bluuebunny/crossref_metadata_2025 huggingface dataset:
1713. B-Cell Subsets in Children and Adolescents Living with Perinatally-Acquired HIV
Authors: Contreras German , zakhour ramia g , Heresi Gloria , Murphy James
Published: November 2023

Background

To gain insight into the mechanisms of immune deficits persisting in children and adolescents living with perinatally-acquired HIV (PHIV) on ART at 4, 6, and 10 years.

Methods

We determined four B-cell subpopulations by flow cytometry after initiation of ART -classical, plasma blast activated, and tissue-like memory B cell MBCs. Macrophage activation was assessed by measuring plasma levels of sCD14. Baseline characteristics and clinical data of study participants were extracted from medical records. Categorical and continuous variables were compared by the Fisher or Wilcoxon rank-sum test.

Results

Eleven PHIV and 22 HIV- were studied. The median age at ART initiation was 4.5 (interquartile range [IQR], 3.2–12.4) years, median CD4% was 23.4 (IQR, 18–31), and plasma median HIV RNA was 4.3 (IQR, 3.1–5.2) log10 copies/mL. Median CD4% and plasma HIV RNA log10 copies/mL at 4, 6, and 10 years were 28 and 3.2; 27.9 and 2.9; and 29.5 and 2.4.

HIV (+) compared to HIV (-) had significantly lower percentages of classical MBCs but higher percentages of plasmablast, activated, and tissue-like MBCs (Figure). Moreover, these differences persisted through 10 years (Figure). Of note, the distribution of the B-cell subpopulations did not change during the six years of evaluation for the PHIV, despite progressive control of HIV replication and immune activation measured as sCD14. (Figure).

Conclusion

Children and adolescents living with perinatally acquired HIV had persistent abnormal B-cell subpopulation distribution despite an effective HIV viremia control and CD4 % restoration following ART initiation. The linkage between the observed persistent immune activation and abnormalities observed within the B cell compartment deserves investigation. The abnormalities in B-cell subpopulations might explain our population's low immune response to vaccines.

Disclosures

All Authors: No reported disclosures
1715. Use of a validated tool to assess transition readiness to adult care of adolescents living with HIV in Rwanda
Authors: Rogo Tanya , Mushimiyimana Febronie , Unyuzumutima Juliette , Tuyisenge Lisine , Kantor Rami
Published: November 2023

Background

Recent African studies report that only 11-60% of transitioned adolescents living with HIV (ALHIV) were successfully retained in care after healthcare transition (HCT) from pediatric to adult care settings. HCT without adequate pre-transition preparation can result in loss of follow-up and poor treatment adherence. Transition guidelines recommend longitudinal transition readiness assessment using an objective measure, a practice not routinely implemented.

Methods

During March-April 2023, HCT readiness was assessed in a cross-sectional study of Rwandan ALHIV age ≥ 18 years attending the University Teaching Hospital of Kigali pediatric HIV clinic and about to transition to adult care. Transition readiness was assessed using the validated Transition Assessment Readiness Questionnaire (TRAQ 5.0), consisting of 20 questions in five subscales: Appointment Keeping; Tracking Health Issues; Managing Medications; Talking with Providers; and Managing Daily Activities. Responses were graded on a Likert scale of 1-5 (1 being “No, I do not know how” and 5 being “Yes, I always do this when I need to”). Scores less than 4 indicate need for education.

Results

In 32 perinatally-infected ALHIV, mean age at diagnosis was 3.7 years (SD 2.7) and at antiretroviral therapy initiation 5.2 years (SD 3.3). Mean number of clinic visits in the prior 12 months was 4 (S.D 0.48, range 3-6). Half were still in high school, and most (88%) lived with their biological parents. The mean TRAQ scores were Appointment Keeping 3.82 (SD 0.61); Tracking Health Issues 3.43 (SD 0.93); Managing Medications 4.56 (SD 0.59); Talking with Providers 4.71 (SD 0.4); and Managing Daily Activities 4.52 (SD 0.46).

Conclusion

In a first-of-its-kind study in East Africa, a validated HCT assessment in Rwandan ALHIV suggests overall readiness in managing medications, daily living tasks and communication with providers. Needs for further education in tracking health and keeping appointments were identified, important for independent self-management of chronic disease. Longitudinal follow-up and comparison to other populations (now feasible due to using a validated tool) are needed, to develop and further evaluate the impact of needed interventions on post-transition outcomes.

Disclosures

Tanya Rogo, MD, AstraZeneca: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support
1719. Duration of antibodies after immunization with the quadrivalent influenza vaccine in children after hematopoietic stem cell transplantation or chemotherapy compared to healthy children
Authors: Cho Yoon Kyung , Ahn Bin , Choi Sujin , Kim Ye Ji , Kang Kyu Ri , Kang Hyunmi , Kang Jin Han
Published: November 2023

Background

Children that have undergone hematopoietic stem cell transplantation (HSCT) are at a higher risk for severe influenza. The purpose of this study was to compare the duration of antibodies after immunization with the quadrivalent influenza vaccine (QIV) in children after hematopoietic stem cell transplantation or chemotherapy compared to healthy children.

Methods

This was a prospective study of children below 18 years old that received the QIV influenza vaccine during the 2021-2022 influenza vaccination season. Children were divided into 3 groups as follows: a) post-HSCT, b) post-chemotherapy, and c) immunocompetent children as a healthy control. Blood samples were taken immediately before immunization, at 1 month, 3 months, 6 months, and 12 months after immunization. Hemagglutination Inhibition (HI) assays were performed. Seropositive rate was defined by the percentage of patients with HI titer ≥1:40. Seroconversion rate (SCR) was defined as follows: 1) in patients with a pre-vaccination HI titer < 1:10, rise in post-vaccination HI titers ≥1:40, or in patients with pre-vaccination HI titers ≥1:40, a 4-fold increase.

