bluuebunny/crossref_metadata_2025 huggingface dataset:
1333. Analysis of the Clinical Utility of the Filmarray Meningitis-Encephalitis Panel using a Threshold Cerebrospinal Fluid White Blood Cell Count of > 50
Authors: Webster William , Palavecino Elizabeth , DeWitt Michael E
Published: November 2023

Background

Current diagnostics for meningoencephalitis pose a risk for suboptimal performance characteristics, with a current equipoise surrounding parameters that influence clinical utility of the BioFire FilmArray Meningitis Encephalitis Panel (MEP). The goal of this study is to examine the clinical utility of the MEP when using a cerebrospinal fluid white blood cell count (CSF WBC) threshold of > 50.

Methods

All MEPs performed at Wake Forest Baptist Hospital from March 2016 to September 2022 were retrospectively analyzed to assess clinical utility of the threshold of CSF WBC > 50. The independent variable was CSF WBC greater or less than 50, with the dependent variable being clinical utility, deemed by the investigator. Logistic regression was performed to assess association of CSF WBC with clinical utility. In a secondary analysis, we repeated the regression using CSF WBC as a continuous predictor.

Results

A total of 522 MEPs were analyzed, with 113 (22%) positive and 409 (78%) negative. Positive MEPs were predominantly viruses (65%) followed by bacteria (25%) and fungi (10%). Enterovirus was the most common pathogen detected in 24 (21%) MEPs, seen in Table 1. Among positive MEPs, characteristics associated with high utility were elevated CSF WBC (p=0.038) and older age (p=0.05). Among all MEPs, high utility was seen with increased CSF WBC > 50 (p< 0.001) and positive cultures (p< 0.001). Post hoc analysis of all MEPs revealed a specificity of 0.45, sensitivity of 0.94, PPV of 0.94, and NPV of 0.45 when using culture as the gold standard for bacteria or fungi. 23 (5%) samples were MEP positive and culture negative. Of these, 11 (48%) were MEP positive for Streptococcus pneumoniae. Among positive MEPs, 17 (15%) had WBC < 50. CSF WBC > 50 was associated with high utility with an odds ratio of 16.1 (p< 0.001, CI 9.68-28.1). When treating CSF WBC as a continuous variable, logistic regression revealed a 25% chance that the MEP would have high utility at this threshold, increasing to 50% at a CSF WBC > 310 (Figure 1).

Baseline Characteristics

Table 1

Probability of Clinical Utility as a Function of CSF WBC

Figure 1

Conclusion

Among MEPs ordered for suspicion of meningoencephalitis, the threshold of a CSF WBC > 50 was associated with high utility. Using this threshold to influence pre-test probability may serve as an important parameter to decrease false positive results of the MEP for diagnosis of meningoencephalitis.

Disclosures

All Authors: No reported disclosures
1336. Presence of Antibodies to non-SARS-CoV-2 Associates With Generation of Neutralizing Antibodies to SARS-CoV-2 Following mRNA Vaccination
Authors: Al Hammoud Roukaya , Del Bianco Gabriela P , Somasunderam Anoma , Hernandez Stacy Gomez , Riggs Kaleigh , Hashmi Syed , Murphy James , Heresi Gloria
Published: November 2023

Background

The immunological interplay between SARS-CoV-2 immunization, SARS-CoV-2 infection, and exposure to other human coronaviruses is poorly understood. Therefore, we evaluated the relationship of the humoral immune responses to SARS-CoV-2 and selected other human coronaviruses (HCoVs).

Methods

We enrolled 42 healthcare workers (HCWs) in a Pediatric Department at a medical school in Houston, Texas, during a Delta variant dominance period (2021) of the SARS-CoV-2 pandemic. All had two immunizations with mRNA SARS-CoV-2 vaccines at a median of 7.4 months before sample collection. Using multiplex assays, we tested binding antibodies (Ab) and neutralizing antibodies (NAb) to SARS-CoV-2 and Ab responses to selected non-SARS-CoV-2 HCoVs.

Results

100% had Ab to all components of a SARS-CoV-2 screening panel that comprised receptor-binding protein (RBD), spike 1 (S1), and spike 2 (S2). 13 out of 42 (31%) had Ab to nucleocapsid antigen (N) suggesting previous coronavirus infection of whom 7 (53%) reported a previous PCR-confirmed SARS-CoV-2 infection and had significantly higher Ab response to each of the four screening antigens. (Table 1) Although all volunteers had notable levels of SARS-CoV-2 specific Abs, only 42% had NAb to SARS-CoV-2. Notable findings for volunteers with NAb included a high frequency of NAb to Wild Type (100%), Alpha (72%) and Delta variants (72%). More mRNA-1273 (Moderna) recipients (61%) had NAb than BTN162b2 (Pfizer) (25%) (p-value: 0.041).

83% of volunteers had detectable Ab to at least one of HCoVs. Ab to SARS-CoV-1 is strongly associated with a positive NAb response to SARS-CoV-2 (44% versus 0, p-value 0.001).

Table 1

Demographic and serological profile

Table 2

Comparison between participants with Neutralizing Ab response and those without

Conclusion

Generation of SARS-CoV-2 NAb following mRNA vaccination of HCWs is strongly associated with the presence of Ab to SARS-CoV-1. The source of SARS-CoV-1 Ab in our population is unknown. The nearly 20% prevalence of SARS-CoV-1 Ab exceeds the known prevalence of SARS-CoV-1 infection. There is may be a neutralization relevant shared immunogen between SARS-CoV-1 and SARS-CoV-2.

