bluuebunny/crossref_metadata_2025 huggingface dataset:
1773. Complement level measurements for children in England suggest a possible unreported Post Streptococcal Glomerulonephritis Outbreak
Authors: Dale Rachel , Manson Ania , Mok Hoi-Ping , Kumararatne Dinakantha , Gkrania-Klotsas Effrossyni
Published: November 2023

Background

Poststreptococcal glomerulonephritis (PSGN) is caused by prior infection with specific strains of group A streptococcus (GAS). PSGN is commonly characterised by significant complement C3 depression and maintained C4 levels, especially in children. The 2022-23 GAS outbreak has been associated with childhood morbidity and mortality in the UK due to invasive GAS infections but no PSGN outbreak has been described.

Methods

We reviewed the laboratory requests for complement C3 and C4 measurements received by the main East of England immunology laboratory for the 48 months between April 1st, 2019 and March 31st, 2023 and for patients under the age of 18 at the time of the request. We collected demographic information as well as concurrent anti antistreptolysin and anti-DNAase B antibody levels. We excluded 4 individuals who had only marginally decreased C3 levels (less than 10% drop from lower limit of normal).

We assigned cases as possible PSGN if C3 was low, C4 was normal and antistreptolysin serologies were not obtained. We assigned cases as probable PSGN if C3 was low, C4 was normal and antistreptolysin and anti-DNAase B antibody levels were elevated.

Results

24 unique patients aged 0-18 were identified (18 boys and 6 girls), 8 possible and 16 probable PSGN cases. All but two of the probable cases were boys. There were no cases of possible or probable PSGN between 9.3.20 and 20.3.22. Half of the observed cases have been observed within the last 12 months, mirroring the reported invasive GAS incidence in England.

Table of possible and probable Post Streptococcal Glomerulonephritis cases, East of England Immunology Laboratory

Conclusion

PSGN is unusual in industrialized countries. The monitoring of C3 and C4 complement level requests suggests a possible undiagnosed concurrent to the GAS PSGN outbreak in the UK and the circulation of possible nephritogenic strains.

Disclosures

All Authors: No reported disclosures
1774. Surveillance for Emerging and Reemerging Pathogens Using Pathogen Agnostic Metagenomic Sequencing in the United States: A Critical Role for Federal Government Agencies
Authors: Downie Diane L , Rao Preetika , David-Ferdon Corinne , Courtney Sean , Lee Justin , Quiner Claire , MacDonald Pia , Barnes Keegan , Fisher Shelby S , Andreadis Joanne D , Chaitram Jasmine , Mauldin Matthew R , Salerno Reyolds M , Schiffer Jarad , Gundlapalli Adi
Published: November 2023

Background

The surveillance and identification of emerging, reemerging, and unknown infectious disease pathogens is essential to national public health preparedness and relies on fluidity, coordination, and interconnectivity between public and private surveillance systems and networks. Implementing and sustaining programs to detect emerging and re-emerging pathogens in humans using advanced molecular methods, such as metagenomic sequencing, requires large investments in testing equipment and developing networks of clinicians, laboratory scientists, and bioinformaticians.

Methods

This study sought to gain an understanding of the role of federal government agencies in supporting such pathogen-agnostic testing of human specimens in the United States. A landscape analysis was conducted of federal agency websites for publicly accessible information on the availability and type of pathogen-agnostic testing and details on flow of clinical specimens and data. The website analysis was supplemented by expert review of results with representatives from the federal agencies.

Results

Operating divisions within the Department of Health and Human Services and the US Department of Veterans Affairs have developed and sustained extensive clinical and research networks to obtain patient specimens and perform metagenomic sequencing at scale. Metagenomic facilities supported by US agencies were not equally geographically distributed across the US. Although many entities have work dedicated to metagenomics and/or support emerging infectious disease surveillance specimen collection, there was minimal apparent collaboration across agencies.

Conclusion

Developing a national sentinel surveillance network with existing resources and infrastructure could potentially increase efficiency, accelerate identification of emerging biothreats, and support coordinated intervention strategies that reduce morbidity and mortality.

Disclosures

All Authors: No reported disclosures
1775. Predictor Factors Of Severe Forms Of Rickettsial Infections
Authors: Hammami Fatma , Koubaa Makram , Rekik Khaoula , Chakroun Amal , Smaoui Fatma , Marrakchi Chakib , Jemaa Mounir Ben
Published: November 2023

Background

Rickettsial infections usually mimic benign viral infection due to similarities in clinical symptoms. However, severe forms and complications might occur changing therfore the prognosis of the disease. We aimed to study the predictor factor of severe forms of rickettsial infections.

Methods

We conducted a retrospective study including all patients hospitalized in the infectious diseases department for rickettsiosis. The diagnosis was confirmed by serologies (seroconversion) and/or positive polymerase chain reaction for Rickettsia in skin biopsy. Severe forms included cases with acute respiratory distress syndrome, myocarditis, meningitis, meningoencephalitis, renal failure or septic shock.

