bluuebunny/crossref_metadata_2025 huggingface dataset:
P-1882. Answering the Call: Volume and Characteristics of External Phone Consultations to Pediatric Infectious Diseases Specialists at a Large Academic Children's Hospital
Authors: Dimo Joana , Ho Erin C , Boguniewicz Juri , Searns Justin B , Messacar Kevin , Cataldi Jessica R
Published: January 2025

Background

Due to the limited supply and geographic distribution of pediatric infectious diseases (Peds ID) specialists, providing unremunerated telephone advice to outside clinicians has become a significant component of day-to-day practice for many academic Peds ID clinicians. This time-consuming service is not classified as direct patient care or adequately captured by traditional billing and productivity metrics. The objective of this study was to quantify and characterize external phone consults to Peds ID specialists at Children’s Hospital Colorado (CHCO), and compare the burden of these phone consults to other pediatric subspecialists.

Methods

External phone consults to pediatric subspecialists at CHCO from April 2019-March 2024 were obtained from the electronic medical record (EMR). Patient and call characteristics for Peds ID were summarized with descriptive statistics.

Results

From 2021-2023, Peds ID received the second most external phone consults (n=6376) of any pediatric subspecialty. From 2019 to 2024, average calls to Peds ID increased 21% from 38 to 46 calls/week. One-quarter of calls were about patients registered in the EMR only for the phone encounter and never for direct patient care. Most calls concerned children < 5 years and 9% were for children 0-7 days old. Eighty-five percent of calls occurred between 8AM-5PM and 23% requested immediate callback. Fridays had the most calls (mean 7.6 calls/day), and Sundays had the least (2.1). Based on dummy time-based RVU codes, the median call time was 11-20 minutes; 36% of calls required at least one follow-up call. Only 11% of calls were expected to lead to direct patient care at CHCO based on clinician recommendation. Peds ID specialists spent over 2000 unbilled hours on external phone consults over the study period and an average of > 10 hours/week in the most recent year of data.

Conclusion

External phone consults to Peds ID at CHCO are increasing and time-consuming, yet do not directly generate revenue and do not reliably lead to direct patient care in our health system. Given limited supply, increased demand, and reimbursement challenges for Peds ID clinicians, different economic models for external phone consults should be explored. Chart review to describe callers, reasons for calls, and patient outcomes may inform these efforts.

Disclosures

Juri Boguniewicz, MD, AstraZeneca: Grant/Research Support
P-1883. Evaluation of IVEnsure Device and Care Platform for Remote Therapeutic Monitoring in OPAT: Interim Analysis of a Pilot Study
Authors: Berenson Mitchell , Dozier Jacob K , Siegrist Emily A , Dvorak Justin D , Meyer Debbie N , Siddique Bushra , Bratzler Dale W , Sassine Joseph
Published: January 2025

Background

Data on medication non-adherence in outpatient parenteral antimicrobial therapy (OPAT) and the implications on clinical outcomes are lacking. Remote therapeutic monitoring (RTM) might offer additional insights into OPAT adherence. We present here a pre-planned interim analysis of a pilot study of IVEnsure, an RTM device, in patients receiving OPAT.

Methods

This prospective study is recruiting adult patients discharged from a tertiary care center on OPAT starting July 2023. After consent, patients are enrolled in an RTM program, including the use of the IVEnsure device, and follow up with a case management team (Figure 1). This FDA-exempt and Medicare-approved healthcare remote monitoring device attaches to the tubing set of any IV medication and transmits infusion-related data in real-time via cellular transmission to generate weekly adherence reports. The study aims to analyze the effect of RTM on hospital readmission outcomes in patients on OPAT, compared to contemporaneous controls in an intention-to-treat analysis.

Results

The interim analysis includes 44 patients (out of 90 planned) and 74 controls. Baseline characteristics are overall similar between both groups (Table 1). Adjusted for patient age at discharge, insurance status, infection class, presence of diabetes, and discharging service, RTM with IVEnsure is associated with a significant decrease in 90-day readmission rate related to the original infection or OPAT (4% vs. 23%, adjusted OR 0.14, 95% CI 0.02-0.54, p=0.01, Tables 2-3), leading to estimated cost savings of $213,825 in the IVEnsure arm, or $4,860 per patient (Table 4). Within the IVEnsure group, 45% of the patients required an intervention by the study team, 75% of which occurred in the first week of OPAT, resulting in improved or sustained adherence in 73% of the patients (Table 5).

Conclusion

RTM with IVEnsure significantly reduced infection-related readmissions and associated costs in patients on OPAT. Study accrual continues to evaluate additional readmission-related outcomes.

Disclosures

Mitchell Berenson, MPH, Community Infusion Solutions: CEO|IVEnsure, Inc.: CEO Jacob K. Dozier, BS, Community Infusion Solutions: COO|IVEnsure, Inc.: COO Debbie N. Meyer, MS, IVEnsure, Inc.: Chief Technology Officer Joseph Sassine, MD, Ansun BioPharma: Grant/Research Support|Cidara Therapeutics: Grant/Research Support|Community Infusion Solutions: Grant/Research Support|F2G: Grant/Research Support|Shionogi: Grant/Research Support
P-1886. Utilizing Artificial Intelligence to Predict Triage in Pediatric Outpatients with Prolonged and Recurrent Fever
Authors: Li Guyu , Huo Nan , Orandi Amir B , Ristagno Elizabeth H
Published: January 2025

