bluuebunny/crossref_metadata_2025 huggingface dataset:
1885. Experience using combined antigen and RT-PCR tests for COVID-19 diagnosis at a Veterans Affairs (VA) Health Care System during the Omicron surge
Authors: Chirumamilla Siri , Powell Krista , Gutman David , Webster Andrew S , Moanna Abeer , Epstein Lauren H
Published: December 2022

Background

Combining rapid antigen and RT-PCR tests optimizes detection of COVID-19 compared with either test alone. Therefore, coincident with the Omicron surge, in November 2021, the Atlanta VA Health Care System (AVAHCS) initiated combination testing for all patients admitted from the emergency department (ED) to the inpatient wards. We retrospectively compared test performance for all patients with combination testing performed at AVAHCS, assessed impact of combination testing on ED disposition, and reviewed clinical characteristics of those admitted from the ED with discordant results.

Methods

We assessed concordance of antigen (Abbott BinaxNOW®) and RT-PCR (either Cepheid GeneXpert® or Roche cobas® 6800) tests performed within 24 hours of each other (i.e., combination test-pairs) for any patient during November 25, 2021–January 27, 2022, and calculated test characteristics of the antigen test using RT-PCR as the gold standard. For those patients evaluated in the ED who had discordant results, we determined ED disposition then performed standardized medical record reviews for those admitted to ascertain clinical history and hospital course and disposition.

Combination Antigen and RT-PCR Testing Algorithm for Patients in the Emergency Department, Atlanta VA Healthcare System

Results

Of 836 combination test-pairs, 112 (13%) were discordant, of which 111 were antigen-negative/RT-PCR positive. Sensitivity of the antigen test was 50%, specificity was 100%, positive predictive value 99%, and negative predictive value was 85%. Of 68 patients evaluated in the ED who had antigen-negative/RT-PCR positive results, 21 (31%) were admitted, of whom 17 (81%) had COVID-19-related symptoms at time of ED evaluation. Of the 21 admitted patients, all were admitted to a COVID isolation unit, 20 (95%) had ≥1 chronic comorbidity, 12 (57%) had not completed vaccination, 14 (67%) received COVID-19-specific treatment while inpatient, 6 (29%) received care in an intensive care unit, 17 (81%) discharged home, and 1 (5%) died during hospitalization.

Flow Diagram of Initial Analysis

Flow Diagram of ED Discordant Results

Characteristics of Discordant Hospitalized Patients

Conclusion

The sensitivity of antigen testing was 50% compared to RT-PCR among patients tested across AVAHCS, consistent with published literature. Combination testing facilitated earlier diagnosis, isolation, and treatment of some patients hospitalized from the ED, likely preventing nosocomial transmission.

Disclosures

All Authors: No reported disclosures.
1887. Hyperglycemia and COVID-19: An independent risk factor for disease severity and death in the Dominican Republic
Authors: Roque Yori A , Luna David De , Mena Lora Alfredo J , Mercado Lisa Maria Castillo , Perdomo Carlos , Acosta Mariela
Published: December 2022

Background

The COVID-19 pandemic has caused an unprecedented global public health emergency. Vaccine uptake in low and middle income countries (LMICs) lags developing nations and immunity from vector-based vaccines commonly used in LMICs may be inferior to mRNA vaccines. Thus, defining clinical characteristics that can help identify and triage cases and allocate resources in LMICs of priority. Hyperglycemia has been associated with higher morbidity and mortality in numerous diseases and in critical illness. We seek to understand the relationship between COVID-19 and hyperglycemia.

Methods

This is a single center retrospective review of cases with COVID-19 between January 2021 and June 2021. Adult patients >18 years of age were reviewed and those with a molecular-based laboratory confirmed SARS-CoV-2 infection were included in our study. Patients with known diabetes, elevated A1C or prior steroid use within 2 weeks of admission were excluded. Clinical characteristics, demographics, glucose levels, C-reactive protein (CRP) and ferritin were reviewed.

Results

A total of 120 patients were reviewed, of which 60.8% were male. Hyperglycemia ( >140mg/dL) was present in 57.5%. Hyperglycemia was associated with elevation of inflammatory markers including CRP and Ferritin (p=0.12) (Table 1). Hyperglycemia was more common in patients requiring supplemental low flow oxygen (table 2) and was more common in patients who did not survive (Figure 1). The mortality rate was higher in the hyperglycemia group with 61.5%, a statistically significant finding.

Association between hyperglycemia and inflammatory markers.

Supplemental oxygen needs and hyperglycemia.

Survival and hyperglycemia.

Conclusion

Hyperglycemia on admission was an independent risk factor for disease progression and death. Inflammatory markers were also higher in patients with hyperglycemia. These patients had no prior steroid use or diabetes. Thus, it is possible that it reflects inflammation, stress, or endocrine end-organ damage due to SARS-CoV-2. If validated in larger studies, this simple test can help clinicians identify patients at risk of decompensation and allocate resources and therapeutics accordingly.

Disclosures

All Authors: No reported disclosures.
1896. Statewide Genomic Surveillance of SARS-CoV-2 Variants in Rhode Island
Authors: Singh Manjot , Novitsky Vladimir , Howison Mark , Carpenter-Azevedo Kristin , Huard Richard , King Ewa , Kantor Rami
Published: December 2022

Background

Global genomic surveillance has allowed identification of SARS-CoV-2 circulating variants responsible for the COVID-19 pandemic. Statewide variant characterization can guide local public health mitigations and provide educational opportunities. We characterized statewide evolution of SARS-CoV-2 variants in Rhode Island (RI).

