bluuebunny/crossref_metadata_2025_split huggingface dataset:
1365. How Severe Are Rickettsial Infections Among Children
Authors: Hammami Fatma , Koubaa Makram , Chakroun Amal , Rekik Khaoula , Smaoui Fatma , Elleuch Emna , Marrakchi Chakib , Jemaa Mounir Ben 
Published: January 2021

Abstract

Background
Rickettsial infections (RI) usually mimic benign viral infection due to similarities in clinical symptoms. However, severe forms and complications have been reported with rickettsiosis. Children can be affected as well. We aimed to study the particularities of RI among children.

Methods
We conducted a retrospective study including all patients aged ≤ 18 years hospitalized for RI between 2000 and 2018. The diagnosis was confirmed by serologies (seroconversion).

Results
In total, we encountered 59 children with confirmed RI, among whom 45 were male (76.3%). The mean age was 14 ±3 years. Forty children had a close contact with animals (71.4%). All patients consulted for a febrile maculopapular skin rash, which was associated to headache in 45 cases (76.3%), vomiting in 28 cases (47.4%) and cough in 8 cases (13.5%). Physical examination revealed an eschar in 13 cases (22%) and meningeal syndrome in 11 cases (18.6%). Laboratory investigations showed thrombocytopenia (31 cases; 52.5%) and liver cytolysis (26 cases; 44%). Severe forms of RI were represented by meningitis in 11 cases (18.6%), pneumonia in 2 cases (3.3%) and myocarditis in one case (1.6%). The treatment was based on doxycycline in 42 cases (71.2%), fluoroquinolones in 10 cases (17%) and macrolide in 7 cases (11.8%) for children aged less than 8 years. The mean duration of treatment was 9 ±3 days. The disease evolution was favourable in all cases.

Conclusion
The diagnosis of RI among children should be largely based on high index of suspicion, careful clinical and laboratory results. Prompt diagnosis is crucial in order to start antibiotics and avoid, therefore, fatal untreated forms.

Disclosures
All Authors: No reported disclosures
1366. Microbiology of Acute Hematogenous Osteomyelitis in Hospitalized Children
Authors: Hu Nina , Hamdy Rana F , Martin Benjamin 
Published: January 2021

Abstract

Background
Acute hematogenous osteomyelitis affects 1 in 5,000 children in the U.S. and Staphylococcus aureus is the most common bacterial cause. At our institution, clindamycin is used empirically for osteomyelitis, despite increasing clindamycin-resistance over the years. The objective of this study is to describe microbiologic results and antibiotic resistance patterns in children hospitalized with acute hematogenous osteomyelitis.

Methods
This was a single-center retrospective cohort study of patients &lt; 21 years of age with acute osteomyelitis hospitalized between 1/1/2010 and 5/31/2019 at Children’s National Hospital. We excluded patients with recent orthopedic surgery, hardware infection, penetrating trauma, or with an underlying immunocompromising condition. We performed chart review to collect data on location of infection; blood, synovial fluid, or surgical site cultures; culture results, and susceptibilities.

Results
Of the 162 encounters of acute osteomyelitis that met inclusion criteria, the average patient age was 8.3 years. Lower extremity infections were most common (105, 64.8%), followed by upper extremity (31, 19.1%), pelvis (14, 8.6%), spine (7, 4.3%), shoulder (4, 2.5%), rib (1, 0.6%) and mandible (1, 0.6%). Almost half of cases (73, 45%) had no positive cultures, and 89 cases (55%) had at least one positive culture from blood or local source (Figure 1). The most common pathogen was methicillin susceptible S. aureus (MSSA) followed by methicillin resistant S. aureus (MRSA) comprising 60 (67%) and 19 (20%) of culture-positive infections respectively. Other isolated pathogens included S. pyogenes (5, 5.6%) Salmonella species (2, 2.2%), S. pneumoniae (1, 1.1%), S. agalactiae (1, 1.1%), and Kingella kingae (1, 1.1%) (Figure 1). Among S. aureus infections, 69 (87%) were susceptible to clindamycin (85% among MSSA, 95% among MRSA).
Categorized Blood and Wound Culture Results

Conclusion
Almost half of all children with acute hematogenous osteomyelitis did not have any microbiologic data to guide antibiotic usage. S. aureus was the most common (87%) isolate, with more MSSA (74%) than MRSA (24%). Non-S. aureus isolates were more likely to grow from surgical specimen cultures than from blood cultures. Clindamycin resistance was more commonly seen in MSSA than in MRSA osteomyelitis.

