bluuebunny/crossref_metadata_2025_split huggingface dataset:
1379. Caregiver Burden related to Rotavirus Gastroenteritis: a systematic literature review
Authors: Carias Cristina , Hu Tianyan , Chen Ya-Ting 
Published: January 2021

Abstract

Background
The health and economic impact of rotavirus gastroenteritis (RGE) is well researched, but the burden of RGE on caregivers and remaining family spillover effects has only been recognized recently. Efforts to quantify caregiver burden allow for a more holistic understanding of RGE’s disease burden; such an understanding is relevant when evaluating interventions to diminish RGE. In this review, we identified the methods used to quantify caregiver burden of RGE and summarize the findings.

Methods
We performed a systematic literature review on caregiver and family burden of RGE using PubMed and Scopus, combining MESH and free-range terms. We selected studies that estimated or conveyed the impact of RGE on the family via interviews, and administration of surveys or instruments. We focused on the caregiver and family’s subjective experience and included studies that quantified caregiver associated disutility weights, reports, stress, or emotional outcomes.

Results
After compiling the results of our search, we selected 10 publications (Figure 1). Four studies used the EQ-5D and the VAS to measure caregiver burden (Table 1). Caregiver utility at time of illness varied between 0.61 (caregivers of hospitalized children, Thailand), and 0.88 (caregivers of children enrolled at outpatient clinics, Canada). Caregiver burden was also measured in Spain (2 studies), Italy (3 studies), Belgium, France, Germany, Latvia, Poland, United States, Sweden, Taiwan and Vietnam, via stress scales (2 studies), especially designed questionnaires (2 studies), and interviews (2 studies). Using a questionnaire, RGE was found to disrupt family activities, cause stress and worry on caregivers; a 10-point stress scale revealed high levels of stress among caregivers in other countries. Using different instruments, the impact of RGE was found to increase with the severity of RGE.
Results of the systematic literature review on caregiver burden.

Caregiver utility for caring for patients with Rotavirus Gastroenteritis (RGE) obtained using the EQ-5D and the Visual Analogue Scale (VAS).

Conclusion
RGE in infants was found to significantly disrupt the quality of life of caregivers, and to impact family activities and routine. Methods to quantify caregiver burden vary often without a validated disease-specific instrument which hinders comparison between different countries and incorporating the results in economic models.

Disclosures
Cristina Carias, PhD, Merck (Employee, Shareholder) Tianyan Hu, PhD, Merck (Employee, Shareholder) Ya-Ting Chen, PhD, Merck & Co., Inc. (Employee, Shareholder)
1381. Rotavirus Gastroenteritis among older adults: discussion based on a systematic literature review
Authors: Carias Cristina , Hartwig Susanne , Kanibir M Nabi , Chen Ya-Ting 
Published: January 2021

Abstract

Background
While the burden of Rotavirus Gastroenteritis (RGE) is well recognized in young children, it is less so in older adults. However, older adults are also at high-risk of Acute Gastroenteritis (AGE) severe outcomes. In this review, we thus aimed to comprehensively assess RGE burden and vaccination impact in older individuals.

Methods
We performed a systematic literature review with PubMed and Scopus, from 2000 to 2019, using MESH and free-range terms. We included only studies that reported the incidence, and/or RV vaccination impact, in adults aged 60 and above and using regional specific data-sources.

Results
We analyzed 11 manuscripts for individuals aged 60 and above (Figure 1). Studies spanned Australia, Sweden, Netherlands, Canada (2), Germany (2), UK (2), and the US (2). Yearly inpatient RV incidence varied between 1.6 per 100,000 in Australia for those 65+ (retrospective database analyses, pre-vaccine); and 26 per 100,000 for those 85+ in Canada (modeling estimates for 2006-10, pre-vaccine). The incidence rate ratio for inpatient RGE between the post and pre-vaccine periods for those 65+ was 0.57 [95% CI: 0.10 – 3.15] in Canada, but 2.24 [95%CI: 1.78-2.83] in Australia, which may be due to increased testing for RV in the elderly post-vaccine. Reductions in the post-vaccination burden of RV and AGE among 60+ were reported in the UK (2 studies), and the US (2 studies) via retrospective database analyses In the UK, post-vaccine reductions in AGE health care-utilization were reported in the Emergency Department (21%), and outpatient centers (walk-in centers: 47%; general practice consultations: 36%).
Retrospective database analyses documenting the incident rate ratio (IRR) of Rotavirus Gastroenteritis (RGE) and Acute Gastroenteritis (AGE) in older adults between the pre and post-vaccine period.