Methods

Deidentified RI SARS-CoV-2 sequences since 2/2020, generated at authors, CDC and commercial laboratories, were extracted from https://www.gisaid.org. Genomic and phylogenetic analyses were conducted with available tools and custom python scripts and, after quality control, sequences were classified as variants of Concern (VOC), variants being monitored (VBM), or non-VOC/non-VBM, per CDC definitions. Specific mutations that are characteristic of the most recent VOCs (Delta or Omicron) were explored outside of their designated lineages.

Results

Of the 1.1 million RI population, 14,933 SARS-CoV-2 sequences were available between 2/2020 and 3/2022. These included 1,542 (11%) sequences from 37 non-VOC/non-VBM lineages until 2/2021, most commonly B.1.2 (21%), B.1.375 (13%), and B.1.517 (6%); 2,910 (19%) sequences from 7 VBM lineages between 3-6/2021, most commonly Alpha (48%), Iota (34%), and Gamma (10%); and 10,481 (70%) sequences from 2 VOC lineages, including 7,574 (72%) Delta mostly between 6/2021 and 12/2021, and 2,907 (28%) Omicron mostly between 1/2022 and 3/2022. Phylogeny showed expected clustering of local variants within regional and global sequences, and continued viral evolution over time. Further VOC evolution was observed, including 87 Delta sub-lineages, most commonly AY.103 (17%), AY.3 (15%), and AY.44 (12%); and 4 Omicron sub-lineages BA.1 (61%), BA.1.1 (32%), BA.2 (7%), and BA.3 (< 1%). Omicron-associated mutations S:del69/70, S:H655Y, or N:P13L were observed in 219 Delta sequences, and Delta-associated mutations ORF1b:G662S, N:D377Y, or M:I82T were observed in 16 Omicron sequences.

Conclusion

Statewide SARS-CoV-2 genomic surveillance allows for continued characterization of locally circulating variants and monitoring of viral evolution. Such data guide public health policies, inform the local health force, and mitigate the impact of SARS-CoV-2 on public health.

Disclosures

Rami Kantor, MD, Gilead Sciences: Grant/Research Support.
1897. The Decline of Respiratory Viruses During the SARS-CoV-2 Pandemic: Public Health Interventions vs. Viral Competition?
Authors: Malik Waleed , Hao Ritche , Shepherd James
Published: December 2022

Background

With the spread of the SARS-CoV-2 pandemic in 2020 and the attendant global precautions such as masking, travel restrictions and social distancing, the WHO FluNet data indicated a decline in flu rates. The CDC data for the 2020-2021 season showed the same decline in US flu as well as other respiratory viruses. Two hypotheses to explain the observed phenomenon are the impact of non-pharmaceutical interventions (NPI) to prevent SARS-CoV-2 infection and suppression of other respiratory viruses by SARS-CoV-2 through a form of resource competition.

Methods

We conducted a study using the EPIC Slicer Dicer analytics tool and the Yale Internal Medicine COVID-19 Database to retrieve data from the Yale New Haven Health System (YNHHS). We tabulated the total number of positive and negative tests for SARS-CoV-2 and a panel of respiratory viruses from September 2, 2018 to April 30, 2022 to cover pre- and peri-pandemic periods. These results were divided into three age groups: ≤12, 13-59, and ≥60. Epidemic curves of each virus with respect to each other, the season, and the introduction of NPIs were constructed to help differentiate between the two hypotheses.

Results

Pre-pandemic data from 09/2018 to 02/2020 revealed seasonal spikes in influenza A and B with 254 positive weekly influenza A/B tests from 11/2018 to 02/2019 for a positivity rate of 7.97% and 481 positive weekly tests (10.53% positivity rate [PR]) from November 2019 to February 2020. There were only 0.35 positive weekly influenza A/B tests (0.05% PR) from 11/2020 to 02/2021 with 2018 positive weekly tests (6.45% PR) for SARS-CoV-2 over the same period. From 11/2020 to 02/2021, there were 56 positive weekly influenza A/B tests (1.44% PR) and 4347 positive weekly SARS-CoV-2 tests (10.35% PR). From 07/2021 to 11/2021, there was an increased rate of positive RSV tests (82 per week, 15.76% PR) and rhinovirus tests (58 per week, 18.73% PR). There were 803 positive weekly tests (2.53% positivity rate) for SARS-CoV-2 over this same period.

Conclusion

Since the start of the SARS-CoV-2 pandemic, the number of positive tests for influenza A/B and seasonal respiratory viruses have not reached pre-pandemic levels across the YNHHS. However, rates of influenza and other respiratory viruses have increased since the relaxation of NPIs.

Disclosures

All Authors: No reported disclosures.
1902. Whole Genome Sequence analysis of early community transmission SARS-CoV-2 samples in the Philippines
Authors: Arevalo Geraldine , Dungca Nina Theresa , Salvana Edsel Maurice , Schwem Brian
Published: December 2022

Background

The Philippines has recorded nearly 3.7 million COVID-19 cases and more than 60,000 deaths. The first three cases of COVID-19 in the country were reported in January 2020 (1 lineage A, 2 lineage B, all Chinese tourists), with the first death outside China occurring among these cases. No cases were reported in February 2020. The first Filipino cases were reported March 2020. With over one million overseas Filipinos repatriated, tracking the introduction of waves of variants and subsequent community spread is important in order to improve future control efforts.