Results

A total of 60 children were included in the preliminary analyses, n=20 in each of the three groups. The SPR at post-vaccination 1 month for both A/H1N1 and H3N2 exceeded 80% in all three groups. The SPR remained above 60% at 3 months post-immunization for both A antigens. However, by 6 months post-vaccination, the SPR dropped to 50% in the post-chemotherapy group for the A/H1N1 antigen, and the geometric mean titers (GMTs) were 26.39. For B/Victoria and B/Yamagata, the SPR was below 40% in the post-HSCT and post chemotherapy group at 1 months and below 20% by 3 months. The GMTs were also below 1:40 for both antigens. In the normal control group, the SPR for B/Victoria was 50% at 1 months and 45% at 3 months post-immunization, and for B/Yamagata, 50% at 1 months and 55% at 3 months post-immunization. However, the GMTs were below 1:40 by 3 months post-immunization.

Conclusion

For A/H1N1, the SPR and GMTs at 6 months in the post-chemotherapy was low. In both the post-HSCT and chemotherapy group, HI titers were low for both B antigens at 1-month post-vaccination, and GMTs showed < 1:40. B antigens contained within QIV need to illicit better protection against Influenza in children.

Disclosures

All Authors: No reported disclosures
1723. Varicella in Uruguay. Epidemiological situation and prevention strategies. Period 2008 to 2021.
Authors: Ferrer Monica Pujadas , Delfino Marcos , Badia Federica , Kenny Juan , Assandri Elizabeth , Olivera Ignacio , Canziani Catalina C , Pírez María Catalina
Published: November 2023

Background

In Uruguay varicella is mandatory notification disease since 1963. Universal vaccination starts in 1999 (OKA strain 1 dose) when incidence was 105/100.000 inhab; in 2014 2nd dose was added (5 years) to prevent outbreaks. Objective: describe epidemiology and variations of the cases notified in Uruguay between 1.1.2008 and 12.31.2021 according vaccine strain.

Methods

Observational, descriptive, retrospective study. All cases reported to the Department of Health Surveillance (DEVISA)-Epidemiology Division-Ministry of Health in period: 1.1.08 to 12.31.21. Data source: DEVISA and Honorary Commission-Fight Against TB-Prevalent Diseases. Variables: notified cases, average annual incidence, age, sex, outbreaks. Vaccine: doses, OKA or MAV/06 strain Statistical analysis: frequency distribution, summary measures and statistical significance tests (significant: p value ≤ 0.05) 4 periods according vaccine strain in nation immunization program were defined: 2008 and 2009 (Oka), 2010 to 2012 (Oka and MAV06); 2013 to 2018 (MAV) and 2019 to 2021 (OKA)

Results

Accumulated cases: 13,896 (annual average: 992). Women: 6639 (48%) Vaccine coverage was around 95-97%. Incidence: 32.2/100,000/inhabitants (95%CI:30-34) in 2008-2009, the rate decrease in 2010-2012 to 21.5 (19-13), in 2013-2018 increased 35,78 (35-36), in this period in 2013, 1968 cases was reported. Rate in 2019-2021: 12 (11-12) [2019: 24, 2020: 7 and 2021: 4,6], with 2 doses of vaccine. There wasn’t a significant difference in annual average cases (AANC) 2008-2013 (AANC: 1025) vs 2014-2018 (AANC: 1293) p=0,345. The AANC in 2019-2021 were 424. [rate in 2019: 24, in 2020: 7 and 2021: 4,6]. There was a significant increase in the annual average of outbreaks 30/2012-2013 vs. 90/2014-2018. In 2019:81, 2020:10 and 2021:7 outbreaks. Between 2008-2018 most cases were reported in the group 10 to 14 years of age (median 187.5m); 2019-2021, 678/1,272 cases were older than 12

Conclusion

Incidence dropped from 105 in 1999 to 24 in 2019. There was a displacement to older ages. The 2nd dose didn’t change incidence and outbreaks frequency. The incidence decreased in 2019-2021. Surely the great decrease in the incidence and outbreaks in 2020 and 2021 was influenced by COVID-19 pandemic. Since 2010 to 2018, the most widely used vaccine contained MAV/06

Disclosures

Marcos Delfino, Pediatrician, pediatric infectologist, Adjunct Professor of pediatric clinic, Pfizer: Finnancial support to travel to IDWeek 2023 Ignacio Olivera, Medical Doctor, Master in Health Economics and Pharmaceutical Economics, Pfizer: Grant/Research Support|Roche: Expert Testimony|Sanofis Pasteur: Grant/Research Support María Catalina Pírez, Pediatrician, Pediatric infectologist, microbiologist Professor of pediatric, Degree V, Merck, Pfizer: Expert Testimony|Merck, Pfizer: Honoraria
1724. Varicella Infections and Vaccination Rates Among Pediatric Solid Organ Transplant Recipients: A Single-Center, Multi-Organ Retrospective Experience (2011-2021)
Authors: Espinoza-Candelaria Gabriela , Green Michael D , Martin Judith M , Sojati Jorna , Michaels Marian G
Published: November 2023

Background

The two-dose varicella-zoster virus (VZV) immunization schedule significantly decreased VZV infections in the US. Yet, among pediatric solid organ transplant recipients (SOT), the characterization of pre-transplant VZV immunity, VZV exposure with progression to disease, and disease outcomes remain poorly described.

