bluuebunny/crossref_metadata_2025 huggingface dataset:
1856. Risk factors for mortality amongst hospitalised patients with Staphylococcus aureus bacteraemia – a prospective cohort study
Authors: Ngiam Jinghao Nicholas , Nasir Haziq , Mo Yin , Chai Louis Yi-Ann , Archuleta Sophia , Fisher Dale , Tambyah Paul Anantharajah
Published: December 2022

Background

Staphylococcus aureus bacteraemia (SAB) remains a common infection with significant mortality, ranging from 20 to 40%. Understanding the risk factors for adverse outcomes in this infection will better prognosticate and guide patient management and disposition.

Methods

We prospectively recruited and examined 634 consecutive patients with laboratory-confirmed SAB. They were characterised in terms of baseline demographics, clinical profile, and laboratory findings at the time of SAB diagnosis. Sensitivity testing was carried out to identify patients who had methicillin-resistant (MRSA) or methicillin-sensitive Staphylococcus aureus (MSSA) infection. All patients were followed up prospectively for clinical outcomes including in-hospital mortality, and sites of metastatic infection. Univariate and multivariable logistic regression was used to identify risk factors associated with mortality in hospitalised patients with SAB.

Results

The overall mortality was 5.8% (n=37). There were no significant differences in gender, but patients who died tended to be 11 years older on average (69.6±14.9 years vs 58.1±18.2 years, p< 0.001). Diabetes mellitus, prior history of structural heart disease, haemodialysis and recent surgery had not been significantly associated with mortality in our cohort. Amongst the patients who died, MRSA infection was significantly more common (45.9% vs 24.8%, p=0.004). On multivariable logistic regression, older age (adjusted OR 1.05, 95%CI 1.02-1.07) and MRSA infection (adjusted OR 2.04, 95%CI 1.01 – 4.09) remained independently associated with mortality. We did not demonstrate an association with prolonged fever or bacteraemia and in-hospital mortality.

Conclusion

Amongst hospitalised patients with SAB, the mortality was low (5.8%). Older age and MRSA infection were the most important risk factors identified in association with mortality.

Disclosures

All Authors: No reported disclosures.
1859. Significance of Bacteremia in Left Ventricular Assist Device Infections due to Pseudomonas aeruginosa
Authors: Murugan Lalithaa Thirunavukarasu , Murugan Lalithaa Thirunavukarasu , Murugan Lalithaa Thirunavukarasu , Banzon Jona
Published: December 2022

Background

Infection is one of the most common complications of Left Ventricular Assist Devices (LVADs). Pseudomonas aeruginosa (PsA) LVAD infections in particular are challenging due to limited antibiotic options and tendency to form biofilm making eradication difficult. In this study we examined the implications of bacteremia in patients with PsA LVAD infections.

Methods

This was a retrospective study of patients treated at our institution between July 1, 2007 and February 1, 2021 who had proven or probable driveline infection (DLI), pump pocket, or pump/cannula infection due to PsA according to International Society for Heart & Lung Transplantation criteria.

Results

Of 717 patients with an LVAD, 51 patients had had proven or probable VAD-specific infections due to PsA.16/51 (31%) had Pseudomonas bloodstream infection associated with the VAD infection, with a median 400 days from initial diagnosis. Only 29% of those with DLI were bacteremic, vs. 66% of those with pump pocket infection, and 50% of those with mediastinitis (Fig 1). Patients who developed bacteremia had a median of 3 episodes (range, 1-5). All but 1 patient with bacteremia received surgery. Of the 16 patients who developed bacteremia, 11 (69%) died vs 9/35 (26%) in patients who were not bacteremic (Fig 2). 10/11 patients who were bacteremic and died had infections limited to driveline.

In 21/41 (51%) of episodes of bacteremia identified, patients were already on antibiotics for PsA with a median duration of 49 days (7-198) prior to onset of bacteremia.

Conclusion

A significant number of patients with PsA LVAD infections develop bacteremia, especially in those with involvement of central LVAD components. The presence of bacteremia should prompt evaluation for ascending infection. Most of the patients who developed bacteremia died, even when infection appeared limited to driveline, and it is possible that endoluminal infections were present in these cases. A substantial proportion of patients with bacteremia were on antibiotics at the time of bacteremia, which suggests that suppressive antibiotics alone may not be effective in controlling PsA LVAD infections.

Disclosures

All Authors: No reported disclosures.
1860. Streptococcus mitis/oralis sepsis in patients with neutropenia after chemotherapy
Authors: Lee Na Yoon , Kang Hyun Mi , Jeong Dae Chul , Kim Seong Koo , Lee Jae Wook , Chung Nack-Gyun , Cho Bin
Published: December 2022

Background

Streptococci are the dominant species in the human oral cavity and upper respiratory tract. Oral mucositis affects 30–40% of the patients receiving chemotherapy and 80% undergoing HSCT. During episode of oral mucositis, patients are at a risk for invasive infections caused by opportunistic pathogens in the oral cavity. The purpose of this study was to investigate the clinical characteristics of S. mitis/oralis invasive infection, and find patients at high risk for with S. mitis/oralis infection in order to prevention of S. mitis/oralis bacteremia.

Methods

Patients receiving chemotherapy or stem cell transplant for malignancies and primary immunodeficiencies at the pediatric bone marrow transplant center of Seoul St. Mary's hospital admitted during January 2017 to December 2020 for blood stream infections were included in this study. Chart review of the patients were done retrospectively.