Disclosures
All Authors: No reported disclosures
1370. Three of Hearts: A Case Series and Literature Review of Pediatric Purulent Pericarditis
Authors: Estes Alyssa , Resident Pediatric , Crews Jonathan , Appachi Elumalai , Care Pediatric Critical 
Published: January 2021

Abstract

Background
Purulent pericarditis is rare in the pediatric population. Three children with purulent pericarditis complicated by tamponade were seen at a children’s hospital from 2018-2019. A review of the literature was conducted to investigate the clinical significance and features of purulent pericarditis.

Methods
Cases of purulent pericarditis in children (age &lt; 18 years) published in English from 2000 to 2020 were reviewed. Patients were included if there was presence of purulent pericardial fluid or if a bacterial pathogen was isolated from pericardial fluid.

Results
Three children with purulent pericarditis and tamponade with associated pneumonia were cared for at our institution. These infections were caused by methicillin-susceptible Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pyogenes. Review of the literature identified 93 children with purulent pericarditis. The median age of the cohort is 4 years old. In 68.8% of children the etiology was identified from culture of pericardial fluid. The most common organism detected was S. aureus (38.7%) and a concurrent infection was seen in 49.4% -pneumonia (36.5%), osteomyelitis (17.2%), soft tissue (7.5%), and meningitis (2.1%). In North America specifically, methicillin-resistant S. aureus was most common 35% (7/20) and associated infection was seen in 80% (16/20). Clinical course was complicated by pericardial tamponade in 68.5% (37/54) of patients, 48.6% (18/37) of those children with tamponade also had pneumonia. Pericardiocentesis is the most frequent initial intervention, performed in 77.4% of cases. The mortality rate was 4.3%.

Conclusion
In pediatric purulent pericarditis, Gram-positive organisms account for 81.2% of all children with positive pericardial fluid culture, and 75% of infections in North America. A bacterial pathogen can be isolated from the pericardial fluid in a majority of patients with purulent pericarditis. There is a high rate of concurrent infection, most notably pneumonia, and there is a strikingly high percentage of tamponade in those cases.

Disclosures
All Authors: No reported disclosures
1376. Oral Vancomycin as Secondary Prophylaxis Against Clostridioides difficile Infection in Pediatric Patients
Authors: Bao Hongkai , Dubrovskaya Yanina , Papadopoulos John , Siegfried Justin , Merchan Cristian , Lighter Jennifer , Jen Shin-Pung 
Published: January 2021

Abstract

Background
Secondary oral vancomycin prophylaxis (OVP) has been utilized in adults with a history of Clostridioides difficile infection (CDI) while receiving systemic antibiotics to prevent CDI recurrence. However, this practice is poorly described in pediatric patients. Rates of CDI recurrence in pediatric patients range from 10-40% and is associated with morbidity and mortality. This study assessed the efficacy and safety of secondary OVP in pediatric patients with subsequent antibiotic exposure.

Methods
This retrospective study evaluated pediatric patients ≤18 years with any history of clinical CDI and receiving systemic antibiotics in a subsequent encounter during the time period of 2013-2019. Patients who received OVP 10 mg/kg (up to 125 mg per dose) every 12 hours during concomitant antibiotics were compared to those who did not. The primary outcome was CDI recurrence within 8 weeks following antibiotic exposure. Secondary outcomes included time to recurrence, severity of recurrence, and isolation of vancomycin-resistant enterococci (VRE) from any site. Risk factors for CDI recurrence were assessed using logistic regression.

Results
A total of 153 patients were screened for inclusion, of which 32 and 47 patients were assigned to the OVP and no OVP group, respectively. Median age was 8.6 years and the most common comorbidities were malignancy (47%) and immunosuppression (46%). Median time since last CDI to study inclusion was 64.5 days in the OVP group and 90 days in the no OVP group, P=0.320. Compared to the no OVP group, OVP patients had longer hospital stays (5 vs 14 days, P=0.001) and more concomitant antibiotic exposure (8 vs 12.5 days, P=0.001). Median duration of OVP was 12 days. CDI recurrence occurred in 12 patients and was significantly lower in the OVP vs no OVP group (3.1% vs 23.4%; odds ratio, 0.106; 95% confidence interval, 0.013-0.864; P=0.022). VRE was not isolated in any patients. After adjustment in a multivariate analysis, only secondary OVP remained as a protective factor against recurrence (odds ratio, 0.082; 95% confidence interval, 0.009-0.748; P=0.027).