Background

Prolonged and recurrent fevers in pediatric outpatients often require specialist consultations, presenting a challenge in accurately triaging to the correct pediatric subspecialty. This study aims to develop an artificial intelligence (AI)-based model to accurately direct pediatric patients to appropriate subspecialties.Table 1.Patient characteristics and the department confirming the final diagnosis

Table 1. Patient characteristics and the department confirming the final diagnosis

Methods

A retrospective study was conducted at the Mayo Clinic, Rochester, from December 1, 2020, to January 1, 2023, involving pediatric patients aged 0 to 18 referred for recurrent fever or fever of unknown origin. Six machine learning models, including gradient boosting, random forest, support vector machines (SVM), k-Nearest Neighbor (KNN), logistic regression (LR) and decision tree, were developed using 7 variables (demographics, chief complaints, referral sources, departments of same-day initial visit, and lab tests results within 30 days before initial visits). Data were extracted from external electronic health records (EHR) using Mayo Data Explorer and Lab Information Management Systems. Precision, Recall, F1 Score, and area under the curve (AUROC) were selected to measure the performance.Table 2.Performance of six machine learning models

Table 2. Performance of six machine learning models

Results

The study evaluated 87 pediatric patients with a median age of 10.2 years (IQR: 4.6-13.8), including 43 (49%) females (Table 1). External provider referrals were noted in 40 (46%) patients. Musculoskeletal pain was the most common chief complaint, identified in 29 (33%) patients, in addition to prolonged or recurrent fever. Infectious disease and rheumatology divisions jointly saw 43 (49%) patients during the initial visit. Sub-optimal performance was observed in six machine learning models (Table 2). The random forest model showed the best results (Accuracy=0.39, Precision=0.34, Recall=0.39, F1 Score=0.35, AUROC=0.60) (Figure).Figure.ROC curves for various models

Figure. ROC curves for various models

Conclusion

This study demonstrates the potential of AI-based models for outpatient triage prediction in pediatric patients with recurrent fever, using EHR data to optimize health resource utilization. This data serves as the groundwork to expand and refine this AI triage tool.

Disclosures

All Authors: No reported disclosures
640. A County-wide Collaboration to Drive Quality Improvement Using Healthcare-associated Infection Surveillance Data from the National Healthcare Safety Network, Centers for Disease Control and Prevention
Authors: Monroe Madeleine , Kang Grace , Torriani Francesca J , Myers Frank , Meyer Karen , de Vera Priscila , Becasen Jarrod , Mabalot Shannon C , Schultz Kerry , binstock Peter , Chang Wun-Ling , Benedek Stacie , Hayes Tamara , jefferson elizabeth A , Warner Shweta , Behm Tamara , Soni Sandeep , Mataya Kyle , Berg Erik A , Menz Aaron , Nickel Alexis , Grace Sadile Mary , Kao Annie S , Johnson Jeffrey , Aiem Heidi , Beatty Mark E , Shah Seema , Chinn Raymond
Published: January 2025

Background

Quality healthcare is dependent on continuous input and feedback. The California Department of Public Health (CDPH) requires that all general acute care hospital (GACH) report healthcare-associated infections (HAI) annually. Comparisons of current facility-specific standardized infection ratios (SIRs) to the National Healthcare Safety Network (NHSN) 2015 SIR baseline provide designations of whether a facility is statistically significantly better, worse, or average are displayed for public reporting purposes. Since then, the annual NHSN and CDPH SIR baselines have dropped below 1 for many HAIs; however, neither NHSN nor CDPH provide facility-specific comparisons to the most recent annual NHSN and CDPH SIRs. Facilities that are performing better or average using the 2015 baseline may be performing average or worse when compared the the most recent baselines (Figure A.).

Methods

The County of San Diego (COSD) HAI program began a collaborative effort with local GACHs in 2020 (Figure B). A work group comprised of Infection Preventionists and Epidemiologists convened to provide input into the format and content. Unique features include: 1) a display of an 18 month select HAI aggregate SIRS for the GACHs; 2) statistical analysis using a NHSN SAS 9.4 Macro to provide facility-specific comparative SIRs to the most recent annual NHSN and CDPH baselines and an 18-month aggregate COSD SIR baselines. Facilities were de-identified; the data were distributed only to Infection Prevention Departments for quality improvement and not used for regulatory purposes,; and met the intent of the NHSN Data Use Agreement.

Results

The first report (8/2023) included comparative SIRs on13 surgeries and central-line associated blood stream and catheter-associated urinary tract infections. The second report (4/2024) adds comparative standardized utilization ratios for central lines and urinary catheters (Figures C, D).

Conclusion

Through this effort, the COSD HAI program has strengthened communication between our local health department and the GACHs and also between GACHs. Future reports will be refined based on the input from the GACHs and could include comparative surveillance data on other HAIs being reported to NHSN and CDPH. Sharing best practices could result in continued decreases in HAIs.

Disclosures

All Authors: No reported disclosures
P-1905. Quality of Life 6 Months After SARS-CoV-2 Infection in Ambulatory and Hospitalized Patients from Lima, Peru: FUNCTION Cohort Study
Authors: Coombes Carolina , Cachay Figueroa Rodrigo Antonio A , Watanabe Takashi , Ballena Isabel , Mejia Fernando , Medina Felix , Gayoso Oscar , Seas Carlos , Otero Larissa , Gotuzzo Eduardo
Published: January 2025

Background

COVID-19 survivors overcome long-lasting symptoms that affect their quality of life (QoL). We assessed the impact on QoL and the factors associated with the persistence and reversibility of poor QoL 6 months after acute COVID 19.