Methods

We analyzed 35 archived samples collected from March to September 2020 at the Philippines National Institutes of Health. SARS-CoV2 RT-PCR positive samples with Ct values from 15 to 25 were sequenced using Illumina HiSeq and analyzed using an in-house bioinformatics pipeline. Lineages were assigned using PANGOLIN. 14 whole genome sequences were generated with sufficient coverage. These were analyzed with 439 whole genome sequences from February to September 2020 that were publicly available on ViruSurf and GISAID to generate transmission maps.

Results

Transmission maps are shown in Figure 1. The earliest community transmission of COVID-19 in the Philippines was from lineage B.6 in March 2020 most closely related to B.6 from India. There is no evidence of onward transmission from the initial reported cases in January 2020 (lineage A and B). In June 2020, the predominant lineage switched to B.1 and its sublineages from Europe, coincident with a surge in cases. Figure 1.Alignment of the whole genome sequences from early Philippine samples and related SARS-COV2 sequences from ViruSurf and GISAID.

Conclusion

Transmission maps are shown in Figure 1. The earliest community transmission of COVID-19 in the Philippines was from lineage B.6 in March 2020 most closely related to B.6 from India. There is no evidence of onward transmission from the initial reported cases in January 2020 (lineage A and B). In June 2020, the predominant lineage switched to B.1 and its sublineages from Europe, coincident with a surge in cases.

Disclosures

Edsel Maurice Salvana, MD, MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria.
1920. Lack of SARS-CoV-2 transmission from a Healthcare Worker to a Cohort of Immunosuppressed Patients during the Omicron Surge, California, 2022
Authors: Karan Abraar , Ferguson Jessica , Salinas Jorge
Published: December 2022

Background

The Omicron surge caused a significant strain on the healthcare system, particularly as it relates to healthcare worker (HCW) infections. Occult infection transmission from HCWs to patients is an important area upon which infection control programs can continue to improve.

Methods

We conducted a retrospective chart review of 9 patients on the immunocompromised solid organ transplant service who were exposed to a highly infectious vaccinated and boosted healthcare worker across 2 days during the Omicron surge in January 2022.

Results

The index healthcare worker began to show symptoms shortly after rounds on the second day of clinical service. Nasopharyngeal rtPCR testing for SARS CoV 2 was positive, Ct value 15.9; a routine screening Covid19 test the day prior using an anterior nares swab had been negative. All 9 patients who were exposed and received follow-up testing on days 3-5 since exposure were negative for SARS CoV 2. One additional healthcare worker who was also exposed tested negative on follow-up testing despite several hours of close contact across 2 days. Both HCWs wore N95 respirators during all patient care and in breakrooms. Patient exposures were less than 15 minutes in duration, but also less than 6 feet in distance.

Conclusion

The index healthcare worker did not transmit SARS CoV 2 to a cohort of immunocompromised patients or to a fellow HCW despite being very infectious. The index HCW wore an N95 respirator during all patient encounters which could have reduced the chance for transmission.

Disclosures

All Authors: No reported disclosures.
1926. Risky businesses: Carbon dioxide monitoring to assess ventilation in grocery stores as an indicator of risk for respiratory virus transmission
Authors: Teran Maria Torres , Cadnum Jennifer , Donskey Curtis
Published: December 2022

Background

Poorly ventilated indoor settings pose a risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viruses. Transmission often occurs in community, but limited information is available on the quality of ventilation in community settings.

Methods

We used carbon dioxide measurements to assess adequacy of ventilation in 6 grocery stores, including large warehouse stores, medium-sized stores, and small neighborhood groceries. Carbon dioxide levels were monitored continuously with values recorded once per minute using a handheld device during multiple shopping trips to each store during both busy (defined as long lines at checkout) and non-busy (defined as no lines at checkout) shopping times. Carbon dioxide readings above 800 parts per million (ppm) were considered an indicator of suboptimal ventilation for the number of people present.

Results

Carbon dioxide levels remained below 800 ppm in all 6 grocery stores during trips at non-busy shopping times, except for transient rises above 800 ppm (peak = 860 ppm) during check out in 2 stores. In 3 of the 6 stores (50%), carbon dioxide levels rose above 800 ppm for prolonged periods during busy shopping times, with considerable variability in levels in different store locations (ie, increased levels in crowded store locations). The figure shows carbon dioxide levels for 1 medium-sized grocery store during typical shopping trips during busy and non-busy shopping periods.

Increase in carbon dioxide levels in parts per million (ppm) in a grocery store during busy and non-busy shopping trips. Peak levels of carbon dioxide above 800 ppm (dotted lines) were considered an indicator of suboptimal ventilation for the number of occupants present.

Conclusion

Ventilation in grocery stores may be sufficient to minimize the risk for airborne transmission of respiratory pathogens during non-busy shopping periods, but in some stores may be sub-optimal in crowded locations during busy shopping times. There is a need for additional studies to assess the quality of ventilation in a wide range of community settings.

Disclosures

All Authors: No reported disclosures.
1931. Antibodies to SARS-CoV-2 in a Medical School Department of Pediatrics
Authors: Del Bianco Gabriela P , Hammoud Roukaya Al , Aitken Mary E , Somasunderam Anoma , Hernandez Stacy Gomez , Rodriguez Gilhen , Aguilera Elizabeth A , Murphy James , Heresi Gloria
Published: December 2022

Background

Healthcare workers are at high risk of Covid-19 (C19) infection and received priority for C19 vaccinations. Therefore, we conducted a serosurvey to determine anti-C19 antibodies and evidence of C19 infection in health care employees who did or did not have direct contact with patients.