Disclosures

All Authors: No reported disclosures
1338. Changes in Volume and Diagnoses in a Pediatric Emergency Department during the COVID-19 Pandemic in Northeast Mexico
Authors: Murillo Paulina Blanco , Tamez-Rivera Oscar , Pineda-Magaña Rommy E , Escobedo-Berumen Lucia , Estrada-Mendizabal Ricardo J , Madrazo-Aguirre Katheryne P , Ruelas-Martinez Manuel , Garcia-Lima Maria Guadalupe
Published: November 2023

Background

During the first months of the COVID-19 pandemic, a reduction in the volume of patients who sought care in pediatric emergency departments (ED) was observed. An apparent change in discharge diagnoses was also witnessed. There is scarce evidence about the impact of the pandemic on pediatric emergency departments in Mexico and Latin America.

Methods

We conducted a retrospective observational study at a tertiary care hospital in Mexico. We compared the volume and discharge diagnoses of patients aged 0-16 years admitted to the ED during the COVID-19 pandemic from Dec 2020 to Feb 2021 and during the same 3 months in the previous year (Dec 2019 to Feb 2020). As a secondary objective, we compared the subjects’ demographic characteristics and comorbidities. Chi-square test was performed to compare proportions and Student’s t test to compare the median age of patients between the two periods.

Results

In the pre-pandemic period (Dec 2019 to Feb 2020) there were 1,686 admissions to the ED, compared to 941 during the pandemic period (Dec 2020 to Feb 2021). This represented a 44.1% decrease in pediatric admissions to the ED. Median age in months was higher during the pandemic period (50.8) compared to the previous year (69.8) (Table 1). There was a significant increase in the percentage of patients who had a positive history of comorbidities. The percentage of infectious and respiratory diseases significantly declined during the pandemic period, particularly pneumonia (13.1% vs. 1.9%), bronchiolitis (10.7% vs. 1.3%), and rhinopharyngitis (4.1% vs. 1.3%) (Table 2). There was also an increase in intoxication cases (1.7% vs. 3.4%) and accidents (6.6% vs. 14.7%). The percentage of neonatal, surgical, neurological, rheumatological, and gastrointestinal diseases also increased during the pandemic period.

Conclusion

There was a substantial decrease in the total volume of patients as well as a significant change in discharge diagnoses between the pre-pandemic and pandemic studied periods. This study adds to the scarcity of literature available about the impact of COVID-19 on pediatric EDs in Mexico and Latin America. Further studies regarding medical attention-seeking behavior during the pandemic are crucial to planning for the allocation of health resources in case of future health emergencies.

Disclosures

All Authors: No reported disclosures
1349. Unveiling the Link between COVID-19 and the Gut Microbiome in an Outpatient Cohort with Mild to Moderate Illness
Authors: Comba Isin Y , Mars Ruben A , Dumais Mitchell , Van Gorp Trena , Harrington Jonathan , O’Horo John C , Kashyap Purna C
Published: November 2023

Background

As the acute phase of the COVID-19 pandemic subsides, an increasing number of individuals are recognized as having long COVID, affecting over 65 million people worldwide. Recent studies have suggested a potential link between long COVID and alterations in the gut microbiome. In this study, we examined the gut microbiome of a large outpatient cohort during acute phase of infection, with the ultimate goal of determining predictors of long-term COVID-19 health outcomes.

Methods

We conducted a study of 394 COVID-19 patients with positive SARS-CoV-2 testing from November 2020 to September 2021 at a multi-site healthcare system. Long COVID was defined as the persistence of symptoms for four weeks or more after illness onset. DNA extraction was performed using the MoBio PowerSoil Pro DNA isolation kit. Samples were sequenced using shotgun metagenomics. Stool SARS-CoV-2 RNA was tested using qRT-PCR of the E gene, and stool ELISA was performed for calprotectin levels. Standard biostatistical tools in R (v 4.2.3) were used for statistical analysis.

Results

Of the 394 COVID-19 patients, 84 (21%) had long COVID, with fatigue being the most common persistent symptom (Table 1). No significant differences were seen in age, BMI, and antibiotic use. Those with long COVID were more likely to be female, had higher Charlson's comorbidity scores, more severe index illnesses. However, the two groups had no difference in SARS-CoV-2 stool PCR positivity or stool calprotectin levels (Table 2). Principal coordinate analysis of Bray Curtis dissimilarities revealed that patients with long COVID had a distinct microbial composition compared with those without long COVID during the acute phase of infection (ANOSIM R2= 0.005, P= 0.01). Categorizing patients by number of long COVID symptoms showed significant differences among groups (ANOSIM R2=0.1, P=0.007), mainly between patients with >3 symptoms and those with 0-1 symptoms (Bonferroni, P= 0.018). Alpha diversity was lower in patients with > 3 symptoms, although this was not statistically significant (Shannon diversity, two-way-ANOVA, P=0.051).

Figure 1

Conclusion

Long COVID patients show distinct gut microbial composition during the acute phase of infection, suggesting a potential role in predicting long-term COVID health outcomes.

Disclosures

John C. O'Horo, Sr., MD, MPH, Janssen Pharmaceuticals.: Grant/Research Support|nference: Grant/Research Support Purna C. Kashyap, MD, Intrinsic Medicine: Advisor/Consultant|Novome Biotechnologies: Advisor/Consultant|Pendulum Therapeutics: Advisor/Consultant
1350. Solid Organ Transplantation From COVID Positive Donors: Trends in Utilization, Discard & Long-term Outcomes in the United States
Authors: Dhand Abhay , Okumura Kenji , Ohira Suguru , Lansman Steven , Nishida Seigo
Published: November 2023

Background

Transplantation of organs from COVID positive (COVID+) donors is increasing. The aim of this study was to assess the trends in utilization, discard, and longer-term outcomes in solid organ transplant (SOT) recipients who received organs from COVID+ donors in the United States (US).

