bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1877. Daptomycin-Induced Creatine Phosphokinase Elevations Among Patients Requiring Outpatient Parenteral Antimicrobial Therapy
Authors: Berg Deanna , Binkley Amanda , Maguire Christina , Norris Anne , Athans Vasilios
Published: January 2025

Background

Daptomycin, a lipopeptide with broad-spectrum gram-positive activity, requires once-daily dosing with weekly creatine phosphokinase (CPK) monitoring for daptomycin-induced muscle injury. There is a paucity of data that describes the incidence of CPK elevations among patients who require extended durations of daptomycin outpatient parenteral antimicrobial therapy (OPAT). Variables associated with elevated CPK levels include high-dose daptomycin (≥ 8 mg/kg), elevated body mass index, and concomitant medication. This study sought to describe the laboratory monitoring and safety profile of daptomycin when used in the OPAT setting.

Methods

We conducted a retrospective, multicenter cohort study of adults who received daptomycin OPAT for at least seven days between January 1, 2022, and December 31, 2023. Patients with an unknown or elevated baseline CPK were excluded. CPK toxicity grades are defined as Grade 0 (≤ 200 U/L), Grade 1 (201-500 U/L), Grade 2 (501-1000 U/L), Grade 3 (≥ 1000 U/L). The primary endpoint was the incidence of CPK elevations during daptomycin OPAT. Secondary endpoints include characterizing factors associated with CPK elevations and safety outcomes.

Results

A total of 188 patients were included in the analysis. Most patients were treated for osteomyelitis (46%), endovascular (19%), or prosthetic joint infection (18%) caused by either staphylococci (63%) or enterococci (19%). The median weight-based daptomycin dose was 7 mg/kg (actual body weight) (IQR 6 – 8), and the median treatment duration was 38 days (IQR 24 – 42 ). A total of 86 patients were on concomitant statin therapy, of which 54% were on a high-intensity statin, and 79% were on a lipophilic statin. CPK toxicity Grade 0 was the highest toxicity among 70% of patients on statin therapy. There were 47 patients (25%) who experienced any CPK elevation (Grade ≥ 1), of which the majority were asymptomatic (44/47, 94%), and CPK elevation led to discontinuation of therapy in 18 patients (Table 1).

Conclusion

The majority of the patients were able to tolerate prolonged daptomycin therapy. Concomitant statin therapy was continued in most patients. Repeat CPK testing in asymptomatic patients and assessment of confounding factors may be appropriate prior to early discontinuation of daptomycin therapy.

Disclosures

Amanda Binkley, PharmD, BCIDP, AAHIVP, Viiv: Advisor/Consultant Christina Maguire, PharmD, Viiv: Advisor/Consultant
P-1930. Absence of Booster Vaccination and Low Cycle Threshold Values Predict Severe and Critical COVID-19 in Fully Vaccinated Individuals: A Multi-Center Retrospective Cohort Study
Authors: Rivera Charles Kevin L , Donna Cruz Ia Marie , Carascal Mark , Perez Ma Cristina , Destura Raul V , Henson Karl Evans R
Published: January 2025

Background

The development of severe/critical Coronavirus Disease 2019 (COVID-19) infection in fully vaccinated individuals is an incompletely defined area of research and lacks clinical scoring tools. Most scoring systems were assessed with unvaccinated patients, making it less clinically applicable in today’s global landscape. Our study validated an existing clinical prediction tool using data from vaccinated individuals and created a new model that could provide improved prediction accuracy.

Methods

Adults fully vaccinated against COVID-19 and admitted to two Philippine tertiary hospitals from March 2021 to August 2022 for breakthrough infections were enrolled. Clinical characteristics, type and number of vaccine doses, and rt-PCR cycle threshold (CT) values were collected. The primary outcome of interest was the development of severe/critical COVID-19. An existing severe/critical COVID-19 prediction tool was validated using the study data, while a new and simpler scoring system was developed from the multiple logistic regression analysis of significant variables.Table 2:Final Model with Significant Factors

Results

Among 803 adults with COVID-19, 138 (17%) received at least one booster dose, and 139 (17%) progressed to severe/critical disease. The existing prediction tool had a sensitivity (Sn) of 96.5%, specificity (Sp) of 11.7%, and area under the receiver-operator curve (AUROC) of 0.54. Multivariable logistic regression showed that age >75y (OR 2.86; 95% CI 1.56 - 5.21), diabetes mellitus (OR 1.76, 95% CI 1.10-2.80), CT value < 20 (OR 1.90; 95% CI: 1.19 - 3.03), suspicion of bacterial co-infection (OR 2.85, 95% CI 1.60-5.07), and non-receipt of a booster dose (OR 0.32; 95% CI: 0.15 - 0.72) were independent risk factors for developing severe/critical COVID-19. The developed scoring system showed a Sn of 89.4%, Sp of 62.7%, and AUROC of 0.76.

Conclusion

A simplified scoring tool using five variables may help predict the progression to severe/critical COVID-19 in fully vaccinated individuals. Although the tool has modest Sn and Sp, it can help triage patients and guide initial therapy. Validation of this tool in larger studies is recommended.

