alexandra K , Pifer Traci , Rijal Manish , Borghese Teresa , Findlen Ursula M , Malhotra S , Adunka Oliver , Shimamura Masako , Mejias Asuncion , Maitre Nathalie , Sanchez Pablo J
Published: December 2021

Background

cCMV infection is a major contributor to childhood neurologic and cognitive disabilities including sensorineural hearing loss (SNHL). Neonatal treatment with ganciclovir/valganciclovir improves hearing outcomes, but its impact on neurodevelopmental outcomes remains an important knowledge gap. We describe the neurodevelopmental outcomes of children with cCMV infection and evaluate the effect of neonatal antiviral therapy on outcomes.

Methods

Since 2013, infants with cCMV infection referred to Nationwide Children’s Hospital’s NEO-ID Clinic have had a complete evaluation at diagnosis as well as follow-up neurodevelopmental assessments. Pertinent demographic, clinical, laboratory, radiographic, and follow-up data were obtained and managed using REDCap. Neurodevelopmental assessments were performed using Bayley Scales of Infant and Toddler Development (BSID) III/IV (cognitive, language, motor domains) at ~ 24 months of age. The Gross Motor Function Classification System was used to classify functional motor impairment. Neurodevelopmental outcomes were compared by receipt of antiviral therapy in early infancy.

Results

95 infants (mean ± SD; gestational age 35 ± 5 wk, birth weight 2121 ± 948 g; Table 1) with cCMV infection had follow-up neurodevelopmental assessments. 62% had central nervous system involvement, 37% had SNHL, 23% developed cerebral palsy (CP), and 6% were diagnosed with autism spectrum disorder. The majority had normal BSID scores (≥ 85) in cognitive and motor domains (65% and 54%, respectively) while 48% had normal scores in the language domain. 35% had severe impairment (< 70) in ≥ 1 domain (Table 2). 9 children had clinically inapparent cCMV infection; 2 (22%) had abnormalities on BSID testing (1, cognitive score: 80; 1, cognitive, language, and motor scores: 65, 68, 73, respectively). 11 (12%) children, including 6 who received antiviral therapy, had severe neurodevelopmental impairment, with CP and severe (< 70) BSID scores in both the cognitive and motor domains.

Table 1. Demographic and Clinical Characteristics of 95 Children with Congenital CMV Infection by Receipt of Antiviral Treatment

Table 2. Neurodevelopmental Outcomes Based on Testing with the Bayley Scales of Infant and Toddler Development (BSID) III/IV

Conclusion

A substantial proportion of children with cCMV infection had moderate (29%) or severe (33%) neurodevelopmental impairment, CP, or autism spectrum disorder, irrespective of antiviral treatment. Urgency exists for antenatal preventive strategies and vaccine development.

Disclosures

Asuncion Mejias, MD, PhD, MsCS, Janssen (Grant/Research Support, Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Roche (Advisor or Review Panel member)Sanofi (Advisor or Review Panel member)
1188. The Effect Of The COVID-19 Pandemic On Influenza-Related Hospitalization, Intensive Care Admission And Mortality In Canadian Children
Authors: Groves Helen E , Papenburg Jesse , Mehta Kayur , Bettinger Julie A , Sadarangani Manish , Halperin Scott , Morris Shaun
Published: December 2021

Background

The COVID-19 pandemic resulted in unprecedented implementation of wide-ranging public health measures globally. During the pandemic, dramatic decreases in seasonal influenza virus detection have been reported worldwide. Information on pediatric influenza-related hospitalizations is limited. We describe influenza-related hospitalization in Canadian children during the 2020/2021 influenza season compared to ten previous seasons.

Methods

Data on influenza-related hospitalizations, intensive care unit (ICU) admissions and in-hospital deaths in children across Canada were obtained from the Canadian Immunization Monitoring Program, ACTive (IMPACT). This national surveillance initiative comprises 90% of all tertiary care pediatric beds in Canada. The total study period included eleven influenza seasons from September 2010 to April 2021 inclusive. Time series modelling was used to compare trends in influenza-related hospitalizations during the 2020/2021 season (September 2020 to April 2021 inclusive) with the ten previous seasons.