Methods

49 participants provided finger stick blood samples collected onto filter papers and tested for antibodies to C19 using Bio-Plex Pro Human SARS-CoV-2 IgG reagents. Antibodies to C19 nucleocapsid (N), receptor-binding domain (RBD), spike 1 (S1), and spike 2 (S2) were measured. Samples were collected 8 to 11 months after C19 vaccines were made available.

Results

All participants received two doses of Pfizer BioNTech or Moderna RNA-based C19 vaccines, and all showed serological evidence of antibodies to C19 RBD, S1, and S2. Antibodies to N, considered a marker of C19 infection, were detected in 16 individuals, of whom 10 reported having a PCR documented C19 infections. 6 individuals had evidence of C19 infection of which they were not aware. Antibody levels were notably higher following infection and for not infected participants following Pfizer-BioNTech vaccination. There was a 20% higher infection rate in participants with direct patient contact.

Conclusion

This vaccinated population had significant rates of strong antibody responses to C19 infection and a notable rate of C19 infections, most notable in those providing direct patient care.

Disclosures

All Authors: No reported disclosures.
1933. Assessment of Effectiveness of mRNA COVID-19 Vaccines Among Health Care Personnel: Monroe County, NY December 2020-March 2022
Authors: Russ Savanah , Myers Christopher J , Diseases Infectious , Licherdell Erin , Peer Thomas , Hurley Christine , Concannon Cathleen , Bowden Acacia , Chinchilli Ellen , Alvarado Alan , Dumyati Ghinwa
Published: December 2022

Background

Risk of infection with SARS-CoV-2 has remained high among health care personnel (HCP) throughout the pandemic, due to both exposure in the community and occupational settings. While vaccine uptake among health care workers is high, real-world continual monitoring of vaccine effectiveness (VE) among this population is crucial for informing future vaccination and prevention efforts.

Methods

Data for this analysis came from a test-negative case-control study conducted among HCP working at two acute care hospitals in Monroe County, NY from December 2020 through March 2022, performed as part of the CDC Emerging Infections Program. Case participants were identified as HCP who had at least one COVID-19 like symptom, and a positive polymerase-chain-reaction (PCR) SARS-CoV-2 test during the study time period. Control participants had a negative SARS-CoV-2 PCR test, regardless of presence of COVID-19 like symptoms. Cases and controls were matched based on the study week of their test date. Conditional logistic regression was used to assess vaccine effectiveness against symptomatic infection. Effectiveness was assessed between December 2020-May 2021, May 2021-October 2021, and October 2021-March 2022.

Results

From December 28th, 2020 through March 12th, 2022, 881 cases and 1794 controls were enrolled. Vaccine effectiveness against symptomatic infection was greatest from December 2020 through May 2021, with mRNA complete series effectiveness at 93.1% (95% CI: 86.9%-96.3%) with complete series VE falling to 25.1% (95% CI: 0.0%-50.9%) during May 2021-October 2021. Waning immunity following receipt of second dose was observed across all time periods. Vaccine effectiveness following receipt of one booster vaccine was found to be 59.2% (95% CI: 43.5-70.6), with evidence of waning immunity two months from receipt of the booster (VE: 46.6%; 95% CI: 14.6%-66.7%).

Conclusion

Protection provided by the COVID-19 mRNA vaccines against symptomatic infection is highly variable among HCP, based on the circulating dominant variant and the time since receipt of each dose. Monitoring of vaccine effectiveness, as well as waning immunity, among this high-risk population is essential to guide future vaccine policies.

Disclosures

christopher J. Myers, MS, Infectious diseases, Pfizer: Grant/Research Support Ghinwa Dumyati, MD, Pfizer: Grant/Research Support.
1946. Efficacy of Approved versus Unapproved Vaccines for SARS-CoV-2 Infection in Randomised Blinded Clinical Trials
Authors: Navarro Andrea Perez , Pilkington Victoria , Hill Andrew , Pepperrell Toby
Published: December 2022

Background

Five SARS-CoV-2 vaccines are approved in North America and/or Europe: Pfizer/BioNTech, Moderna, Janssen, Oxford-AstraZeneca and Novavax. Other vaccines have been developed, including Sinopharm, SinoVac, QazVac, Covaxin, Soberana, Corbevac, Medicago, Clover and Cansino, but are not approved in high income countries. This meta-analysis compared the efficacy of approved and unapproved vaccines in randomised clinical trials (RCTs).

Methods

A systematic review of clinical trial registries, PUBMED and EMBASE identified placebo-controlled RCTs of SARS-CoV-2 vaccines prospectively evaluating risks of symptomatic or severe infection with clearly defined endpoints. For each trial, risk of bias was assessed using Cochrane tool 2.0 and the CONSORT checklist. In the pre-defined meta-analysis, relative risks of symptomatic infection and severe disease were compared for each vaccine versus placebo, using Cochrane-Mantel Haenszel Tests (random effects method).

Results

There were 21 RCTs assessing efficacy of the COVID-19 vaccines identified. One RCT was excluded for high risk of bias. Ten RCTs in 206,667 participants evaluated 5 approved vaccines; 10 RCTs in 158,599 participants evaluated 8 unapproved vaccines. In the meta-analysis, prevention of symptomatic infection was 84% (95% C.I. 68-92%) for approved vaccines versus 72% (95% C.I. 65-77%) for unapproved vaccines, with no significant difference between vaccine types (p=0.13). Prevention of severe SARS-CoV-2 infection was 95% (95% C.I. 78-99%) for approved vaccines versus 84% (95% C.I. 72-91%) for unapproved vaccines (p=0.12). In addition, the risk of serious adverse events was similar between vaccine types (p=0.49).