Disclosures

Karl Evans R. Henson, MD, FIDSA, BSV Biosciences: Honoraria|Cathay Drug Company, Inc: Grant/Research Support|MSD: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria
P-1937. Multisystem inflammatory syndrome in children (MIS-C) - Accurate Diagnosis for Targeted Treatment
Authors: Sundararajan Sanjana , Pinninti Swetha , Boppana Suresh
Published: January 2025

Background

Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory post-acute COVID-19 condition that clinically overlaps with Kawasaki disease (KD). However, the recommended first-line therapy differs for these two conditions. The Centers for Disease Control (CDC) and centers for state and territorial epidemiologists (CSTE) updated the surveillance case definition for MIS-C in 2023 to improve specificity. Since it has been suggested that 15%-20% of children identified using the 2020 definition will not meet the updated definition. While the incidence of MIS-C has decreased, waning immunity and low vaccine uptake in children requires continued vigilance and research. The objective of this study is to determine the utility of the 2023 CSTE/CDC definition to identify children with MIS-C at a quaternary care pediatric center.

Methods

Children diagnosed and treated for MIS-C at the Children’s of Alabama (COA) between January 2020 and December 2022 were enrolled in a prospective follow-up study. Demographic, clinical, and laboratory data, and treatment regimens were abstracted from the electronic medical record (EMR). The CDC 2020 and the 2023 CTSE/CDC criteria were applied to the cohort.

Results

The study cohort includes 126 children diagnosed and treated for MIS-C at COA between 2020 and 2022. The demographic and clinical features are summarized in Table 1. Of the 126 children, 92.8% (117/126) and 93.6% (118/126) respectively met the 2020 and the updated 2023 definition for MIS-C. While 81.7% (103/126) of children were treated with IVIG + steroids, 18% (23/126) were treated with IVIG only. In addition, 12 children required immunomodulators (Anakinra /Remicade /Infliximab) for resolution of symptoms after treatment with IVIG + steroids. Favorable short and mid-term outcomes were documented in all children in this cohort.

Conclusion

Over 90% of children with MIS-C met the criteria for MIS-C diagnosis with either the 2020 or the revised 2023 definition. The lack of definitive clinical or laboratory biomarkers and significant clinical overlap with other entities makes it challenging to identify all children with MIS-C highlighting the need for a better understanding of the pathogenesis, biomarker discovery, and effective therapies.

Disclosures

Swetha Pinninti, MD, Moderna: Grant/Research Support|Pfizer: Grant/Research Support Suresh Boppana, MD, GSK: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support
P-1942. Unexpected Cardiac Deaths in Patients with COVID-19 Infection
Authors: Malik Aimon , Jabeen Atika , Chemaitelly Hiam , Thomas Anil G , Shams Sherin , Saleem Samah , Bhutta Zain A , Azad Aftab M , Al Khal Abdullatif , Abu-Raddad Laith J , Abou-Samra Abdul-Badi , Butt Adeel A
Published: January 2025

Background

There are contradictory reports regarding the association of COVID-19 with sudden cardiac deaths. It is unclear whether these deaths are the result of known cardiac disease and risk factors or are unexpected based on prevalent risk factors. Our aim was to determine the association between COVID-19 infection and UCD among individuals who died of a cardiac cause in Qatar.

Study Flowsheet

Methods

All deaths in Qatar in adults >18 years old with any cardiac cause listed as the primary or immediate cause of death were individually reviewed to determine whether the death was unexpected based on the individual’s clinical risk profile. For each case of validated UCD, up to 5 controls with a non-cardiac primary cause of death were identified, matched on age groups, sex, nationality, number of coexisting conditions, and vaccine doses to individuals who died of non-cardiac causes in the same calendar month. Adjusted odds ratios (aOR) comparing odds of prior COVID-19 infection in cases relative to controls were estimated using conditional logistic regression.

Association between prior COVID-19 infection and incidence of Unexpected Cardiac Deaths (UCD) in the matched cohorts.

Results

Among a total of 10,541 deaths, we matched 326 UCD cases to 604 controls with a non-cardiac cause of death. The median age was 48 years for cases and 49 years for controls, 87% were male, and 18% of cases and 20% of controls were Qatari nationals. Approximately three-quarters in each group had no documented comorbidities, and approximately two-thirds were unvaccinated. Prior COVID-19 infection was not associated with a higher risk of UCD (aOR 0.74, 95% CI 0.48, 1.13). No association was observed between prior COVID-19 and UCD in subgroup analyses by age groups, or vaccination status. Qatari nationals, females, and those with > 4 comorbidities were less likely to experience UCD associated with prior COVID-19.

Conclusion

COVID-19 is not associated with an increased risk of UCD. The observed cardiac deaths are more likely due to the underlying risk profile of the decedents.

Disclosures

Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support
P-1946. Epidemiology and Factors Associated with SARS-CoV-2 Transmission Among Students Following Resumption of Face-to-Face Classes in a Private University in Metro Manila, Philippines
Authors: Do Dianne Hazel P , Padua Jay Ron O
Published: January 2025

Background

Coronavirus disease (COVID-19) has brought disruptions in our lives including the education system. In the Philippines, the education system has transitioned to online and modular distance learning delivery of instruction due to the pandemic. To date, there has been no local study on the clustering rates within schools in the Philippines following resumption of face-to-face classes. This study aims to describe the demographic and clinical characteristics of students with confirmed COVID-19 and to determine the incidence of clustering among students after resumption of face-to-face classes.

Methods

A retrospective cross-sectional study on high school and college students of a private university with confirmed COVID-19 during the Academic Years (A.Y.) 2021-2022 and 2022-2023. Data was collected through digital medical charts review and analysis done using real statistics, multiple logistic regression model and cluster analysis.