Retrospective database analyses documenting the incident rate ratio (IRR) of Rotavirus Gastroenteritis (RGE) and Acute Gastroenteritis (AGE) in older adults between the pre and post-vaccine period.

Conclusion
While the burden of RGE mainly falls on young children, it also affects older adults. Retrospective database analyses reveal that, likely due to indirect vaccination benefits, increases in RV vaccination coverage have had an impact on lowering RGE, and AGE cases and healthcare utilization in older adults, a group at high-risk of severe outcomes for AGE.

Disclosures
Cristina Carias, PhD, Merck (Employee, Shareholder) Susanne Hartwig, n/a, MSD Vaccins (Employee) M.Nabi Kanibir, MD, Merck/MSD (Employee, Shareholder) Ya-Ting Chen, PhD, Merck & Co., Inc. (Employee, Shareholder)
1387. Current practices in the diagnosis and treatment of varicella infections in the United States
Authors: Fergie Jaime , Pawaskar Manjiri D , Veerkani Phani , Samant Salome , Harley Carolyn , MacEwan Joanna , Schwartz Taylor T , Surati Shikha , Conway James H 
Published: January 2021

Abstract

Background
The Advisory Committee on Immunization Practices recommended a 1 dose varicella immunization program in 1996, expanding this to include 2 doses in 2006. As a result, more than 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented annually in the United States. Since varicella infections have become uncommon, the response of health care providers (HCPs) to patients presenting with varicella symptoms may result in misdiagnosis and/ mistreatment. This study investigated the diagnostic and treatment strategies used by HCPs for managing varicella infections in US children.

Methods
An online cross-sectional survey of licensed HCPs was conducted, after an Institution review board approval and HCP consent. 8 clinical vignettes with information on patients with varying varicella symptoms (representing uncomplicated and complicated cases) were presented. For each vignette, HCPs selected a diagnosis and appropriate intervention(s) from pre-determined lists. Descriptive analyses were performed.

Results
A total of 153 HCPs (50 nurses, 103 doctors) completed the survey. Mean age was 44 years, 62% were female, and 82% were licensed after 1995. Varicella infection was correctly diagnosed 79% of the time. HCPs were able to recognize uncomplicated cases of varicella 85% of the time and complicated cases 61% of the time. HCPs recommended the correct intervention 43% of the time for uncomplicated cases and 25% of the time for complicated cases. For example, HCPs recommended antibiotics 17% of the time and/or antivirals 18% of the time (Table 1), of which 25% and 69% (respectively) were not appropriate per the American Academy of Pediatrics guidelines respectively. Antibiotics were incorrectly recommended 6% of the time for uncomplicated cases of varicella.
Table 1. Additional Diagnosis & Treatment Results

Conclusion
Given the low incidence of varicella infections in the US, complicated cases of varicella may be under-recognized or inappropriately treated by some HCPs. Additional training may help HCPs better recognize/ treat cases of varicella. Further, ensuring high rates of varicella vaccination is important to avoid vaccine preventable conditions and to minimize unnecessary exposure to antimicrobial and antiviral therapies.

Disclosures
Jaime Fergie, MD, AstraZeneca (Speaker’s Bureau)Sobi, Inc. (Speaker’s Bureau) Manjiri D. Pawaskar, PhD, Merck & Co., Inc (Employee, Shareholder) Phani Veerkani, MD, DrPH, Merck (Research Grant or Support) Salome Samant, MBBS, MPH, Merck & Co., Inc., Kenilworth, NJ, USA (Employee, Shareholder) Carolyn Harley, PhD, Merck (Consultant) Joanna MacEwan, PhD, PRECISIONheor (Employee) Taylor T. Schwartz, MPH, Merck (Consultant, Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Shikha Surati, MPH, Merck & Co., Inc. (Employee, Shareholder)
112. Impact of Respiratory Viral PCR Panels (RVP) and Serum Procalcitonin (PCT) on Antibiotic Days of Therapy (DOT) in Patients Admitted with Lower Respiratory Tract Infections (LRTI)
Authors: Bilinskaya Anastasia , Kuti Joseph L , Linder Kristin 
Published: January 2021

Abstract

Background
IDSA advocates for the use of RVP and PCT to reduce inappropriate antibiotic use. These assays were implemented in our health system without formal antimicrobial stewardship intervention. Herein, we evaluated assay utilization and impact on antibiotic DOT in patients admitted with LRTI.