Methods

We enrolled symptomatic patients who tested positive for SARS-COV-2 with an antigenic or RT-PCR test between August 2021 and October 2022. We classified subjects according to disease severity: B1 (mild: outpatient), B2 (moderate: outpatient with pneumonia), B3 (severe: inpatient with oxygen supply) and B4 (critical: inpatient admitted to intensive care unit). Measurements were taken at baseline (BL), month 1 (M1), 3 (M3), and 6 (M6) after acute infection. We evaluated QoL with the RAND-36 questionnaire which provides a score for the Physical Component Score (PCS) and the Mental Component Score (MCS). The PCS comprises scales for physical functioning, role limitations due to physical health, pain and general health. MCS includes scales of role limitations due to mental health, energy/fatigue, emotional wellbeing, and social functioning. PCS and MCS scores were standardized on a 0-100 scale and poor QoL was considered < 40 in each scale.

Results

We enrolled 147 participants: 46 in B1 (31%), 39 in B2 (27%), 22 in B3 (15%), and 40 in B4 (27%). We lost to follow-up 33 participants (22.5%) from BL to M6. Significant improvements in PCS were observed between BL and M6 within B3 [35.77 (95%CI 29.7-41.8) vs 51.63 (95%CI 47.1-56.2), p=0.0002] and B4 [28.8 (95%CI 24.5-33.2) vs 43.3 (95%CI 39.4-47.2), p< 0.0001]. In the MCS, significant improvement occurred within B3 between BL and M6 [44.0 (95%CI 36.9-51.0) vs 54.4 (95%CI 49.89-58.86) p=0.0229]. Low MCS and PCS at M6 after COVID-19 was associated with both pulmonary and cardiac clinical abnormalities at M1, M3 and M6. Additionally, only low PCS at M6 was associated with diabetes, age older than 60 years and cardiac clinical abnormalities at BL. Patients who reversed their poor QoL at M6 to a normal value were 122 (83%) for MCS and 93 (63.27%) for PCS. Factors associated with increased reversibility in both scales were severity group B3 and male sex.

Conclusion

Our findings, the first cohort study on post COVID-19 from Peru, underscore the need for ongoing physical and mental patient monitoring beyond the acute phase of COVID-19.

Disclosures

All Authors: No reported disclosures
P-1908. The Relationship Between Long COVID and PHQ-4 Measures of Emotional Health
Authors: Kricorian Christopher
Published: January 2025

Background

The COVID-19 pandemic was one of the most devastating public health crises in US history. Millions of Americans experience ongoing symptoms, often termed “Long COVID.” Long COVID (LC) has been defined as symptoms lasting 3 months or longer that were not present prior to the COVID infection. LC’s neurological effects have been associated with psychological issues like depression. Furthermore, given that many individuals with LC report difficulty getting treatment for these symptoms, the emotional effects associated with LC may be profound.

Methods

The US Census Bureau conducts an ongoing study called the Household Pulse Survey, with the purpose of measuring emergent social and economic matters facing U.S. households. Data analyzed was collected January 9 - February 5, 2024. Respondents were asked about their self-reported COVID-19 experiences and their mental health, as measured by the Patient Health Questionnaire-4 (PHQ-4) for depression and anxiety. The survey was conducted in English and Spanish and the survey sample was N=68,544. Data were analyzed using χ2 and between group contrast analysis.

Results

Of those surveyed, N=9,298 or 16.5% reported experiencing LC. When asked about their experiences during the last two weeks, 60.1% reported feeling anxious on several days or more, vs. 40.5% of those who had experienced COVID-19 but had no long term symptoms (termed Short COVID or SC) and 38.7% of those who had not contracted COVID-19 (called No COVID or NC), with LC significantly higher than both other groups (p< .05). Fully 51.1% of LC respondents were unable to stop or control their worrying, vs. 29.1% SC and 31.9% NC= (both comparisons vs. LC, p< .05). Similarly, those with LC were also significantly more likely to report having experienced little pleasure or interest in doing things (47.5% vs. 25.2% SC and 30.4% NC, p< .05) and feeling down, depressed or hopeless in the past two weeks (48.3% vs. 27.4% SC and 30.9% NC, p< .05).

Conclusion

Many Americans surveyed report experiencing LC and this appears to be associated with significant negative mental health effects, as measured by the PHQ-4. Further research should examine the relationship between LC and mental health, as well as mechanisms of how these factors relate to one another.

Disclosures

All Authors: No reported disclosures
P-1910. Long COVID Resolution Status and Health Impacts
Authors: Kricorian Christopher
Published: January 2025

Background

Many Americans continue to experience Long COVID (LC), which can affect a broad range of physical and mental functions. Understanding symptom prevalence is important to developing public health response.

Methods

An online survey was conducted by the US Census Bureau (N=68,544). Self-reported health metrics (mobility, seeing, hearing and concentration) were compared between those reporting unresolved LC (LC-U), resolved LC (LC-R), previous short COVID (SC), and those not contracting COVID (NC). Data were analyzed using χ2 and between group contrast analysis.