Results

During the 2020/2021 influenza season there were no pediatric influenza infection-related hospitalizations. This was a significant decrease compared to the predicted total influenza-related hospitalizations for this period (p< 0.001). No pediatric ICU admission or deaths were reported for the 2020/2021 influenza season.

Conclusion

We show complete absence of influenza infection-related hospitalization in children in Canada during the 2020/2021 season. This significant decrease is likely related in large part to non-pharmacological public health interventions implemented during the COVID-19 pandemic, although the potential role of viral interference is unknown. Our findings suggest measures such as use of facemasks, hand-washing, distancing and school closures may be beneficial for influenza control and mitigation of future influenza epidemics.

Disclosures

Helen E. Groves, PhD, MBBCh BAO, Abbvie (Other Financial or Material Support, Dr. Groves reports personal fees from Honoraria received from Abbvie for education meeting presentation, not relevant to the submitted work.) Jesse Papenburg, MD, AbbVie (Grant/Research Support, Other Financial or Material Support, Personal fees)Medimmune (Grant/Research Support)Sanofi Pasteur (Grant/Research Support)Seegene (Grant/Research Support, Other Financial or Material Support, Personal fees) Manish Sadarangani, BM BCh, DPhil, GlaxoSmithKline (Grant/Research Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support)Sanofi Pasteur (Grant/Research Support)Seqirus (Grant/Research Support)Symvivo (Grant/Research Support)VBI Vaccines (Research Grant or Support) Shaun Morris, MD, MPH, DTM&H, FRCPC, FAAP, GSK (Speaker’s Bureau)Pfizer (Advisor or Review Panel member)Pfizer (Grant/Research Support)
1191. Pediatric Long Haul Post COVID-19: Is New Jersey’s Experience Different?
Authors: Bhargava Aakriti , Farrand Lauren , Zieniewicz Stephen , Brenner Dennis J , Yeh Timothy S , Hasan Uzma
Published: December 2021

Background

COVID-19 impacted nearly 4 million children, accounting for 14% of total cases in the US, 1.3-3.2% of total reported hospitalizations and less than 1% deaths attributed to COVID-19. Many studies report persistent symptoms in adults several months after acute COVID-19. Similar findings have been reported from a small cohort of children in Italy. To date there are no studies reviewing long haul symptoms in children in the US.

Methods

With the goal of defining long haul in pediatric population, and providing comprehensive care to these patients, RWJBarnabasHealth launched a post-COVID CARE program in October 2020 for children. The program has provided care for approximately 16 patients with COVID related Multisystem Inflammatory Syndrome (MIS-C) and 48 pediatric patients with COVID. The goal of the Pediatric Post-COVID CARE program was to provide a multidisciplinary approach for children ages 0-21 years impacted with COVID-19. This included patients who experienced ongoing symptoms >4 weeks from initial COVID-19 illness. All children were assessed by a pediatric infectious disease physician and triaged to appropriate subspecialties, all part of the long-haul care team. In addition, physical therapy and psychology support services were provided to facilitate return to normalcy.

Results

To date, our program has evaluated 64 patients. 28% experienced at least 1 symptom 4 weeks after acute COVID-19. Median age was 14 years and 77.8% were female. The follow-up study was conducted from October 2020 to May 2021. Data was collected 2 weeks, 6 weeks, 3 months, and 6 months post discharge or initial evaluation in clinic. 28% of patients were antibody positive, 55.6% experienced fatigue, 50% experienced shortness of breath or cough, 50% experienced ‘brain fog’,33% chest pain and 44.4% experienced anxiety and/or depression.

Conclusion

Early identification of patients and comprehensive protocols may facilitate return to normalcy for children with lingering somatic symptoms worsened by impact of social isolation, economic stresses, lost parental jobs, and food insecurity among many other contributing factors. Further research is needed to determine why children of certain ethnicities are impacted differently.