Methods

We performed a retrospective analysis of patients < 18 years old who received a SOT between Jan 1, 2011 - Dec 31, 2021, at the UPMC Children's Hospital of Pittsburgh, a quaternary, multi-organ pediatric care center. Inpatient, outpatient, and telephone encounters were reviewed as documented in the patients’ electronic health records (EHRs) via automated and manual data extraction.

Results

674 patients underwent 832 SOT procedures; 370 children met the inclusion criteria. 287 patients had documentation of their VZV pre-transplant vaccine status and no contraindication for vaccination; 59% had unknown, negative, or indeterminate pre-transplant VZV IgG. While 257 children received at least 1 VZV dose before SOT, another dose was administered for only 41% of those with negative or indeterminate serology in the pre-transplant period. 35 children did not have a documented VZV pre-transplant immunization status; 63% had unknown or negative VZV IgG and were eligible for vaccination by age and immunocompetence. 33 patients had VZV exposures; 2 children developed VZV disease - neither had received post-exposure prophylaxis (PEP). 5 patients were prescribed an antiviral as PEP, 2 received IVIG incidentally, and none received VZV immunoglobulin. In total, there were 4 primary VZV and 4 herpes zoster (HZ) medically attended cases among 8 patients. All 8 received antiviral treatment; 3 in the inpatient setting and 5 exclusively outpatient. All cases were limited to cutaneous lesions without dissemination. None of the patients who developed primary VZV had conclusive evidence of protective VZV IgG pre-transplant. Post-herpetic neuralgia complicated 1 HZ case.

Conclusion

VZV exposure and disease still occur, albeit at low levels and with mild manifestations, among pediatric SOT recipients in the two-dose VZV vaccine era. Optimization of VZV immunity in the pre-transplant period and preventing progression to disease after exposure to VZV remain goals of care.

Disclosures

Michael D. Green, MD, MPH, ADMA: Advisor/Consultant|Allovir: Advisor/Consultant|Bristol Myers Squibb: Advisor/Consultant|ITB-MED: Advisor/Consultant Judith M. Martin, MD, Merck, Sharp and Dhome: Grant/Research Support Marian G. Michaels, MD, MPH, Merck: Grant/Research Support|Viracor: Grant/Research Support
2879. Utilization of vector autoregressive models for multivariable time-series analysis to evaluate the difference between days of therapy and days of antibiotic spectrum coverage in an inpatient antimicrobial stewardship program
Authors: Murakami Shutaro , Honda Hitoshi , Akazawa Manabu
Published: November 2023

Background

Days of therapy (DOT), commonly used to estimate antimicrobial consumption, has some limitations. Days of antibiotic spectrum coverage (DASC), a novel metric, overcomes these limitations. This study examined the difference between these two metrics of inpatient intravenous antimicrobial consumption in assessing antimicrobial stewardship efficacy and antimicrobial resistance by using the vector autoregressive (VAR) model with time-series analysis, which has been used in macroeconomics.

Methods

Differences between DOT and DASC were investigated at a tertiary care center in Japan over eight years using VAR models with three variables in the following order: 1) the monthly proportion of prospective audit and feedback (PAF) acceptance as an index of antimicrobial stewardship efficacy; 2) monthly DOT and DASC adjusted by 1,000 days present as indices of antimicrobial consumption; and 3) the monthly incidence of five, drug-resistant organisms as an index of antimicrobial resistance (Clostridioides difficile infections (CDI), extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, methicillin-resistant Staphylococcus aureus (MRSA), drug-resistant Pseudomonas aeruginosa, and drug-resistant Enterobacterales).

Results

The Granger-causality test, which evaluates whether incorporating lagged variables can help to predict other variables, found that PAF acceptance contributed to DOT and DASC; these in turn contributed to the incidence of drug-resistant P. aeruginosa. Notably, only DASC helped to predict the incidence of drug-resistant Enterobacterales. Another VAR analysis demonstrated that a high proportion of PAF acceptances was accompanied by decreased DASC in a given month while increased DASC was accompanied by an increased incidence of drug-resistant Enterobacterales, unlike with DOT.

Conclusion

VAR models with variables in the order of PAF acceptance, antimicrobial consumption, and antimicrobial resistance suggested that DASC, including antimicrobial spectrum information, may more accurately reflect the impact of PAF on antimicrobial consumption and be superior to DOT for predicting the incidence of drug-resistant Enterobacterales.

Disclosures

Hitoshi Honda, MD, Moderna: Honoraria Manabu Akazawa, MPH, PhD, Astellas Pharma: Advisor/Consultant|GSK: Advisor/Consultant|Jansen: Advisor/Consultant|Shionogi: Advisor/Consultant|Takeda: Advisor/Consultant
1732. The Value of the Influenza Cell-Based Vaccine in the Pediatric Population. A Dynamic Transmission Modelling Approach in the U.S.
Authors: Mould-Quevedo Joaquin F , Nguyen Van
Published: November 2023

Background

Seasonal influenza poses a huge public health issue for children globally, resulting in significant disease and economic burdens. In addition, children are major influenza spreaders across the multiple age groups because they may pass on more of the virus for a longer period. This research aimed to evaluate the economic and health impacts of the cell-based quadrivalent influenza vaccine (QIVc) compared to the standard-dose egg-based quadrivalent influenza vaccine (QIVe) in U.S. children (6 months-17 years), from the payers and societal perspective.