Conclusion
Secondary OVP effectively reduces the risk of recurrent CDI in pediatric patients with a history of CDI while receiving systemic antibiotics. Future prospective studies should validate these findings.

Disclosures
Cristian Merchan, PharMD, BCCCP, abbive (Speaker’s Bureau)
1380. Current status of the legal landscape regarding Rotavirus Vaccination in the United States
Authors: Bhatti Alexandra , Carias Cristina , Chen Ya-Ting 
Published: January 2021

Abstract

Background
In the US, the Advisory Committee on Immunization Practices recommended routine rotavirus vaccination for all infants in 2006. Since then, rotavirus (RV) vaccination coverage (VC) has increased; however, RV VC is still below that of other routine childhood vaccines. All states require children to be vaccinated against certain communicable diseases as a condition for childcare attendance; other states require that children with diarrhea are excluded from childcare. Given the potential impact of these policies on VC, we sought to understand the legal landscape affecting rotavirus (RV) vaccination.

Methods
Legal epidemiological methods using Westlaw NEXT database were used to complete a systematic assessment of RV vaccination requirements for childcare entry and evaluate the ease at which non-medical exemptions are attained. These methods were also used to evaluate state diarrhea childcare exclusion policies.

Results
Six states require RV vaccination for childcare attendance: Wyoming (2018); Ohio and Rhode Island (2015); Idaho (2011); North Dakota (2008); and Pennsylvania (2002) (Figure 1). All 6 states permit non-medical exemption that allow children to be exempt from vaccination. Ohio, North Dakota, and Pennsylvania are the most lenient, only requiring parental signature to withdraw from vaccination; while Wyoming is the least lenient, requiring a signed notarized official document. Childcare diarrhea exclusion policies were found in 28 states.
Rotavirus Vaccination Requirements for Childcare Entry by State as of 2019.

Conclusion
To date, a minority of states have implemented RV vaccination policies while more states have diarrhea exclusion policies. However, vaccination policies may play a role in increasing VC and consequently lower acute gastroenteritis and diarrhea burden. In 2017, the VC for the full series of RV vaccination was 73.2%. Four of the states that have RV state vaccination policies had higher state-wide vaccination coverages than the national average. Given the concern in reducing diarrhea transmission, as evidenced by the large number of diarrhea exclusion policies, and the potential impact of policies on higher VC which may result in greater protection and reduction in RV disease, considerations should be given to implementing such policies in more states.

Disclosures
Alexandra Bhatti, JD, MPH, Merck (Employee) Cristina Carias, PhD, Merck (Employee, Shareholder) Ya-Ting Chen, PhD, Merck & Co., Inc. (Employee, Shareholder)
1382. Varicella Burden Disease in Argentina: 4 Years after National Vaccination Strategy
Authors: Neyro Silvina , Juarez Maria del Valle , Pasinovich Marina , Rancaño Carolina , Katz Nathalia , Elbert Gabriela , Yunes Marcela López , Stecher Daniel , Lucconi Verónica , Saralegui Martín , Mykietiuk Analía , Vizzotti Carla 
Published: January 2021

Abstract

Background
In Argentina, around 150,000-180,000 total Varicella (VZV) cases per year (c/y) are registered; however, underreport exists and some 400,000 cases are estimated to occur annually. Varicella vaccine (VV) was included in the National Immunization Schedule (NIS) in 2015, with a 1-dose schedule administered at 15 months-of-age. We aimed to describe and to compare the epidemiological situation of VZV infections in Argentina in two periods: pre (2010-2014) and post (2016-2018) vaccine introduction in NIS.
Global Incidence rates and vaccine coverages

Incidence rates (age groups)

Methods
Before-and-after study comparing cases and incidence rates (100,000) of varicella reported to the National Health Surveillance System between pre-vaccination period (Pre-VV) and post-vaccination (Post-VV), excluding year of intervention (2015) since it was considered a transition year. Epi Info 7 was used for data analysis.