Disclosures

All Authors: No reported disclosures
1192. Correlation Between SARS CoV 2 Viral Load and Clinical Evolution of Patients Under 15 Years of Age with COVID 19 in a General Hospital in the Province of Buenos Aires, Argentina
Authors: Brizuela Martin , Goñi Sandra , Cardama Georgina , Sommese Leandro , Farina Hernan
Published: December 2021

Background

SARS CoV2 infection produces clinical manifestations of different severity. The pediatric population represents less than 10% of cases, with a mortality of less than 1%. The severity of the condition and mortality are mainly associated with comorbidities. There is controversy about the correlation between the viral load of SARS CoV2 in respiratory samples and the evolution and severity of the clinical picture. The CT (cycle threshold) in the detection of the SARS CoV 2 genome in respiratory samples can be used as an indirect indicator of the viral load in the analyzed samples.

Goals

to determine the correlation between the SARS CoV 2 CT values in the detection of the viral genome with the severity of the clinical picture. Describe the clinical, epidemiological, and laboratory characteristics of patients with PCR-confirmed SARS CoV2 infection in respiratory samples.

Methods

A retrospective, observational and analytical study that included patients under 15 years of age with confirmed SARS CoV2 infection by PCR of respiratory samples treated at the Hospital Isidoro Iriarte in the city of Quilmes between March 1 2020 and April 30, 2021.

Results

485 patients (n) were included. The distribution by severity of the clinical picture was mild (84%, n = 408), moderate (12%, n = 59) and severe (4%, n = 18). Comorbidities were more frequent among patients with moderate and severe symptoms. Viral load was associated with severity of clinical manifestations. Patients with moderate and severe COVID19 required hospital admission more frequently for a longer time, the use of supplemental oxygen and antibiotics were more frequent in patients with moderate and severe symptoms. Symptoms of lower respiratory tract infection such as cough and respiratory distress were more frequent in patients with moderate and severe symptoms. No patient required admission to the ICU or mechanical ventilation. No patient died.

Conclusion

In this study, patients with moderate and severe COVID19 infection had a higher viral load in respiratory samples, a higher frequency of comorbidities, a higher frequency of hospitalization and a longer hospital stay. Lower respiratory symptoms were associated with moderate and severe symptoms, while odynophagia, vomiting, and diarrhea were associated with mild clinical symptoms.

Disclosures

All Authors: No reported disclosures
1193. Mucosal Antibody Responses to Respiratory Syncytial Virus (RSV) in Infants and Young Children
Authors: Souverbielle Cristina Tomatis , Ye Fang , Mertz Sara , Peeples Mark E , Ramilo Octavio , Mejias Asuncion
Published: December 2021

Background

The burden associated with RSV infection is substantial. Although RSV initially infects the upper respiratory tract, there is limited information of the mucosal concentrations of antibodies (Abs) directed to RSV specific proteins and whether patient’s age and disease severity influence production of mucosal Abs.

Methods

From 2017 to2019 we enrolled previously healthy children < 2 years of age hospitalized with RSV infection and obtained acute and convalescent (day; D30) nasopharyngeal (NP) samples to measure preF and postF specific IgG and IgA Abs by ELISA. Demographic and clinical data were collected and analyzed according to Abs responses.

Results

We enrolled 77 children (median [IQR] age: 2.8 [1.5-5.2] months; 49 % females) within the first 24 hours of hospitalization. Of those 25 (33%) patients required PICU care. A significant increase in convalescent IgG preF Abs titers was detected in 62 (81%) children, while IgA preF titers significantly increased in all but one child on D30. The magnitude of the increase was 56-fold higher for preF IgA versus preF IgG (p< 0.0001). PostF IgG and IgA titers were also increased on D30 but at significant lower levels.

Infants < 3 months of age compared with those >3-24 months had significantly higher baseline preF and postF IgG Abs titers (p < 0.001) but not IgA antibodies. D30 preF and post F IgG titers were higher in children > 6 months of age (p < 0.0001) but only preF titers fold change significantly correlated with age (r=0.4, p< 0.0001). These correlations were not identified with IgA preF antibodies. There were no statistical differences in antibody titers at baseline and on D30 according to breastfeeding, and disease severity as defined by the need for PICU care.