Methods

The public health and cost outcomes of QIVc and QIVe was estimated using a dynamic age-structured susceptible-exposed-infected-recovered transmission model. The model was calibrated to a low (2011-2012) and high incidence (2017-2018) influenza seasons, matching Centers for Disease Control and Prevention (CDC) reported data. The relative vaccine effectiveness of QIVc over QIVe in children was taken from a meta-analysis based on observational studies in the U.S. Within the dynamic model, adults (18-64yrs) received QIVc and older adults (65yrs+) the adjuvanted influenza vaccine; only vaccination type differences were accounted in the 6mons-17yrs age group. Probability of events, costs and utility values were obtained from U.S. literature. Coverage rates for all age-groups was taken from official CDC pre-pandemic reports. The robustness of the results was assessed in probabilistic sensitivity analyses.

Results

Within a low incidence season (LIS), switching from QIVe to QIVc in 6 months- to 17-year-olds may prevent 2.9 million symptomatic cases, 1.1 million outpatient visits, 31,667 hospitalizations, and 4,163 deaths annually. As an opposite, within a high incidence season (HIS), switching from QIVe to QIVc may prevent 1.7 million symptomatic cases, 648,263 outpatient visits, 16,688 hospitalizations, and 2,126 deaths. In both scenarios, LIS and HIS, QIVc would be a cost-saving strategy with US$1.4B and US$468.7M savings from a societal perspective and US$989.8M and US$252.8M savings from a payer perspective, respectively.

Conclusion

The analysis shows that QIVc in children is expected to prevent hospitalizations and deaths, and result in substantial savings in healthcare costs.

Disclosures

Joaquin F. Mould-Quevedo, PhD, CSL Seqirus Inc.: Employee|CSL Seqirus Inc.: Employee|CSL Seqirus Inc.: Stocks/Bonds|CSL Seqirus Inc.: Stocks/Bonds Van Nguyen, PhD, CSL Seqirus Inc.: Advisor/Consultant|CSL Seqirus Inc.: Advisor/Consultant|CSL Seqirus Inc.: Honoraria
1734. Influenza, SARS-CoV-2, and routine childhood vaccines – trends in vaccine hesitancy in hospitalized children before and during the COVID-19 pandemic
Authors: Orbea Marisa , Panjabi Anurag , Lopez Michelle , Cunningham Rachel , Boom Julie A , Healy C Mary , Bocchini Claire
Published: November 2023

Background

Vaccine hesitancy (VH) is adversely affecting the public health response to the COVID-19 pandemic. Similarly, influenza vaccine uptake is suboptimal.

We monitored trends in VH to influenza, COVID-19, and routine childhood vaccines.

Methods

A repeated cross-sectional survey in English and Spanish of caregiver influenza and COVID-19 knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 mo-18 yrs at a pediatric hospital. We enrolled over 4 seasons (S); ‘19-20 (S1), ‘20-21 (S2), ‘21-22 (S3), ‘22-23 (S4). In S4, we targeted caregivers of children 6 mo-11 yrs. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey; PACV score ≥ 50 denoted VH.

In S4, a messaging intervention was piloted. Caregivers were randomized to watch 1 of 2 COVID-19 educational videos; half watched a second video featuring a family adversely impacted by COVID-19. All caregivers completed a survey to assess acceptance and efficacy of the video(s) in changing intent to vaccinate their child.

Figure 1.

Participant flow chart from 2019-2023

Results

Across all seasons, ≥ 92% of caregivers approached were enrolled. Most (48%) identified as Hispanic/Latino, 35% as White, and 19% as Black. By parental report, 94% of children in S1, 91% in S2, 91% in S3, and 89% in S4 were up-to-date with routine vaccines. Based on PACV score, 13% were VH in S1, 17% in S2, 19% in S3, and 20% in S4 (p=0.14).

During S2-3, fewer caregivers endorsed “flu can be a dangerous infection in children” and “I am scared of my child getting the flu” (p< 0.01). Decreased concern recovered in S4 but did not translate to increased vaccine uptake (Table 1).

Caregivers were less scared of their child getting COVID-19 and more scared of the vaccine in S4. Fewer caregivers in S4 were willing to receive the COVID-19 vaccine; 46% in S2, 54% in S3, and 29% in S4 had/planned to vaccinate their child (Table 2).

Of 800 caregivers, 74% liked the educational videos and 54% thought they were helpful when considering the COVID-19 vaccine for their child. Of 399, 73% liked the family story and 50% thought it was helpful.

Table 1.

Trends in caregiver attitudes regarding the influenza vaccine

Table 2.

Trends in caregiver attitudes and vaccine acceptance during the COVID-19 pandemic

Conclusion

Parental concern regarding influenza is largely back to pre-pandemic levels but vaccine acceptance has not recovered. Vaccine uptake against COVID-19 remains suboptimal. Educational videos may help caregivers when deciding about the COVID-19 vaccine for their child.

Disclosures

C.Mary Healy, MD, Dexcom Inc: Stocks/Bonds|Intuitive: Stocks/Bonds|Quidel Corporation: Stocks/Bonds|Up to Date: Honoraria|Vapotherm: Stocks/Bonds Claire Bocchini, MD, Pfizer: Local sub-I for pediatric SARS-CoV-2 vaccine trials
1736. Routine Vaccination Status at Time of Transplant for Pediatric Liver, Kidney and Heart Recipients
Authors: Reis Christopher , Ristagno Elizabeth H , Madigan Theresa
Published: November 2023

Background

Vaccine preventable infections (VPIs) are a significant cause of hospitalizations and morbidity and mortality for pediatric solid organ transplant (SOT) recipients. In this single-center study, we assessed up-to-date (UTD) status of routine childhood immunizations among our institution’s pediatric SOT recipients.