Methods
Records of patients admitted to our health system in January 2019 with a diagnosis of LRTI (ICD 10 codes: J13-22, J44, or J85) were reviewed. Patients &lt; 18 years old, receiving active treatment at time of admission for a concurrent infection, or had a RVP or initial PCT ordered &gt; 48 hours from admission were excluded. Patients were cohorted based on at least one test ordered (VPPC) vs neither (CTRL). The primary endpoint was total antibiotic DOT, including inpatient and outpatient. Secondary endpoints were hospital length of stay (LOS), 30 day readmission (30DR), and all cause mortality (ACM). Multivariate linear regression was used to determine variables associated with DOT.

Results
Of 294 patients included, 15 (5.1%), 84 (28.6%), and 43 (14.6%) had RVP alone, PCT alone, or both ordered, respectively, resulting in 142 (48.3%) patients in the VPPC group. Providers modified therapy based on PCT and RVP results in 39.4% (50/127) and 33.3% (7/21) of patients, respectively. Median (IQR) DOT was similar between VPPC and CTRL groups (7 [5–9] vs 7 [3–8] days; p=0.159), respectively. Inpatient DOT (4 [2–5] vs 3 [2–4] days; p=0.001) and LOS (99.5 vs 81.7 hours; p=0.001) were longer in the VPPC group. VPPC patients were more likely to receive anti-pseudomonal B-lactams (anti-PSA) (26.8 vs 16.4%; p=0.044) and anti-MRSA antibiotics (45.1 vs 34.9%; p=0.096). No difference in 30DR (13.4 vs 15.1%; p=0.793) or ACM (2.1 vs 3.3%; p=0.794) was observed. Variables significantly associated with increased DOT were non-ICU admission, positive chest X-ray, LOS, younger age, and receipt of anti-MRSA or anti-PSA antibiotics.

Conclusion
Over one month, RVP or PCT was ordered in nearly half of admitted LRTI patients in our health system, but modification of therapy based on results was infrequent. The unrestricted use of these tests without stewardship intervention did not impact overall antibiotic DOT, LOS, 30DR, or ACM. These data emphasize the need for additional intervention to enhance the clinical utility of these tests.

Disclosures
Joseph L. Kuti, PharmD, Allergan (Speaker’s Bureau)bioMérieux (Research Grant or Support, Other Financial or Material Support, Speaker Honorarium)Melinta (Research Grant or Support)Merck & Co., Inc. (Research Grant or Support)Paratek (Speaker’s Bureau)Summit (Other Financial or Material Support, Research funding (clinical trials))
1389. Economic Evaluation of Universal Varicella Vaccination in Mexico
Authors: Chacon-Cruz Enrique , Meroc Estelle , Costa-Clemens Sue Ann , Verstraeten Thomas 
Published: January 2021

Abstract

Background
Universal varicella vaccination (UVV) has proven to be cost-effective in countries where implemented. However, this has not yet been evaluated for Mexico. We assessed the cost-effectiveness of UVV in the Mexican Immunization Program from both healthcare and societal perspectives.

Methods
The annual disease burden (varicella cases/deaths, outpatient visits, and hospitalizations) were derived from Mexican seroprevalence-published data adjusted to the 2020 country’s population. The annual economic burden was calculated by combining disease with Mexican published unit cost data. Four different vaccination strategies were evaluated: 1. One dose of a single varicella vaccine at 1 year old; 2. Two doses of single varicella vaccine at 1 and 6 years; 3. One dose of a single varicella vaccine at 1 year, and quadrivalent measles-mumps-rubella-varicella vaccine (MMRV) at 6 years; 4. Two doses of MMRV at 1 and 6 years.
We developed an economic model for each vaccination strategy where 20 consecutive birth cohorts were simulated. The impact of vaccination (number of avoided cases/deaths) was evaluated for a 20 years follow-up period based on vaccine effectiveness (87% and 97.4%), and assuming a 95% coverage. Subsequently, we estimated net vaccination costs, benefit-cost ratio (BCR), annual costs saved, cost-effectiveness ratio.

Results
From annual disease burden estimation, avoided cases with one dose, and two doses were of 20,570,722 and 23,029,751, respectively. From the 20 years cohort, the yearly number of varicella cases was estimated at 2,041,296, and total costs at $115,565,315 (USD) (healthcare perspective) and $165,372,061 (healthcare and societal perspectives). Strategies 1 and 2 were found to be cost-saving (BCR &gt;1) (Figure 1), and strategy 3 to be cost-effective (CE) ($1539 per Life Year Gained). Strategy 4 was not CE. Strategies 1 and 2 would allow saving annually $53.16 million and $34.41 million, respectively, to the Mexican society.
FIGURE 1

Conclusion
1.The disease and economic burden of varicella in Mexico are high.
2.UVV with four different vaccination strategies results in a high reduction of cases.
3.From healthcare and societal perspectives, UVV was shown to be cost-effective (with strategy 3), and cost-saving (with strategies using one dose or two doses separately).