Efficacy of approved and unapproved SARS-CoV-2 vaccines

Percentage efficacy of approved and unapproved SARS-CoV-2 vaccines against symptomatic infection (Panel A) and severe disease (Panel B). Vaccines are arranged by approval-status (approved vaccines to the left and unapproved vaccines to the right of discontinuous line) and colour-coded by vaccine type. Error bars represent 95% confidence intervals.

RIBSP, Research Institute for Biological Safety Problems; IFV, Instituto Finlay de Vacunas.

Conclusion

This meta-analysis of 20 RCTs in 365,266 participants, showed no significant difference in efficacy between the approved and unapproved SARS-CoV-2 vaccines for endpoints of either symptomatic or severe infection. Differences in study design, end-point definitions, variants and prevalence of infection may have influenced the results. Head-to-head RCTs will be required to make definitive conclusions. If efficacy is proved definitively, new patent-free vaccines could lower costs of worldwide SARS-CoV-2 vaccination campaigns significantly.

Disclosures

All Authors: No reported disclosures.
1950. Factors Influencing COVID-19 Vaccine Uptake among Reproductive-Aged Women in Jamaica
Authors: Pinkney Jodian A , Carroll Kamali , Bryan Lenroy , Witter Givana , Ashour Dina , Shebl Fatma , Hyle Emily P , Ojikutu Bisola , Bogart Laura
Published: December 2022

Background

Little is known about the factors which influence COVID-19 vaccine uptake among reproductive-aged women in Jamaica.

Methods

We conducted a cross-sectional, web-based survey of 192 reproductive-aged women in Jamaica from February 1- 8, 2022. Participants were recruited from a convenience sample of women (patients, providers and staff) at a tertiary care hospital whose demographic characteristics are shown in Table 1. We assessed self-reported COVID-19 vaccination status, vaccine confidence (defined as confidence in the safety and efficacy of vaccines and the system that delivers them) and medical mistrust beliefs (e.g., “I don’t trust the COVID-19 vaccine”). We conducted exploratory factor analysis using principal axis factoring and oblique equamax rotation on 22 survey items. Three factors were extracted which conceptually aligned with three subscales: lack of vaccine confidence, government-related COVID-19 medical mistrust, and race-based COVID-19 medical mistrust; we retained items with factor loadings > 0.40. The final subscale variables and their descriptive statistics are shown in Table 2. In addition, we used multivariable modified Poisson regression to calculate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for the association between vaccine uptake and pregnancy status adjusting for education and factors scores. Variables with a p value < 0.1 were retained in the final regression model.

Results

Of 192 respondents, 72(38%) were pregnant and 120 (62%) were non-pregnant. Pregnancy was negatively associated with vaccine uptake (aPR=0.70, 95%CI=0.51 - 0.96; p=0.029). Women with higher scores on the lack of vaccine confidence subscale (i.e., less confident in vaccine) were less likely to be vaccinated (aPR=0.72, 95%CI=0.61 - 0.86; p< 0.001). Government-related COVID-19 medical mistrust and race-based COVID-19 medical mistrust were not significantly associated with vaccine uptake (see Table 3).

Conclusion

Findings suggest that pregnancy and lack of vaccine confidence are factors associated with lower vaccine uptake among reproductive-aged women in Jamaica. Bolstering vaccine confidence, through the use of evidence-based interventions, may help to increase COVID-19 vaccine uptake in this population.

Disclosures

All Authors: No reported disclosures.
1968. SARS-CoV-2 Anti-Spike IgG Antibodies in Neonates After Maternal Vaccination Against COVID-19 During Pregnancy and Outcomes
Authors: Casillas Casillas Maria C , Lopez-Enriquez Claudia C , Reyes Jimena , Ramírez Haua Jose L , Rendon Macias Mario E
Published: December 2022

Background

Worldwide, attempts to understand the neonatal response and the benefits of immunity conferred by the mother to continue preventing COVID-19 infection in vulnerable groups. Therefore, research on the efficacy of vaccination against SARS-CoV-2 in pregnancy remains as an important tool to prevention of complications.

Methods

Cross-sectional study in which blood samples from 379 neonates taken from the umbilical cord. The inclusion criteria were: newborns of mothers with a history of vaccination against SARS-CoV-2 during pregnancy. Infants whose mothers had COVID-19 infection at birth, or receiving any immunosuppressive treatment during pregnancy were excluded.

Results

379 neonates were studied for their antispike IgG levels. The majority were full-term female neonates were of adequate weight for their gestational age and without complications during their birth, 28 neonates required NICU care for their. Antispike IgG levels were obtained in 94.9% . Mothers received first dose at first trimester in 28.4%, second trimester in 51.9% and in the third trimester 19.6). A total of 318 mothers (87.8%) completed the two-dose schedule receiving the same vaccine, six (1.6%) received another anti-COVID vaccine, and the remaining 39 (10.7%) received only one dose of vaccine. 64.9% were vaccinated with the BNT162b2 vaccine, were higher leves when received two vaccine doses compared to only one. Vaccines that stimulated highest levels were mRNA-1273 and BNT162b2, lowest levels were found in the CoronaVac and Ad5-nCoV vaccines. Finally, it should be noted that only four neonates presented levels below 0.8 BAU/mL (non-positive).

Conclusion

This study provides evidence on timing of maternal anti-COVID vaccination, antibody production, and transplacentary transfer ensuring maternal and neonatal protection through vaccination is key to encourage women to be vaccinated against COVID-19 during pregnancy. Follow-up studies in infants are needed to understand the persistence of placental-transferred antispike IgG and the role of breast milk antibodies in maximizing the protection of infants at this stage of risk of severe SARS-Cov-2 disease. These findings have implications for determining new public health and vaccination strategies for pregnant women.