Results

We encountered 472 cases among which 98 cases were severe (20.8%). Median age was 43[25-60] years among severe forms and 38[24-53] years among non-severe forms (p=0.132). Maculopapular skin rash (56.7% vs 88% ; p< 0.001), arthralgia (56.1% vs 77.3% ; p< 0.001) and eschar (16.3% vs 27% ; p=0.029) were significantly less frequent among severe forms. Meningeal syndrome (34.7% vs 8.3% ; p< 0.001), vomiting (56.1% vs 41.8% ; p=0.011) and cough (28.6% vs 13.9% ; p=0.001) were significantly more frequent among severe forms. Leukocytosis was significantly more frequent among severe forms (35.7% vs 20.6% ; p=0.002). The optimal cut-off value of white blood cell count for predicting severe forms was 7595/mm3, with a sensitivity of 61.9% and a specificity of 59.7%. The area under the curve was 0.622 and the 95% conﬁdence interval ranged from 0.558 to 0.686. Elevated C-reactive protein levels (66.3% vs 65.5%; p=0.879) and accelerated erythrocyte sedimentation rate (36.7% vs 40.1%; p=0.543) were noted among severe and non-severe forms of rickettsiosis, with no significant difference.

Conclusion

The revealing symptoms of severe forms were characterized by the presence of vomiting, cough and meningeal syndrome, in the absence of the typical maculopapular skin rash and eschar. Leukocytosis was more frequent among severe forms of rickettsiosis. The diagnosis of severe forms should be kept in mind in order to promptly initiate the adequate treatment.

Disclosures

All Authors: No reported disclosures
1776. Coinfection of severe fever with thrombocytopenia syndrome virus and Coxiella burnetii infection by the developmental stage of hard ticks in the subtropical region of South Korea
Authors: Kim Yuyeon , Heo Sang Taek , Yoo Jeong Rae , Kim Misun , Lee Keun Hwa
Published: November 2023

Background

Severe fever with thrombocytopenia syndrome virus (SFTSV) is transmitted through tick bites. Ticks are potential vectors for the bacterium Coxiella burnetii (C. burnetii) that causes Query fever. Here, we analyzed SFTSV and C. burnetii co-infection rates in ticks in rural areas of Jeju Island, South Korea.

Methods

Free ticks were collected from the natural environment of the island between 2016 and 2019, and SFTSV RNA was extracted. Additionally, ribosomal RNA gene sequencing was used to identify Coxiella species.

Results

Haemaphysalis longicornis (H. longicornis) was the most common tick species followed by H. flava. Tick number gradually increased from April, peaked in August, and was lowest in March. Of all the collected ticks, 82.6% (2,851/3,458) were nymphs, 17.9% (639/3,458) adults, and 0.1% (4/3,458) larvae. SFTSV-infected ticks comprised 12.6% of all ticks; their numbers were the lowest in November–December, increased from January, and were mostly identified in the adult stage during June–August. C. burnetii infections were detected in 4.4% of the SFTSV-infected H. longicornis ticks. Coxiella burnetii co-infection was mainly observed in the nymph stage of H. longicornis, with the highest infection rate in January, followed by December and November.

Conclusion

Our findings suggest that Jeju Island has a high SFTSV and potential C. burnetii infection in ticks. This study provides important insights regarding SFTS and Q fever risk to humans in South Korea.

Disclosures

All Authors: No reported disclosures
1777. Yellow Fever Dynamics in Ghana During the Past Century
Authors: Judson Seth D , Dowdy David W , Asiedu-Bekoe Franklin , Biritwum-Nyarko Alberta , Kenu Ernest , Schroeder Lee
Published: November 2023

Background

Although West Africa has the largest burden of Yellow Fever (YF) cases globally, less is known about YF dynamics in this region. YF virus is thought to circulate via three transmission cycles in Africa: the sylvatic, savannah/intermediate, and urban cycles. Understanding the relative contribution of each cycle and the populations at risk could inform allocation of YF diagnostics and vaccines. Therefore, we analyzed the history of YF in Ghana over the past century to inform preparedness for future outbreaks.

Methods

We reviewed the primary literature for all YF outbreaks in Ghana as well as WHO YF documents, including the Disease Outbreak News and Weekly Epidemiology Record. We investigated the epidemiology of each outbreak to determine the most likely regions and populations involved. We also reviewed the epidemiology, vectors, and seasonality of outbreaks to determine the most likely cycles.

Results

From 1910-2022 there were 2378 cases and 872 deaths reported due to YF in Ghana (Figure). The first confirmed outbreak of YF in Ghana occurred in 1910, and for 50 years the majority of outbreaks occurred in coastal regions via the urban cycle, with outbreaks beginning early in the year during the dry season. Following this period, there were large outbreaks of urban YF in multiple regions (including the Upper East, Upper West, Eastern, and Volta regions). In 1992 childhood YF immunization became routine in Ghana and smaller outbreaks occurred in northern regions where immunization was less complete. Twelve reactive vaccination campaigns occurred from 1951-2021. Since 2005, outbreaks of YF in Ghana have been due to the sylvatic/savannah cycles. A mass preemptive vaccination campaign was conducted in 2020, followed by a sylvatic/savannah outbreak in 2021 among largely unvaccinated nomadic groups.