Results

During the four year study period, there were 4,647 admissions, and 2,358 (50.7%) experienced at least 1 episode of fever. Overall, the incidence of bacteremia was 10.9% of all febrile children. The most common pathogen causing bacteremia was S. mitis/oralis (24%), followed by E. coli (14.3%), Klebsiella spp. (10.5%), and S. epidermidis (7.4%). Candida sepsis occurred in 3.5% of the children. By year, the proportion of bacteremia caused by S. mitis/oralis was 19% in 2017, 21% in 2018, 41% in 2019, and 25% in 2020. 51% of S. mitis/oralis bacteremia occurred 8-14 days after day 0 of chemotherapy. A multivariate analyses on risk factors for S. mitis/oralis bacteremia was the underlying disease AML (OR, 4.6; 95% CI, 2.4-8.7; P< 0.001), and the use of cytarabine (OR, 4.5; 95% CI, 2.4-8.5; P< 0.001). Compared to ALL, AML has a HR 3.7 (95% CI 1.9-7.2) of bacteremia with S. mitis/oralis. Prolonged duration of fever ( >7 days) was observed in 13.4% of the patients, and a fever duration >14 days was observed in 2 patients. Complications such as septic shock, n=4 (6.0%), ARDS, n=1 (1.5%), infective endocarditis, n=2 (3.0%) were observed.

Conclusion

S. mitis/oralis sepsis causes significant morbidity in patients undergoing treatment for malignancies. Patients with AML are at the highest risk, especially after induction or consolidation chemotherapy including cytarabine.

Disclosures

All Authors: No reported disclosures.
1872. Clusters of SARS-CoV-2 infection across six schools for children with intellectual and developmental disabilities
Authors: Gemmell Michael P , Walsh Tyler , Imbeah Adwoa , Bono Kelly , Baldenweck Megan , Sherby Michael R , Newland Jason , Gurnett Christina
Published: December 2022

Background

In-person learning is important for children with intellectual and developmental disabilities (IDD) because of the additional health, vocational, and functional services for students at these schools. It may be difficult to reduce SARS-CoV-2 transmission in IDD schools because students require assistance with activities of daily living such as eating, during which social distancing and masking cannot occur. Surveillance testing and cluster tracking in schools for children with IDD, which may be considered high-risk environments for transmissions, could have benefits for mitigating transmission and keeping students in schools. The objective of this study was to identify SARS-CoV-2 clusters in IDD specific schools to compare viral transmission in delta and BA.1 variant waves.

Methods

A saliva-based PCR test was offered to students and staff for weekly SARS-CoV-2 screening at six Special School District (SSD) schools dedicated to children with IDD. Clusters, which are considered 2 or more positives cases in the same classroom having an epidemiological link, were then recorded. All weekly testing took place between November 23, 2020 and May 27, 2022. Clusters were recorded from November 15, 2021 to January 28, 2022. A Fisher's exact test was used to compare categorical variables.

Results

545 (90%) and 113 (16%) students participated in weekly testing. 160 participants tested positive throughout the study, 23 (14%) during the delta variant wave and 115 (72%) during the BA.1 variant wave. There was no significant variation in age, race, ethnicity, gender, or vaccination status between positive cases recorded from alpha, delta, and BA.1 variant waves (Table 1). Notably, the vaccination rate of positive participants was lower than the vaccination rate of participants who did not test positive. 42 clusters were recorded, 3 (7%) during the delta variant wave and 39 (93%) during the BA.1 variant wave (Fig. 1). Table 1.Demographics and SARS-CoV-2 Vaccination Status of Positive Cases during Three Variant WavesFigure 1.Reported Counts of Positive Cases and Clusters per Week at SSD Schools

Conclusion

The highly transmissible BA.1 variant resulted in an increase in clusters observed in IDD specific schools. Mitigation strategies for less transmissible alpha and delta waves were not as effective in reducing transmission during the BA.1 wave.

Disclosures

Jason Newland, MD, AHRQ: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|PEW Charitable Trust: Grant/Research Support|Pfizer: Grant/Research Support.
2319. Analysis of the potential impact of effectiveness and availability of mRNA influenza vaccine on hospitalization and mortality
Authors: Haghpanah Fardad , Hamilton Alisa , Klein Eili Y
Published: December 2022

Background

Influenza viruses constantly change because of antigenic drift. Due to the time currently needed to develop and distribute flu shots, vaccines are often ill-matched to circulating influenza strains. One silver lining of the COVID-19 pandemic was the acceleration of mRNA technology, which could significantly reduce the timeline between strain choice and deployment, potentially increasing vaccine efficacy. Significant private and public investments would be required to accommodate accelerated vaccine development and approval. Hence, it is important to understand the potential impact of mRNA technology on influenza hospitalizations and mortality.

Methods

We developed a compartmental model stratified by age group to evaluate the potential effect of increased vaccine effectiveness (defined as a two-level measure of protection against infection and hospitalization) on influenza hospitalizations and mortality in the United States. We assume that mRNA technology can only shorten the time from strain choice to distribution but not distribution and administration. Thus, later decisions on vaccine composition would increase effectiveness but reduce availability. To assess this tradeoff, we evaluated two scenarios where strain choice was delayed until summer resulting in a more effective vaccine: (1) available to all age groups in the fall, or (2) available by August but only for adults 65 years and older.

Results

Assuming current vaccine coverage rates, if not available until October, the vaccine would need a minimum of 80% effectiveness against infection to see a decrease in hospitalizations and deaths (Figures 1A and 1B). When delayed until November, even a 100% effective vaccine could not reduce hospitalizations or deaths (Figures 1C and 1D). For the elderly, a 50% effective vaccine against infection (Figures 1E and 1F) or a vaccine 40% effective against infection and 60% against hospitalization available in late summer was similar to an 80% effective vaccine available in October for all ages.

Age-stratified weekly number of influenza-associated hospitalization per 100,000 population and total number of deaths in the United States for an mRNA vaccine that would be available in either October (A and B), November (C and D), or by late summer but only for the 65+ age group (E and F). The Baseline represents the 10-year average weekly hospitalization rate and mortality during the Flu Season (October to May).