Disclosures

All Authors: No reported disclosures.
1969. SARS-CoV-2 seroprevalence among patients with cancer and healthcare workers from an oncology referral center during the first year of COVID-19 vaccination in Mexico
Authors: Villaseñor-Echavarri Rodrigo , De-la-Rosa-Martinez Daniel , Frias-Jimenez Emmanuel , Martin-Onraet Alexandra , Ruiz-Garcia Erika , Cruz-Cruz Alonso , Herrera-Montalvo Luis Alonso , Vilar-Compte Diana
Published: December 2022

Background

Cancer patients (CPs) with COVID-19 have an increased risk of adverse outcomes. In addition, CPs seem to have a lower immune response to SARS-CoV-2 vaccination. This study aimed to evaluate SARS-CoV-2 spike antibodies (anti-S Abs) following COVID-19 vaccination in CPs and healthcare workers (HCWs).

Methods

We conducted a point-seroprevalence study in CPs and HCWs who received a two-dose scheme with either BNT162b2, AZD1222, or Sputnik-V vaccine. We measured anti-S Abs by quantitative immunoassay to assess humoral immune response. Besides, we quantified anti-nucleocapsid antibodies in a subgroup of individuals to determine prior infection. We compared anti-S Abs titers in both groups and stratified by vaccine type, prior infection, and clinical characteristics. We conducted a multivariate logistic regression to determine variables associated with a poor humoral response.

Results

Six hundred forty-one individuals were included: 174 (27%) CPs and 467 (73%) HCWs. The median anti-S Abs titter was higher among HCWs compared to CPs (2568 U/mL vs. 1807 U/mL, p=0.002). Both CPs and HCWs with prior infection had higher anti-S Abs titter (p< 0.001). Regardless of the time since vaccination, a higher proportion of subjects with titers < 250 U/mL was observed in CPs (p< 0.001) (Fig 2). In the multivariate analysis, older age (p=0.036), AZD1222 (p=0.003), and Sputnik-V (p=0.020) were associated with lower humoral response among the entire cohort.

SARS-CoV-2 spike antibody titers among cancer patients and healthcare workers.

Global differences in anti-S Abs titers between CPs and HCWs groups (a) and antibody titers in CPs and HCWs groups stratified by type of received vaccine (b). Abbreviations: CP: Cancer patients, HCW: Healthcare workers.

SARS-CoV-2 spike antibody titers according to time since vaccination among cancer patients and healthcare workers.

Abbreviations: CP: Cancer patients, HCW: Healthcare workers.

Conclusion

In this study, both CPs and HCWs showed an adequate response to vaccination; however, CPs had lower anti-S Abs titers and a faster decline over time. Based on our results, new strategies should be assessed to sustain the humoral response to vaccination and thus decrease the COVID-19 burden among the oncologic population.

Disclosures

All Authors: No reported disclosures.
1974. Title: A novel low-dose self-amplifying mRNA vaccine (GRT-R910) induces strong and broad boost in cellular and humoral immune response following primary series with a chimpanzee adenovirus SARS-CoV-2 vaccination
Authors: Turgut Tolga , Ahmed Uzma , Kachura Melissa , Kraemer Lauren , Nganje Charmaine , Hart Meghan , Jaroslavsky Jason , Kounlavouth Sonia , Marral Martina , Venkatraman Harshni , Kuan J C , Palmer Christine , Scallan Ciaran , Rappaport Amy , Jooss Karin , Uriel Alison , Ustianowski Andrew
Published: December 2022

Disclosures

Ciaran Scallan, PhD, Gritstone Bio: Salaried employee of Gritstone|Gritstone Bio: Stocks/Bonds Andrew Ustianowski, MD, PhD, Gilead: Advisor/Consultant|Gilead: Board Member|Gilead: Honoraria|Gilead: Speaker fees|Pfizer: Honoraria|Pfizer: Speaker fees|Vir/GlaxoSmithKline: Advisor/Consultant|Vir/GlaxoSmithKline: Board Member.

Background

The SARS-CoV-2 pandemic continues, with new variants of concern fueling periodic increases in COVID-19 cases. Authorized vaccines have provided protection against severe disease but less so for incident cases. Boosts with these vaccines have demonstrated waning protection. New vaccines, including those which induce immunity against more conserved regions outside of Spike, may improve upon these and be key to long-term protection and may be a useful approach against novel coronaviruses.

Methods

GO-009 (CORAL-Boost, NCT05148962) is an open-label study, conducted in the UK, of a self-amplifying mRNA vaccine encoding for Wuhan Spike (S) and highly conserved non-S T cell epitopes (GRT-R910; R910). R910 is given as 1 or 2 doses after vaccination with an authorized adenovirus or mRNA SARS-CoV-2 vaccine. The first two cohorts assessed 10µg and 30µg doses of R910 in older (≥60y) adults who had previously received ChAdOx1. Subsequent cohorts assess two boost doses in older and younger adults who have received an adenovirus or mRNA vaccine. Primary objectives are safety and reactogenicity and secondary objectives include cellular and humoral immunogenicity.

Results

Ten and seven adults received 10 or 30µg (cohorts 1 and 2) of R910, respectively. Reactogenicity and unsolicited adverse events were mostly mild/moderate and transient. The majority of severe events (malaise, fatigue, myalgia, Inj. site pain/tenderness/swelling) after dose 1 were experienced by 1 subject in cohort 2. Analysis of both IgG binding and neutralizing antibodies demonstrated a boost of anti-S antibodies after one dose of R910; geomean ID50 titers from 92 to 2370 and 99 to 1553 for 10 and 30µg, respectively. ELISpot analyses demonstrated that R910 boosted and broadened T cell responses to S and non-S T cell epitopes.