Methods

We collected immunization data on all pediatric patients who underwent liver, kidney, or heart transplants between January 1, 2011 and December 31, 2021 at Mayo Clinic, Rochester, MN by retrospectively reviewing electronic medical record data. We also assessed whether patients were evaluated by a pediatric infectious diseases (PID) specialist within 1 year of transplant. Immunization status was determined using the CDC child and adolescent immunization schedule, excluding seasonal influenza and SARS-CoV-2 immunizations.

Results

A total of 143 patients were included in our study (n = 45 liver, 54 kidney, 44 heart recipients); 49.7% were male. At the time of transplant, 39 patients were considered UTD (27.3% [Figure 1]). There was no difference by organ type (p = 0.59) and whether patients had seen PID prior to transplant (p = 0.17). Excluding live viral vaccinations, 45 patients were UTD (31.5%). Human papillomavirus was the least UTD vaccine series (Figure 2). Most patients were not UTD in just one or two series (Figure 1). A significant difference in UTD status was found based on age at transplant (p = 0.03), with younger patients having higher rates of UTD status (mean age 7.1 [SD 5.75] vs 9.9 [SD 5.92] years).Figure 1.Vaccination status of pediatric SOT recipients at time of transplant and number of incomplete series.Figure 2.Vaccination status by series for eligible pediatric SOT recipients.

Conclusion

To date, this study is the largest cohort of pediatric SOT recipients of three organ types assessing routine childhood vaccination status. In this single-center cohort spanning 11 years, we found that less than a third of patients were UTD on routine childhood immunizations at the time of transplant. While some immunizations can be given post-transplant, every effort should be made to update vaccines among transplant candidates to optimize efficacy and protection, thereby reducing the consequences of VPIs within this vulnerable population. Further studies are needed to address reasons for under-immunization and develop strategies to improve vaccination rates.

Disclosures

All Authors: No reported disclosures
2880. Propensity score-weighted analysis of the impact of outpatient parenteral antimicrobial therapy (OPAT) plan reconciliation on unscheduled care
Authors: Sieling William D , Ross Jennifer , Evans Michael , Billmeyer Kaylyn , Hirsch Elizabeth B , Kline Susan E , Galdys Alison
Published: November 2023

Background

Outpatient parenteral antimicrobial therapy (OPAT) is a mechanism for delivery of antimicrobial therapy over a prolonged period in an environment outside of inpatient care. Benefits of OPAT include avoidance of hospital stays, prevention of hospital-associated conditions, and significant cost savings. We analyzed the frequency of all-cause 90-day emergency department (ED) visits, readmissions, and mortality of patients pre- and post-implementation of OPAT plan reconciliation in June of 2020.

Methods

Unique, adult OPAT recipients discharged to home or post-acute care facilities from an academic hospital between 6/2017 and 6/2022 were included in our cohort. On 6/14/2020, a program was launched that entailed OPAT plan review and reconciliation by infectious diseases (ID) pharmacists prior to OPAT recipients discharging from acute care; all participants discharged on or after this date were included in the post-intervention cohort. (Figure 1) Data on patient characteristics, admission events, and outcomes were collected from the electronic medical record. We performed a propensity score weighted analysis with pre-defined variables to determine which demonstrate an association with our outcomes. We accounted for missing data by using multiple imputation.

Results

2408 OPAT patients meeting inclusion criteria were identified: 1650 pre-implementation and 758 post-implementation. (Table 1) Variables for which the standard mean difference between groups was ≥ 0.1 include race, chronic kidney disease, length of stay, ID consultation, and payor. (Figure 2) In our propensity-weighted analysis, there was a statistically significant difference between the proportion of patients in the pre- and post-implementation groups that presented to the ED (pre- 22.3%; post- 17.9%; p=0.032) or were readmitted (pre- 39.1%; post- 33.1%; p=0.008) within 90 days after discharge from index admission. (Table 2) There was no significant difference in the 90-day all-cause mortality between the pre- and post-implementation cohorts.

Conclusion

Following institution of OPAT plan reconciliation by ID pharmacists prior to discharge from acute care, OPAT recipients were significantly less likely to experience 90-day ED visits or 90-day readmissions.

Disclosures

Elizabeth B. Hirsch, PharmD, Melinta Therapuetics: Honoraria|Merck and Company, Inc.: Grant/Research Support
1739. Mumps Vaccine Hesitancy: Current Evidence and An Evidence-Based Campaign in Japan
Authors: Ugai Satoko , Ugai Tomotaka , Kanayama Tetsuya , Kamiya Hajime , Saitoh Akihiko , Slopen Natalie
Published: November 2023

Background

Mumps is still endemic in Japan because mumps vaccination is voluntary. In this study, we investigated associations of parental socioeconomic status, family structure, and knowledge/belief about mumps and mumps vaccine with parental decision to vaccinate their children using a questionnaire survey; and, we evaluated effectiveness of a campaign based on the survey results.

Methods

We conducted a cross-sectional survey of parents with children aged 1 to 6 years attending preschools or kindergartens in Tokamachi City, Japan. We assessed the association of parental factors with their decision to vaccinate their children using multivariable logistic regression analyses. We designed a campaign, based on the survey results and compared the number of provided mumps vaccinations before and after the campaign using a trend test.