Conclusion

As the majority of influenza-associated hospitalizations and deaths are in adults 65 years and older, a combination policy targeting higher vaccine effectiveness for this age group in the short term would be the most efficacious.

Disclosures

All Authors: No reported disclosures.
1877. COVID-19-Associated Hospitalizations among Long-Term Care Facility Residents Ages ≥65 Years — COVID-NET, 14 U.S. States, March 2020–January 2022
Authors: Taylor Christopher , Whitaker Michael , Anglin Onika , Pham Huong , Patel Kadam , Milucky Jennifer , Reingold Arthur , Alden Nisha B , Meek James , Ward Katelyn , Teno Kenzie , Kohrman Alexander , Como-Sabetti Kathy , Eisenberg Nancy , Spina Nancy L , Bushey Sophrena , Billing Laurie M , Sutton Melissa , Talbot Keipp , Swain Ashley , Havers Fiona P
Published: December 2022

Background

Adults aged ≥65 years and those with underlying medical conditions, including residents of long-term care facilities (LTCF), are at increased risk for COVID-19-associated hospitalizations and other severe outcomes.

Methods

Hospitalizations among LTCF residents aged ≥ 65 years from March 2020–January 2022 were described using data on a representative sample of hospitalizations from the CDC’s COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance network of > 250 acute care hospitals in 99 counties across 14 states. A Poisson regression model adjusting for age, race/ethnicity, underlying medical conditions, vaccination status, month of admission, and do-not-resuscitate/intubate-or-provide comfort-measures-only (DNR/DNI/CMO) code status examined the relationship of LTCF residency to death during COVID-19-associated hospitalization.

Results

Of 11,901 hospitalizations among adults aged ≥ 65 years reported during the study period, 2,965 (24.9%) were LTCF residents; most resided in nursing homes (53.8%) or assisted living facilities (26.8%). LTCF residents hospitalized with COVID-19 were older and more likely to have cardiovascular disease, congestive heart failure, a neurologic condition, dementia, or ≥ 3 underlying medical conditions than non-residents (Figure). The proportion of LTCF residents vs non-residents who required intensive care unit admission or invasive mechanical ventilation were not statistically different (23.2% vs 23.5% and 10.7 vs 13.5%, respectively). The proportion of in-hospital death was higher among LTCF residents than non-residents (22.8% vs 14.4%, p < 0.01). More LTCF residents have a DNR/DNI/CMO code status (48%) compared to non-residents (19%). The fully adjusted regression model found the risk ratio for death was 1.03 (95% CI, 1.01–1.05) among LTCF residents compared to non-residents.

Conclusion

Compared to non-residents, LTCF residents were older, had more underlying conditions, and had a higher risk of in-hospital death. After adjusting for multiple potential confounders, results suggest that LTCF residency is a weak but significant independent risk factor for death during COVID-19-associated hospitalization.

Disclosures

All Authors: No reported disclosures.
1889. Knowledge, beliefs and practices about COVID-19 infection and vaccination in healthcare personnel at non-acute care facilities
Authors: Mansoor Armaghan-e-Rehman , ONeil Caroline A , McDonald David , Fraser Victoria J , Babcock Hilary , Kwon Jennie H
Published: December 2022

Background

The objective of this study is to characterize the experiences, knowledge, beliefs, and perceptions of risk related to COVID-19, infection prevention practices, and COVID-19 vaccination among healthcare personnel (HCP) at three non-acute care facilities.

Methods

The study protocol was approved by the Washington University IRB. Between April-May 2021, anonymous surveys were distributed to HCP at three non-acute care facilities in St. Louis, MO. Data was collected on demographics, experience working in healthcare, COVID-19 exposures, knowledge and beliefs about infection prevention policies and procedures, PPE use, perception of risk of acquiring COVID-19, and COVID-19 vaccination status.

Results

There were 156 respondents; 78% were female, and 53% reported >10 years of healthcare experience. The largest proportion (32%) were in direct patient care as nurses or nurses’ aides. A majority (97%) reported adequate knowledge of how to protect themselves from COVID-19 at work, and most (95%) reported access to adequate PPE supplies.

HCP (58.7%) reported that wearing a mask or face shield made communication difficult, 56% stated they had taken on additional responsibilities due to staff shortages, and 53% indicated that their job became more stressful because of COVID-19. More than a quarter (28%) had considered quitting their job due to COVID-19. HCPs were more concerned about acquiring COVID-19 in the community than at work (47 vs 33%).

When asked about the COVID-19 vaccine, 78% of respondents reported receiving at least one dose of vaccine and 72% had completed a primary vaccine series. The most common reasons given for deciding to get vaccinated were a desire to protect family and friends (84%) and wanting to help stop the spread of COVID-19 (82%). For unvaccinated respondents (29%), the most common reasons for not receiving vaccination were concern for side effects (53%) and belief that the vaccine was not tested well enough (50%).

Conclusion

A significant proportion of HCP reported stress and increased responsibilities at work due to COVID-19, and 1 in 4 considered leaving their job. A majority were vaccinated, with concerns about side effects or inadequate vaccine testing cited as the most common concerns by unvaccinated HCPs.

Disclosures

All Authors: No reported disclosures.
1894. Sensitivity of Symptom-Based Screening for COVID-19 in Active Duty Service Members
Authors: Matthews Zachary , Cybulski Daniel , Frankel Dianne , Kieffer John , Casey Theresa , Osuna Angela , Marcus Joseph E
Published: December 2022

Background

Symptomatic COVID-19 screening has been a cornerstone of case identification during the pandemic. Despite the myriad of COVID-19 symptoms, screens have focused on fever, cough, and dyspnea. It is unknown how well these symptoms identify cases in a healthy military population. This study aims to evaluate the utility of symptom-based screening in identifying COVID-19 through different COVID-19 waves.