Conclusion

The dynamics of YF in Ghana have changed over the past century. Initial outbreaks of YF in Ghana were characterized by the urban cycle. Following multiple vaccination campaigns, recent outbreaks reflect the sylvatic and savannah cycles. Regions currently at highest risk for future YF outbreaks are those with unvaccinated populations and suitable habitats for the vectors and non-human primates that propagate the sylvatic and savannah cycles

Disclosures

All Authors: No reported disclosures
1781. Spatial Epidemiology of Pneumonia Mortality in Korea: Regional Clustering and Bayesian Spatial Regression Analysis for its Determinants
Authors: Kisiju Trishna , Song Hyemin , Lee Soomin , Jang Joonsu , Chun Byung Chul
Published: November 2023

Background

Pneumonia is the third leading cause of mortality in Korea (2021). This can be attributed to the country’s rapid economic growth paired with demographic shift leading to a brisk increase in the aging population. Owing to this, we aimed to examine the regional disparity in pneumonia mortality and the associated determinants

Methods

Municipality-level pneumonia (ICD-10 code, J12-J18) deaths rates (2019) in Korea were extracted from Statistics Korea. Global Moran’s I statistics was used to test for spatial autocorrelation using 999 Monte Carlo simulations. Local Indicators of Spatial Association (LISA) clustering was used to explore the clusters of pneumonia mortality. The determinants were extracted from the Korean Statistical Information Service, including high-risk drinking, smoking rate, regular exercise rate, the prevalence of chronic diseases like hypertension, diabetes, and obesity, the number of doctors per 1000 population, passive smoking from households and workplaces, PM­10 level, rate of unmet medical facilities, and the degree of financial independence. Following the selection of potential determinants through non-spatial generalized linear models, a Bayesian spatial regression using the Integrated Nested Laplace Approximation (INLA) was conducted to estimate the regional determinants of pneumonia mortality. The Besag, York, and Mollié (BYM) model was implemented.

Results

A positive spatial autocorrelation was present for pneumonia mortality (I = 0.446, P = 0.001). Regional disparity in pneumonia mortality was evident from LISA clustering, which revealed high-risk clusters in the northeast and central regions of the peninsula (Figure 1). Financial independence was protective (Relative risk (RR) = 0.848, 95% credible interval (CrI) = 0.774–0.928) whereas the prevalence of hypertension was a significant risk factor for pneumonia mortality (RR = 1.116, 95% CrI = 1.029-1.209). Root Mean Square Error (RMSE) in the prediction of pneumonia mortality by the BYM model was minimum (Figure 2-3).Figure 1.Local Indicators of Spatial Association (LISA) clustering of pneumonia mortality in Korea (2019).Figure 2.Spatial distribution of the observed pneumonia mortality versus that predicted by INLA-BYM. INLA-BYM, Integrated Nested Laplace Approximation-Besag York Mollié modelFigure 3.Spatial distribution of the predicted pneumonia mortality versus error in prediction. INLA-BYM, Integrated Nested Laplace Approximation-Besag York Mollié model; SE, Standard error

Conclusion

Regional disparity in pneumonia mortality exists in Korea, which can be explained by the degree of financial independence and the prevalence of hypertension. Policies to curb infection in high-risk areas are encouraged.

Disclosures

All Authors: No reported disclosures
1785. Infectious Etiologies for Post-Donation Deferrals in a Military Blood Donation Center
Authors: Kwon Somin , Casleton Brian , Rivera Glorimar , Gella Melita , Winkler Erin , Kieffer John , Osuna Angela , Casey Theresa , Yun Heather , Marcus Joseph
Published: November 2023

Background

The burden of transfusion-transmitted infections (TTIs) among blood recipients remains low due to strict blood donor selection as well as extensive post-donation screening. However, the military has the unique challenge of providing blood in austere environments with limited testing capabilities. This study evaluates infectious etiologies of deferred blood donors at a large military blood donation center.

Methods

All blood donors at the Armed Service Blood Bank Center-San Antonio between 2017-2022 with positive post-donation screening tests for hepatitis C (HCV), hepatitis B (HBV), HIV, HTLV-1/2, Zika, West Nile virus (WNV), T. cruzi, T. pallidum, or Babesia were evaluated. Patients were deferred from donating based on FDA criteria including a positive screen with positive confirmatory testing, a positive screen with indeterminate confirmatory testing, and a second occurrence of a positive screen with negative confirmatory testing.

Results

Of the 89,459 blood donors during the study period, 213 (238 per 100,000 donors) met FDA criteria for deferral. T. pallidum (n=45, 50.3 per 100,000), HCV (n=34, 38.0 per 100,000), and HBV (n=19, 21.2 per 100,000) were the most common infections seen in those with both positive screening and positive confirmatory testing. The majority of HIV (95%), Chagas (78%), HTLV-1/2 (50%) deferrals were due to indeterminate confirmatory tests following initial positive screens. The majority of deferrals for HBV were for a second occurrence of a positive screening test despite negative confirmatory testing.

Conclusion

The rates of deferral due to positive post-donation screening for infectious diseases were low in this military cohort. In environments with limited resources, donor testing in service members should focus on HBV, HCV, and T. pallidum as the most common pathogens. Our findings also highlight the need for better diagnostics in screening donors for HIV, Chagas, and HTLV-1/2 due to frequent indeterminate confirmatory tests.