Results

Among those surveyed, 42.2% experienced SC, 41.3% did not experience COVID-19 (NC), 9.7% experienced LC-R, and 6.8% had LC-U. At least some mobility impairment was reported by 28.7% of NC respondents and 27.6% of LC-R (ns). LC-U reported significantly greater mobility impairment (38.1%, p< .05) and SC reported less (15.8%, p< .05). LC-U were most likely to report difficulty seeing (46.8%), followed by LC-R (37.2%), NC (30.5%), and SC (23.3%) (all comparisons p< .05). NC (19.5%) and LC-R (19.6%) were about equally likely to report any hearing difficulty (ns). LC-U reported significantly greater difficulty hearing (27.0%, p< .05) and SC reported significantly less (15.0%, p< .05). LC-U were most likely to report any difficulty concentrating or remembering (55.1%), followed by LC-R (40.4%), NC (28.9%) and SC (22.2%, all comparisons p< .05).

Conclusion

LC-U respondents reported the greatest difficulty across all four variables while SCreported the least. NC and LC-R reported similar hearing and mobility challenges, but LC-R performed worse than NC on seeing and concentration. It seems paradoxical that SC respondents reported fewer challenges than NC, but perhaps those who experienced SC were healthier to begin with and thus less vigilant about avoiding COVID. Despite claiming resolved LC, LC-R still reported worse seeing and concentration than both SC and NC (albeit better than LC-U). Additional research is needed to examine both the factors associated with contracting LC and the long-term effects that may remain even after people believe they have recovered from LC.

Disclosures

All Authors: No reported disclosures
P-1955. Trends in Skilled Nursing Facility Outbreak Characteristics by Prevalent SARS-CoV-2 Variant - Los Angeles County, July 2020 - January 2024
Authors: O’Shea Brendan , Neikirk Amanda , Khanqadri Israa , Babaie Camellia , Rubin Zachary A , Gounder Prabhu
Published: January 2025

Background

Los Angeles County (LAC) skilled nursing facilities (SNFs) experienced recurrent COVID-19 surges coinciding with the emergence of new SARS-CoV-2 variants. The impact of new SARS-CoV-2 variants on SNF outbreaks relative to other measures, such as the use of COVID-19 vaccines and policies to control COVID-19, in SNFs is unknown. We described trends in LAC SNF COVID-19 outbreak size and duration by SARS-CoV-2 variants detected.

Methods

All SNF COVID-19 outbreaks, defined as > 1 case in a resident, were reportable to LAC Department of Public Health (DPH); SNFs were required to follow DPH recommendations for control including testing all staff and residents weekly and offering COVID-19 vaccines according to national guidelines. An outbreak ended when no cases were detected for > 14 days. We obtained SARS-CoV-2 isolates from respiratory specimen for whole genome sequencing when possible and attributed outbreaks to the predominant SARS-CoV-2 variant detected among sequenced cases. Kruskal-Wallis test was conducted to assess for differences in outbreak characteristics by variant.

Results

We analyzed characteristics of 418 LAC SNF outbreaks with > 1 sequenced case during 7/4/2020–1/5/2024 (Table 1). Median number of cases/100 licensed beds ranged from 10 (1st quartile [Q1]–3rd quartile [Q3]: 5–21) for Delta- to 62 (Q1–Q3: 47–78) for Omicron (BA.1)-associated outbreaks. Median outbreak duration ranged from 29 days (Q1–Q3: 22–37) for Omicron (BA.2/XBB)- to 58 days (Q1–Q3: 46–70) for Omicron (BA.1)-associated outbreaks. The median licensed bed size of outbreak-associated SNFs was similar across variant groups.

Conclusion

Our results indicated that variations in SNF outbreak size and duration by SARS-CoV-2 lineage did not ecologically correlate with changes in vaccine policy (Table 2 and Figure 1) or with DPH recommendations for controlling COVID-19 outbreaks in SNFs (which remained consistent during the evaluation period). Our results provide additional evidence that certain SARS-CoV-2 variants are more transmissible (Table 3); conducting genomic surveillance can guide public health policymakers and SNF providers on implementing enhanced measures to mitigate COVID-19 outbreaks.

Disclosures

All Authors: No reported disclosures
P-1959. B.1.617.2 Outbreak Mitigation on an International Steel Cargo Ship Utilizing a Multidisciplinary Approach
Authors: Mann Yasmeen , Numi Mariia , Edwards Ryan A , Lai Joyce , Joshi Seema , Patel Pragnesh , Blankenship Heather M , Soehnlen Marty K , Zervos Marcus , Mossing Michael , Rehman Najibah K
Published: January 2025

Background

The SARS-CoV-2 B.1.617.2 (Delta) variant emerged in India and became widespread in the United States in 2021. Evidence suggested it was more transmissible than other variants.Figure 1:SARS-CoV-2 Cases on the Steel Cargo Ship Timeline

Methods

From 01 May to 22 May 2021, 14 cases of COVID-19 were linked to an international steel cargo ship docked on the Detroit River, after 5 new members joined the crew from India. Cases were reported to the Detroit Health Department (DHD) on 08 May 2021. A strict weekly testing schedule was maintained by DHD. Control measures included a multidisciplinary partnership between DHD, local universities and hospitals. The multidisciplinary team (MDT) considered environmental health, infection control and behavioral health interventions. Measures for control included testing, and quarantine, vaccine, antibody therapy, and access to hospital care.

Results

14 out of 21 total crew members were confirmed positive (attack rate 67%). Once no new cases were found, a 14-day working quarantine was applied per the Centers for Disease Control (CDC) guidance. On 13 May 2021, the DHD vaccine outreach team administered Janssen COVID-19 vaccine, without incident, to all medically eligible crew (n = 19). Janssen was selected considering the ship’s upcoming departure from Detroit and the limitation for follow-up doses.