Methods

A convenience sample of 600 active-duty service members who arrived at JBSA in 2021 and 2022 was included in this study. We compared 200 symptomatic service members who tested positive for COVID-19 in each of FEB-APR 2021 (prior to the emergence of the Delta variant), JUN-AUG 2021 (Delta variant was predominant), and JAN 2022 (Omicron variant was predominant). Collected data included test date, reported symptoms, and vaccination status. Comparisons were conducted via Chi-Square or Fisher’s Exact test.

Results

Of the 600 symptomatic active-duty service members who tested positive for COVID-19, the most common symptoms were sore throat (n=385, 64%), headache (n=334, 56%), and cough (n=314, 52%). While sore throat was the most prominent symptom during Delta (n=140, 70%) and Omicron (n=153, 77%), headache was the most common prior to Delta (n=93, 47%). There were significant differences in symptoms by vaccination status (Table 2). Overall, screening for fever, cough, and dyspnea had a 65.1% sensitivity in this cohort (Table 3) with its lowest sensitivity in the pre-Delta cohort (53.5%) and highest sensitivity in the fully vaccinated Omicron cohort (78.3%).

Conclusion

In this descriptive cross-sectional study evaluating symptomatic military members with COVID-19, symptom prevalence varied based on the predominant COVID-19 variant as well as patients’ vaccination status. As screening strategies evolve with the pandemic, changing symptom prevalence should be considered.

Disclosures

All Authors: No reported disclosures.
1898. The Impact of Polymerase Chain Reaction Versus Antigen Based COVID-19 Testing on Subsequent Infections in Military Trainees
Authors: Cybulski Daniel , Matthews Zachary , Kieffer John , Casey Theresa , Osuna Angela , Kasper Korey , Frankel Dianne , Yun Heather , Marcus Joseph E
Published: December 2022

Background

Screening large groups of individuals entering a congregate setting has been a challenge during the COVID-19 pandemic. Current Infectious Disease Society of America guidelines recommend polymerase chain reaction (PCR)-based screening in symptomatic and at-risk individuals over antigen based testing due to higher sensitivity. However, there are limited real-world data describing secondary COVID-19 cases after different arrival testing strategies.

Methods

Between January 1 - August 31, 2021 all trainees attending United States Air Force Basic Military Training underwent arrival testing for COVID-19. Trainees who arrived January 1, 2021 - May 21, 2021 were tested via PCR and those from May 24, 2021 - August 31, 2021 via antigen test. All trained in groups of 30-50 and slept in communal quarters. Symptomatic secondary cases within the first two weeks of training were identified by individual as well as training group and compared based on method of arrival testing. For this study, a case cluster was defined as > 5 cases.

Results

A total of 24,601 trainees arrived during the study period with 406 (1.6%) trainees testing positive on arrival, of which 134 (33%) were symptomatic. Initial positivity rate was greater for PCR testing as compared to antigen testing (2.5% vs 0.4%, RR: 5.4, 95% CI: 4.0-7.3, p< 0.001). With PCR testing, training groups were significantly more likely to have a positive case on arrival (57% vs 11%, RR: 5.3, 95% CI: 3.7-7.7, p< 0.001). However, PCR testing was not associated with a difference in training groups with a secondary case (20% vs 22%, RR: 0.9, 95% CI: 0.66-1.2, p=0.53), number of training groups with a case cluster (4% vs 6.7%, RR: 0.61, 95% CI: 0.3-1.2, p=0.16), or number of days after arrival until development of symptomatic secondary case (median 8 vs 6.5 days, p=0.37) as compared to antigen testing.

Conclusion

This study describes two strategies of arrival testing for COVID-19 in a congregate setting at high risk for disease transmission. In this study, PCR-based testing was associated with more arrival cases. However, there was no difference in the number of training groups having a secondary case or a case cluster. This study supports the utility of antigen-based arrival testing for congregate settings.

Disclosures

All Authors: No reported disclosures.
1900. Time to appropriate care-seeking for Covid – 19 symptoms.
Authors: Ekat Martin Herbas , Doukaga Tatia Adoua , Ibara Bienvenu Rolland Ossibi
Published: December 2022

Background

in sub-Saharan Africa, the symptoms of covid-19 are similar to those of several pathologies frequently encountered in this region, which can confuse the diagnosis both for the patient and for health structures with limited resources. We studied self-reported time to care-seeking from the onset of covid-19 symptoms.

Methods

This was a cross-sectional study. Patient’files who attended the medical emergencies Unit of Brazzaville University Hospital, for symptoms suggestive of Covid - 19 between May 2020 and February 2022, were collected. The diagnosis of Covid-19 was confirmed by RT-PCR or antigen test. Delay, between the rise of Covid- 19 symptoms and the attendance at the medical emergencies Unit, was recovered from the history of the disease reported by the patients themselves. When the patient had reported a duration of 'about one week' in the delay we noted '7 days' and 'about 2 weeks' corresponded to '14 days' taking this into account we used the Weibull regression model accelerated failure-time metric to identify potential risk factors which were subsequently presented as a time ratio (TR).

Results

102 patients were included, 57 (55.88%) were women, the median age was 64 years (Interquartile Range (IQR): 56 – 71), history of hypertension and diabetes was found respectively in 51 (50%) and 27 (26.47%) patients. 13 (12.75%) were vaccinated against Covid – 19. The median time to care-seeking was 7 days (IIQ: 5 – 7). Being vaccinated (adjusted Time Ratio (aTR): 1.69 (95% CI: 1.09 – 2.6) p=0.02) and having a cough (aTR: 1.74 (95% CI: 1.2 – 2.52) p=0.03) was associated with a longer time to care-seeking. On the other hand, being Hypertensive (aTR: 0.68 (95% CI: 0.51 – 0.9) p= 0.006), asthenic (aTR: 0.46 (95% CI: 0.23 – 0.91) p= 0.03) and having respiratory distress (aTR: 0.48 (95% CI: 0.26 – 0.89) p=0.03) were associated with a faster time to care-seeking.