Disclosures

All Authors: No reported disclosures
1795. Exploring the role of reported sexual contact in mpox cases in California, May - October, 2022
Authors: Kim Elissa , Saadeh Kayla
Published: November 2023

Background

An estimated 94% of mpox cases in the United States have been acquired via male-to-male sexual contact, but non-sexual transmission has been documented. We compared demographics, clinical characteristics, and exposure information among mpox cases in California who did and did not report sexual exposure (SE) in the 21 days prior to infection.

Methods

All mpox cases reported in California from May - Oct 2022 were eligible for inclusion. SE was defined as reported sexual engagement and/or close intimate contact with another person within 21 days prior to symptom onset or having a reported first rash/lesion in the genital, perianal, or groin areas. Cases who neither reported SE nor first rash/lesion in those areas were defined as cases without SE. Cases with missing SE history were excluded. The California Healthy Places Index (HPI), a geospatial equity index, was used to evaluate social determinants of health in respondents’ communities of residence.

Results

Of 5278 cases reported in the study period, 4201 (79.6%) reported SE history data. Of those, 3661 (87.1%) reported SE (133 (3.6%) were identified by lesion location). A higher proportion of females (n=22, 22.9%, p< 0.01) reported no SE compared to other gender identities. A higher proportion of Black/African American (n=93, 18.6%, p< 0.0001) and Hispanic/Latino (n=280, 16.3%, p=0.0002) reported no SE compared to White (n=110, 8.6%, p< 0.0001). A higher proportion of straight/heterosexual persons (n=100, 29.9%, p< 0.0001) reported no SE compared to gay/lesbian persons (n=303, 10.0%, p< 0.0001). Persons in HPI Q1 (least opportunities to lead healthy lives) had the highest percentage reporting no SE (n=40, 11.4%, p< 0.001), while Q3 and Q4 (most opportunities to lead healthy lives) had the lowest SE reporting (n=27, 5.5% and n=42, 5.6%, respectively).

Table 1

Characteristics of Mpox Cases that Reported Sexual Contact vs Those That Did Not Report Sexual Contact in the 21 days prior to symptom onset, California, May 17-Oct 12, 2022

Conclusion

Females reporting Black/African American or Hispanic/Latino race/ethnicity identifying as straight/heterosexual, and persons living in HPI Q1 were less likely to report SE than their counterparts. Factors that may influence one’s willingness to disclose SE were not measured in this analysis. Nonetheless, variation in report of SE among confirmed mpox cases indicates that providers should consider mpox when clinically relevant, even in cases without reported SE.

Disclosures

All Authors: No reported disclosures
1796. Use of SARS-CoV-2 Antibody Tests by U.S. Infectious Disease Physicians: Qualitative Results of an Emerging Infections Network Survey, March 2022
Authors: Santibanez Scott S , Gundlapalli Adi , Beekmann Susan E , Uyeki Timothy M , Satheshkumar Panayampalli , Plumb Ian D , David-Ferdon Corinne , Polgreen Philip M , McDonald L Clifford , Jones Jefferson M
Published: November 2023

Background

Although clinical applications of SARS-CoV-2 antibody tests during the COVID-19 pandemic were limited to identifying recent/prior infection, how these tests were used for clinical management of COVID-19 patients is unknown. We consider US infectious disease (ID) physicians’ perceptions about SARS-CoV-2 antibody tests to inform preparedness for future events.

Methods

In March 2022, we surveyed members of the Emerging Infections Network (EIN), a national network of ID physicians on use of SARS-CoV-2 antibody assays, interpretation of results, and clinical scenarios for which such tests were considered. We analyzed comments provided in a free text field for key themes.

Results

Overall, 96 respondents provided non-mutually exclusive free-text comments. Fourteen used serology to assess patients with suspected MIS-C. Another 8 used serology in individuals with immunocompromising conditions, including organ transplant recipients and those with human immunodeficiency virus (HIV) infection, for example, when making decisions to utilize anti-SARS-CoV-2 mAbs (available at the time of the survey but no longer authorized for PReP or treatment.) Twenty-one respondents shared that the most important need for SARS-CoV-2 antibody assays was to discern a correlate of immune protection. Twenty-six considered that serology was not useful for clinical decision-making, and 23 recognized the limitations of the antibody tests, called for more studies, and indicated that additional guidance would be beneficial, noting for example, “Many clinicians order antibody tests but have no idea how to interpret or misinterpret, so guidelines on usage and when not to use would be extremely helpful.”

Conclusion

This analysis provides historical insights into challenges practicing ID physicians faced in the midst of a pandemic. During March 2022, some respondents reported use of SARS-CoV-2 antibody assays including when making treatment decisions. As diagnostic and treatment modalities continue to evolve, federal agencies, medical societies, and academic partners can consider providing guidance on appropriate use of novel tests in clinical practice for near term and future responses.

Disclosures

Philip M. Polgreen, MD, Eli Lilly: Case adjudication for a clinical trial
1800. Candida Auris and Neighborhood Socioeconomic Vulnerability in Maryland
Authors: Smith Lauren Leigh , Falvey Jason , Blythe David , Vaeth Elisabeth , Rubin Jamie , Perlmutter Rebecca , Rock Clare , Roghmann Mary-Claire , Leekha Surbhi
Published: November 2023

Background

Candida auris is an emerging fungal pathogen increasingly recognized as a cause of healthcare-associated infections including outbreaks. The first case of transmission was detected in Maryland in June 2019. This study aims to describe characteristics of patients with C. auris and determine if patients were more likely to reside in a disadvantaged neighborhood or receive care from a nursing home in a disadvantaged area.