Methods

Rates of utilization, discard, and outcomes of SOT from deceased donors with a positive COVID PCR test from respiratory tract between March 2020 and December 2022 were analyzed using the de-identified United Network for Organ Sharing (UNOS) database.

Results

During the study period, 1185 COVID+ donors led to the transplantation of 1249 kidneys, 592 livers, and 168 hearts.

The center-wise acceptance rate for organs from COVID+ donors increased from 2021 to 2022: heart from 31% to 73%, kidney from 53% to 88%, and liver from 53% to 89%.

Discard rates of kidneys from COVID+ donors remained high: left kidney- 29%, right kidney- 32% and were significantly higher than kidney discard rates for COVID negative (COVID-) donors (p < 0.001)

When compared to COVID- donors, COVID+ donors were younger and had a lower median Kidney Donor Profile Index (0.51 vs. 0.54, p = .004), lower median serum creatinine (0.9 vs. 1.05 mg/dl, p< 0.001), similar median serum total bilirubin (0.6 mg/dl, p = .15), and similar left ventricular ejection fraction (60%, p = .84). Six months, one-year and 18-month overall and graft survival were comparable between recipients of COVID+ and COVID- donors (table 1) (figures 1).Table 1:Characteristics and outcomes of solid organ transplantation from COVID+ and COVID- donors

Graft Survival: COVID+ vs. COVID- donors

Conclusion

Utilization of organs from COVID+ donors has improved across various transplant centers in the US. Kidney discard rate from COVID+ donors remain high. Longer-term outcomes of SOT from COVID+ donors are encouraging and are helping to successfully expand the donor pool.

Disclosures

All Authors: No reported disclosures
1351. Predictors of Loss of Infectivity Among Healthcare Workers with Primary and Recurrent SARS-CoV-2 infection: An Observational Cohort Study
Authors: Dzieciolowska Stefka , Longtin Yves , Charest Hugues , Roy Tonya , Fafard Judith , Levade Ines , Longtin Jean , Parkes Leighanne , Villeneuve Jasmin , Savard Patrice , Corbeil Jacques , De Serres Gaston
Published: November 2023

Background

Factors associated with loss of infectivity in healthcare workers (HCWs) with COVID-19 are poorly understood. Understanding predictive factors could help optimize return-to-work criteria and minimize absenteeism.

Methods

Prospective observational cohort study of HCWs with COVID-19 conducted between Feb 20 2022 and March 6 2023 in 20 institutions in Montreal, Canada, with clinical/laboratory follow-up on Day 5, 7 and 10 of infection. Infectivity was determined by viral culture (Vero E6 cells) on nasopharyngeal swabs. Predictors of loss of infectivity were investigated by univariate and multivariate logistic regression.

Results

Overall, 121 participants (79.3% female, mean age 40 years) were recruited. Most (n=107, 88.4%) had received ≥3 vaccines and 20 (16.5%) had a history of prior COVID-19. The proportion of HCWs with a positive viral culture decreased from 71.9% on day 5 of infection to 18.2% on day 10. The proportion of HCWs with a positive RT-PCR decreased from 93.3% (112/120) on day 5 (median Ct value, 23.4 [IQR, 20.6-27.9]) to 61.2% (74/120) on day 10 (median Ct value, 32.5 [IQR, 28.5 to undetectable]). Rapid antigen detection test (RADT) positivity decreased from 81.5% on day 5 to 34.2% on day 10.

Participants with recurrent COVID-19 had lower likelihood of infectivity at each visit (OR on day 5, 0.14; 95% CI 0.05-0.40; p< 0.001; OR on day 7, 0.04; 95% CI, 0.01-0.33; p=0.003) and none were infective on day 10 (p=0.02). At each visit, recurrent cases had higher median RT-PCR Ct values than primary infections (p< 0.03) and were more likely to have a negative RADT result (p< 0.01).

By multivariate analysis, ongoing infectivity was associated with a RT-PCR Ct value < 23 (adjusted OR [aOR] on day 5, 22.75; p< 0.001; aOR on Day 7, 182.30; p< 0.001; and aOR on Day 10; 24.71; p=0.02). A history of previous COVID-19 was associated with a lower probability of infectivity on Day 5 (aOR, 0.005; p=0.003). By contrast, symptom improvement (including fever) and RADT result were not independent predictors of loss of infectivity.

Conclusion

A lower RT-PCR Ct value is associated with ongoing infectivity, whereas COVID-19 reinfection is a predictor of loss of infectivity. These findings could help optimize return-to-work algorithms.

Disclosures

All Authors: No reported disclosures
1353. Safety of AZD7442 (Tixagevimab/Cilgavimab) for Post-exposure Prophylaxis of COVID-19: Final Analysis of the STORM CHASER Phase 3 Study
Authors: Levin Myron J , Ustianowski Andrew , Thissen Jesse , Seegobin Seth , Beavon Rohini , Dey Kanika , Kelly Elizabeth J , Near Karen A , Streicher Katie , Kiazand Alexandre , Esser Mark T
Published: November 2023

Background

In the STORM CHASER phase 3 post-exposure prophylaxis study, 300-mg intramuscular (IM) AZD7442 (tixagevimab/cilgavimab) reduced symptomatic COVID-19 by 33.3% vs placebo at primary analysis (P=0.212; median follow-up: 183 days) and was well tolerated. We report final safety data from STORM CHASER.