Conclusion

the vaccine increases time for care-seeking, especially when it is associated with the classic signs of COVID-19 such as cough. To limit the under-notification of cases in sub-Saharan Africa, Covid 19 testing must be generalized.

Disclosures

All Authors: No reported disclosures.
1905. High food insecurity during the COVID-19 pandemic among secondary school teachers - Tajikistan, 2021
Authors: Akhmedov Davron , Horth Roberta , Nabirova Dilyara
Published: December 2022

Background

The COVID-19 pandemic’s global disruptions resulted in food insecurity and negative consequences beyond direct health impact. Increased understanding of these consequences can protect critical infrastructure workers, including teachers, in future pandemics and COVID-19 waves.

Methods

We conducted a descriptive cross-sectional study from September through October 2021 in Kulyab, Tajikistan. Teachers, systematically recruited from 54 secondary schools, responded to an online structured questionnaire on food security and negative consequences. We defined food insecurity as (1) being very worried about not having food, (2) having run out of food a lot more than before the pandemic, or (3) having to skip meals often because of insufficient money, and high food insecurity if all applied. Multivariable logistic regressions were conducted to identify variables associated with high food insecurity.

Results

Of 1,575 teachers surveyed, 44% had food insecurity, and 14% had high food insecurity. Negative consequences experienced included, 40% income loss, 7% having to move households, 67% depression/anxiety, and 44% fear of leaving home due to violence. Food insecurity was independently greater among teachers with school age children (15% vs. 9%), that had to quarantine or isolate (18% vs. 9%), and who had COVID-19 (21% vs. 13%). Odds of high food insecurity were higher among teachers with significant income loss (Adjusted odds ratio (AOR): 3.3, 95% CI: 1.9-5.7), depression/anxiety (AOR 1.8, 95% CI: 1.2-3.0), fear of leaving home due to violence (AOR 2.6, 95% CI: 1.7-4.1), and teleworking vs in-person (AOR 1.6, 95% CI: 1.1-2.3). Odds were lower among teachers who practiced physical distancing (AOR 0.5, 95% CI: 0.3-0.7) and with household members > 60 years old (AOR 0.4, 95% CI: 0.1-0.8).

Conclusion

During the COVID-19 pandemic teachers in our study experienced high food insecurity, income loss, and anxiety or depression. Safety nets could be strengthened and focused for health threats affecting populations access to food.

Disclosures

All Authors: No reported disclosures.
1911. A Pilot Study to Evaluate the Effectiveness of Nasal and Oral Povidone Iodine in Reducing the Burden of Severe Acute Respiratory Syndrome 2 RNA in Patients with COVID-19
Authors: Redmond Sarah , Jones Lucas D , Nguyen Alexandria , Ghaddara Hussein , Cadnum Jennifer , Donskey Curtis
Published: December 2022

Background

Nasal and oral application of topical antiseptics such as povidone iodine could potentially reduce the risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, limited information is available on the efficacy of such agents in reducing the burden of SARS-CoV-2.

Methods

We conducted a pilot non-blinded, randomized trial to compare the effectiveness of 3 doses of povidone iodine (each dose with 10% intranasal and 1% gargle) administered every 8 hours versus the control with phosphate-buffered saline in reducing the burden of SARS-CoV-2 RNA in the nares and oropharynx of patients with COVID-19. Swabs were used to collect anterior nares and oropharynx samples before the first and second doses and 8 hours after the final dose (24 hours after the initial dose). Real-time polymerase-chain reaction (RT-PCR) was used to assess the burden of viral RNA. Analysis of variance was used to compare cycle threshold values for povidone iodine versus control patients. Subjects were surveyed about adverse reactions to treatment.

Results

As shown in the figure, SARS-CoV-2 cycle thresholds were similar in the povidone iodine (N=10 subjects) and control (N=8 subjects) groups prior to treatment. After initiation of treatment, there was no significant difference in cycle thresholds for the povidone iodine versus control subjects (P >0.05). No adverse effects of treatment were reported.

Effect of intranasal and oral application of povidone iodine versus phosphate-buffered saline on nasal and oropharyngeal SARS-CoV-2 RNA. Error bars show standard error.

Conclusion

Our findings suggest that that nasal and oral application of povidone iodine have limited effectiveness in reducing the burden of SARS-CoV-2. Future studies are needed to assess for effectiveness of more frequent dosing intervals and to determine if povidone iodine reduces recovery of viable virus by culture.

Disclosures

All Authors: No reported disclosures.
1913. Baltimore City Health Department COVID-19 Community-based Testing Results
Authors: Dye Shamola , Agnes Isabella , Phelan-Emrick Darcy , Greenbaum Adena
Published: December 2022

Background

The Baltimore City Health Department (BCHD) began community-based COVID-19 testing in response to the pandemic on April 21, 2020. The purpose was to provide access to COVID-19 testing to underserved communities. BCHD designed the program to accommodate transportation limitations, limited-access to internet and phones, and non-English speakers. BCHD has continued hosting up to five community-based testing sites per week. This analysis examines the test results of BCHD’s COVID-19 community-based testing program to date.

Methods

Patients completed an intake form, which included demographic information, at the testing event, prior to providing their specimen for COVID-19 testing. For this analysis, patient demographics and test results were analyzed using REDCap software.