Figure 1. Vulnerability Index of C. auris Patients in the State of Maryland. Severely disadvantaged is defined as SVI percentile ranking greater than or equal to the 75th percentile. Red indicates the percentage of C. auris patients living in severely disadvantaged census tracts.

Methods

We performed a descriptive analysis of all cases of C. auris among Maryland residents from June 2019 to December 2021. Maryland Department of Health conducted active surveillance through point prevalence surveys around newly detected cases. We geocoded patient home addresses and skilled nursing facilities (SNFs) with outbreaks to assign a census block group or tract. The social vulnerability index (SVI) and the area deprivation index (ADI) were obtained at the state level, with an SVI ≥ 75th percentile or an ADI ≥ 80th percentile considered severely disadvantaged consistent with prior work. 

Results

140 individuals tested positive for C. auris in the study period. The median age was 68 (IQR 53-74), and 91 (65%) case-patients were male.  46 (33%) of case-patients had a positive clinical culture while 100 were detected on surveillance PCR-positive screening swabs.  60 (43%) of case-patients resided at a SNF.  37 (26%) of case-patients were ventilated and 87 (62%) had a documented wound.

33 (28%) case-patients, with an identifiable address, resided in severely disadvantaged neighborhoods.  C. auris patients disproportionately came from neighborhoods with higher crowding, higher proportions of uninsured, and racial/ethnic minority status (Figure 1). 30% of SNFs with C. auris transmission were in neighborhoods in the bottom 20th percentile of state neighborhood socioeconomic disadvantage.

Conclusion

Neighborhood socioeconomic vulnerability may play a role in the emergence and transmission of C. auris in a community. Further work is needed to understand patient-level risk factors as well as how staffing levels and care environments in SNFs are affected by neighborhood socioeconomic factors.

Disclosures

Lauren Leigh Smith, MD, MAS, LEAP Fellowship: Grant/Research Support
1801. About Damn Time: HAV, HBV, and Tetanus Screening and Vaccination during Hospitalization in Persons who Use Drugs
Authors: Streifel Amber C , Sarti Jose E Rivera , Sikka Monica K , Conte Michael , Winders Bradie , Varley Cara D
Published: November 2023

Background

Rates of serious injection related infections (SIRI) in persons who use drugs (PWUD) have increased over the past two decades. Admissions for SIRI are an opportunity for screening and vaccination of preventable infections like hepatitis A virus (HAV), hepatitis B virus (HBV) and tetanus given significant barriers to preventive care in the outpatient setting for this population. The purpose of this study was to evaluate rates of screening and subsequent vaccination for hepatitis A, hepatitis B, and tetanus for PWUD admitted to the hospital for treatment of serous bacterial infection.

Methods

We conducted a retrospective review of adult patients admitted for a bacterial infection requiring > 2 weeks of antibiotics with both infectious disease (ID) and addiction medicine consults. Data on patient demographics, screening recommendations, and testing and vaccination administration were collected via chart review.

Results

280 patients were eligible for inclusion. Of the 198 (70.7%) patients determined at risk for HAV, ID recommended vaccination for 21 (10.6%) and 15 (7.6%) received HAV vaccine during the admission. Of the 174 (62.1%) patients at risk for HBV, ID recommended vaccination for 32 (18.3%) and 25 (14.4%) received HBV vaccine prior to discharge. 88 patients (31.4%) had no documentation of prior tetanus vaccination and ID recommended tetanus vaccination for 3 (1.1%). 5 patients (1.8%) received a tetanus booster during admission. In univariable analysis, the strongest factor associated with HAV (Odds Ratio 142.19, 95% Confidence Interval: 27.34-739.44) and HBV (Odds Ratio 18.98, 95% Confidence Interval: 7.02-51.37) vaccination during admission was ID recommendation for vaccine.

Conclusion

Screening and vaccination for HAV and HBV remains low in the inpatient setting, as does tetanus vaccination in high-risk patients. A large proportion of our population (70%) were at risk for one or more of these preventable infections. Given the limited access and significant barriers to healthcare in this vulnerable population, efforts should be taken to maximize inpatient screening and vaccination for HAV, HBV, and tetanus.

Disclosures

Monica K. Sikka, MD, F2G: Grant/Research Support
1802. Reconstructing Twelve Years of Dengue Outbreaks in the Caribbean Using Travel Surveillance
Authors: Taylor-Salmon Emma , Morrison Andrea , Grubaugh Nathan D
Published: November 2023

Background

Dengue is the most common arboviral disease worldwide and the leading cause of febrile illness among US travelers returning from the Caribbean. Infectious disease surveillance of international travelers is an effective method for detecting pathogens circulating in resource-limited areas. Due to the large number of infected travelers diagnosed in Florida, we hypothesized that we could use travel surveillance data to reconstruct local outbreaks in the Caribbean, focusing on Cuba, Dominican Republic, Haiti, Jamaica, and Puerto Rico.

Methods

We obtained reports of international travel-associated dengue virus infections diagnosed in Florida between 2009-2022 from the Florida Department of Health (FL DOH) mosquito-borne disease surveillance system. We calculated travel incidence rates using the yearly number of air travel passengers arriving in Florida from international destinations. We calculated local incidence rates from yearly dengue case counts from Caribbean countries and territories with local transmission, provided by the Pan-American Health Organization (PAHO).