Conclusion

Children hospitalized with RSV infection demonstrated significantly increased titers of mucosal preF and post F IgG and IgA specific Abs in convalescent samples. Baseline IgG Abs where higher in younger infants, which likely reflects maternally acquired antibodies. Age significantly correlated with Abs production, suggesting a more robust immune response in older children.

Disclosures

Mark E. Peeples, PhD, Janssen (Research Grant or Support)Pfizer (Research Grant or Support) Octavio Ramilo, MD, Adagio (Consultant)Bill & Melinda Gates Foundation (Grant/Research Support)Janssen (Grant/Research Support)Lilly (Consultant)Merck (Consultant, Grant/Research Support)NIH (Grant/Research Support)Pfizer (Consultant)SANOFI (Board Member) Asuncion Mejias, MD, PhD, MsCS, Janssen (Grant/Research Support, Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Roche (Advisor or Review Panel member)Sanofi (Advisor or Review Panel member)
1194. Assessing Healthcare Professionals’ Knowledge of Shigella Transmission, Risk Factors, and Prevention – DocStyles Survey, 2020
Authors: Haston Julia C , Esschert Kayla Vanden , Ford Laura , Plumb Ian D , Logan Naeemah Z , Watkins Louise Francois , Garcia-Williams Amanda
Published: December 2021

Background

Shigella infection typically manifests as a self-limited gastrointestinal illness (shigellosis) and affects some populations disproportionately, including children, travelers, people experiencing homelessness, and men who have sex with men (MSM). Healthcare professionals (HCPs) are positioned to play an active role in the prevention and control of shigellosis but may not be aware of the multiple routes of Shigella transmission, risk factors, and prevention strategies.

Methods

Porter Novelli Public Services’ Fall DocStyles 2020 web-based survey was administered to HCPs in the United States to assess their clinical practice and knowledge about many health-related issues. Questions about acute diarrhea and shigellosis were completed by pediatricians, primary care physicians, nurse practitioners, and physician assistants. We analyzed responses to four questions related to Shigella transmission, risk factors, prevention, and barriers to patient education.

Results

Of the 2196 panelists contacted, 1503 were included (68% response rate). Most identified contaminated food and water as potential routes of Shigella transmission (84.9% and 78.8%, respectively), but substantially fewer recognized person-to-person contact (39.5%), fomite transmission (32.5%), or sexual activity (17.6%) as ways adults can become infected. Similarly, MSM were infrequently identified as being at risk for shigellosis (34.5%). Many HCPs reported counseling patients to wash hands and avoid food preparation when ill with Shigella (85.9% and 77.2%), but only 29.4% reported recommending avoiding sex. Only 7.1% of respondents correctly identified all routes of transmission, 21% identified all risk factors, and 22% identified all prevention strategies. Delay in diagnosis was the most frequently reported barrier to educating patients about shigellosis.

Conclusion

HCP knowledge of shigellosis is incomplete. Identified gaps in knowledge were related to MSM as an at-risk population and transmission of Shigella through fomites and person-to-person contact (including sexual contact). Informing HCPs about transmission, risk factors, and opportunities for prevention could improve recognition and stop the spread of shigellosis in vulnerable communities.

Disclosures

All Authors: No reported disclosures
1195. Comparative Analysis Between Acute and Sub-Acute Brucellosis
Authors: Hammami Fatma , Koubaa Makram , Chakroun Amal , Rekik Khaoula , Marrakchi Chakib , Smaoui Fatma , Jemaa Mounir Ben
Published: December 2021

Background

Brucellosis remains a public health problem. Its myriad and non-specific manifestations vary according to the clinical presentation. We aimed to compare the clinical and laboratory features between acute and sub-acute brucellosis.

Methods

We conducted a retrospective study including all patients hospitalized for acute and sub-acute brucellosis in the infectious disease department between 1992 and 2020.