Disclosures
All Authors: No reported disclosures
1391. Enhanced Education and Administration of Influenza Vaccine in a Pediatric Subspecialty Practice
Authors: McCarthy Carol A , Carson Leslie L , Russell George H , Lucas F L 
Published: January 2021

Abstract

Background
Strategies to increase influenza (flu) immunization rates are desirable. Some children who are at increased risk for severe disease may only be seen in a subspecialty office during the months when flu vaccine is offered. Subspecialists may also provide education for families that are uncertain about benefits of vaccines.

Methods
During the 2019- 2020 season, our multispecialty pediatric practice, which includes divisions of Endocrinology, Gastroenterology, Infectious Disease, Nephrology, Pulmonary, and Surgery, initiated a quality project to increase delivery of flu vaccine during visits. Beginning 10/1/19, providers were encouraged to use tools in the electronic medical record (EMR) to ask about flu vaccine status and administer if indicated and accepted. Flu immunizations given for all divisions, as well as individual divisions, were compared with the previous 2018–2019 season.

Results
From 9/1/19 -3/31/20, 615 doses of flu vaccine were administered for 5667 patients for a rate of 10.9 %. This was an increase from 9/1/18- 3/31/19 when 256 doses were given for 5760 patients (4.4%, p&lt; .0001). All divisions had a significant increase in flu vaccine rates except for infectious disease. Review of certain high risk disorders showed significant increased rates for diabetes and asthma but not for inflammatory bowel disease, HIV infection, chronic renal disease, or cystic fibrosis. During this project an EMR flu tool was not used for 1788 patients (32%). Of the remaining 3879 patients, 1982 (51%) reported prior receipt of flu vaccine and 579 (15%) were not eligible for state supplied vaccine. For 1318 eligible patients, flu vaccine was accepted by 631 (48%) and given to 615 patients. Flu vaccine was declined by 687 (52%) patients.

Conclusion
There is opportunity to provide education and flu vaccine during pediatric subspecialty visits. All specialties increased the number of flu vaccine given except for infectious disease. This is likely because this division has routinely offered flu vaccine and visits for travel declined in 2020. Although the practice overall gave more flu vaccine from the prior year, there appear to be missed opportunities. Further quality improvement work will strengthen the EMR flu screening tools to increase participation and learn more about why flu vaccine is declined.

Disclosures
All Authors: No reported disclosures
1395. Influenza B-Associated Pediatric Mortality in the US Between 2010 and 2019
Authors: Bandell Allyn , Piedra Pedro , Ambrose Christopher S , Jhaveri Ravi , Jhaveri Ravi 
Published: January 2021

Abstract

Background
To assess the contribution of influenza B to mortality in the US pediatric population, we analyzed the proportion of influenza-associated pediatric mortality attributed to influenza A and B over nine influenza seasons using national surveillance data. The effectiveness of influenza vaccines against influenza B in the pediatric population was also assessed.

Methods
The study period was the 2010/11 to 2018/19 influenza seasons. Proportions of circulating strains in the general population and influenza-associated pediatric mortality for each season were obtained from annual Centers for Disease Control and Prevention Morbidity and Mortality Weekly Reports on influenza. A Chi-squared test with Yates’ correction was used to assess the contribution of influenza B to pediatric mortality relative to its circulation among influenza viruses. Consolidated vaccine effectiveness (VE) against influenza B for inactivated influenza vaccine (IIV) in the 2010/11 to 2017/18 seasons and live attenuated influenza vaccine (LAIV) in the 2010/11 to 2015/16 seasons were obtained from a published meta-analysis and annual US Flu VE Network studies. There were no US data on LAIV VE for 2016/17 and 2017/18.

Results
During the 2010/11 to 2018/19 seasons, influenza B accounted for 4.0%–29.2% of all circulating influenza strains. A/H3N2 viruses were the predominant circulating strain in most seasons. In the same period, influenza B accounted for 7.0%–54.1% of pediatric influenza-associated mortality (Figure). The proportion of influenza B-related deaths was significantly higher (p&lt; 0.01) than what would have been expected based on the proportion of circulating influenza B strains in the general population, overall and in the 2010/11, 2012/13, 2016/17, and 2017/18 seasons. Point estimates of VE against influenza B for children aged 2–17 years ranged from 33%–70% for IIV between 2010/11 and 2017/18, and from 53%–82% for LAIV between 2010/11 and 2015/16.
Proportion of circulating influenza B strains compared with influenza B-associated pediatric mortality in the US between the 2010/11 and 2018/19 seasons

Conclusion
During the study period, influenza B accounted for a disproportionate percentage of pediatric mortality in the US relative to its overall circulation. These data counter the perception that influenza B is less severe than influenza A in children and highlight the importance of influenza vaccination to prevent influenza and its complications.