Results

In total, 1391 of 1617 (86%) eligible parents completed the survey. Among these parents, 229 (16%) vaccinated their children. In multivariable analyses, higher parental education (odds ratio (OR) = 2.21; 95% CI, 1.59-3.08; P < 0.001), greater knowledge about mumps and the mumps vaccine (OR=1.88; 95% CI, 1.60-2.21; P < 0.001), and living without grandparents (OR=1.44; 95% CI, 1.05-1.99; P= 0.024) were significantly associated with parental decision to vaccinate their children. The number of provided mumps vaccinations increased dramatically following the campaign (P < 0.001).

Conclusion

Clear explanations of mumps and mumps vaccines from pediatricians may be an effective strategy to increase vaccination coverage. Further research is needed to examine the relevance of our findings to the uptake of other voluntary vaccines among children, as well.

Disclosures

All Authors: No reported disclosures
1750. Factors associated with respiratory pathogen panel utilization in children hospitalized with acute respiratory illness — New Vaccine Surveillance Network, Kansas City, 2017–2021
Authors: Lyon Edward , Lee Brian R , Clopper Benjamin R , Moline Heidi L , Selvarangan Rangaraj , Schuster Jennifer E
Published: November 2023

Background

Respiratory pathogen panels (RPP) are multiplex PCR platforms that detect several respiratory viruses from one specimen. For most children hospitalized with acute respiratory illness (ARI), management is supportive, and detection of a specific virus from RPP does not impact clinical care. Therefore, clinical RPP use is not standardized, and ordering is at the discretion of the clinician. We sought to understand factors associated with RPP utilization among pediatric patients hospitalized with ARI.

Methods

From October 2017 to September 2021, participants < 18 years hospitalized with ARI were enrolled at a single site in the New Vaccine Surveillance Network (NVSN). Eligible patients were residents of Jackson County, MO, had one or more ARI symptoms (e.g., cough, fever, nasal congestion) lasting < 14 days, and were enrolled within 48 hours of admission. Parent interviews and medical chart reviews were conducted. All participants had a research RPP, but results were not available to the clinical providers. Clinical providers were able to order a clinical RPP (cRPP), for which they received test results. Characteristics of NVSN enrollees hospitalized with ARI with and without a cRPP are described. Lastly, medical complexity was assessed via the pediatric complex chronic conditions classification system (CCC) then analyzed via chi- square test between groups.

Results

During the study period, 1,038 participants were enrolled, and 555 (53.4%) received a cRPP. Most, 299 (53%), cRPPs were ordered in the emergency department or urgent care before admission. Age was a significant factor associated with cRPP use (Table 1). cRPP participants were more likely to have complex chronic conditions, and/or technology dependence. No difference in cRPP use was observed by race/ethnicity, payer status, or sex. More participants were enrolled in 2020-2021, but the overall usage of cRPP is similar between years (Table 2).

Conclusion

In this large cohort of children hospitalized with ARI, medical complexity, technological dependence, and age < 2 months were associated with increased utilization of cRPPs. Understanding the impact of cRPP on clinical care requires further investigation to better understand the utility of these tests.

Disclosures

Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Honoraria|Altona Diagnostics: Grant/Research Support|Baebies Inc: Advisor/Consultant|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|Bio-Rad: Grant/Research Support|Cepheid: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Lab Simply: Advisor/Consultant|Luminex: Grant/Research Support
1751. The Conundrum of Neonatal Herpes Simplex Virus (HSV) Disease: Co-infections do Happen!
Authors: Mejias Asuncion , Taveras Jeanette , Dendi Alvaro A , Pifer Traci , Crisan Rachelle , Sanchez Pablo J
Published: November 2023

Background

Traditional dogma states that identification of one pathogen in neonates undergoing sepsis evaluation excludes other infections like HSV. At Nationwide Children’s Hospital Columbus, OH, all neonates with suspected sepsis are evaluated for bacterial and viral infections including HSV disease. The frequency of coinfection with HSV when another pathogen is identified in an ill-appearing neonate is not fully known, yet timely treatment is paramount to lessen HSV morbidity and mortality.Table 1.Frequency and type of bacterial and viral coinfections in infants ≤ 42 days of age with HSV infection

Methods

From 1/2007-12/2022, infants ≤ 42 days old with a positive HSV PCR from blood, cerebrospinal fluid (CSF), or mucosal sites were identified by ICD-9/10 codes (before 2012) and subsequently by prospective surveillance. Information regarding bacterial cultures and/or viral PCRs, clinical and outcome data were reviewed. Infants coinfected with HSV and another viral or bacterial pathogen were identified.

Results

We identified 88 infants who tested positive for HSV by PCR of a body site and had bacterial and other viral studies performed. The rate of coinfections was 14% (12/88; Table 1). Bacterial cultures were positive in 3% (3/88) of infants: a full-term 11-day old with E. coli UTI and HSV-1 skin-eye-mouth (SEM) disease; a full term 11-day old with H. influenzae bacteremia and HSV-2 disseminated (DISS) disease, and a 24 wks’ gestation infant with E. coli sepsis who died at 8 days of age with HSV-2 DISS disease. Viral co-detection included positive enterovirus (EV) PCR in 8% (4/52) of infants (3, CSF; 1, blood/mucosal sites). All four had HSV DNA detected from mucosal sites only: 3 HSV-1 and EV PCR + in CSF on days 6-25 of age and an infant with EV myocarditis [EV blood PCR +] at 8 days of age and HSV-2. A respiratory virus was identified in 12% (5/43) of infants: 3 with DISS disease (2, HSV-2; 1, HSV-1) born at 35, 37, and 34-wks’ and had concomitant rhinovirus (RV; died), RSV, and parainfluenza-3 infection at 4, 30, and 31 days old, respectively. The remaining 2 infants had RV infection and HSV-1 SEM (44 days old) and HSV-1 mucosal site infection (11 days old).