Results

Most infected travelers recently arrived from Cuba; however, travel dengue incidence poorly correlated with local dengue incidence there (R = 0.502), raising concerns about the accuracy of local surveillance. Conversely, travel dengue incidence from the Dominican Republic, Jamaica and Puerto Rico strongly correlated with local incidence (R = 0.744, 0.942, and 0.930), implying that travel data is a good predictor of local outbreaks in these countries. We discovered that during outbreak years different dengue virus (DENV) serotypes were responsible for outbreaks on each island, demonstrating that regional outbreaks are likely due to overall favorable conditions, such as mosquito abundance, and not due to a new introduction or mutation.

Conclusion

Travel surveillance data provides a good approximation of local dengue incidence in some Caribbean countries but does not correlate strongly with local case reporting from Cuba and Haiti. This raises the possibility of using real-time tracking and sequencing of dengue cases in Florida, paired with travel surveillance data, to detect Caribbean outbreaks as they are occurring to inform public health policy in resource-limited countries.

Disclosures

All Authors: No reported disclosures
1805. Tennessee’s Drug Diversion Investigation Team: A Collaborative Approach to a Growing Public Health Problem
Authors: Wren Callyn , Evans Christopher D , Godwin Simone , Gambrell Ashley , Patel Dipen , Nation Michelle , Talley Pamela , Wilson Christopher
Published: November 2023

Background

Injection drug use using nonsterile equipment can lead to transmission of viral, bacterial, and fungal infections. Frontline healthcare workers (HCW) are at high risk for substance use disorder due to unprecedented job stress and access to injectable controlled substances. The Tennessee Department of Health (TDH) developed a collaborative investigative process to determine the risk of bloodborne pathogen (BBP) transmission from licensed HCWs engaging in drug diversion. This program recommends public health action and provides consultation to improve drug diversion programs.

Methods

In 2019 TDH formed a drug diversion investigation team (DDIT) consisting of pharmacists, epidemiologists and medical directors from the HAI and HIV/STI/Viral Hepatitis programs. The DDIT responds to notification by the Health-Related Boards (HRB) of a licensed HCW under investigation for diversion of injectable products. The DDIT interviews the investigator and meets the facility drug diversion program to review drug diversion policies and processes. Based on the suspected method(s) and, if known, the individual’s Hepatitis B/C and HIV status, recommendations are made regarding the need for patient notification and testing.

Results

From 2020–2022 the DDIT received notification of 49 licensed HCWs under investigation for diversion of injectable products. Patient notification and testing was recommended in seven facilities for CDC Category A infection control breaches; in two cases, later HCW testing negated the need for further action. Among the 34 facilities queried, only five (14.7%) had existing policies for for-cause BBP testing. Other recommendations to improve diversion programs include infection prevention participation and releasing “not eligible for rehire” status to other facilities.

Conclusion

The TDH DDIT facilitates communication with HRB on reported cases of injectable drug diversion. Joint investigations with facilities raise awareness of the risk of BBP transmission and improve facility diversion programs. Tennessee facilities are adding for-cause BBP testing to their investigation procedures. The TDH DDIT model receives mostly positive responses from facility and health system drug diversion teams and may be considered by other public health jurisdictions.

Disclosures

All Authors: No reported disclosures
1824. Impact of Social Determinants of Health on Preferred Treatment of Trichomonas vaginalis and Chlamydia trachomatis
Authors: Arena Christen , Kenney Rachel M , Eriksson Erin , Brar Indira , Veve Michael
Published: November 2023

Background

The 2021 CDC Sexually Transmitted Infections (STI) Treatment Guideline modified preferred therapy for Trichomonas vaginalis (TV) and Chlamydia trachomatis (CT) from single dose to a 7-day course. Social Determinants of Health (SDOH) are non-medical factors that influence a person’s life; little is known regarding the association between SDOH and TV and CT treatment. The study objective was to evaluate treatment of TV and CT infections after the guideline update and determine if health inequities exist with use of preferred therapy.

Methods

IRB approved, retrospective cohort of patients ≥ 15 years with confirmed diagnosis of uncomplicated TV or CT in outpatient settings. Excluded: pregnant/nursing, allergy to preferred therapy, unable to take oral. Primary outcome: proportion who received guideline preferred vs non-preferred (alternative, discordant, or null) antibiotic therapy. Logistic regression was used to identify variables associated with preferred treatment; SDOH were exposures of interest. Secondary outcomes: test of cure (≤ 3 months), any repeat positive test (recurrence/reinfection), any retreatment, expedited partner therapy (EPT) offered. A sample of 712 patients was needed to detect a 10% difference between two exposures (α=0.05, β=0.2).