Results

Total test volume for year 2020 (4/21/2020 -12/30/2020) was 15,839, year 2021 (1/5/2021- 12/30/2021) was 13,087, and year 2022 (1/4/2022 - 4/1/2022) was 2,261. Average percent positivity for year 2020 was 9%, year 2021 was 7%, and year 2022 to date was 6%. Patient ethnicity was Non-Hispanic 85.5%, Hispanic 13.5%, and Did not respond/Don’t know 1.0%. Race was Black or African America 61.1%, White 25.0%, Asian 2.8%, American Indian/Alaska Native 0.1%, Native Hawaiian or Other Pacific Islander 0.1%, and Unknown 10.7%. Total positive COVID-19 results among Black/African Americans in 2020, 2021, and 2022 respectively were 1567 (12.8%), 1177 (15.1%), and 218 (22.1%). Total positive COVID-19 results among White in 2020, 2021, and 2022 respectively were 541 (10.1%), 441 (12.1%), and 60 (15.1%) respectively. Total positive COVID-19 results among Asians in 2020, 2021, and 2022 were 63 (20.9%), 47 (11.0%), and 4 (25.5%) respectively. Total positive COVID-19 results among Native Hawaiian or Other Pacific Islander in 2020, 2021, and 2022 respectively were 4 (16.7%), 4 (20.0%), and 2 (0.0%) respectively. Total positive COVID-19 results among American Indian/Alaskan in 2020, 2021, and 2022 were 3 (13.6%), 1 (7.1%), and 2 (66.7%) respectively.

Conclusion

BCHD’s community-based testing program has completed over 31,000 tests to date. COVID-19 percent positivity among patients showed a decline across the three years. This analysis demonstrates how a local health department can provide testing to the communities.

Disclosures

All Authors: No reported disclosures.
1925. Prevalence of SARS-CoV-2 Infection in Immunocompromised Patients Following Receipt of Tixagevimab/Cilgavimab
Authors: Lim Sarah , Morris Keeley , Fess Lydia J , Como-Sabetti Kathy , Lynfield Ruth
Published: December 2022

Background

Tixagevimab/cilgavimab (TC) was approved by the FDA in December 2021 for use as pre-exposure prophylaxis in patients with moderate to severe immune compromise. On February 24, FDA recommended a second dose for patients who received the original dosing because of decreased activity against Omicron subvariants. We were interested in reviewing TC experience in Minnesota.

Methods

Minnesota Department of Health established a voluntary TC patient registry in December 2021, including date of treatment, COVID-19 vaccination status and immunocompromising conditions. Patients were matched to state COVID-19 case data from December 1, 2021 to April 22, 2022, to examine occurrence of SARS-CoV-2 infection (a positive test by PCR or antigen) following receipt of TC.

Results

Data were available for 289 patients, representing 5-10% of all patients treated with TC in Minnesota. 53% were male with a median age of 62 (IQR 48-70). 13 patients (4.5%) had not received COVID-19 vaccine at the time of initial TC dose. 128 patients (44%) received 2 doses of TC. Immunocompromising conditions included: hematological malignancy (114, 39.4%), treatment with immunosuppressant medications (113, 39.1%), solid organ transplant (45, 15.6%), and stem cell transplant (13, 4.5%). 5 patients (1.7%) had a positive SARS-CoV-2 test (4 PCR, 1 antigen) following receipt of TC (Table 1); patients tested positive on days 7, 11, 13, 17 and 48/70. Three patients were on rituximab and 2 had hematological malignancy. All 5 had received 3 doses of COVID-19 vaccine prior to receipt of TC. Variant information was available for 2 patients: BA.1 and BA.1.1. 1 patient required hospitalization for COVID-19 and died 39 days after the positive test but had 3 subsequent negative tests before discharge; death was attributed to underlying malignancy. Table 1:Characteristics of patients with positive SARS-CoV-2 tests following treatment with tixagevimab/cilgavimab.

Conclusion

In a convenience sample of 289 patients who received TC, 5 patients had COVID-19, with 3 occurring within the SARS CoV-2 incubation period following receipt of TC. One of the other patients was positive after receiving 2 doses of TC. Following effectiveness of TC will be useful as SARS CoV-2 continues to evolve.

Disclosures

All Authors: No reported disclosures.
1929. A Qualitative Analysis of COVID-19 Vaccination Intent and Recommendations to Increase Uptake Among Residents and Staff in Six Seattle Homeless Shelters
Authors: Cox Sarah N , Thuo Nicholas , Rogers Julia H , Meehan Ashley A , Link Amy C , Lo Natalie K , Manns Brian , Ogokeh Constance E , Chow Eric J , Rolfes Melissa A , Mosites Emily , Achkar Morhaf Al , Chu Helen Y
Published: December 2022

Background

COVID-19 vaccines are important to mitigate severe disease in congregate settings, yet uptake remains lower among people experiencing homelessness (PEH) than in the general population. This study aimed to explain changes in COVID-19 vaccination intent over time and identify modifiable factors to improve vaccine acceptance among PEH.

Methods

We utilized the Health Belief Model and 3Cs Model of Vaccine Hesitancy to develop a conceptual framework to explore factors that may influence COVID-19 vaccination intent among PEH. Between July 27 - October 15, 2021, we conducted semi-structured interviews (SSIs) and focus group discussions (FGDs) across six homeless shelters in Seattle-King County, Washington. Residents and staff aged 18 years and older were recruited through purposive sampling for SSIs and convenience sampling for FGDs. We captured retrospective information about perceptions of and intent to receive COVID-19 vaccines between March 2020 - August 2021. Thematic analysis was conducted using Dedoose.