Conclusion

Response measures taken for this ship involved quarantine, isolation, disinfection and ventilation protocols, installation of filter units, behavioral health recommendations for anxiety-reducing strategies, antibody therapy, hospital care, vaccine administration and education. A MDT approach and multicomponent control strategy was critical to mitigate further spread. DHD’s communicable diseases investigations, vaccination, and testing capabilities were essential, including continued guidance from the Michigan Department of Health and Human Services (MDHHS) and CDC. Full transparency from the ship crew prevented potential spread of the variant in Detroit.

On 02 June 2021, the ship was cleared by DHD, MDHHS, and CDC to depart. This incident led to the approval and vaccination of 3 subsequent ships whose crews also originated from the Indian subcontinent. This study provides a model for investigation and control of infection related to international ships.

Disclosures

Seema Joshi, MD, AbbVie: Grant/Research Support Marcus Zervos, MD, Johnson and johnson: Grant/Research Support|Moderna: Grant/Research Support
P-1968. Mask fatigue, compliance, and illness among healthcare workers during the COVID-19 pandemic
Authors: Patel Ria , Jayaram Aparna , Ali Mirza , Mena Lora Alfredo J
Published: January 2025

Background

During the COVID-19 pandemic, healthcare facilities frequently adopted mandatory masking to protect patients and healthcare workers (HCWs). Although effective in preventing virus spread, prolonged masking can induce discomfort and fatigue among HCWs. As the pandemic progressed, the prolonged use of masks became a source of growing discomfort and presented increasing challenges with masking policy compliance. There is a paucity of data on masking fatigue among HCWs.

Mask use in HCWs with mask fatigue

Methods

We performed an anonymous survey of at two hospitals in Chicago. An anomyous survey was sent via hospital list-servs to all HCWs. The survey was sent on May 23, 2023 and collected the clinical roles of participants, masking habits during the pandemic, masking fatigue, and self-reported influenza-like illness (ILI). Data was tabulated and descriptive statistics used.

Differences in sickness frequency as a correlate of mask fatigue

Results

A total of 90 HCWs provided responses, with 66% experiencing mask fatigue throughout the study period. In 2020, among HCWs who reported mask fatigue, 46% of always wore their masks, while 3% never wore masks (Figure 1). In 2021, HCWs who always wore their masks decreased to 6%, while the percentage of HCWs who never wore their masks increased to 26% (p=0.0075). An statistically significant increase (p=0.0312) in reported ILI was seen among HCWs with mask fatigue in 2021 (Figure 2).

Conclusion

Masking fatigue was common during the pandemic and increased with time. Reduced masking due to this fatigue may have led to increased ILI in HCWs. Fatigue and non-compliance can contribute to HCW absenteeism and transmission to vulnerable patients. Finding strategies to mitigate mask fatigue and ensure consistent adherence to masking policies is critical during respiratory virus season or future respiratory pandemics.

Disclosures

All Authors: No reported disclosures
P-1982. SARS-CoV-2 Rebound during Acute Infection is Associated with Long COVID
Authors: Ramdeep Nisha , Herbert Carly , Antar Annukka A R , Soni Apurv , Manabe Yukari C
Published: January 2025

Background

SARS-CoV-2 rebound, defined as recurrence of a positive SARS-CoV-2 test after testing negative during an acute infection, has received attention in patients treated with nirmatrelvir/ritonavir. We examined the association between SARS-CoV-2 rebound in untreated patients with delayed viral clearance and subsequent self-reported long COVID.

Methods

From October 2021 to February 2022, the Test Us at Home (TUAH) study enrolled 7361 participants to self-collect anterior nasal specimens for SARS-CoV-2 RT-PCR testing every 24-48 hours for 10-14 days. In August 2023, 244 participants with ≥ 1 positive test during the original study period were surveyed about long COVID symptoms, defined as new symptoms persisting for 3+ months post-infection. Viral rebound was defined as testing positive, negative, and subsequently positive again during the 10-14 day study period. Only participants with ≥ 3 molecular (RT-PCR) tests were included (Figure 1). The associations between rebound (outcome) and presence of long COVID (exposure 1) as well as different symptoms of long COVID (exposure 2) were examined using separate multivariable logistic regression models that adjusted for participant-level confounding variables.

Results

Data from 215 eligible participants were analyzed; 77 (35.8%) had long COVID. 75 of 215 (34.9%) experienced rebound. Long COVID was associated with 13-fold higher odds of experiencing viral rebound during acute infection (OR: 13.1, 95% CI: [6.79, 26.2]). When adjusting for other symptoms and covariates, there was an association between viral rebound and 1) post-acute fatigue (OR: 2.93, 95% CI: [1.04, 8.48]) and 2) taste or smell changes (OR: 4.96, 95% CI [1.76, 15.7]). There were no notable associations in demographics or pre-existing conditions with viral rebound.

Conclusion

Acutely infected COVID-19 participants who experienced viral RNA rebound in the first 14 days after symptom onset were significantly more likely to have long COVID with fatigue or changes in taste or smell.