Methods

In STORM CHASER (NCT04625972), adults without prior SARS-CoV-2 infection or COVID-19 vaccination were enrolled within 8 days of exposure to a SARS-CoV-2–infected individual and randomized 2:1 to receive a single intramuscular dose of 300-mg AZD7442 (N=749) or placebo (N=372). Results are reported from the November 12, 2022 final data cut-off. The primary safety endpoint was assessment of adverse events (AEs), serious adverse events (SAEs), medically attended AEs (MAAEs), and AEs of special interest (AESIs). AESIs included injection site and hypersensitivity reactions. Efficacy data have previously been reported.

Results

Across both the AZD7442 and placebo groups, 928 (82.1%) participants completed the study. Median follow-up was 455 days (∼15 months) in both groups. AEs occurred in 46.5% and 51.9% of participants administered AZD7442 and placebo, respectively (Table). Most AEs were mild to moderate in severity; 30 (4.0%) and 26 (7.0%) of participants in the AZD7442 and placebo groups, respectively, reported an AE of grade 3 (severe) or higher. SAEs occurred in 2.7% and 4.3% of AZD7442 and placebo participants, MAAEs in 12.7% and 14.0%, AESIs in 0.5% and 1.1%, and deaths in 0.4% and 0.5%, respectively.

Conclusion

These findings support the long-term safety of AZD7442.

Disclosures

Myron J. Levin, MD, Dynavax: Advisor/Consultant|GSK: Advisor/Consultant|GSK: Grant/Research Support|GSK: Data safety monitoring/Advisory board|Johnson & Johnson: Grant/Research Support|Merck & Co.: Advisor/Consultant|Moderna: Grant/Research Support|Novavax: Grant/Research Support|Pfizer: Advisor/Consultant|Seqirus: Advisor/Consultant Andrew Ustianowski, MD, PhD, Gilead: Honoraria|Gilead: Advisory Board|GSK: Honoraria|Janssen: Honoraria|Merck: Honoraria|Merck: Advisory Board|Sanofi: Honoraria|ViiV Healthcare/GSK: Advisory Board Jesse Thissen, MSc, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Seth Seegobin, PhD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Rohini Beavon, PhD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Kanika Dey, MSc, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Elizabeth J. Kelly, PhD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Karen A. Near, MD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Katie Streicher, PhD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Alexandre Kiazand, MD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds Mark T. Esser, PhD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds
1359. Understanding Data Completeness from Sites Participating in the N3C Limited Data Set
Authors: Koren Yuval , Aggarwal Shivani , Poscover Daniel , Barr Charles
Published: November 2023

Background

Numerous data sources such as registries utilize data collected across multiple sites, typically across a geographic region. Understanding the degree to which individual sites contribute core data components such as diagnoses, treatments, procedures, and measurements, is an essential step when conducting analyses using a multi-site database. The National COVID Cohort Collaborative (N3C) is the largest repository of deidentified clinical data from 18.9 million patients tested for or diagnosed with COVID-19 in the United States, and has been cited in over 150 publications, preprints, and presentations. Data is systematically collected across electronic health records from multiple sites and harmonized into the OMOP Common Data Model (CDM). Here, we aim to describe data completeness from participating sites using the N3C Level 3 Limited Data Set.

Methods

Key OMOP CDM data tables (measurement, drug_exposure, condition_occurrence, and procedure_occurrence) from two N3C data releases six months apart (August 2022 and February 2023) were assessed. A site was considered to contribute to a key data table if a threshold of at least 1,000 records and lag of no more than 5 months within 6 months prior to the data release date through the data release was observed for that site. Records with dates after the data release date or with missing dates were not included. The proportion of sites with data in at least one key table and data in all key tables in the August 2022 and February 2023 data releases was determined.

Results

Of the 77 sites identified in the N3C Limited Data Set in August 2022, 76.6%-83.1% had data in at least one key table and 75.3% (N=58) had data in all four key tables. A drop of 6.8% in the number of sites with data in all 4 key tables was observed in the February 2023 data release. The condition_occurrence table was most impacted by site attrition (12.5%) between these data releases, while the drug_exposure was the least impacted (3.2%).

Conclusion

We observed a minor heterogeneity and a high proportion of sites contributing key data tables through the two N3C data releases under investigation. Assessing such sites characteristics during the study design phase may be an essential step when designing high-quality real-world studies that utilize multi-site data.

Disclosures

Yuval Koren, MSc, AstraZeneca: Grant/Research Support Daniel Poscover, MBA, AstraZeneca: Grant/Research Support Charles Barr, MD, MPH, AstraZeneca: Grant/Research Support
1360. Remdesivir in COVID 19 patients with kidney disease: A study on the renal function and outcomes
Authors: Barez Marie Yvette , Lagura C R Y S T A L F A Y E G , Ivy Leano-Togonon Jennifer
Published: November 2023

Background

The COVID-19 pandemic has high mortality rates in patients with kidney disease. Remdesivir, an antiviral nucleotide prodrug, showed to shorten time to recovery in adults hospitalized with COVID 19. However, individuals with kidney disease were not included in clinical trials, thus when emergency use authorization was granted, it was recommended to avoid use in patients with eGFR < 30mL/min “unless benefit outweighs the risk”. In this study, we aim to determine the effect of Remdesivir on renal function and outcomes among COVID19 patients with kidney disease.

Methods

This retrospective study included the following: >18 years old, RT-PCR confirmed COVID19 infection treated with Remdesivir and who were confirmed to have kidney disease.