Results
Vaccination coverage (VC) for 2015 was 44.7%; 74.4% in 2016; 76.8% in 2017 and 81% in 2018 (Figure 1). 728,392 cases of VZV were notified (R=363.1) in Pre-VV period and 222,305 cases in Post-VV (R=180.7), with a global incidence rate reduction of 49% (95%CI= 40.9-56.2; p&lt; 0.001). Both 12-24 months of age and 2-4 years old groups (Pre-VV R=2,253 and Post-VV R=900; Pre-VV R=2,399 and Post-VV R=875, respectively) showed the greatest reductions in incidence rates (-59.3% [95%CI 58.7-60] p&lt; 0.001 and -61.7% [95%CI 61.3-62] p&lt; 0.001). Age groups not affected by vaccination (&lt; 1 year, 5-9 years and 10-14 years) presented minor but significant reductions (-56.4% [95%CI 55.6-57.3] p&lt; 0.001; -35% [95%CI 34.5-35.4] p&lt; 0.001; and -28.6% [95%IC 27.6-29.7] p&lt; 0.001 respectively) (Figure 2).

Conclusion
A decreasing trend in VZV number of cases and incidence rates was observed, especially in children less than 5 years old, despite suboptimal VC. The reduction of VZV cases in non-vaccinated age groups could be related to a decline in the transmission risk. Improving VC will likely reflect a greater impact on the burden of disease.

Disclosures
All Authors: No reported disclosures
1383. Characterizing Real-world Patterns of Early Childhood Vaccination
Authors: Butler Anne M , Newland Jason , Sahrmann John , O’Neil Caroline , Sayood Sena , McGrath Leah 
Published: January 2021

Abstract

Background
Vaccine hesitancy is increasingly common, but more information is needed on patterns of childhood vaccination. We characterized patterns of vaccine delay among commercially-insured children in the U.S.

Methods
Using the IBM MarketScan Commercial Database, we identified infants who received a timely first dose of diphtheria-tetanus-acellular pertussis (DTaP) vaccine from October 2009 to June 2017. We used CPT codes to collect vaccine administration history on antigen, formulation, dose, and date. We ascertained injectable and oral vaccine antigens (DTaP, polio, pneumococcal conjugate, rotavirus, Haemophilus influenza type b (Hib), measles, mumps, rubella, varicella). Timely receipt was defined as concomitant administration of the CDC-recommended number of antigens during the following time windows: 2, 4, 6, and 12-15 months of age (grace period: -7, +21 days). We generated heat maps to illustrate age distributions at receipt of specific antigens and doses. We created Sankey diagrams to illustrate the number of antigens received concomitantly during each time window and depict transitions to different states over time (e.g., no vaccine delay to vaccine delay). For each antigen and dose, we estimated the cumulative incidence of receipt.

Results
Among 1,066,216 eligible infants, the majority (84%) concomitantly received all 5 CDC-recommended antigens at 2 months of age while others only received 1 (1%), 2 (2%), 3 (4%) or 4 (9%) antigens. Many vaccinations were delayed – 30% and 39% of children did not receive all recommended antigens concomitantly at 4 and 6 months, respectively. The heat map shows wide variation in age at vaccination. For several antigens including Hib, measles, mumps, rotavirus, rubella, and varicella, the cumulative incidence increased steeply at ≥2 time points, suggesting vaccine delay for some infants (e.g., the first dose of Hib was administered to 85% of infants by 2 months of age, with subsequent small but distinct increases at 4, 6, 12, and 15 months of age).

Conclusion
Using real-world data to study early childhood vaccination patterns, we observed evidence of substantial deviation from the CDC-recommended schedule. These results expand current knowledge on the magnitude and timing of antigen- and dose-specific vaccine delay on a population level.

Disclosures
Jason Newland, MD, MEd, FPIDS, Merck (Grant/Research Support)Pfizer (Other Financial or Material Support, Industry funded clinical trial) Leah McGrath, PhD, NoviSci, Inc. (Employee)
1388. DTaP-containing combination vaccines use and adherence to the recommended infant-toddler vaccination series among privately insured children in the US
Authors: Loiacono Matthew M , Pool Vitali , Van Aalst Robertus 
Published: January 2021

Abstract

Background
Despite universal recommendation of the 3 + 1 diphtheria, tetanus, and pertussis (DTaP) vaccine series in infants and toddlers, adherence (i.e. coverage and timeliness) remain suboptimal in the US. DTaP-containing combination vaccines are presumed to improve vaccine coverage rates and timeliness, but research on this topic is limited. The purpose of this study was to compare adherence to the recommended infant-toddler vaccination series between recipients of DTaP-containing combination vaccines (i.e. quadrivalent/pentavalent) and stand-alone vaccines (i.e. trivalent).