Disclosures

Yukari C. Manabe, MD, Cepheid: Research materials to JHU|Chembio: Research materials to JHU|Hologic: Research grant to JHU|Roche: Research materials to JHU
P-1983. A Longitudinal Study of COVID-19 Sequelae and Immunity: Effects of SARS-CoV-2 Reinfection
Authors: Bravver Paula M , Higgins Bryan , Sneller Michael
Published: January 2025

Background

Post-acute sequelae of SARS-CoV-2 (PASC) affects approximately 10-30% of COVID-19 patients. Previous research suggests that reinfection with SARS-CoV-2 is associated with worsening PASC regardless of patients’ vaccination status and that reinfection contributes additional risks of pulmonary and other sequelae. The aims of this analysis are to describe rates of SARS-CoV-2 reinfection among patients followed on a longitudinal post-COVID-19 study with different vaccination statuses and compare the effect of reinfection on pulmonary symptoms and function and other PASC symptoms.

Methods

A sub-analysis of a NIAID clinical longitudinal study of COVID-19 was used with a convenience sample of 284 patients infected with SARS-CoV-2. Data was collected at enrollment and at six-month follow-up visits. Reinfection was documented by clinicians during follow-up visits and data on vaccination status was collected at baseline and follow-up visits. Pulmonary function tests including forced vital capacity (FVC), forced expiratory volume (FEV), FEV1/FVC ratio, and diffusing capacity of carbon monoxide (DLCO) were performed annually.

Results

Participants with SARS-CoV-2 reinfection, and those without reinfection, had similar vaccination rates. Among reinfected patients, nearly two thirds of participants reported an improvement in severity or resolution of their PASC symptoms following reinfection. Additionally, no patient without a history of PASC at enrollment developed PASC symptoms after their reinfection. In examining pulmonary function, there was no significant difference in FVC, FEV1, FEV1/FVC, and DLCO changes when comparing patients who were reinfected with SARS-CoV-2 to those who were not.

Conclusion

SARS-CoV-2 reinfection was not observed to be related with vaccine status, was not associated with new or worsening PASC symptoms, and there was no observed decline in pulmonary function when comparing reinfected and not reinfected patients. Continued longitudinal follow-up of this NIAID cohort will help clarify the effect of SARS-CoV-2 reinfection on the natural history of PASC and can inform overall clinical care when treating COVID-recovered patients.

Disclosures

All Authors: No reported disclosures
P-1984. AB2CO: a mortality risk score for COVID-19 patients admitted to intensive care units
Authors: Reis Gomes Virginia Mara , Pires Magda Carvalho , Delfino-Pereira Polianna , Nobre Vandack , Marcolino Milena S
Published: January 2025

Background

During the COVID-19 pandemic, several scoring systems have been developed and tested to stratify patients according to their risk levels, enabling the proper allocation of resources and increasing the likelihood of successful outcomes. However, there remains a gap in the availability of an effective tool for predicting in-hospital mortality among COVID-19 patients admitted to the intensive care unit (ICU). Most of the studies are bounded my methodological flaws which may lead to different bias, and uses data before the emergence of new variants and the broad use of vaccionation, that my impact scores' performance. We aimed to address this gap by developing a novel risk score and comparing it with other existing scores using more recent data.

Area under the ROC curve of the AB2CO risk score

Methods

This multicenter observational study included adult (≥18 years) patients with laboratory-confirmed COVID-19 who were admitted to 18 ICUs from 9 Brazilian cities, from September/2021 to July/2022. A total of 558 patients were included in the analysis, median age was 69 years (interquartile range 58-78), 56.3% were men, 19.7% required invasive mechanical ventilation (IMV), and 44.8% died during hospitalization. Potential predictors were selected based on a thorough literature review. Generalized Additive Models were used to assess outcomes and predictors, while LASSO regression was employed to develop the mortality score. Risk groups stratification were divided based on the predicted death probability as intermediate, high, and very high risk.

Calibration plot of the AB2CO risk score

Results

The final model, named AB2CO, comprised 6 variables: age, pO2/FiO2, respiratory function (respiratory rate or indication of IMV), COPD, and obesity. The AB2CO model showed an area under the Receiver Operating Characteristic curve of 0.781 (95% CI 0.744 to 0.819), good overall performance and an excellent calibration. Furthermore, on a complete case analysis the score achieved a discrimination ability of 0.783 (CI 95% 0.743-0.822), and it was compared with other existing scores and exhibited better performance than all of them.

Conclusion

The AB2CO score is a simple and easy tool, based on only six varibles routinely available in ICU. It may provide guidance for clinical decisions.

Discrimination ability for each risk score applied in the Brazilian database of COVID-19 patients admitted to the intensive care unit, and comparison of the derived and other existing scores.

Disclosures

All Authors: No reported disclosures
P-1986. COVID-19 Surveillance in Infants, Minnesota, October 2023–January 2024
Authors: Ruhland Abbey J , Meyer Stephanie , Como-Sabetti Kathryn , Fell Ashley , Talsma Elle , O’Toole Siobhan , Lynfield Ruth
Published: January 2025

Background

The impact of COVID-19 in infants is incompletely understood. We conducted active surveillance, including interviews of parents of infants with COVID-19.

Methods

We attempted phone interviews of parents of infants aged < 12 months with lab-confirmed COVID-19 reported to the Minnesota Department of Health from 10/1/2023–1/31/2024 using a standardized form. Analyses were performed using SAS 9.4.

Results

Parents of 1161 (35%) infants were interviewed. There were no differences among those interviewed vs. not by white/non-white, urban/rural residence, or age. Median age was 6 months (IQR 3–8 months), 65% white, non-Hispanic, 53% male, 46% received federal assistance (WIC), and 38% attended childcare. 25% had an ill household member prior to, and 55% after, infant illness.

95% reported symptoms with fever (84%) and coryza (82%) most common. Co-pathogen detections were reported in 16% (68% RSV).