Results

More female students were affected than male students in the senior high school and college level while almost equal distribution was seen among the junior high school level. Majority were fully vaccinated to COVID-19 with 1 booster dose. The presumed route of transmission was mostly from close contacts in school. Most common symptoms were cough, colds and fever. Most infections were mild. Among those vaccinated, the timing of infection from last vaccination showed varied results (9 to less than 12 months in junior high; 3 to less than 6 months and 6 to less than 9 months in senior high and college). The timing of recovery did not show significant difference (p-value=0.637) among different education levels. Based on the regression analysis, there is no variable which can be significantly associated with transmission of infection among close contacts either at school or at home. The highest number of cases and clustering were observed among medical and health-allied colleges and programs.

Conclusion

Based on the study results, clustering can occur in school settings in the Philippines. Despite the low cases in the community, transmission is still present among university students. Therefore, infection prevention and control strategies must still be strictly observed until the virus is completely eradicated in order to prevent sporadic outbreaks.

Disclosures

All Authors: No reported disclosures
P-1949. The Self-Controlled Risk Interval: An Evolving Method for Vaccine Effectiveness Estimation in Complex Real-World Data
Authors: Fix Jonathan , Marchese Anthony M , Beyhaghi Hadi , Rousculp Matthew D
Published: January 2025

Background

Post-marketing assessments of vaccine effectiveness (VE) are critical to informing health policy, understanding real-world vaccine performance, and ensuring confidence in vaccination efforts, though imperfect comparator groups can limit the accuracy of VE assessments. The self-controlled risk interval (SCRI) design, a case-only analytic method historically used in safety studies, controls for time-invariant confounding using within-person comparisons and has recently been used to assess VE. This targeted review identifies and characterizes SCRI’s growing role in VE research.Table 1:Vaccine Effectiveness Studies that Used the Self-Controlled Risk Interval Design

Methods

Targeted database searches were conducted in Medline, Embase®, Embase Preprints, and BIOSIS Previews®, and the preprint servers: medRxiv, preprints with The Lancet, and Research Square. Key terms (and related variations) included: vaccine effectiveness, COVID-19 vaccines, and self-controlled risk interval.

Results

Two VE studies that used the SCRI design were identified (Table 1). Both were retrospective database studies (one using electronic health records and the other insurance claims data), evaluated SARS-CoV-2 infection, and used similar post-vaccination control windows, but featured different post-vaccination risk windows and were conducted among notably different populations. An additional 10 identified studies included post-vaccination person-time in the comparison group but did not make within-person comparisons to address important potential confounding, acknowledging that post-vaccination benefits are not appreciated immediately. These studies varied in the study populations, outcomes assessed, comparison group composition, and analytic methods.

Conclusion

Use of SCRI for VE estimation has been limited; however, the increasing inclusion of post-vaccination control arm person-time in other COVID-19 VE studies merits the broadening of its application. The results of this review suggest that, in the context of COVID-19, SCRI VE evaluation is a promising tool where there are no suitable comparison groups, increasingly complex individual backgrounds (e.g., infection history, number and timing of doses, or heterologous vaccination), or insufficient information for confounding control.

Disclosures

Jonathan Fix, PhD, Novavax, Inc.: employee|Novavax, Inc.: Stocks/Bonds (Public Company) Anthony M. Marchese, PhD, Novavax Inc: Employee|Novavax Inc: Stocks/Bonds (Public Company) Hadi Beyhaghi, MD, PhD, Novavax, Inc.: employee|Novavax, Inc.: Stocks/Bonds (Public Company) Matthew D. Rousculp, PhD, Novavax, Inc.: employee|Novavax, Inc.: Stocks/Bonds (Public Company)
P-1954. Wastewater-Based Surveillance More Accurately Describes Disease Burden Of COVID-19 In Communities with Less Than 60,000 Inhabitants – An Ontario-Wide Study
Authors: Hegazy Nada , Ken Peng K , Hu Joan , Dean Charmaine , Renouf Elizabeth , Delatolla Robert
Published: January 2025

Background

The emergence of COVID-19 in Canada prompted extensive efforts in population-wide surveillance, including wastewater-based surveillance (WBS). WBS offers insights into the prevalence of infectious disease burden, however, reasons for poor correlation between hospital admissions and wastewater viral signal in some locations across Ontario remain unclear, while others demonstrate remarkable correlations. This study aims to elucidate the parameters influencing hospitalization-WBS correlation quality to guide infectious disease research and surveillance.Figure 1:Geographic overview of sampling locations in Ontario, Canada

Methods

Wastewater viral signals and daily hospital admissions geospatially linked with the surveyed sewersheds, were obtained from the Ontario Wastewater Surveillance Initiative. The study included 94 sampling sites (Figure 1), excluding those with inadequate sampling frequency. Spearman’s rank correlation coefficient (ρ) was calculated between hospital admissions and wastewater signals for all included sites during the Omicron BA.1 and BA.2 waves from Nov. 1st,2021 to Jun. 30th, 2022. Regression trees were constructed using the R packages “rpart” and “rpart.plot” to identify factors influencing hospitalization-WBS ρ, including population size, hospital admissions range, proportion of zero admissions, and site isolation status.Figure 2:Regression trees representing a classification model for evaluating the correlation quality between hospitalizations and wastewater signal during the Omicron BA.1 wave – coinciding with a period of waned vaccination immunity (A) and the Omicron BA.2 wave – coinciding with a period of significant vaccination immunity (B).