Results

There were 106 patients included; the mean age was 62.25±13.96 years old, more than half of the population were males (53%). The majority of the population had acute kidney injury (70.7%) while the rest had chronic kidney disease and 25% underwent renal replacement therapy. Most of them were classified as severe (66%) and critical (25%) COVID infection.

To determine effects on renal function laboratory parameters were determined at baseline and after completion of treatment. There was an overall significant improvement in eGFR (< 0.01), albuminuria (0.013) and in acid-base balance (0.003) and odds ratio showed that none of the demographic, clinical and laboratory profile significantly increased the chance of death in terms of overall clinical outcome.

In terms of overall clinical outcome, this study had a mortality rate of 4.9% as 5 out of 106 patients expired.

Conclusion

Use of Remdesivir in patients with kidney disease was not associated with renal function deterioration. Contrary to concerns there was rather an overall significant improvement in eGFR, degree of albuminuria and acid-base balance after treatment regardless of their disease severity and its use in patients on hemodialysis have not shown any detrimental impact on mortality.

Disclosures

All Authors: No reported disclosures
1364. Association Between Tixagevimab/Cilgavimab Administration and Self-Reported SARS-CoV-2 Infection During the Omicron Surge
Authors: Mathew Daniya S , Saunders-Hao Patricia , Jain Sumeet , Ball Trever , Abel-Bey Amparo , Bowman Keisha , Gandhi Shivanthidevi , Gautam-Goyal Pranisha , Brown Zenobia
Published: November 2023

Background

Immunocompromised patients are at high risk for COVID-19 morbidity and mortality. While findings from the PROVENT study led to emergency use authorization of tixagevimab/cilgavimab (TC) for pre-exposure prophylaxis, less is known of its protection in vaccinated immunocompromised patients against the SARS-CoV-2 Omicron variants and subvariants. The purpose of this study was to evaluate association between TC and self reported SARS-CoV-2 infection during the Omicron variant surge in vaccinated immunocompromised persons.

Methods

This was a retrospective study that surveyed and evaluated electronic health records of patients who received TC between January 2022-November 2022. TC’s protection against SARS-CoV-2 infection was evaluated preliminarily by average monthly infection rates before and after the BA.5 variant was regionally predicted to be < 50% of infections (October 29, 2022). Multivariate logistic regression was used to determine odds of infections during 4 months before and 4 months after subvariants, while controlling for age, race, gender, vaccination status, and immunocompromised conditions.

Results

43% (126/293) of recruited patients completed the study’s survey. All patients were vaccinated with at least primary series for SARS-CoV-2 infection. A majority were female (53.2%), > 65 yrs (61.1%), White (70.4%), and immunocompromised with solid malignancy (61.1%). Average monthly infection rate during the BA.5 variant was 4.4% and after was 12.1%. Patients who received a vaccine booster twice were 68% less likely to be infected prior to Omicron subvariants compared to those who only received their primary vaccination series (OR=0.32; p=0.10). During this period, patients with rheumatoid arthritis were 5.6 times more likely than patients with solid malignancy to be infected (OR=5.64; p=0.07). During Omicron subvariants, patients with Lupus were most likely to be infected compared to patients with solid malignancy, but not statistically significant (OR=1.78; p=0.69).

Conclusion

In the presence of changing vaccine coverage, therapies, and changing variants, the effectiveness of TC in the Omicron era is difficult to assess. These preliminary findings describe a real world snapshot of SARS-CoV-2 infections in high-risk patients who received TC.

Disclosures

All Authors: No reported disclosures
1368. In-hospital and post-discharge mortality among adults with COVID-19 associated hospitalization, COVID-NET, March 2020–April 2021.
Authors: Patel Kadam , Kirley Pam Daily , Kawasaki Breanna , Meek James , Openo Kyle P , Monroe Maya , Henderson Justin , Lynfield Ruth , Sosin Daniel M , Rowe Adam , Bushey Sophrena , Shiltz Eli , Sutton Melissa , Keipp Talbot H , Swain Ashley , Whitaker Michael , Taylor Christopher , Havers Fiona P
Published: November 2023

Background

Since the COVID-19 pandemic began in 2020, > 1 million persons have died in the US due to COVID-19. While various research illustrated in-hospital mortality in detail, post-discharge mortality has not been well described. Data from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) were used to describe in-hospital and post-discharge mortality among adults hospitalized with COVID-19 in the US during the first year of the pandemic.

Methods

COVID-NET is a population-based surveillance system in 14 states that captures laboratory-confirmed COVID-19-associated hospitalizations, defined as any patient residing in the catchment areas with a positive SARS-CoV-2 test during hospitalization or ≤ 14 days prior to admission. Detailed chart reviews were conducted by trained surveillance officers on a representative sample stratified by age group, state, and month. Cases were linked to death certificate data to identify those who died ≤ 60 days after hospital discharge. Data were restricted to adults ages ≥ 18 years admitted from March 2020–April 2021. Proportions of mortality and hospitalization rate (per 100,000) were calculated by month to investigate trends in adults aged ≥ 75 years.

Results

176,044 hospitalized adults met the COVID-NET case definition during the study period; 26,149 underwent full chart review. Overall, 9.7% died in-hospital and 6% died post-discharge; among those ≥ 75 years, these proportions were 18.1% and 16.2%, respectively (Figure 1). Among adults who died post-discharge, 47.5%, 33.1% and 28.3 were discharged to another facility, hospice, and private residence +/- services, respectively. Post-discharge mortality among those ≥ 75 years exceeded in-hospital mortality during October 2020 and December 2020 – February 2021. Hospitalization rates among those ≥ 75 years peaked in December 2020; the following month, January 2021, had the highest proportion of post-discharge mortality (22.6%) in this age group (Figure 2).