Results

We encountered 104 patients (50.2%) with acute brucellosis and 103 patients (49.8%) with sub-acute brucellosis. Patients with sub-acute brucellosis were significantly older (45.1±17.2 years vs 36.5±17.5 years; p< 0.001). Male gender represented 64.4% of acute brucellosis cases and 67% of sub-acute brucellosis cases (p=0.6). Night sweats (78.8% vs 65%; p=0.027), myalgia (34.6% vs 21.4%; p=0.034) and asthenia (70.2% vs 45.6%; p< 0.001) were significantly more frequent among acute brucellosis cases. Back pain was significantly more frequent among sub-acute brucellosis cases (78.6% vs 28.8%; p< 0.001). Fever (89.4% vs 83.5%; p=0.2), weight loss (29.8% vs 32.4%; p=0.6) and arthralgia (56.7% vs 51.5%; p=0.4) were noted among acute and sub-acute brucellosis group, with no significant difference. Lymph nodes were significantly more frequent among acute brucellosis cases (15.5% vs 1.9%; p=0.002). Splenomegaly (13.5% vs 6.8%; p=0.1) and hepatomegaly (6.7% vs 5.8%; p=0.7) were more frequent among acute brucellosis group, with no significant difference. Laboratory investigations revealed leukopenia (21.2% vs 8.7%; p=0.012) and thrombocytopenia (19.2% vs 7.8%; p=0.016), which were significantly more frequent among acute brucellosis group. While elevated C-reactive protein levels were more frequent among sub-acute brucellosis group (52.4% vs 39.4%; p=0.06), elevated liver enzymes were more frequent among acute brucellosis group (38.8% vs 23.1%; p=0.087), with no significant difference. The mean duration of hospitalization was longer among sub-acute brucellosis cases (16±11 days vs 7±4 days; p< 0.001).

Conclusion

The presence of sweating, myalgia and asthenia associated with leukopenia and thrombocytopenia was suggestive of acute brucellosis, while back pain, especially among the elderly, was suggestive of sub-acute brucellosis.

Disclosures

All Authors: No reported disclosures
1197. Development and Implementation of Innovative Syringe Service Programs for Veterans in Rural and Urban Settings
Authors: Ho Minh Q , Dinges Elizabeth , Slazinski Karen , Byrd Jacqueline , Ahmed Mohammed
Published: December 2021

Background

Syringe Services Programs (SSPs) is one aspect of a comprehensive Harm Reduction approach necessary to reduce the transmission of blood borne infections including Hepatitis B, Hepatitis C, and HIV. Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that in 2019 that 595,000 veterans engage in opioid misuse with at least 57,000 veterans engaging in heroin. Stigmas to SSP are pervasive in the community and within the government system. Federal law prohibited the use of federal funds to purchase sterile needles or syringes for the purposes of illegal use of drugs by injection. It was officially clarified in May 24, 2021 that the prohibition to purchase syringes does not apply to Veterans Health Administration (VHA). While awaiting approximately 2 years to secure this clarification, syringes were obtained through a community donation. We aim to describe our process including difficulties encountered and data collected for SSP at two locations. Difficulties included developing an anonymous process to track quality, motivating providers to refer, educating highest risk veterans, providing face to face engagement during COVID-19 pandemic and ability to mail Harm Reduction kits containing sterile syringes.

Illiana VA Program Information Sheet

Orlando VA Program Information Sheet

Methods

Of the 140 facilities within VHA, there are currently only two SSPs established, Illiana VA and Orlando VA. A retrospective analysis of Harm Reduction benefits was performed among veterans who engaged with the two SSPs between 2018 to 2021.

Orlando VA SSP Intake Process Map

Process that veteran undergo when they engage with Orlando VA SSP

Contents of Standard SSP Kit Distributed to Veterans at Orlando VA

Results

Approximately 3000 syringes were dispensed. Of the 17 veterans, 65% received syringes, 82% received naloxone, 100% engagement in mental health and 94% engagement in substance use disorder clinics. In total, 65% were screened for HIV, 82% for HCV and 29% for sexually transmitted infections.