Results

Regression tree analysis identified critical population size thresholds influencing hospitalization-WBS ρ: populations under 66,000 exhibited weaker ρ (ρ > 0.650) during Omicron BA.1, and under 187,000 during the BA.2 wave (Figure 3). Larger population areas exhibited stronger hospitalization-WBS ρ, suggesting both are reliable infectious disease burden indicators, influenced by differences in community immunity dynamics between the two waves.

Conclusion

Populations under 66,000 during a period of waned vaccine immunity and under 187,000 during a period of significant vaccine immunity exhibit distinct relationship between hospital admissions and wastewater signals. These thresholds mark key sizes of communities where the efficacy of wastewater surveillance becomes more pronounced, emphasizing its utility in smaller populations where clinical surveillance of infectious diseases may be limited.

Disclosures

All Authors: No reported disclosures
P-1963. Changes in COVID-19 Sentiment and Behavior among Healthcare Professionals Over Time in a Rural State
Authors: Wright Brianna S , Kang Daniel , Scherer Aaron , Ward Melissa , Diekema Daniel , Herwaldt Loreen
Published: January 2025

Background

We assessed attitudes towards COVID-19 and use of COVID-19 infection prevention practices during the pandemic among employees at an academic health center in a rural state.Figure 1:Reported Level of Worry about Spreading SARS- CoV-2

Methods

We invited all employees aged >18 years reporting prior COVID-19 on a screening survey to participate and randomly selected other participants (Ps) from among those not reporting prior COVID-19 to create a study cohort of 302 participants. Ps completed surveys at 3-month intervals (T0, T3, T6, T9). We used the Chi-squared test to assess changes in Ps’ responses between individual time points.Figure 2:Reported Willingness to Go into Public Places

Results

At T0 most Ps thought their risk of acquiring COVID-19 either in the hospital or the community was low (< 3%) and < 20% worried that they or their household members would “catch COVID-19.” However, 45% of Ps were worried about spreading SARS-CoV-2 asymptomatically.

Ps’ perceived likelihood of getting COVID-19 at the hospital and in the community did not change. The percent of Ps who were very worried about getting COVID-19 was significantly lower at T1 (1.7%), T2 (2.6%), and T3 (5.7%) than at T0 (11.3%; P < .05 for all). The percent of Ps who were very worried that household members would get COVID-19 decreased from T0 (16.6%) to T1 (8.0%; P = .03).

After vaccines were introduced, Ps tended to report being less worried about spreading COVID-19, more willing to go to public places and less likely to wear face masks in the public. Shortly after the Delta variant emerged, these sentiments changed direction but did not return to their baseline cautiousness level. Shortly before the Omicron variant emerged, the sentiments of those who were seropositive at any time and those who remained seronegative during the study period diverged, with the latter being more worried about asymptomatic spread, less willing to go to public places and more willing to mask in the community than those who seroconverted. Consistent with these changes, 21 of 26 (80.8%) seroconversions occurred during the Omicron surge.Figure 3:Changes in Reported Use of Face Coverings in Public

Conclusion

Some attitudes and behaviors changed over time possibly related to vaccine availability and the predominant SARS-Co-V2 variant. Ps who remained seronegative tended to be more concerned about getting COVID-19 and were more likely to continue using COVID-19 infection prevention practices.

Disclosures

Daniel Diekema, MD, MS, D(ABMM), Affinity Biosensors: Grant/Research Support|bioMerieux, Inc: Grant/Research Support Loreen Herwaldt, MD, 3M: Grant/Research Support|PDI: Grant/Research Support
P-2004. Risk Factors for Death in Children with Multisystem Inflammatory Syndrome in Children — United States, 2020-2022
Authors: Yousaf Anna R , Simeone Regina , Lindsey Katherine N , Shah Ami B , Wu Michael J , Free Rebecca J , Zambrano Laura D , Campbell Angela P
Published: January 2025

Background

Although multisystem inflammatory syndrome in children (MIS-C) incidence has decreased, cases continue to occur and can have notable morbidity and mortality. This investigation evaluates clinical and demographic risk factors for death from MIS-C.Table 1.Demographic and clinical risk factors for death in children with Multisystem Inflammatory Syndrome in Children, United States, 2020-2022

Methods

We evaluated children reported to CDC national MIS-C surveillance with illness onset February 2020–December 2022 and known illness outcome. We performed multivariable logistic regression to estimate odds of death compared with survival for patient characteristics and MIS-C organ involvement. Model covariates were selected a priori including age at MIS-C onset, date of MIS-C onset, race and ethnicity, and presence of any underlying medical condition. To compare risk of death across the pandemic we evaluated patients with date of MIS-C onset in five pandemic waves corresponding to peaks of MIS-C activity.Table 2.Organ system involvement risk factors for death in children with Multisystem Inflammatory Syndrome in Children, United States, 2020-2022

Results

Of 8,767 MIS-C cases reported, there were 76 (9%) deaths (Table 1). Compared with children aged 5–11 years, children < 1 year and 16–20 years had increased odds of death (aOR 4.8 [1.7–13.6], p< 0.01, and 8.2 [4.6–14.8], p< 0.001, respectively). American Indian/alaska Native (AIAN) and Native Hawaiian/Pacific Islander (NHPI) children had increased odds of death compared with White non-Hispanic children (aOR 5.4 [1.4–20.9, p=0.01 and 5.9 [1.5–23.1, p=0.01, respectively). Children with MIS-C illness onset after wave 1 had decreased odds of death compared with those during wave 1. Presence of >1 underlying medical condition was associated with higher odds of death (aOR 2.3 [1.5–3.7, p< 0.001); diabetes, congenital heart disease, neurologic, immunosuppressive/autoimmune, and noncardiac congenital disorders were all independently associated with death. Cardiovascular, respiratory, neurologic, and renal MIS-C organ involvement increased odds of death while children with mucocutaneous involvement had decreased odds (Table 2).