Disclosures
Allyn Bandell, PharmD, AstraZeneca (Employee, Shareholder) Pedro Piedra, MD, Roche (Consultant)Shionogi (Grant/Research Support) Christopher S. Ambrose, MD, MBA, AstraZeneca (Employee, Shareholder) Ravi Jhaveri, MD, AbbVie (Grant/Research Support)Alios (Research Grant or Support)Gilead (Grant/Research Support)Medimmune/AstraZeneca (Employee)Merck (Grant/Research Support)Saol Therapeutics (Consultant)Seqirus (Consultant)
1396. Live Virus Vaccination Following Pediatric Liver Transplantation: Results from Two Academic Children’s Hospitals
Authors: Newman Alexander M , Posch Leila C , Gianchetti Lauren , Rand Elizabeth B , Mohammad Saeed , Downes Kevin J , Muller William J 
Published: January 2021

Abstract

Background
Guidelines for immunization following solid organ transplantation discourage live virus vaccination (LVV) in most recipients. Single-center studies support LVV as safe and effective in orthotopic liver transplant (OLT) recipients on steroid-free immunosuppression (IS). We retrospectively evaluated LVV after OLT at 2 pediatric hospitals.

Methods
Records from OLT recipients between Jan 2007 and Dec 2017 at Lurie Children’s (Chicago) and Children’s Hospital of Philadelphia were reviewed. Patients who underwent OLT at either institution, had ≥ 2 years of follow up, and had documentation of vaccination prior to OLT were included. Adverse events (AEs) within two weeks of receipt of LVV were captured. Factors that might influence the selection of patients for LVV were reviewed, including choice, dose, frequency, and levels of IS medications. IS in non-vaccinated patients was compared to vaccinated patients at two year post-transplant follow-up in both groups using Chi-Square and T-test.

Results
Data from 249 patients met inclusion criteria. Varicella zoster (VZV) vaccine was given at least once to 92 patients post-transplant, and MMR to 91 (Table 1). Compared to patients who were re-vaccinated after transplant, those who received their first LVV after OLT were transplanted at a younger age (0.8 v 2.2 years) and received LVV sooner post-OLT (649 v 907 days). AEs were rare for either LVV: 2 experienced injection site reaction, 2 localized rash, and 1 had fever. One recipient experienced worsening rejection one month after MMR and received IV steroids and increased IS, but had no clinical findings concerning for viral infection from vaccination. Most LVV recipients were on a single IS agent both at time of LVV and 2 year post-OLT (Table 2), with tacrolimus the most frequent agent. Compared to those that did not received LVV post-OLT, those that did were on one IS agent more often. Tacrolimus levels were similar among patients receiving LVV post-OLT compared with those who did not.
Table 1

Table 2

Conclusion
In a series of pediatric OLT recipients, post-OLT LVV was generally safe and well tolerated. Patients who received LVV post-OLT were more often on one IS agent at 2 year follow up compared to those who did not. Our study supports prospective efforts to define guidelines for patients who may safely receive LVV after OLT.

Disclosures
Kevin J. Downes, MD, Merck, Inc. (Grant/Research Support)
1398. Maternal Knowledge and Perceptions about Routine Immunisation in a Slum Area of Pakistan
Authors: Mustafa Ghulam , Mustafa Abdul Mannan 
Published: January 2021

Abstract

Background
To know the baseline coverage and potential obstacles for children vaccination before starting a health awareness program.

Methods
A cross sectional study on immunization coverage in the slum area of Multan, Pakistan was conducted and a total of 312 mothers were interviewed face to face for Knowledge, Attitudes, and Perceptions (KAP).

Results
Among the children less than 3 years, 33 % fully, 46 % partially and 21 % were not at all immunized. High levels of BCG and OPV zero rates (79%) and low rates of OPV3/DPT3 (48%) and measles (41%) vaccines were found. Majority of the mothers were satisfied with the program. Most of the mothers were aware about the importance of vaccination but were ignorant for the need to complete the schedule. There were many misconceptions and beliefs among the mothers of partial and unimmunized children. The majority were of view that vaccines contain ingredients that will make the children infertile.

Conclusion
There is a need to enhance the maternal knowledge about the vaccine preventable diseases and importance of completing the immunization schedule. Also the misconception about the vaccines need be specifically addressed.

Disclosures
All Authors: No reported disclosures