Conclusion

These numbers, while modest, are notable, especially given the financial and organizational barriers that were in place. Furthermore, the COVID-19 pandemic impacted full implementation and outreach. With the recent, official clarification on syringe purchase and support for SSPs, the number of SSPs in the VA will grow, along with opportunity for more robust data collection. The experience of both facilities is a model for programs currently in development and moves us closer to ending the HIV epidemic by 2030.

Disclosures

All Authors: No reported disclosures
1198. Lyme Disease Post-Exposure Prophylaxis by Single-Dose Doxycycline in Three Healthcare Systems
Authors: Marx Grace E , Schotthoefer Anna M , Schwartz Brian S , Draper Evan , Rivera Christina G , Zeuli John , Scotty Erica , Pollak Jonathan S , Schwartz Amy M , Beck Alyssa , Hinckley Alison F
Published: December 2021

Background

Lyme disease, the most common tickborne disease in the United States, may be prevented by taking a single 200-mg dose of oral doxycycline after a high-risk bite from a blacklegged tick. Currently, it is not known how Lyme disease post-exposure prophylaxis (PEP) might vary by region and healthcare system. We identified single-dose doxycycline medication orders in three healthcare systems in states with high incidence of Lyme disease and compared associated patient and provider characteristics.

Methods

Electronic health record data during 2012 – 2016 were obtained from three healthcare systems: Geisinger (Pennsylvania), Marshfield Clinic (Wisconsin), and Mayo Clinic (Minnesota/Wisconsin). Creation of analytic variables and analysis were harmonized across the three sites. Medication orders for single-dose doxycycline ≤200 mg that were accompanied by specific key words or diagnostic codes (e.g., tick bite; Lyme disease prevention) were considered evidence of PEP. Manual chart review was performed from a random subset to evaluate the algorithms used to identify PEP.

Results

Among 2,937,585 patients with at least one medication order or clinical encounter during the study period, 14,102 single-dose doxycycline orders for Lyme disease PEP for 13,172 unique patients were identified. The typical patient receiving PEP was older (mean age 51 – 58 years), male (56 – 59%), and non-Hispanic White (81 – 98%). The annual seasonality of medication orders was bimodal, with peaks occurring during April – July and October – November. The most common encounter setting was an outpatient clinic or urgent care center (80 – 91%); medication orders after patient phone calls in the absence of an in-person visit occurred frequently (14 – 19%) in two health systems. Chart abstractions (n=600) revealed instances of PEP prescribed inappropriately (e.g., bite from a non-blacklegged tick; patient with symptoms of acute Lyme disease).

Conclusion

Lyme disease PEP with a single dose of doxycycline was frequently prescribed in healthcare systems where there is a high incidence of Lyme disease. PEP was most commonly prescribed to non-Hispanic Whites over the age of 50 years. Public health initiatives for tickborne disease prevention should include clinician education on the appropriate use of Lyme disease PEP.

Disclosures

Anna M. Schotthoefer, PhD, HelixBind (Other Financial or Material Support, salary support) John Zeuli, PharmD, INSMED (Other Financial or Material Support, honoraria for educational speaking)
1201. Diphtheria in Veterans Health Administration (VHA), 2000-2021
Authors: Schirmer Patricia , Lucero-Obusan Cynthia A , Sharma Aditya , Oda Gina , Holodniy Mark
Published: December 2021

Background

Diphtheria is caused by Corynebacterium diphtheriae and can cause respiratory or skin infections. Transmission occurs primarily person-to-person via respiratory tract and rarely from skin lesions or fomites. In the Veterans Health Administration (VHA), we perform surveillance for nationally notifiable diseases such as diphtheria. In early 2021, there were 4 alerts for C. diphtheriae. Therefore, we investigated diphtheria prevalence in VHA over the last 20 years.

Methods

Isolates of C. diphtheriae were identified from VHA data sources from 1/1/2000-2/28/2021. Patient demographics, co-morbidities, microbiologic data, treatment, outcomes, and vaccination status were obtained via electronic medical record (EMR) review.