Mortality among hospitalized adults ages ≥18 years with laboratory-confirmed COVID-19, COVID-19-Associated Hospitalization Surveillance Network, March 2020–April 2021

Figure 1

Hospitalization Rate and Mortality among laboratory-confirmed COVID-19 among adults ages ≥75 years, COVID-19 Associated Hospitalization Surveillance Network, March 2020–April 2021

Figure 2

Conclusion

Among all deaths in adults with a COVID-19-associated hospitalization, two-thirds occurred in-hospital and one-third occurred ≤ 60 days post-discharge. Increases in post-discharge mortality followed a period of high COVID-19-associated hospitalization rates among ≥ 75 years.

Disclosures

All Authors: No reported disclosures
1374. Foodborne disease outbreak at a delivery pizza and sushi restaurant, Kazakhstan, 2023
Authors: Ablimitova Feruza , Balmagambetov Arystan , Horth Roberta , Nabirova Dilyara
Published: November 2023

Background

On February 3, 2023, the Kazakhstan Ministry of Health was notified of 71 hospitalized cases of acute gastointestinal illness among people who had ordered food from a delivery sushi and pizza restaurant in Talgar (population=50,000). We conducted an investigation from February 4 to 16 to identify risk factors.

Methods

We conducted a retrospective cohort study among people who consumed food from the sushi bar from January 31 to February 1, 2023. To find additional cases, we used a line list of orders made by customers provided by the restaurant. We interviewed customers by telephone and face-to-face. Patient gastric samples and food samples were submitted for microbial testing. We conducted an environmental assessment. We performed Poisson logistic regression using R software.

Results

Of 381 people identified, 364 were interviewed, of which 215 (59%) had become ill. Main symptoms were abdominal pain (98%), diarrhea (94%), nausea (94%), headache (91%), chills (82%), fever (81%), and vomiting (55%). Mean illness duration was 4 days (range=1-8). Mean onset time was 34 hours (range=6-91 hours) and 33% were hospitalized. Risk of illness was significantly higher among people who ate Caesar sushi rolls (1.55, 95% confidence interval [CI]=1.18-2.04), chicken and mushroom pizza (1.74, CI: 1.16-2.5), and "American" pizza (1.59, CI: 1.21-2.09). Among people who became ill, 60% had eaten Caesar sushi rolls and 40% american pizza. Attack rate was highest among those who had chicken pizza (97%). There was no common ingedient identified in the three foods. E.coli at concentration 103 and Enterococcus spp. were detected in Caesar rolls. Of 22 gastric samples tested, B. cereus was detected in 45%, Enterococcus in 50%, E. coli in 23%. Environmental assessment found several food safety violations including improper storage conditions, prepared foods being stored with raw materials, and missing or expired workers' health and food certifications.

Factors associated with acute gastrointestinal illness, Talgar, Kazakhstan, 2023

Conclusion

Because multiple pathogens were detected in food and patient samples and disease was associated with multiple foods, we suspect that food contaminated at different points in the preparation process was likely the source of the outbreak. The restaurant was closed and sanitized. We made recommendations to improve food handling and safety practices.

Disclosures

All Authors: No reported disclosures
1375. Strengthening Global Capacity to Detect Antimicrobial Resistance Threats
Authors: Benoit Tina , Aubert Rachael , Clemente Jacob , Sievert Dawn
Published: November 2023

Background

Antimicrobial resistance (AR) poses a major global threat, with a reported 1.27 million deaths in 2019. This resulted in years of life lost as well as a large burden on the healthcare system. Transmission of resistant pathogens is not limited to one geographic area and can easily be influenced by international travel and trade of food and other products. Addressing the global threat of AR is recognized as a major action item within the U.S. National Action Plan for Combating Antibiotic Resistant Bacteria. In 2021, the Centers for Disease Control and Prevention (CDC) established the Global Antimicrobial Resistance Laboratory and Response Network (Global AR Lab & Response Network). The network provides financial and technical support to partners, with a focus on detecting and monitoring existing threats, identifying risk factors, preventing and controlling spread, and mitigating the emergence of new threats.

Methods

In just over 2 years, CDC has invested more than $40 million through the Global AR Lab & Response Network on projects with more than 20 organizations in nearly 50 countries. Using a multi-pathogen approach, the network focuses on healthcare-associated, sexually transmitted, fungal, enteric, and invasive bacterial and respiratory pathogens.

Results

CDC’s Global AR Lab & Response Network is strengthening capacity to detect and respond to AR threats identified in the CDC 2019 AR Threats Report. Accomplishments include implementing trainings for high quality laboratory methods; monitoring resistance in bacteria and fungi to inform on changes in resistance and improve interventions; training and implementing activities to prevent, detect, and respond to AR in healthcare settings; and enhancing data sharing nationally, regionally, and globally.

Conclusion

Through this innovative approach with plans for expansion, the Network will continue to use a One-Health methodology to focus on enhancing global capacity to quickly detect AR threats and built upon existing laboratory and response efforts. Findings from these projects will also inform intervention strategies to address current and future AR threats.