Results

We conducted 31 SSIs (25 residents and six staff) and eight FGDs with 43 residents. Participants reported that too much contradictory and changing information about COVID-19 vaccines led to confusion. Information deemed trustworthy (i.e., objective, honest, professional, and recommended by others) contributed to individual’s knowledge and in some cases changed their vaccination intent. Despite intention to vaccinate, participants reported barriers to COVID-19 vaccine access including availability, eligibility, appointments, and timeliness. While many intended to get vaccinated on their own, others were motivated by incentives and requirements. Participants presented recommendations to improve COVID-19 information content and dissemination, access, and incentives in shelter settings (Table 1). Table 1.Recommendations for Interventions to Increase COVID-19 Vaccine Uptake in Shelter Settings

Conclusion

COVID-19 vaccination strategies that are rooted in the voices and experiences of PEH are presented and can inform improved vaccine implementation among key stakeholders. Future research should test recommended strategies to determine feasibility and effectiveness in shelter settings.

Disclosures

Helen Y. Chu, MD, MPH, Cepheid: Reagents|Ellume: Advisor/Consultant|Gates Ventures: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant.
1945. Effects of COVID-19 Vaccines on Outcomes Among Hospitalized COVID-19 Patients
Authors: Hoskins Serene , Restrepo Marcos I , Cadena Jose
Published: December 2022

Background

After COVID-19 vaccinations, breakthrough infections appear to be of public health concern. There is limited data regarding clinical effectiveness of COVID-19 vaccination. Our aim was to determine the differences in clinical outcomes among COVID-19 unvaccinated versus vaccinated patients who required hospitalization.

Methods

This was a retrospective cohort study of COVID-19 hospitalized patients between 7/25/21 and 9/6/2021. Previously infected COVID-19 patients were excluded. The patients were classified as fully vaccinated vs. unvaccinated (CDC guidelines). The primary outcome included the need for advance oxygen therapy (high flow nasal cannula, non-invasive ventilation, mechanical ventilation), ICU admission, or 28-day all-cause mortality. We performed a subgroup analysis according to the immunocompetent status and older age (≥65 years).

Results

We enrolled 207 patients, stratified as unvaccinated (n=147 [71%]) vs. fully vaccinated (n=60 [29%]). Unvaccinated patients were younger (median age 58 vs. 71 years old, p< 0.001) and more likely to require oxygen (n=105[71%] vs. n=35[58%], p=0.07) compared to vaccinated patients.

Unvaccinated patients were more likely to reach the primary outcome (n=59 [40%] vs. n=16 [26%], p=0.08) when compared to vaccinated patients. The subgroup analyses revealed that unvaccinated patients had higher rates of the primary outcome when ≥65 years old ( n=27/46 [58.7%] vs. n=13/37 [35.1%], p=0.047), immunocompetent (n=57/139 [41%] vs. 13/53 [24.5%]) and both groups combined (n=22/39 [56%] vs. 11/38 [28.9%], p=0.021), respectively.

Conclusion

Unvaccinated patients represented the largest proportion of hospitalized patients. Unvaccinated patients were younger and required oxygen therapy. Unvaccinated immunocompetent patients aged ≥ 65 had worse outcomes compared to vaccinated patients. Further studies are needed to identify unmeasured characteristics that may be associated with poor clinical outcomes.

Disclosures

All Authors: No reported disclosures.
1960. Mucosal rAd5 Immunization against SARS-CoV-2 Spike Elicits Cross-Reactive Nasal and Serum Neutralizing Antibodies and Protects Against Beta Variant Challenge in African Green Monkeys
Authors: Flitter Becca A , Tedjakusuma Sarah N , Lester Colin A , Neuhaus Elena D , Johnson Susan , Dora Emery G , Peinovich Nadine , Jegede Clara B , Tucker Sean N
Published: December 2022

Background

Mucosal vaccination may offer increased protection against SARS-CoV-2 compared to parental immunization. Here, we describe immunogenicity and efficacy following viral challenge in non-human primates after intranasal delivery of three unique non-replicating adenoviral vector vaccine (rAd5) candidates.

Methods

African green monkeys (AMG) were prime boost immunized 29 days apart with vaccine candidates either expressing the parental spike protein alone (Wuhan-S), spike plus nucleocapsid (Wuhan-S-N), or the spike protein from the beta variant (beta-S). Serum and nasal swabs were collected every 14 days and humoral responses to full length spike (S) and receptor binding domain (RBD) were assessed. All AMGs were challenged with SARS-CoV-2 B.1.351 (beta variant) on day 56. Viral loads measured every two days by TCID50 in nasal washes and bronchial lavage fluid post challenge.

Results

Mucosal immunization with Wuhan-S induced significant increases in serum IgG and IgA responses against the homologous parental lineage, as well as beta, delta, and omicron variants. In nasal samples, Wuhan-S immunization elicited over 500-fold increases in in cross-reactive IgA against multiple variants of concern including delta and omicron. While the beta-S rAd5 vaccine candidate induced enhanced serum IgG responses to homologous S and RBD proteins, this approach resulted in less cross-reactive antibodies to other variants compared to Wuhan-S rAd5 vaccine. Despite the differences in the ability to elicit cross-reactive antibody responses, all vaccinated AMGs challenged with SARS-CoV-2 B.1.351 (beta variant), had a significant reduction in viral titers by TCID50 in the nasal passages and reduced viral load in bronchial lavage fluid compared to unvaccinated controls.

Conclusion

These results demonstrate mucosal administration of rAd5 clinical candidate vaccine, Wuhan-S, is immunogenic and offers cross-protective humoral responses in both serum and nasal compartments against a mismatched SARS-CoV-2 challenge virus.