Results

33 C. diphtheriae isolates were identified representing 32 unique individuals. 17 isolates were identified from 2000-2015 and 16 were identified from 2016-2021. Isolates were from cutaneous (16), blood (10), urine (4), pulmonary (2), and throat (1) specimens. In 11 individuals, clinical significance was unclear (no antibiotics given, note mentioned that it was being considered a contaminant - i.e., isolate may have been incorrectly labeled as “C. diphtheriae” instead of “diphtheroid”). Only 3 isolates had toxin testing documented. One C. diphtheriae biovar gravis blood isolate was associated with sepsis without another source identified. The throat isolate was a nontoxigenic strain. No cutaneous isolates underwent susceptibility testing, but all 15 individuals received antibiotics (1 patient had 2 isolates). 11 had additional organisms identified in addition to C. diphtheriae. Table 1 describes demographics, co-morbidities, and vaccination status of cutaneous cases. Only 1 case (in 2021) had EMR documentation of local public health department reporting.

Table 1. Characteristics of Unique Individuals with Cutaneous Diphtheria Isolates in VHA, 2000-2021

Conclusion

Nearly as many isolates have been identified in the last 5.5 years compared to the previous 15 years which may be related to more robust molecular identification methods available in VHA. Most C. diphtheriae isolated was from cutaneous sources that were acute in onset. About 33% were identified as C. diphtheriae but were not treated. EMR documentation of toxin production and public health department reporting was lacking.

Disclosures

All Authors: No reported disclosures
1202. Chagas Disease Awareness in a Hispanic Community of the Greater New Orleans Area
Authors: Hincapie Marcela , Bernabé Kerlly , DeCuir James , Thompson Julie , Avendano Mariana , Nawas George , Dumonteil Eric , Herrera Claudia , Echeverri Margarita
Published: December 2021

Background

Chagas disease is a neglected tropical disease responsible for severe disease burden in Latin American countries (≥ 6 million cases). It is increasingly reported in the Southern United States, with an estimated 89,410 human cases (nationwide estimate: 300,000), many of them acquired in endemic zones in Latin America.

Methods

Cross-sectional study to assess the change in knowledge about Chagas disease and triatomine vectors among Hispanic immigrants living in the Greater New Orleans area. All consented participants answered the baseline questionnaire, then received a short video presentation, and completed a post-test to evaluate change in knowledge. Consents, online questionnaires and training were administered in Spanish and English, as needed. Frequencies were computed to describe differences in demographic variables and questions in the pre-posttest. Data was analyzed with R software.

Results

A total of 64 adults (66% women, median age 58 years) completed the pre-post tests and attended the educational intervention. Participants have been living in the US for an average of 23 years and represented 11 countries. Majority were born in Honduras (27%) followed by Nicaragua (16%), United States (13%), Colombia (11%), Ecuador (9%), Guatemala (6%), Mexico (6%) and other counties (12%). Most participants recalled exposure to Chagas disease vectors. Although in the pre-test about half reported ever seeing a Triatomine, less than 20% correctly identified one of three images of a Triatomine provided in the questionnaire. Knowledge about how the disease is transmitted to humans increased from pre to posttest. While higher percentages of men (80%) than women (69%) answered correctly at the pre-test, in the post-test higher percentages of women (97%) than men (95%) responded correctly. In addition, 98% of participants reported that the presentation was clear, 85% would like to learn more about Chagas Disease, and 100% would like to be screened.

Conclusion

Results indicate the positive impact that an educational intervention may have on the knowledge about the disease. Considering the high percentage of Hispanic immigrants in US, increasing awareness of Chagas disease may contribute in the prevention and early detection of the disease among this high-risk population.

Disclosures

All Authors: No reported disclosures
1203. A Descriptive Analysis of an Opioid Use Disorder Care Continuum in an Infectious Diseases Clinic
Authors: Blevins Sarah R , Grubbs James A , Stivers Tiffany , Sabitus Kathryn , Weeks Ryan , Thornton Alice
Published: December 2021

Background

On December 17, 2020, U.S. CDC released an advisory reporting the highest drug overdose rate on record. Kentucky ranks in the top 5 states for opioid overdose deaths. Retention in opioid use disorder (OUD) treatment is associated with decreased overdose deaths. University of Kentucky HealthCare’s infectious disease division (UKID) implemented a multi-disciplinary approach to expand access to medication for opioid use disorder (MOUD) for patients with injection drug use-associated infections (IDU-AI). This program is modelled after the Ryan White Cares Act to engage and retain patients.