Conclusion

R910 was well tolerated. One R910 boost vaccination increased existing humoral and cellular immunity against S while inducing a broad T cell response against non-S SARS-CoV-2 proteins. A 10µg R910 boost increased neutralizing antibody titers comparable to a 10-fold higher dose (100µg) with authorized mRNA vaccines in a similar population (Munro et al 2021). A 10µg dose was selected for further study. Data post mRNA primary series will also be presented.
1988. Piperacillin-tazobactam plus Ceftriaxone for Enterococcus faecalis endocarditis: A Single Center Experience
Authors: Lee Rachael A , Rodriguez Martin , Stripling Joshua , Thottacherry Elizabeth
Published: December 2022

Background

Enterococcus faecalis is a leading cause of Infective Endocarditis (IE). IE guidelines recommend combination of penicillin (PCN) or ampicillin (AMP) with ceftriaxone (CTX) in susceptible strains. OPAT allows for antibiotic continuation at home; however outpatient AMP is limited due to frequent dosing and instability. Piperacillin-tazobactam (PTZ) has similar but not identical activity against penicillin binding proteins (PBP) compared to AMP and PCN, suggesting that PTZ may be a substitute in OPAT. This study compares outcomes in those with E. faecalis IE discharged with either PTZ or PCN with CTX.

Results of primary outcomes including death at 90 days and readmission at 90 days for those discharged on either PTZ or PCN in combination with CTX for E. faecalis endocarditis

Results of non infectious complications and changes in antibiotic therapy in both groups post discharge

Methods

This single center retrospective study took place from 2016 - 2020. Adults > 18 years with AMP susceptible E. faecalis IE diagnosed using Duke’s criteria and blood or tissue cultures were included, with cultures confirming PCN susceptibility. Primary endpoint was failure of therapy at 90 days, defined as death due to any cause or infection relapse. Secondary outcomes were duration of antibiotics, change in regimen and non-infectious complications.

Results

Overall, 34 patients were identified, 17 in each group. Average age was 60–80 years, majority having a high Charleston comorbidity index. One did not have available AMP susceptibility but was PCN susceptible. 19 were managed surgically (65% PTZ group, 47% PCN group). Average total antibiotic course was 8.2 and 7.3 weeks in PTZ and PCN groups, with average OPAT course being 4.5 and 4.4 weeks. Primary endpoint was met in 18% patients in the PTZ group and 24% in the PCN group. Of the PCN group, 1 was admitted 4 months later due to an E. faecalis device infection, outside of primary endpoint. Nearly 80% completed antibiotic therapy with 29% in the PTZ group and 35% in the PCN group readmitted for non-infectious complications, including metabolic imbalances, stroke, volume overload and gastro-intestinal bleed. Hyperkalemia was seen in the PCN group with 3 patients requiring readmission. Seizures were not reported with combined PCN and ceftriaxone.

Conclusion

Similar outcomes were seen using either PTZ or PCN with CTX for treatment of enterococcal IE. Discharging patients on PCN is not always a feasible option. In these instances, PTZ could be considered as an alternative OPAT agent despite dissimilar mechanism of action compared to AMP and PCN.

Disclosures

All Authors: No reported disclosures.
1992. Risk of Infective Endocarditis in Streptococcal mitis Bloodstream Infections Among Patients with Neutropenia from Hematologic Malignancies
Authors: Monk Miranda M , Elshaboury Ramy H , Patel Nikitha R , Kubiak David W , Alobaidly Maryam , Hammond Sarah P
Published: December 2022

Background

Streptococcus mitis is a common colonizer of the human oral and gastrointestinal tract. Patients with neutropenia due to hematologic malignancy (HM), particularly those prescribed fluoroquinolone prophylaxis are at increased risk of a S. mitis bloodstream infection (BSI). Risk of infective endocarditis (IE) in this patient population remains unclear.

Methods

This was a multicenter, retrospective study of neutropenic (ANC < 500 K/uL) patients with HM from November 2016 - February 2022. Patients were included if they had S. mitis isolated in at least 1 blood culture bottle. The primary outcome was number of patients who developed IE based on cardiac imaging. Secondary outcomes included number of patients who underwent IE workup via cardiac imaging and BSI recurrence within 12 weeks.

Results

Among 171 patients who met the inclusion criteria, 101 (59%) were male and median age was 60 years old (range 19-86). Patient demographics, microbiologic information and outcomes are shown in Table 1. All patients in the cohort had native cardiac valves. Acute leukemia/myelodysplastic syndrome was the most common HM (n=129, 75%), followed by lymphoma (n=27, 16%), multiple myeloma (n=10, 6%) and chronic leukemia (n=5, 3%). Most patients had a transthoracic echocardiogram (TTE) (n=97, 56.7%) within 7 days of BSI. Of these patients, 1 had suspected valvular vegetations on TTE, but transesophageal echocardiogram (TEE) was negative. Two patients had negative TTEs, but there was a high clinical suspicion, so cardiac computed tomography was performed and showed no valvular vegetations. Despite negative cardiac imaging, 1 patient completed 6 weeks of empiric treatment for IE based on radiographic findings in the torso suggesting visceral infarcts. One patient had S. mitis BSI recurrence within 12 weeks of first positive culture. Median duration of antimicrobial therapy for BSI was 15 days (range 8-43).