70% reported emergency (ED) or urgent care (UC) visits; 8% were hospitalized. Having a codetection (OR=4.14, p< 0.01) or underlying condition (OR=2.12, p=0.03) was associated with hospitalization.

16% of illnesses were considered severe by parents. Codetections (OR=2.46, p< 0.01), being non-white (OR=2.46, p< 0.01), receiving WIC (OR=1.99, p< 0.01), or having household income < $30,000 (OR=2.28, p< 0.01) were associated with severe illness. 80% of households had ≥ 1 adult vaccinated, but only 29% were vaccinated < 6 months prior to infant infection; 34% of households with other children had ≥ 1 child vaccinated.

10% of cases remained unrecovered at 30 days after positive test. Factors linked to non-recovery included codetections (OR=2.30, p< 0.01), prematurity (OR=2.19, p< 0.01), being non-white (OR=1.62, p=0.02), receiving WIC (OR=1.56, p=0.03), and low household income (OR=2.09, p< 0.01).

Conclusion

Among MN infants reported with COVID-19 with interview data, most visited ED/UC, and 16% were considered severely ill by parents. We found medical conditions, race, socioeconomic disparities, and codetections associated with severe and/or longer lasting illness. Improved understanding of the role of codetections and other risk factors, and encouraging up to date vaccination in households, may help mitigate the impact of severe COVID-19 in infants.

Disclosures

All Authors: No reported disclosures
P-1991. Unique Demographic Characteristics of Patients Experiencing Long COVID
Authors: Kricorian Christopher
Published: January 2025

Background

As the COVID-19 pandemic retreats, health care providers now treat many patients experiencing lingering symptoms long after their initial infection, also known as Long COVID (LC). Given that the population of those affected by LC has been generally cumulative, understanding the current demographics of this population is critical to public health planning.

Methods

The US Census Bureau Household Pulse Survey data was used in this analysis. The survey data was collected January 9 - February 5, 2024. Respondents were asked about a variety of demographic factors, as well as their self-reported COVID-19 experiences. The survey was conducted online; N=68,544 respondents were included in the analysis. Demographic factors were compared between those reporting LC, COVID-19 infection that had resolved (Short COVID, or SC), and those who had not experienced COVID (No COVID, or NC). Data were analyzed using X2, between group contrast analysis, and non-parametric tests.

Results

Among those surveyed, 16.5% reported experiencing LC, 42.2% reported SC and 41.3% reported NC. Among those who reported LC, 64.3% identified as female (vs. 53.1% SC and 53.0% NC, comparisons to LC p< .05). The median incomes by group were LC $54.6k, SC $75.4K, and NC $59.2K (all pairwise comparisons p< .001). Median age for those with LC was 50 years old, SC was 52 years old, and NC was 60 years old (all pairwise comparisons p< .001). LC individuals were 10.1% Hispanic of any race, compared to SC 8.0% and NC 7.6% (comparisons to LC p< .05). Additionally, 6.3% of those with LC described themselves as Black or African American, vs. 5.7% of SC and 9.6% NC (comparisons to NC p< .05).

Conclusion

Patients experiencing LC have a substantially different demographic profile than both those who experienced SC and NC. LC individuals are younger, poorer, more female, and more likely to be Hispanic. The reasons for these differences are unclear and merit further study, but the general finding that people with LC are more likely to belong to marginalized groups suggests they could have greater difficulty getting adequate care. Reportedly, LC patients may feel their illness is trivialized by others, and these findings underscore the importance for medical personnel to identify and validate LC patient experiences.

Disclosures

All Authors: No reported disclosures
P-1992. Significant Positive Correlation of PD-1 and PD-L1 Levels in Children with Post-acute Sequelae of SARS-CoV-2 Infection in Taiwan
Authors: Hsu Yu-Lung , Chen Pei-Chi , Wu Lawrence Shih-Hsin , Hsieh Kai-Sheng , Lai Huan-Cheng , Lin Hsiao-Chuan , Hwang Kao-Pin , Wang Jiu-Yao
Published: January 2025

Background

Post-acute sequelae of SARS-CoV-2 infection (PASC) is a condition that impacts certain children following recovery from COVID-19. Programmed death-1 (PD-1) and its ligands, PD-L1 and PD-L2, may play a critical role in the immune response in PASC. However, the specific functions of these components in PASC among pediatric patients remain unclear.

Methods

The study participants were recruited from the DISCOVER (Diagnosis and Support for COVID Children to Enhance Recovery) study, conducted at the China Medical University Children's Hospital in central Taiwan during the Omicron outbreak. Children aged 3-18 years, previously diagnosed with SARS-CoV-2 infection via polymerase chain reaction (RT-PCR) or antigen rapid tests and identified specifically for post-acute sequelae of SARS-CoV-2 infection (PASC) in the outpatient department, were enrolled from October 1, 2022, to August 15, 2023. The investigation assessed the clinical characteristics of children with PASC, including measuring serum levels of PD-1, PD-L1, and PD-L2 to examine their interrelationships and the influence of demographic factors.Figure 1.Correlation between PD-1 and PD-L1 levels in PASC children

Results

Baseline characteristics of the study cohort (N=108) indicated an average age of 9.59 years, with 55.6% being male. All children had confirmed infections via antigen rapid tests, with 70.4% vaccinated against COVID-19. Only a small proportion (5.6%) were hospitalized, and none required ICU care. Our analysis identified a significant positive correlation between PD-1 and PD-L1 concentrations (r=0.92, P< 0.001) in children with PASC. In contrast, there was no significant relationship between PD-1 and PD-L2 (r=0.14, P=0.138). There were no significant differences in PD-1 concentrations across different age groups, genders, vaccination statuses, or various PASC symptoms.Figure 2.PD-1 level in PASC children with or without COVID-19 vaccination

Conclusion

The significant correlation between PD-1 and PD-L1 highlights a potentially enhanced immunosuppressive state in children after COVID-19, which might predispose them to PASC. Our findings suggest the need for further investigation into the PD-1/PD-L1 axis to fully understand its implications in this vulnerable population.