Results

473 (66%) patients received preferred therapy; patient characteristics are in Table 1. Patients < 25 years had more asymptomatic disease compared to older patients (198 [54%] vs 150 [44%], P=0.01). Patients who received Emergency Department (ED) care were more likely to receive preferred therapy compared to outpatient clinics (201/264 [76%] vs 272/448 [61%], P=< 0.001). Black race, lower median income, and public insurance covaried with ED care. After adjusting for female sex, receipt of ED care was independently associated with preferred therapy (Table 2). 181 (25%) patients had 3-month test of cure performed; repeat positive test/retreatment was more frequent in patients who received non-preferred therapy (25 [11%] vs 24 [5%], P=0.01). EPT was offered in 35 (7%) and 8 (3%) patients in the preferred and non-preferred groups (P=0.03).Table 2:Variables Associated with Receipt of Preferred Therapy. Abbreviations: ED, Emergency Department; UnAdjOR, unadjusted odds ratio; AdjOR, adjusted odds ratio

Conclusion

Preferred therapy was more frequent in patients who received ED care. EDs represent an important safety net and provide high-level care for patients with SDOH barriers.

Disclosures

Erin Eriksson, PharmD, BCPS, BCIDP, Stryker Corp: Stocks/Bonds Indira Brar, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Janssen: Grant/Research Support|Janssen: Honoraria|ViiV: Advisor/Consultant|ViiV: Grant/Research Support|ViiV: Honoraria Michael Veve, PharmD, MPH, National Institutes of Health: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support
1826. Demographics and Risk Factors Associated with HIV Testing among Uninsured Patients Accessing a Free PrEP Program in Northwest Florida
Authors: Boney Colton , Park Erin G
Published: November 2023

Background

Underserved communities in the south are disproportionally affected by the Human Immunodeficiency Virus (HIV). Despite highly effective prevention methods, communities such as sexual minority men (SMM), persons of color (POC) and individuals experiencing multiple social determinants of health (e.g. lack of insurance, poverty) face many obstacles to HIV testing and Pre-Exposure Prophylaxis (PrEP). This study describes demographic characteristics and risk factors associated with HIV testing within the context of a no-cost PrEP program for uninsured persons living in Escambia County, FL.

Methods

Enrollment data from the program was used to characterize the relationship between HIV testing, race/ethnicity, prior PrEP use, among other factors. Chi-square and Fisher Exact tests between HIV testing and risk factors were examined, and program demographics were compared to the county’s census data to see if the program reached more POC. With approval from the Florida Department of Health, OASIS provided a limited data set containing all HIPAA compliant information in their enrollment and HIV test forms. Statistical analysis was conducted using Stata v16.

Results

Of the 107 participants, 13% reported never been tested for HIV and 63.5% reported never been on PrEP. Findings suggest that HIV testing differed by gender, ethnicity, sexual orientation, number of sexual partners, prior STI diagnosis, and sex with an anonymous partner (p< 0.05). For example, White patients were more likely to have never had an HIV test as compared to Black participants (p< 0.05). When reviewed, the program's profile contains 5.53% more people of color as compared to Escambia County's Census demographics for 2020.

Conclusion

Our findings suggest that many factors are associated with HIV testing uptake in this population of uninsured patients served by the OASIS program. Understanding the demographic and health factors associated with lower uptake can help clinicians target populations who can benefit from HIV education and testing.

Disclosures

All Authors: No reported disclosures
1828. The Stratification of HIV Viral Suppression Rates and Related Health Outcomes of UNMC HIV Clinic Patients by Local Zip Code in Omaha, NE
Authors: Carter Mark , Fadul Nada , Liu Jennifer , Tarfa Adati , Cordon Brent , Lyden Elizabeth
Published: November 2023

Background

Previous research has established associations between self-reported racial/ethnic identity and poorer HIV outcomes; Black patients have disproportionately higher prevalence and poorer viral suppression rates compared to White patients. Expanding upon this research by identifying local Nebraska zip codes with poorer health outcomes will further characterize the concept of “structural racism” which refers to the perpetuation of racial discrimination by reinforcing systems of oppression related to housing, healthcare, and other social determinants of health.

Methods

Within the patient database at the UNMC HIV specialty clinic, 1,261 adult patients 19 years and older with HIV-1 infection were recruited. The analysis was done with 1097 patients who reside in Nebraska and have SVI data available. Demographic and clinical data were obtained through the patient database. Weighted-average SVI calculations were completed for each patient zip code by using the ratio of total addresses in each census tract to total addresses in the zip code. The SVI score range is 0-1, 0 being lowest risk and 1 being highest risk. Areas with SVI scores ≥ 0.9 have been characterized as being particularly high risk. Fisher’s exact test was used to look at the association of sociodemographic characteristics with the SVI (dichotomized < 0.9 vs. ≥ 0.9). A p-value < 0.05 was considered statistically significant.

Results

There is a statistically significant association between poverty level and SVI group (p = 0.0073). Among patients with SVI < 0.9, 48.1% of patients at or below 100% poverty level compared to 60.9% of patients who have SVI ≥ 0.9 (very high risk). A statistically significant association between race and SVI group (p < 0.0001) is seen; the proportion of Black patients is higher in areas with very high SVI (51.3%) compared to areas with SVI < 0.9 (28.0%). There is a statistically significant association between poor viral suppression and SVI group (p = 0.0076). 11.7% of those who reside in areas with SVI ≥ 0.9 have viral loads ≥ 200 copies/ml compared to 5.6% of those who live in areas with SVI < 0.9.

Map of SVI Score by Zip Code in Omaha, NE

Conclusion

The results are consistent with the study hypotheses that racial minority patients are more likely to reside in areas with high SVI and that high SVI is associated with poverty and poorer clinical outcomes.