Conclusion

14% of neonates with HSV infection had concomitant bacterial, respiratory viral, or enteroviral disease. The identification of a pathogen besides HSV in neonates with suspected sepsis does not rule out HSV disease.

Disclosures

Asuncion Mejias, MD, PhD, MsCS, Astra-Zeneca: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Sanofi-Pasteur: Advisor/Consultant
1753. Neutropenia as a Function of Ganciclovir Exposure During Treatment of Congenital Cytomegalovirus Disease
Authors: Nishikawa Javier K , Aban Inmaculada , Acosta Edward , Sanchez Pablo J , Kimberlin David
Published: November 2023

Background

Congenital cytomegalovirus (cCMV) infection is the leading cause of non-genetic sensorineural hearing loss (SNHL) in childhood. Treatment of infants with symptomatic cCMV disease with intravenous (IV) ganciclovir or oral valganciclovir improves audiologic outcomes when started in the first month of age. Neutropenia is the most common adverse event of antiviral treatment, occurring in 19-63% of infants. No correlation between ganciclovir drug exposure and development of neutropenia has been identified.

Methods

We utilized pharmacokinetic (PK), pharmacodynamic (PD), and hematologic data from three international, NIH-funded studies of IV ganciclovir or oral valganciclovir conducted by the Collaborative Antiviral Study Group (CASG) from 2002-2018. The minimum absolute neutrophil count (ANC) was used to classify each patient as life-threateningly, severely, moderately, mildly or never neutropenic, as defined in the Division of AIDS Toxicity Tables. The mean 12-hour area under the curve (AUC12) values of patients from each category were compared using ANOVA. The correlation between the minimum ANC value and the AUC value was estimated using Pearson correlation. Ordinal logistic regression determined if AUC was a significant predictor of neutropenia category.

Results

139 subjects were included, with 18 (13%) developing an ANC below 500 prompting suspension of antiviral treatment. AUC12 exposure as a function of degree of neutropenia is presented in Figure 1. AUC12 weakly correlated with the ANC (p=0.02; R=0.20), suggesting that higher AUC values very weakly correlated with higher ANC values, the opposite of what was hypothesized. In comparison, the ANOVA showed no significant difference (P=0.72) between each group of subjects, meaning that each category of neutropenia status had equivalent drug exposure. Ordinal logistic regression did not show that AUC12 is a significant predictor of neutropenia category (P=0.62).Figure 1:AUC Values Across Five Categories of Neutropenia

Conclusion

We did not observe a high correlation between AUC12 and neutropenia. However, most participants only had one AUC12 result from time of study enrollment, so our results do not exclude the possibility that such a correlation exists. Future analyses will explore additional PK parameters, such as Cmax and half-life, as a function of ANC values.

Disclosures

Inmaculada Aban, PHD, Roche: Steering Committee Member David Kimberlin, MD, Gilead: Grant/Research Support|Gilead: Served as site PI on pediatric remdesivir study. All monies went directly to my university and not to me.
1756. Takeaways from Investigation of a Large Invasive Group A Streptococcus Outbreak in a Skilled Nursing Facility, Virginia, 2022-2023
Authors: Abdelfattah Rehab R , Bonnefond Clarissa , Kiefer Carolyn A , Rehkopf Kayleigh , Spindle Holly E , Bair Patricia , Lineberger Sarah
Published: November 2023

Background

Group A Streptococcus (GAS) primarily infects the respiratory tract, skin, and soft tissue. Invasive GAS (iGAS), in which the bacteria infect a normally sterile body site, is severe and can be life threatening, especially in older adults. The Virginia Department of Health investigated a prolonged iGAS outbreak in a skilled nursing facility from March 2022 - April 2023. Cases continued despite multipronged outbreak response.

Methods

A case was defined as GAS isolated from a sterile or nonsterile body site. Cases were identified through active surveillance, retrospective chart review, colonization screening by skin/throat swab, and culture. Multiple onsite visits were conducted to assess infection control practices at the facility. Genotyping (emm type) analysis was performed on resident and staff isolates.

Results

From March 2022 to April 2023, 30 (71.4%) GAS cases were identified among facility residents, and 12 (28.6%) cases among staff. Ten residents (23.8%) died. GAS was isolated from throat (21, 50%), wounds (14, 33.3%), from more than one site (2, 4.8%), and invasive infections (5, 11.9%). Twenty (47.6%) cases were identified through colonization screening; the carriage rate among residents was 7% (16 positive out of 230) and 2.8% among staff (4 positives out of 142). Sequencing was conducted on 34 isolates, 33 (97%) were emm type 89 and were within < 10 single nucleotide polymorphisms (SNP) apart. Infection prevention assessments identified gaps in hand hygiene, wound care, and environmental cleaning and disinfection.

Conclusion

Genotyping results suggested common source exposure. GAS might have transmitted several times between colonized or infected residents and staff which caused the extended outbreak. Multiple challenges at the facility contributed to a prolonged outbreak despite aggressive interventions. Challenges included high staff turnover; use of agency staff since the beginning of the COVID-19 pandemic; change in facility ownership; suboptimal infection prevention practices including wound care; and lack of appropriate active surveillance for GAS infections. Review of epidemiological data, frequent onsite infection prevention assessments, numerous educational sessions, and active follow-up were all crucial strategies for outbreak mitigation.