Conclusion

IE is uncommon in neutropenic HM patients with native cardiac valves and S. mitis BSI. In this cohort where approximately half had a TTE after bacteremia and median duration of BSI therapy was 15 days, recurrent BSI was rare, suggesting that IE cases were not underdiagnosed in those without cardiac imaging. Cardiac imaging such as TTE to rule out IE may not be necessary for all patients in this population.

Disclosures

Ramy H. Elshaboury, PharmD, Eli Lilly: Honoraria|Gilead Sciences: Grant/Research Support David W. Kubiak, PharmD, BCPS, BCIDP, FIDSA, Astellas Pharma, Inc.: Advisor/Consultant|AVIR Pharma Inc: Advisor/Consultant|Cidara Therapeutics: Advisor/Consultant Sarah P. Hammond, MD, F2G: Advisor/Consultant|F2G: Grant/Research Support|GSK: Grant/Research Support|Scynexis: Grant/Research Support.
2003. Comparison of Confirmed and Probable Cases of Vibriosis, Tennessee, 2017–2021
Authors: Hanna Samir , Carpenter Abby , Garman Katie , Dunn John R
Published: December 2022

Background

Vibriosis causes an estimated 80,000 illnesses and 100 deaths in the United States each year. Commonly reported exposures include consuming raw or undercooked seafood and contact with seawater. To facilitate case ascertainment and better understand the epidemiology of vibriosis, CDC requested inclusion of positive culture-independent diagnostic testing (CIDT) cases to the 2017 case definition. We reviewed confirmed (culture positive) and probable (CIDT positive) cases in Tennessee (TN) from 2017-2021.

Methods

Vibrio reports from clinical and state public health laboratories were reviewed. Demographic, clinical, and exposure data were collected through routine case interviews using The Cholera and Other Vibrio Illness Surveillance (COVIS) Report. Confirmed and probable cases were described and compared using Epi Info 7.

Results

A total of 164 Vibrio cases were reported from 44 counties across TN. In total, 135 (82%) cases were interviewed including 72 (53%) confirmed cases (all sources) and 63 (47%) probable cases. Half of cases from each case status were 40-69 years old. Twenty-four percent of probable cases versus 7% of confirmed cases were under 10 years old. Of confirmed cases, 64% were males compared to 51% of probable cases. Most cases (90% of confirmed and 75% of probable cases) were among non-Hispanic white population. Almost all probable cases (97%) reported gastrointestinal (GI) symptoms. Among confirmed cases, 70% reported non-GI symptoms such as cellulitis. Thirty three percent of both confirmed and probable cases were hospitalized. Confirmed cases were more likely to report travel out of state (OR 5.1, p-value < 0.0001) and exposure to seawater (OR 3.4, p-value 0.002) compared to probable cases. When comparing confirmed cases from stool specimens (27 cases) to probable cases, travel out of state remained significant (OR 4.8, p-value 0.0001) as well as seafood consumption (OR 6.8, p-value 0.0008).

Conclusion

Demographic and clinical features differed between confirmed and probable cases. Out of state travel, seafood consumption, and exposure to seawater were reported more often by confirmed cases. Reflex culturing is recommended to better facilitate case ascertainment and understand the epidemiology of vibriosis.

Disclosures

All Authors: No reported disclosures.
2004. Contemporary Clinical Epidemiology of Pediatric Shigella spp. Infections in Houston, TX, 2016-2021
Authors: Tabarani Christy , Arias Cesar A , Wanger Audrey , Flores Anthony R
Published: December 2022

Background

Infections due to Gram-negative pathogens that cause gastrointestinal illnesses are a significant cause of morbidity in children. The contemporary clinical and epidemiological features of pediatric Shigella spp. infections in urban cities in the United States are not well described.

Methods

We used a retrospective cohort of patients (0-18 years of age) from a network of hospitals in Houston, TX. Only patients with Shigella spp. isolated from clinical samples dated from 2016 to 2021 were included in the study. Demographic, clinical, and microbiological data and susceptibility profile were extracted from the medical record.

Results

We identified a total of 73 pediatric patients with Shigella spp. Infections. The median age at presentation was 5 years. Hospital admission occurred in 32 % of infections with a median length of stay of 1 day (Table 1). Of cases with available clinical data, 80% of patients with Shigella spp. infections reported fever (Table 2). Of note, 62% of patients developed bloody diarrhea (Table 2). The majority of patients infected with Shigella flexneri (4/7) reported a history of international travel. Seizures were observed in 5 patients. No episodes of bacteremia were identified. Among patients with an identified exposure, daycare attendance and contact with individuals experiencing similar symptoms were the most common (Table 2). The majority of Shigella species were S. sonnei (90.4%) (Table 3). Resistance to trimethoprim-sulfamethoxazole (TMP-SMX) was common (45/68, 66%) among Shigella spp. isolates tested. No resistance to third generation cephalosporins was observed. (Table 3). Although azithromycin was the most common antibiotic used for treatment, susceptibility testing for this antibiotic was not performed in any of the cases.

Conclusion

Infections due to Shigella spp. are a significant burden among pediatric patients in a major metropolitan health care system (Houston, TX). Bloody diarrhea was the most common presentation, although the presence of Shiga-toxin-positive isolates was unknown. The observed high frequency of resistance to TMP-SMX and emergence of multi-drug resistant Shigella spp. in other countries warrants continued surveillance.

Disclosures

Cesar A. Arias, MD, PhD, Entasis Phramceuticals: Grant/Research Support|MeMed Diagnostics: Grant/Research Support|Merck: Grant/Research Support.