Methods

. This ongoing project began enrollment in June 2019. Any patient ≥18 years old with IDU-AI and OUD is eligible for enrollment unless pregnant or incarcerated. Patients are eligible for transportation assistance, mental health services, and medical case management. They may start MOUD with UKID or be referred elsewhere. In this analysis, we describe our opioid use disorder care continuum and identify reasons for patient attrition and areas to improve

Results

Our continuum components are referral, eligible, enrolled, start MOUD, and retention at month 1, 3, and 6. To date, 533 patients have been referred. Of these, 383 (71.9%) were eligible and 150 (39%) enrolled. Reasons patients did not enroll: discharged stable (41.5%), left AMA (16.9%), declined (10.8%), deceased (6.7%), discharged to other hospital (3.6%), missed clinic visit (9.7%), hospice (1%), other (10.8%). Reasons patients declined: no reason (28.6%), refused to discuss (19.1%), no interest (14.3%), travel (4.8%), declined ID follow-up (4.8%), time limits (9.5%). Ninety-three patients have been enrolled ≥6 months; 83 are on MOUD. Sixty-seven, 29, and 20 patients were retained at month 1, 3, and 6, respectively.

Conclusion

UKID engages patients in OUD treatment, but retention rates are comparable to those described in non-ID settings. Most attrition occurs between eligibility and month 3, suggesting patients are most vulnerable when they consider change and start MOUD. These time points should be priority for patient engagement by clinic staff. Also our staff size struggles to meet the demand. The number of referrals is prohibitive for our small team to approach everyone in a timely manner. More programs like this one are needed.

Disclosures

All Authors: No reported disclosures
1205. Vaccine Hesitancy in Paediatric Practice and Predictors of Physician-Reported Vaccine Compliance
Authors: Allan Kate E
Published: December 2021

Background

This study explores the frequency with which Canadian paediatricians encounter vaccine hesitancy in their clinical practice, the most common approaches to parent resistance, impact of hesitancy practice and predictors of physician-reported vaccine compliance.

Methods

This analysis used data collected from Canadian paediatricians and paediatric subspecialists via a one-time survey distributed by the Canadian Paediatric Surveillance Program in the fall of 2015. Descriptive analyses were conducted to determine the frequency of hesitancy, approaches to parent resistance and impact on clinical practice. A classification tree was generated to determine the most important predictors of physician-reported vaccine compliance.

Results

A total of 669 paediatricians completed the survey. Eighty-nine percent (n=588) of respondents indicated they had encountered hesitancy in their practice, with the top concerns including: Autism, too many vaccines, risk of a weakened immune system, and vaccine additives. The most common responses to parent resistance included discussing risks of non-vaccination, restating the vaccine recommendation and referring to reliable patient resources. Forty-five percent (n=301) of physicians indicated that hesitancy impacted their practice. Overall, the best predictor of physician-reported vaccine compliance was the use of a personal endorsement or anecdote (x2=6.955,df=1, adj.p< 0.01). Among physicians who did not use a personal endorsement, the next best predictor of vaccine compliance was spending 10 minutes or more discussing vaccination (x2=7.418, df=1,adj.p< 0.05).

Conclusion

This study contributes to a nascent body of literature related to paediatricians’ experience with vaccine hesitancy in a Canadian context, particularly as it relates to the impact of hesitancy on practice. This study demonstrates the ubiquity of hesitancy in clinical practice, the profound impact of hesitancy on paediatricians and highlights promising responses to parental hesitancy that may improve vaccine compliance. Future research should explore potential hesitancy interventions including using a personal endorsement and prolonged engagement using more rigorous methods of evaluation.

Disclosures

Kate E. Allan, PhD, Pfizer (Other Financial or Material Support, Postdoctoral Fellowship at the Centre for Vaccine-Preventable Diseases (at University of Toronto) is funded by Pfizer.)