Conclusion

Younger (< 1 year) and older (16-20 years) age, AIAN and NHPI race and ethnicity, MIS-C early in the pandemic, and underlying medical conditions are risk factors for death from MIS-C. Cardiovascular, respiratory, neurologic, and renal involvement increased risk of death. Identifying risk factors associated with death may help clinicians with management and prognosis.

Disclosures

Regina Simeone, PhD, Pfizer: Stocks/Bonds (Private Company)
P-6. Effect of a school-based tutorial about the HPV vaccine for female middle school students on the HPV vaccination rate in Japan
Authors: Murata Yo , Saito Yuya , Obonai Toshimasa
Published: January 2025

Background

Vaccine hesitancy related to the HPV vaccine poses a global challenge. In Japan, the Ministry of Health, Labour and Welfare (MHLW) rescinded recommendations for the inclusion of the HPV vaccine in the national immunization program following reports of adverse events in 2013, which led to a drop in the vaccination rate to less than 1%. Despite the MHLW's decision to reinstate the recommendations in 2022, the vaccination rate has remained low partly because the information targeting children and their guardians is insufficient. This study aimed to assess the effect of a school-based vaccine tutorial on the HPV vaccination rate in female middle school students in Japan.Figure 1:Difference in the pre- and the post-intervention vaccination rate.

Methods

This prospective study, conducted in Higashimurayama, Tokyo from September 2023 to March 2024, enrolled female students aged 13 to 14 years in seven middle schools. Four and three schools formed the tutorial group and control group, respectively and information about HPV vaccination was provided to the tutorial group at school. The difference in the pre-intervention vaccination rate (September 2023) and the post-intervention vaccination rate (March 2024) was assessed using a questionnaire. Additionally, HPV vaccine knowledge and the rate of students’ discussing the vaccine with their family were compared.Table 1:Knowledge about cervical cancer, HPV infection and HPV vaccination among tutorial group and control group.

Results

In total 123 and 175 students from the tutorial and control group, respectively, were analyzed. The pre-intervention vaccination rate was 9.8% and 7.4% (p=0.476), and the post-intervention vaccination rate was 16.3% and 9.7% for the respective group, indicating an increase of 6.5% and 2.3%, respectively (p=0.068). (Figure 1) Knowledge about the HPV vaccine increased to a significantly greater degree in the tutorial group (Table 1), and the rate of students’ discussing the vaccine with their family was significantly higher in the tutorial group after the intervention (46% vs 28%; p=0.0018).

Conclusion

Although the HPV vaccine tutorial did not cause a statistically significant increase in the vaccination rate, it demonstrated an upward trend in the tutorial group. Furthermore, the tutorial increased knowledge and interest in the vaccine among both the students and their family, suggesting that HPV vaccine tutorials can improve the HPV vaccination rate.

Disclosures

All Authors: No reported disclosures
P-2019. Retrospective Cohort Study on use of Monoclonal Antibodies against COVID19 during Pregnancy
Authors: Vikraman Praveen Kumar , Shamayl Ahmed , Gandhi Shivanthidevi , Sohail Rubab , Akerman Meredith , Sison Cristina , Donaghy Henry
Published: January 2025

Background

The safety and efficacy of monoclonal antibodies (MAB) against SARS-CoV-2 virus was studied in pregnant individuals with COVID19 infection. We examined adverse outcomes associated with MAB infusion in pregnant patients with COVID19 and compared mortality outcomes between the cohorts; pregnant patients with COVID19 who received MAB and pregnant patients with COVID19 who did not receive MAB.

Methods

A cross-sectional retrospective chart review of pregnant patients with COVID19 treated in the Northwell Health System from January 2021 to January 2022 was conducted. Outcomes studied included comparing demographic and clinical characteristics amongst pregnant women who received MAB infusion vs. pregnant women who did not receive MAB infusion, the association between MAB infusion and adverse pregnancy outcomes within one month of MAB infusion, and the association between MAB infusion and 30-day all-cause mortality.

Results

A total of 269 patients were studied. 49% were White, mean ± SD age was 31.8 (5.5) years, 26% were vaccinated for COVID19, 45% received MAB infusion, 3% reported adverse infusion related events, and 4% reported adverse pregnancy outcomes.

Subjects that received MAB infusion were more likely to be older (33 vs. 30.8 years, p=0.0008) and vaccinated (85% vs. 14%; p< 0.0001). Monoclonal antibody utilization was higher in Caucasian women compared to other racial and ethnic groups (p< 0.0001). In subjects that received MAB infusion, 9% (n = 11) reported an adverse pregnancy outcome. Only 1 subject passed away at 30 days (did not receive MAB infusion). All subjects receiving MAB survived at 30 days.

Conclusion

The number of patients who received MAB and reported adverse infusion related events and adverse pregnancy outcomes within 1 month of MAB infusion were low. Patients who had been vaccinated and Caucasian patients were more likely to receive monoclonal antibody. Further study is needed to elucidate factors influencing the differential uptake of novel therapeutic options for the management of SARS-CoV-2, including access to care and factors influencing patient preferences in using new therapies.