Disclosures

All Authors: No reported disclosures
1378. Seroprevalence and risk factors for cysticercosis in Mexican-Americans in Starr County, Texas
Authors: Duffey Megan M , O’Connell Elise M , Leining Lauren M , Tang Nina L , Hanis Craig L , Brown Eric L , Gunter Sarah M
Published: November 2023

Background

Neurocysticercosis (NCC) is a parasitic infection caused by the tapeworm Taenia solium, and is a leading cause of epilepsy and chronic headaches in endemic areas including Latin America, Africa, and Asia. The epidemiology of NCC has not been well-studied in the United States to date, but small epidemiological studies suggest evidence of this disease in populations living in poverty and who have immigrated from an endemic region. There is a population living in Starr County, Texas along the Texas-Mexico border in whom the presence of other neglected tropical diseases has been demonstrated due to the intersection of poverty, climate, and high rate of immigration.

Methods

Our study was a serologic survey and risk factor analysis of cysticercosis in a pre-existing cohort of Mexican-Americans in Starr County, Texas. We used a triplex enzyme-linked immunoassay (ELISA) against cysticercosis-specific antigens and self-reported survey data and neighborhood-level variables to conduct a risk-factor analysis of seropositive participants.

Results

We identified an overall seropositivity to T. solium in 7.4% (45/605) of the cohort which likely represents a combination of parasite exposure, T. solium disease outside of the central nervous system, old calcified NCC, and viable or degenerating NCC. Female gender, specific occupation and indoor versus outdoor occupation were found to be significantly associated with cysticercosis seropositivity. Thirty-nine of the 45 seropositive participants were female (p 0.021), 26 were employed in healthcare, caregiving, or social service (p 0.009), and 42 were employed in an indoor occupation (p < 0.001). These occupations could pose a risk for T. solium transmission. A geospatial analysis of cases at the census tract level showed increased percentage of seropositivity centered around urban cities Rio Grande City and Roma, as well as smaller city La Grulla and census-designated place Alto Bonito.

Conclusion

There is a critical need to investigate these cysticercosis-seropositive cases with brain imaging to evaluate for neurocysticercosis, as well as conduct an epidemiological investigation to determine disease transmission in Starr County.

Disclosures

All Authors: No reported disclosures
1381. Barriers and Facilitators to Prompt Diagnosis of Tuberculosis in Lima, Peru
Authors: Geadas Carolina , Millones Ana Karina , Acosta Diana , Farroñay Sheyla , Torres Isabel , Jimenez Judith , Lecca Leonid , Yuen Courtney
Published: November 2023

Background

Tuberculosis (TB) infectiousness decreases significantly with only a few days of therapy, but delayed diagnosis often leads to late treatment initiation. We conducted a sequential explanatory mixed-methods study to understand the barriers and facilitators to prompt diagnosis and identify areas for improvement.

Methods

We enrolled 100 adults who started TB therapy in the Carabayllo district of Lima, Peru, between November 2020 and February 2022 and administered a survey about their symptoms and healthcare encounters. We calculated the time from symptom onset to first healthcare visit and to diagnosis. We conducted semi-structured interviews of 26 participants who had a range of delays, investigating their experiences navigating the health system. Interview transcripts were inductively coded for concepts related to diagnostic barriers and facilitators and suggestions for improvement.

Results

Overall, 38% of patients sought care from public facilities and 42% from the private sector. Only 33% reported being diagnosed with TB on their first visit. The median total diagnostic delay was 9 weeks (interquartile range [IQR] 4–22), with a median of 4 weeks (IQR 0–9) before contact with the health system and of 3 weeks (IQR 0–9) after. There was a median of 3 (IQR 2–4) health visits before diagnosis. Several factors contributed to a delayed diagnosis. Many patients attributed their symptoms to an alternative cause or had misconceptions about the disease, and often postponed seeking care. Once they sought care, the vast majority of patients had multiple encounters, sometimes alternating between the public and private sectors. Having a referral document and being seen by a pulmonologist often expedited the diagnosis. Several patients identified a need for more education about the disease through community campaigns and for better access to pulmonologists.

Factors impacting the time to diagnosis of tuberculosis in the Carabayllo district of Lima, Peru

Conclusion

We identified important diagnostic delays related to both patient- and health system-associated factors. Misinformation about TB, poor accessibility of health services, and the need for multiple encounters to obtain diagnostic tests were major factors leading to delays. Better strategies for community education and integration between the public and private sectors should be priorities in the efforts to combat TB.

Disclosures

All Authors: No reported disclosures
1383. Malaria Prophylaxis Use In a Travel Clinic, How Are We Doing?
Authors: Hogan Dennis , Bishburg Eliahu , Suryadevara Madhu
Published: November 2023

Background

Malaria chemoprophylaxis is indicated for travelers going to geographic areas designated as endemic for malaria. Often persons traveling to their native countries where malaria is present consider themselves immune and decline chemoprophylaxis. This study aimed to evaluate malaria chemoprophylaxis utilization in a travel clinic and whether it is correlated with the patient’s native place.

Methods

A retrospective study of patients attending a travel clinic between 2021 to 2023. Data were extracted on demographics, trip destinations, trip duration, and, malaria chemoprophylaxis prescribed. Pharmacies were contacted to verify prescription filling. Patients admitted with malaria were analyzed at the same time period. Comparison between groups was made using a chi-square test. p < 0.05 is considered significant.