Disclosures

All Authors: No reported disclosures
1830. Social determinants of cardiovascular disease risk factor control among people living with HIV
Authors: Cutshaw Melissa Klein , Jones Kelley , Longenecker Chris , Okeke Nwora Lance
Published: November 2023

Background

HIV is associated with an elevated risk of cardiovascular disease, yet hypertension and high cholesterol are often sub-optimally treated in people with HIV. The role of racial disparities and social determinants of health in the management of these cardiovascular risk factors is poorly understood.

Average systolic blood pressures vs TIS score (hypertension treatment intensity), by Black race

TIS (therapeutic intensity score) was calculated by dividing the patient’s antihypertensive medication dosage by the maximum daily dosage approved by the US Food and Drug Administration, then summing this proportion for each antihypertensive medication prescribed. For example, if a patient was prescribed two antihypertensive medications each at 75% of the maximum approved dosage, the TIS score would be calculated as 1.5 (0.75 + 0.75).

Methods

We performed a cross-sectional analysis of adult patients with HIV among three academic medical centers in the United States. We considered various social determinants of health including race, sex, measures of economic stability, education level, health insurance, health literacy, social deprivation index by zip code, and measures of psychosocial stress. We examined a hybridized outcome of risk factor control (poor or good) and treatment intensity (minimal or maximal) for two key cardiovascular risk factors, hypertension and hyperlipidemia. Multinomial logistic regressions were performed to identify factors associated with cardiovascular risk factor control and intensity, with “good control, maximal treatment” used as the reference group.

Results

Overall, 371 persons were included in the analysis. Participants were 23.5% female, 59.6% Black, 7.3% Hispanic/Latino, with a median age of 59 (interquartile range 53-64). Among study participants with hypertension, Black participants were more likely to have poor control despite maximal treatment (relative risk ratio [RRR] 2.95, 95% CI: 1.30-6.66). In our hyperlipidemia analysis, having the highest quartile of perceived stress was more common among participants with poor than good cholesterol control (27.0% vs 15.9%, p=0.032). Compared to participants with good control and maximal treatment of high cholesterol, participants with the highest quartile of perceived stress were more likely to have poor control with minimal (RRR: 2.80, 95% CI: 1.02-7.63) or maximal (RRR: 3.64, 95% CI: 1.20-11.1) treatment.

Conclusion

Race and social determinants of health, including perceived stress, appear to influence cardiovascular disease risk factors among persons with HIV.

Disclosures

Nwora Lance Okeke, MD MPH, Gilead Sciences: Advisor/Consultant
2895. Expanding PrEP by Embedding Navigators in High STI Testing Clinical Sites
Authors: Braithwaite R Scott , Pitts Robert , Kapadia Farzana , Ban Kaoon
Published: November 2023

Background

Opportunities for PrEP continue to be missed in key populations. We established a PrEP navigation program (“SNAPS”) with the goals to (1) increase PrEP uptake among groups disproportionately impacted by HIV and (2) preserve and improve PrEP adherence in an NYC safety-net hospital setting.Table 1:Demographic Profiles For Pre-SNAPS and Post-SNAPS Individuals.Chi-squared or t-test approximation may be incorrect due to small sample size.Table 2.MPR for Post-SNAPS Individuals After 1 Year of Follow-up. Chi-squared or t-test approximation may be incorrect due to small sample size.

Methods

SNAPS consisted of 5 components: (1) Surveillance of clinical sites where STI testing is high but PrEP use is rare e.g., ED and Women’s Health Clinic (WHC), (2) Navigation for PrEP-eligible individuals (3) Accelerated follow-up with PrEP experts, (4) Point-of-care counseling and lab testing, and (5) Seamless longitudinal care. SNAPS launched 6/2019 with 2 full-time navigators. One year pre- vs post-SNAPS implementation we compared the sociodemographic profiles of PrEP initiators, their site of enrollment, and their medication possession ratios (MPRs), a proxy for PrEP adherence. Those on PrEP were a mixture of urgent and continuity care adults initiating PrEP at a safety-net hospital system. Bivariable analyses, employing Chi-square and t-test statistics, were conducted to compare sociodemographic profiles and MPR pre- vs post-SNAPS.

Results

We analyzed data on 274 (n=147 pre-SNAPS and n=127 post-SNAPS) individuals on PrEP. Compared to the pre-SNAPS period, post-SNAPS individuals were more likely to be cisgender women (33.9% vs 13.6%), Black or Latinx (84.3% vs 49.6%), uninsured (35.4% vs 29.3%), and Spanish speaking (58.3% vs 17.0%) (Table 1). Post-SNAPS individuals were more likely to be started on PrEP from the ED (51.2% vs 0%) or WHC clinic (10.2% vs 0%). Mean MPR for post-SNAPS was significantly lower than pre-SNAPS, 0.64 vs 0.89 (p < 0.001). Among post-SNAPS individuals, MSM were more likely to have higher MPRs compared to MSW and WSM individuals (Table 2). Furthermore, no difference in MPR was noted by race, preferred language, or insurance type.

Conclusion

SNAPS successfully identified and linked key populations historically missed for PrEP opportunities. Efforts to improve SNAPS should target medication adherence.

Disclosures

All Authors: No reported disclosures