Disclosures

Becca A. Flitter, PhD, MPH, Vaxart Inc: Stocks/Bonds Sarah N. Tedjakusuma, n/a, Vaxart Inc: Stocks/Bonds Colin A. Lester, n/a, Vaxart Inc: Stocks/Bonds Elena D. Neuhaus, n/a, Vaxart Inc: Stocks/Bonds Susan Johnson, PhD, Vaxart Inc: Stocks/Bonds Emery G. Dora, n/a, Vaxart Inc: Stocks/Bonds Nadine Peinovich, MPH, Vaxart Inc: Stocks/Bonds Clara B. Jegede, n/a, Vaxart Inc: Stocks/Bonds Sean N. Tucker, PhD, Vaxart Inc: Stocks/Bonds.
1966. Protection afforded by prior infection, vaccination, and hybrid immunity against symptomatic BA.1 and BA.2 Omicron infections.
Authors: Altarawneh Heba N , Chemaitelly Hiam , Ayoub Houssein H , Tang Patrick , Hasan Mohammad R , Yassine Hadi M , Al-Khatib Hebah A , Smatti Maria K , Coyle Peter , Al-Kanaani Zaina , Al-Kuwari Einas , Jeremijenko Andrew , Kaleeckal Anvar Hassan , Latif Ali Nizar , Shaik Riyazuddin Mohammad , Abdul-Rahim Hanan F , Nasrallah Gheyath K , Al-Kuwari Mohamed Ghaith , Butt Adeel A , Al-Romaihi Hamad Eid , Al-Thani Mohamed H , Al Khal Abdul Latif , Bertollini Roberto , Abu-Raddad Laith J
Published: December 2022

Background

Protection offered by five different forms of immunity, combining natural and vaccine immunity, was investigated against symptomatic SARS-CoV-2 infection from Omicron BA.1 or BA.2, and severe, critical, or fatal COVID-19 from BA.1 or BA.2, in Qatar, between December 23, 2021 and February 21, 2022.

Methods

Six national, matched, test-negative case-control studies were conducted on a sample of 272,861 PCR-positive tests and 669,628 PCR-negative tests to estimate effectiveness of BNT162b2 (Pfizer-BioNTech) vaccine, mRNA-1273 (Moderna) vaccine, natural immunity due to prior infection with pre-Omicron variants, and hybrid immunity from prior infection and vaccination.

Results

Effectiveness of prior infection alone against symptomatic BA.2 infection was 46.1% (95% CI: 39.5-51.9%). Effectiveness of two-dose BNT162b2 vaccination alone was negligible at -1.1% (95% CI: -7.1-4.6), but nearly all individuals received their second dose >6 months earlier. Effectiveness of three-dose BNT162b2 vaccination alone was 52.2% (95% CI: 48.1-55.9%). Effectiveness of hybrid immunity of prior infection and two-dose BNT162b2 vaccination was 55.1% (95% CI: 50.9-58.9%). Effectiveness of hybrid immunity of prior infection and three-dose BNT162b2 vaccination was 77.3% (95% CI: 72.4-81.4%). Meanwhile, prior infection, BNT162b2 vaccination, and hybrid immunity all showed strong effectiveness ( >70%) against severe, critical, or fatal COVID-19 due to BA.2. Similar patterns of effectiveness were observed for BA.1 and for the mRNA-1273 vaccine. Figure 1.Effectiveness of prior infection, vaccination, and hybrid immunity against symptomatic Omicron infection and against severe, critical, or fatal COVID-19 for the BA.1 (panels A and B, respectively) and BA.2 (panels C and D, respectively) subvariants in the BNT162b2-vaccine study.Figure 2.Effectiveness of prior infection, vaccination, and hybrid immunity against symptomatic Omicron infection and against severe, critical, or fatal COVID-19 for the BA.1 (panels A and B, respectively) and BA.2 (panels C and D, respectively) subvariants in the mRNA-1273-vaccine study.

Conclusion

There are no discernable differences between BA.1 and BA.2 in the effects of prior infection, vaccination, and hybrid immunity. Vaccination enhances the protection of those with a prior infection. Hybrid immunity resulting from prior infection and recent booster vaccination conferred the strongest protection.

Disclosures

Adeel A. Butt, MBBS, Gilead Sciences: Grant/Research Support.
1973. The Antibody Neutralization Level after a BNT162b2 Vaccine Booster in Korean Healthcare Workers
Authors: Choo Eun Ju , Park Sunghee
Published: December 2022

Background

We compared neutralizing antibodies in healthy healthcare workers against two different coronavirus 2019 disease (Covid-19) vaccines, a messenger RNA (mRNA)-based vaccine (BNT162b2) and a genetically modified organism (virus vector) vaccine (ChAdOx1), to obtain immunity. In our cohort, we tried to compare the level of neutralizing antibody production after a BNT162b2 vaccine booster and to analyze the level of neutralizing antibody titers for delta and omicron variant.

Methods

On November 23 to 25, 2021 and December 23 to 24, 2021, a total of 2,133 HCWs at Soonchunhyang University Bucheon Hospital had been vaccinated with BNT162b2 (Pfizer-BioNTech). Among the 115 HCWs who participated in the preceding study, all participants had no history of Covid-19 infection or suspected symptoms at the time of registration. We collected blood samples from participants four weeks after a third dose. All blood samples were analyzed using the commercial virus neutralization test kit (Genscript Biotech Corporation, Piscataway, NJ, USA).

Results

Titers were measured 2 months after the initial vaccination and before the booster of the BNT162b2 vaccine (i.e. 6 months after the initial vaccination), and 4 weeks after the booster. Neutralizing antibody level measured by percentage inhibition of surrogate virus neutralization test (sVNT) readings at negative control (unvaccinated) and 4 weeks after booster vaccination. BNT/BNT/BNT group was defined as a booster dose with BNT162b2 (Pfizer) after two doses of BNT162b2 vaccine (Pfizer) 3 weeks apart. ChA/ChA/BNT group was defined as a booster dose with BNT162b2 (Pfizer) after two doses of ChAdOx1 vaccine (AstraZeneca/Oxford) 12 weeks apart.

Conclusion

We found that the neutralizing antibody levels against omicron variant were higher among those who received a booster dose of the BNT162b2 vaccine.

Disclosures

All Authors: No reported disclosures.