Results

One hundred patients were included. Median age 55.5 years (21-80). 62 % (62) were females while 38% were males. There were ninety-four 94 travelers to Africa, 6 to South America, and 1 to Asia. Of the travelers, 44 were US natives while 56 were non-US natives. The median trip duration was 14 and 15 days among US and non-US natives respectively. All 100 patients received prescriptions for malaria prophylaxis: Atovaquone/Proguanil was prescribed to 94, while 6 were given mefloquine. Of the 100 prescriptions, 58 were filled. Of the 44 travelers who were US natives,33/44 (75 %) filled their prescriptions. Among the 56 non-US natives, 25/56 (44 %) filled prescriptions, p -0.002. During the study period, 10 patients (6 females and 4 males) were admitted with a diagnosis of malaria in returning travelers, median age of 54.5 years. The median trip duration was 19 days. All were non-US natives returning from Africa (Nigeria, Ghana, Guinea, and Mali). Only 1/10 patients took mefloquine chemoprophylaxis. All the patients were treated successfully without sequelae.

Conclusion

In our travel clinic malaria chemoprophylaxis was prescribed to all patients as indicated, US native patients filled their prescriptions significantly more than nonnative patients. Malaria in returning travelers was diagnosed exclusively in non-US natives who did not take malaria chemoprophylaxis.

Disclosures

All Authors: No reported disclosures
1384. Verbal Autopsy as a Tool to Identify Probable Cause of Death in People with Acute Febrile Illness in Zambia — January 2020-December 2022
Authors: Hooker Katie R , Kapombe Priscilla , Silver Rachel , Ciuba Chandler , Cheelo Mweene , Moyo Saviour , Mulenga Lloyd , Rao Carol Y , Hines Jonas
Published: November 2023

Background

Acute febrile illness (AFI) surveillance improves a country’s understanding of what diseases are circulating. However, fever as an entry point for patient identification casts a wide net that will likely capture non-infectious causes of AFI. We used mortality surveillance data to examine probable causes of death (CoD) potentially associated with AFI to expand our understanding of febrile illness in Zambia.

Methods

The Zambian Ministry of Health provided verbal autopsy (VA) data from 27 (of 117) districts representing ∼50% of Zambia’s population. The World Health Organization’s standardized tool for VA was used by hospital staff to interview relatives or close associates of deceased persons of all ages on clinical presentation and circumstances prior to death. The InterVA-5 validated computer algorithm provided a CoD. Using questionnaire data, we applied an AFI case definition based on common global AFI surveillance criteria: a febrile person with a fever duration of < 1-14 days and a mild, moderate, or severe fever classification (in lieu of a temperature cutoff). We analyzed the CoDs and SARS-CoV-2 infections among those that met our AFI case definition in R.

Results

From January 2020 to December 2022, 51,751 VAs were conducted on people over 28 days old–14,503 (28%) reported fever prior to death, of which 12,071 (23%) met our AFI case definition. Broadly, we found that 64% of those that met our AFI case definition had an infectious CoD, 32% had a non-communicable CoD, and 4% had other CoDs. Specifically, the most reported CoDs were acute respiratory infection (14%), diarrheal disease (11%), and HIV/AIDS (10%). A positive SARS-CoV-2 test was reported in 965 (8%) persons with AFI versus 1,876 (5%) without AFI (p< 0.001).

Conclusion

AFI-associated deaths were primarily attributable to infectious disease, as identified through VA. AFI is one approach for multi-pathogen surveillance that provides valuable insight into circulating diseases, including SARS-CoV-2, but findings are limited by which pathogens are targeted for testing. Mortality surveillance is a valuable supplementary data source when attempting to understand inconclusive findings in AFI surveillance and aids in a country’s understanding of common causes of febrile illness not captured through AFI surveillance diagnostics.

Disclosures

All Authors: No reported disclosures
1389. Parasitic Diseases Surveillance in Kazakhstan: Incidence Trends and Future Projections
Authors: Kirpicheva Ulyana , Shapiyeva Zhanna
Published: November 2023

Background

The COVID-19 pandemic has had a significant impact on healthcare systems worldwide, leading to a weakening of surveillance for parasitic diseases during quarantine measures in many countries. In 2022, this effect was observed in the Republic of Kazakhstan, where a significant increase in parasitic diseases was reported.

Methods

The prediction of parasitic incidence was carried out based on official statistical data on the incidence of the population of Kazakhstan from 2011 to 2022. Exponential smoothing was used for incidence forecasting with 95% CI. Forecasts were carried out for echinococcosis, opisthorchiasis, ascariasis, enterobiasis, and giardiasis.

Results

In 2022 there was a significant increase in parasitic diseases among the population of the Republic of Kazakhstan, with a total of 9,026 cases registered. Most cases were helminthiasis, accounting for 85% of all cases, while intestinal protozoal invasions accounted for 15%. The most prevalent parasitic diseases were enterobiasis, with an incidence rate of 24.9 per 100,000, followed by giardiasis with a rate of 6.8 per 100,000. Echinococcosis had an incidence rate of 3.9 per 100,000, while ascariasis and opisthorchiasis had rates of 6.4 and 2.5 per 100,000, respectively (Figure 1).

However, the expected incidence rates for parasitic diseases in 2023-2025 are projected to be lower than the long-term average incidence. There will be a significant decrease in the incidence rate of opisthorchiasis and enterobiasis. In 2023, the incidence rate of opisthorchiasis is expected to be 1.45 per 100,000, while the incidence rate of enterobiasis will be 12.1 per 100,000. This trend is projected to continue in 2024-2025 (Table 1).

Conclusion

As negative trends in parasitic diseases are observed, it is crucial to remain vigilant and take proactive measures to prevent the spread of these diseases. Following the results, additional measures were taken in the Republic of Kazakhstan to prevent echinococcosis and opisthorchiasis, such as strengthening the interdepartmental commission and enhancing epidemiological surveillance. It is essential to continue monitoring the situation and take proactive measures to prevent the spread of parasitic diseases.

Disclosures

All Authors: No reported disclosures