Disclosures

All Authors: No reported disclosures
P-2032. The Time to Return to Work in Healthcare Workers With COVID-19 Infection Treated With Ensitrelvir, a Novel Oral Inhibitor of 3C-Like Protease of SARS-COV-2
Authors: Katsuta Makoto , Kitazono Masatoshi , Nagai Naohito , Karibe Hiroto , Takahashi Yusaku , Ariwa Yasuko , Sonoyama Takuhiro , Yamaguchi Tomoyoshi
Published: January 2025

Background

Early diagnosis and treatment with antivirals are important in COVID-19 management. This study aimed to investigate the time to return to work and COVID-19 symptom improvement in healthcare workers treated with ensitrelvir.

Methods

A retrospective single-center, observational study was conducted to assess the effect of ensitrelvir on the time to return to work and the resolution of symptoms at the time of return in healthcare workers diagnosed with COVID-19 between June and September 2023 during the Omicron dominant period. The differences in patient background between the ensitrelvir treated group and no antiviral treatment group was not adjusted, and we conducted descriptive analysis. The criteria for returning to work were defined as improvement of symptoms and an antigen quantification test result of ≤ 100 pg/mL after the 6th day of onset.

Results

A total of 102 healthcare workers were registered, and ensitrelvir was administered in 60 cases. The average number of days from onset of symptoms to ensitrelvir administration was 0.8 days. The female proportion was 76.7% and 78.6% in the ensitrelvir-treated and non-treated groups, respectively, with average ages of 38.2 and 30.6 years in each group, respectively. The severity of COVID-19 was mild in all cases. No side effects were observed in the ensitrelvir-treated group. The average time to meet the criteria for returning to work was 6.9 days in the ensitrelvir treated group and 7.7 days in the non-treated group. 35 patients (58.3%) in the ensitrelvir-treated group and 15 patients (35.7%) in the non-treated group experienced recovery (fever resolution and disappearance of COVID-19 symptoms) on the day of returning to work. Additionally, 25 patients (41.7%) in the ensitrelvir-treated group and 27 patients (64.3%) in the non-treated group experienced improvement (fever resolved but some symptoms remained) on the day of returning to work.

Conclusion

This study showed that early treatment of COVID-19 with ensitrelvir may improve symptoms and reduce the number of days to return to work. The results suggest that early antiviral drug administration to healthcare workers may contribute to the maintenance and continuity of routine healthcare, thereby avoiding Healthcare workers shortage.

Disclosures

Makoto Katsuta, Shionogi & Co., Ltd.: Lecture fees Takuhiro Sonoyama, MD, Shionogi & Co., Ltd.: Stocks/Bonds (Private Company) Tomoyoshi Yamaguchi, MD, Shionogi & Co., Ltd.: Lecture fees
P-9. Standardized Model for SARS-CoV-2 and Influenza Vaccination of Hospitalized Patients: A Before-After Quality Improvement Study
Authors: Linkenheld-Struk Amber L , Williams Victoria R , Chan Karen , Carating Helene , Marchesano Romina , Do Jennifer , Sullivan Sherri , Beechinor Danette , Silverstein William K , Leis Jerome A
Published: January 2025

Background

Hospitalized patients are at increased risk of complications from viral respiratory infection. Seasonal vaccination can reduce this risk and may be missed in the community for patients with prolonged hospital admissions. The optimal approach to ensuring timely vaccination of eligible inpatients against both seasonal influenza and SARS-CoV-2 has yet to be established.

Methods

We implemented a before-after quasi-experimental study of a standardized model for vaccinating patients admitted to an acute care hospital. The target population was inpatients designated as alternate level of care (ALC), defined as those recovered from their acute medical illness and awaiting transfer to post-acute care facility. The model involved an automated daily report of ALC patients without documented receipt of seasonal influenza or SARS-CoV-2 vaccine. This report was communicated daily by Infection Preventionists to unit-level pharmacist, physician, and unit leads to assess, consent and administer vaccination as appropriate. Vaccination rates of baseline (2022-23) and intervention (2023-24) seasons were measured and compared between identical time periods (10 Oct to 19 Jan). The primary outcome was the proportion of ALC patients vaccinated upon discharge, broken down by hospital versus community-initiated administration.

Results

At baseline, hospital-initiated vaccine accounted for 3.4% and 2% of vaccines in eligible patients against influenza and SARS-CoV-2, respectively. Post intervention, rates of hospital-initiated vaccination increase significantly for influenza (12%, OR 3.88, 95% CI 2.48-6.09; p< 0.001) and SARS-CoV-2 (10.7%, OR 5.76, 95% CI 3.30-10.04; p< 0.001). For influenza and SARS-CoV-2 vaccination during the intervention season, hospital-initiated vaccination contributed 76.3% and 78.4% of vaccination rate in Oct-Nov, as compared to 33.7% and 29.4% in Dec-Jan.

Conclusion

A standardized model resulted in significant uptake in vaccination against both influenza and SARS-CoV-2 during the 2023-24 respiratory viral season in ALC patients. The greatest impact occurred early in the season, likely due to slower uptake in the community. Further study is needed to assess the impact of this intervention on inpatient outcomes.