Disclosures

All Authors: No reported disclosures
P-2010. Association between Urbanicity and Up-to-date COVID-19 Vaccination Coverage among Healthcare Personnel and Residents of Nursing Homes - National Healthcare Safety Network, United States, March 3, 2024
Authors: Haas Lori , Oliver Darielle , Woods Austin , Reses Hannah E , Barbre Kira A , SOE M I N N M , Lu Meng , Edwards Jonathan R , Rowe Theresa , Bell Jeneita
Published: January 2025

Background

CDC recommends that residents and healthcare personnel (HCP) in nursing homes be up to date with COVID-19 vaccinations to protect residents, who are at increased risk for severe COVID-19. COVID-19 vaccination coverage is often lower in rural versus urban populations; it is unclear if this applies to residents and HCPs in nursing homes. We assessed the association of urbanicity with up-to-date COVID-19 vaccination of residents and HCP in U.S. nursing homes.

Methods

We conducted a cross-sectional study of 14,304 nursing homes reporting to the CDC’s National Healthcare Safety Network (NHSN) for the week ending March 3, 2024. Up-to-date COVID-19 vaccination was receipt of an updated 2023-2024 COVID-19 vaccine. We used the 2006 NCHS urban-rural classification scheme for counties to group nursing homes as urban, suburban, and rural. We used logistic regression models to assess the association between urbanicity and up-to-date vaccination among residents and HCP. Facility size, social vulnerability index, and region were tested as potential confounders; facility size met the criteria for confounding (≥10% change in parameter estimates) and was included in the model.

Results

Among residents, vaccination was similar in rural (43.2%), suburban (41.3%), and urban (41.7%) nursing homes. Controlling for facility size, there was no association between urbanicity and odds of vaccination for residents (rural vs. urban: OR=1.0 [95% CI 1.0-1.1]; suburban vs. urban: OR = 1.0 [96% CI 0.9-1.0]); Table 1). Among HCP, urban nursing homes had the highest coverage at 9.1%; coverage at suburban and rural nursing homes was 6.9% and 5.7%, respectively. Controlling for facility size, compared to HCP in urban nursing homes, HCP in rural (OR= 0.7 [95% CI 0.5-0.6]) and suburban (OR= 0.7 [95% CI 0.7-0.8]) nursing homes had lower odds of vaccination (Table 2).

Conclusion

Up-to-date vaccination coverage among HCP and residents was low. HCP working in suburban and rural nursing homes were less likely to be up to date with COVID-19 vaccination than their urban counterparts. Coverage among residents did not vary by urbanicity. There is room to improve vaccination coverage among nursing home residents and HCP, especially among HCP working outside of urban areas.

Disclosures

All Authors: No reported disclosures
P-2037. Epidemiology, Clinical Features and Outcomes of COVID 19 Patients Post Evusheld Therapy Among Immunosuppressed Patients
Authors: Kale-Pradhan Pramodini , Channey Sarah , Sharma Mamta , Lebovic Daniel , Giuliano Christopher , Johnson Leonard B , Bhargava Ashish
Published: January 2025

Background

Evusheld® is a combination of two monoclonal antibodies, Tixagevimab and Cilgavimab. It was developed for the pre-exposure prophylaxis (PrEP) and treatment of COVID-19 illness for those who are immunocompromised. There is paucity of long-term real-world data on the use of Evusheld among the immunosuppressed patients against the SARS-CoV-2 Omicron variants.

Methods

A retrospective cohort chart review of patients 18 years and older who received the two dose Evusheld regimen from December 1, 2021 to January 31, 2023 at a community teaching institution was performed to evaluate the effectiveness of Evusheld as PrEP of COVID-19 patients. Evusheld as PrEP was indicated for patients with active solid tumor and hematologic malignancies or those receiving immunosuppressive treatment including CART therapy, biologic agents and high-dose corticosteroids (i.e., ≥ 20 mg prednisone or equivalent per day when administered for ≥ 2 weeks). The following data was collected: patient demographic, development of COVID19 after receiving Evusheld®, intensive care unit (ICU) length of stay (LOS), hospital LOS, ventilation requirement, duration of ventilation, and mortality among these patients within six months of receiving Evusheld therapy.

Results

Of the 663 patients screened, 459 were excluded primarily for duplicate patients. The mean age of the 204 included patients was 68.3 years and 97 (47.5%) were female. Eighteen (8.8%) patients had a positive COVID-19 test within 180 days of receiving Evusheld. None of the COVID positive patients were admitted to the hospital or required mechanical ventilation. All COVID positive patients survived.

Conclusion

Our study shows that Evusheld was effective in preventing COVID-19 among the immunocompromised patients during the six-month follow-up period. This study also showed that patients who developed COVID-19 after Evusheld did not develop severe disease or require hospitalization.

Disclosures

All Authors: No reported disclosures