Disclosures

All Authors: No reported disclosures
1758. Persons who Inject Drugs Leaving Medical Encounters against Medical Advice during an HIV Outbreak in Kanawha County, WV — A Mixed Methods Study
Authors: Balenger Adelaide , Pieczykolan Lauren Love , Bonacci Robert A , McClung R Paul , Agnew-Brune Christine , Perez Stephen , Wilson Suzanne , Hudson Alana , Young Sherri A , Curran Kathryn
Published: November 2023

Background

In 2021, an HIV outbreak investigation among persons who inject drugs (PWID) in Kanawha County, West Virginia identified that patients frequently left medical encounters against medical advice (AMA). Leaving encounters AMA is linked to high rates of readmission and mortality and leads to missed opportunities for HIV testing and HIV care engagement. We identified factors associated with leaving encounters AMA among PWID in this HIV outbreak.

Methods

For 65 PWID with HIV diagnosed during 1/1/2019–6/18/2021 who resided in Kanawha County, we analyzed demographic, clinical, and encounter data abstracted from inpatient and emergency department medical records from one year prior to HIV diagnosis through 6/18/2021. In addition, we analyzed data from qualitative interviews conducted in June 2021 with a purposeful sample of 26 PWID and 45 community partners (service providers, law enforcement, policymakers, and religious leaders), examining themes related to leaving encounters AMA.

Results

We identified 307 inpatient and emergency department encounters, including 80 (26%) encounters during which the patient left care AMA (Table 1). Among 65 PWID with diagnosed HIV infection, 37 (57%) ever left an encounter AMA, and of those, 16 (43%) were not virally suppressed (Table 2). Patients left encounters AMA more frequently when they were diagnosed with injection drug use (IDU)-related infections or when heroin use was documented during the encounter (Table 1). During interviews, providers cited staffing shortages, barriers to implementing integrated care models, and the complex social and medical needs of PWID, as challenges to care delivery among PWID. From the perspective of PWID, barriers to care retention included maltreatment and stigma from clinical staff, social isolation, and withdrawal symptoms.

Conclusion

The high frequency of leaving encounters AMA highlights serious gaps in treatment services and barriers to care for PWID associated with this outbreak. Challenges related to complex medical and social needs, including recent IDU, and prior negative experiences in healthcare facilities may have contributed to PWID leaving medical encounters AMA. Patient-centered care that addresses these challenges could improve patient experiences and health outcomes among PWID.

Disclosures

All Authors: No reported disclosures
1760. Wastewater-based surveillance for influenza A and RSV and its correlation with clinical disease in Edmonton, Alberta
Authors: Bhavanam Sudha , Qiu Judy , Du Kristine , Acosta Nicole , Zelyas Nathan , Li Qiaozhi , Buss Emily , Frankowski Kevin , Hubert Casey R J , Parkins Michael , Hrudey Steve , Pang Xiao-Li , Lee Bonita
Published: November 2023

Background

Wastewater (WW)-based surveillance (WBS) of SARS-CoV-2 has been shown to provide a leading indicator to COVID-19 clinical disease including confirmed cases and associated-hospitalizations. To this point, however, longitudinal monitoring of endemic respiratory diseases such as influenza A (IAV) and respiratory syncytial virus (RSV) have minimally been explored. We sought to correlate WW measured endemic virus RNA from municipal WW treatment plants (WWTP) with clinical data to understand WBS performance for endemic respiratory disease in Alberta’s capital city, Edmonton.

Methods

WW was collected thrice weekly from the two WWTP servicing the Edmonton-area (population ∼1.3 million) between Jan’22 & Feb’23. 24-hour composite samples were processed by Centricon ultracentrifugation, and RNA extracted. IAV, and RSV were quantified in duplicate by established RT-qPCR assays. WW SARS-CoV-2 level values adjusted by population served by each WWTP were compared with clinical cases in sewershed-matched areas in Edmonton Health Zone. Daily IAV and RSV case numbers were generated from IAV and RSV specimen testing data extracted from Alberta Precision Laboratory-Public Health Laboratory and FSA of the specimens was used to create the sewershed-matched case data.

Results

A total of 361 wastewater samples from the two WWTPs were collected between January 2022 and February 2023: 83 (30%) tested positive for IAV and 185 (51.2%) for RSV. Over two respiratory viral seasons, 2021/2022 and 2022/2023, IAV peaked in May/June 2022 and again in Nov/Dec 2022. IAV and RSV measured in WW positively correlated with daily confirmed clinical cases within the Edmonton Health Zone (Pearson correlation IAV, r2=0.61, p< 0.0001; RSV, r2=0.65, p< 0.0001). Relative to the 2021/2022 season, the WW RSV peak in the 2022/2023 season occurring in November/January was much greater.

Figure 1

Population normalized Flu A concentrations in wastewater vs. population normalized case rates in the Edmonton Health Zone.

Figure 2

Population normalized RSV concentrations in wastewater vs. population normalized case rates in the Edmonton Health Zone.

Conclusion

WBS of IAV and RSV demonstrated strong correlations with clinically confirmed diseases in sewershed-matched areas in Edmonton, Alberta. WBS enables objective, inclusive and unbiased monitoring of endemic respiratory viral disease activity.

Disclosures

All Authors: No reported disclosures