Disclosures

All Authors: No reported disclosures
P-12. Evaluating the Epidemiological Impact of Lowering the Recommended Age for Adult Pneumococcal Vaccination in the United States
Authors: Bakker Kevin , Meleleo Giulio , Sharomi Oluwaseun , Nachbar Robert , Oidtman Rachel
Published: January 2025

Background

In the United States, there are two age-based pneumococcal vaccine recommendations – children aged 0-2 years and adults aged 65+ years. Adults aged 50-64 are recommended to receive a pneumococcal vaccine if at increased risk of pneumococcal disease; disease burden in this age groups represents the third highest level of pneumococcal disease. PCV20, a 20-valent PCV, and PCV15 are higher valent vaccines currently approved for adults. V116, an investigational adult specific PCV is being developed to specifically broaden protection in the adult population, by including key serotypes in currently licensed vaccines and 8 unique serotypes responsible for ∼30% of pneumococcal disease in adults in the US.

Cumulative IPD cases in a 10-year projection period for V116 and PCV20.

Methods

We evaluated the impact of lowering the pneumococcal adult age-based vaccine recommendations in the United States to individuals aged 50+ years using a model that tracked age- and serotype-specific Streptococcus pneumoniae (SP) transmission. The model was calibrated to historical age- and serotype-specific invasive pneumococcal disease (IPD) data in the United States spanning 2000-2019. We evaluated the impact of lowering the recommended vaccination age in adults to 50+ years-old with V116. For projections we maintained an 80/20 coverage of PCV20/PCV15 in 82% of children and assumed a VCR of 57% for adults aged 65+. In the 50+ years old scenario, we reduced VCR to 46%, which was the age-specific tetanus rates for individuals aged 50-64 years-old multiplied by the reduction in uptake from the Shingrix vaccine when the recommended age was lowered. These adult VCR values assume a PCV was received in the last 10 years.

Results

Reducing the adult recommended vaccination age to 50+ years with the reduced VCR, led to similar overall reductions in IPD incidence when compared to maintaining the vaccination age at 65+ years (Table 1). The additional reductions in IPD in 50-64 year-olds was negated by the increase in cases in individuals aged 65+ years, due to vaccine waning.

Conclusion

If the recommended pneumococcal vaccination age for adults is reduced, additional efforts must be made to minimize the reduction of VCR, otherwise total IPD incidence will be similar to the current 65+ year-old age recommendation due to vaccine waning.

Disclosures

Kevin Bakker, PhD, Merck & Co., Inc.: Grant/Research Support|Merck & Co., Inc.: Stocks/Bonds (Public Company) Giulio Meleleo, PhD, Merck & Co., Inc.: Vendor Oluwaseun Sharomi, MSc, PhD, Merck & Co., Inc.: Full time employee|Merck & Co., Inc.: Stocks/Bonds (Public Company) Robert Nachbar, PhD, Merck & Co., Inc.: US 7,219,020, US 5,292,741|Merck & Co., Inc.: Vendor|Merck & Co., Inc.: Stocks/Bonds (Public Company) Rachel Oidtman, PhD, Merck & Co., Inc.: Full time employee|Merck & Co., Inc.: Stocks/Bonds (Public Company)
P-2065. Profile and Risk Factors of Breakthrough COVID-19 Infections Among Healthcare Workers Post-Vaccination
Authors: Panaligan Mario M
Published: January 2025

Background

This study aimed to assess breakthrough COVID-19 infections in vaccinated healthcare workers, characterize their demographic and clinical profiles and identify associated risk factors.

Methods

A cross-sectional study was conducted in four hospitals using a stratified sampling approach. Data were collected via standardized questionnaires and analyzed using descriptive statistics for demographic and clinical features, with Chi-square or Fisher’s exact test to examine for significant associations and T-tests or Mann-Whitney U Tests for significant differences.

Results

Among 378 vaccinated healthcare workers, all experienced breakthrough infections, the majority during the surge of the omicron variant. Overall, 60% were females, and 91.5% were below 44. There were 172 (45.5%) nurses, 66 (17.5%) physicians, and the remaining were paramedical personnel. Breakthrough infections were shorter in vaccinated individuals (mean 11 days, SD = 5.58) compared to unvaccinated (mean 14 days, SD = 8.11). For those who developed their first breakthrough infection, the need for hospitalization and abnormal clinical and laboratory findings were significantly lower compared to unvaccinated. Among the vaccinated, higher rates of first breakthrough infection were significantly associated with being healthcare-associated and part of an outbreak. During the surge of infections due to the omicron variant, community-associated exposure and hospitalization were significantly higher among unvaccinated patients. Healthcare-associated contact was significantly associated with vaccinated people. By regression analysis, breakthrough infections due to omicron were significantly associated with a higher number of vaccine doses (OR 4.465 95% CI 1.978, 10.083) and hospitalization (OR 11.2 95% CI 2.386, 52.728). The probability of contracting the omicron variant with unknown exposure in patient care units within the past 14 days is lower (OR 0.389, 95% CI 0.174-0.866).

Conclusion

Breakthrough COVID-19 infections occurred in all vaccinated healthcare personnel, with new variants and healthcare-related duties playing significant roles.

Disclosures

All Authors: No reported disclosures
P-2068. Assessing New York City’s COVID-19 Vaccine Rollout Strategy: A Case for Risk-Informed Distribution
Authors: Schwalbe Nina , Nunes Marta C , Cutland Clare , Wahl Brian , Reidpath Daniel
Published: January 2025

Background

This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City (NYC).

Methods

A retrospective ecological study was conducted assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and NYC Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in NYC. Population data were obtained from Census Bureau and NYC Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors.

Results

Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3 months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45–64 years in the wealthiest quintile).

Conclusion

A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower.

Disclosures

All Authors: No reported disclosures
P-2072. COVID-19 and RSV Prevention Products in Pregnancy – Overcoming COVID-19 Network, United States, October 2023–March 2024
Authors: Simeone Regina , Newhams Margaret M , Zambrano Laura D , Orzel Amber , Lindley Megan , Payne Amanda B , Calixte Jemima , Lindsey Katherine N , Wu Michael J , Randolph Adrienne G , Campbell Angela P
Published: January 2025

Background

Maternal vaccines for COVID-19 and respiratory syncytial virus (RSV) are tools to prevent severe infant respiratory disease. Among recently pregnant people with hospitalized infants < 6 months with COVID-19 or COVID-like illness, we evaluated receipt of these products and association with provider recommendations, other vaccine receipt, and acceptability of future vaccines in pregnancy.

Methods

Mothers of infants < 6 months hospitalized either for COVID-19 or COVID-like illness were interviewed for the Overcoming COVID-19 Network. Outcomes were 1) verified receipt of COVID-19 and maternal report of RSV vaccines during pregnancy by provider recommendation (among those eligible for updated/new vaccine based on date of vaccine approval and infant date of birth), 2) influenza and Tdap vaccine receipt during pregnancy, and 3) willingness to receive vaccines in future pregnancies.

Results

Caregivers of 514 (68%) of 760 hospitalized infants < 6 months were interviewed; 216 (42%) of 514 interviews were among mothers. Seven (5%) of 147 eligible mothers received COVID-19 vaccine during pregnancy, 8 (5%) were vaccinated 1 to 180 days before pregnancy, and 132 (90%) were vaccinated >180 days before pregnancy or not at all. Ten (9%) of 113 eligible mothers received the RSV vaccine during pregnancy; 20 (19%) mothers who did not receive RSV vaccine reported their infant receiving an infant monoclonal antibody against RSV. Provider recommendation was associated with maternal receipt of both COVID-19 and RSV vaccines during pregnancy (Figure 1A, 1B). Tdap was the most received vaccine during pregnancy (n=117 [61%]) (Figure 2). Willingness to receive vaccines in a future pregnancy was common for Tdap (n=93, 58%), influenza (n=88, 55%), and RSV (n=87, 54%). Only 22% (n=35) of mothers stated they would be willing to receive a COVID-19 vaccine in a future pregnancy.

Conclusion

Among mothers of infants hospitalized with COVID-19 or COVID-19-like illness, few had received a COVID-19 vaccine during or within 180 days before pregnancy. Tdap and influenza vaccines were more commonly received during pregnancy and were more acceptable in future pregnancies. Provider recommendation was associated with receipt of COVID-19 and RSV vaccines during pregnancy.

Disclosures

Regina Simeone, PhD, Pfizer: Stocks/Bonds (Private Company) Adrienne G. Randolph, MD, MSc, Illumina, Inc.: Reagents|Inotrem: Advisor/Consultant|Thermo Fisher, Inc.: Advisor/Consultant
P-2111. Automated Bacterial Growth Detection, Bacterial Species Estimation and Antimicrobial Susceptibility Testing on Agar Plates Using a Light Transmission-based Monitoring System
Authors: Ariizumi Reiichi , Umebayashi Kyohei , Maeta Shogo , Ozaki Hiroaki , Fujisawa Akihiko , Tezen Tomoya , Tsunashima Takanori , Ito Kaoru , Abe Daichi , Yamaguchi Kazunori , Ohnuma Kenichiro , Ishida Nami , Ebisawa Kei Furui , Ohji Goh , Nakajima Masakazu , Taketani Makoto
Published: January 2025

Background

Culturing bacteria on agar plates is essential for diagnosing bacterial infections, but it usually takes overnight and is labor-intensive. We have developed a novel device using a thin-film transistor image sensor to measure light transmission through agar plates every five minutes during incubation (Nakada et al. ASM 2023 and IDweek 2023). Here we present a proof of concept study for using this device for automated early detection and disk-diffusion susceptibility testing and compare the results to those obtained by experienced microbiology technicians.

Methods

Chromogenic agar plates were used for early detection and subsequent species estimation based on colony color changes, i.e. Enterobacteriaceae on CHROMagar mSuper CARBA plates and Staphylococci on MDRS-K plates. Statistical background subtraction was used for early detection of bacterial growth and histogram comparison of pseudo-color images created by correcting the intensity of red, blue, and green lights for species estimation.

For disk diffusion tests susceptible and resistant E. coli and S. aureus were inoculated on Mueller-Hinton plates against the known agents and incubated for 18 hours with monitoring. Transmitted light images after 18 hours were first binarized and the distance of the shortest bacterial growth pixel from the center of the corresponding antibiotic disk was measured as the inhibition zone diameter.

Results

The device detected Enterobacteriaceae and MRSA as early as 6 and 8 hours after incubation, respectively, when the suspensions were densely streaked (Figure 1).

The device also estimated the bacterial species with sensitivity and specificity over 90% for Enterobacteriaceae, however, the specificity for MRSA against MRCNS was approximately 70% (Table 1).

An example of the automated inhibition zone measurement is shown in Figure 2.

All automated measurements agreed well with the manual measurements (Table 2).

Conclusion

The performance in the bacterial detection, species estimation and the zone diameter measurement indicated that the device can be useful in accelerating, automating, and standardizing routine testing in microbiology laboratories.

Disclosures

Goh Ohji, MD, Ph.D, CarbGem Inc.: Advisor/Consultant Masakazu Nakajima, B. Engineering, CarbGeM Inc.: Board Member|CarbGeM Inc.: Ownership Interest