Methods
We used the Optum de-identified Clinformatics Data Mart database to create a cohort of children born between 2009 and 2016 with &gt; 24 months of continuous enrollment from birth, and records of &gt; 1 DTaP vaccine receipt. Patients were classified by DTaP-containing vaccine receipt: combination vaccines only, stand-alone vaccines only, or a mixture of both. The primary adherence outcome was completion of the 4-dose series within 20 months of life. We adjusted outcomes for gender, birth year, race, and socioeconomic status via a logistic regression model.

Results
The cohort contained 200,568 female (48.6%) and 211,882 male (51.4%) children. Of these children, 167,091 received combination vaccines only (40.5%), 61,342 received stand-alone vaccines only (14.9%), and 184,017 received a mixture of both (44.6%). Completion of the 4-dose series was highest among children who received combination vaccines only (75.5%), followed by those who received a mixture of vaccines (72.7%) and those who received stand-alone vaccines only (54.5%). Relative to those who received stand-alone vaccines only, adjusted odds of completion were approximately 2.9 times higher among combination vaccine recipients (odds ratio, OR = 2.93 [95% CI: 2.87, 2.98]) and 2.5 times higher among those who received a mixture of vaccines (OR = 2.54 [2.49, 2.59]).

Conclusion
DTaP-containing combination vaccine use was associated with significantly greater adherence. Although these results warrant further investigation to better understand the determinants of infant vaccination adherence, such evidence may further support preferential recommendations for combination vaccine use.

Disclosures
Matthew M. Loiacono, MSc, Sanofi Pasteur (Employee) Vitali Pool, MD, Sanofi Pasteur (Employee) Robertus Van Aalst, MSc, Sanofi Pasteur (Employee)
1394. Impact of 7-Valent and 13-Valent Pneumococcal Conjugate Vaccines in the United States: A Systematic Literature Review
Authors: Kistler Kristin , Gomez-Espinosa Evelyn F , Sutton Kelly , Chapman Ruth , Dillon-Murphy Desmond , Wasserman Matthew 
Published: January 2021

Abstract

Background
The availability of 7-valent (PCV7) and 13-valent (PCV13) pneumococcal conjugate vaccines (PCVs) in the United States (US) since 2000 and 2010, respectively, has substantially reduced the occurrence, morbidity and mortality of pneumococcal disease. This systematic literature review aimed to assess the impact of the PCVs in reducing the pneumococcal disease burden since their introduction.

Methods
We searched Embase and Medline and disease-surveillance websites for observational studies of US participants &lt; 19 years, published 1999–2019 and reporting incidence or prevalence of acute otitis media, invasive pneumococcal disease, meningitis, or pneumococcal disease-related morbidity, mortality, healthcare resource utilization (HCRU) or costs.

Results
Of 499 citations identified from the databases and other sources, 125 met inclusion criteria (Figure), all indicating clear reductions in multiple manifestations of pneumococcal disease with PCV7 and PCV13 use. However, variations across studies in outcomes reported, study years, and age strata, confounded assessment of vaccine impact on specific pneumococcal disease outcomes and key burden indicators, such as tympanostomy tube placement and antibiotic prescriptions.

Conclusion
PCVs have greatly decreased multiple manifestations of pneumococcal disease in the US. However, granular data on the frequency and morbidity associated with specific pneumococcal diseases and on associated HCRU are needed to quantify the public-health impact of these vaccines.

Disclosures
Kristin Kistler, PhD, Evidera, Inc. (Employee, Evidera, Inc. received the funding to conduct this study.) Evelyn F. Gomez-Espinosa, BSc, PhD, Evidera Inc (Employee, Scientific Research Study Investigator)Pfizer Inc (Consultant, Scientific Research Study Investigator) Kelly Sutton, PhD, Evidera (Other Financial or Material Support, Evidera, Inc. received the funding to conduct this study.) Ruth Chapman, MSc, PhD, Evidera, Inc, (Evidera, Inc. received the funding to conduct this study.) (Consultant) Desmond Dillon-Murphy, MSc, PhD, Evidera, Inc. (Evidera, Inc. received the funding to conduct this study.) (Consultant) Matthew Wasserman, MSc., Pfizer Inc. (Employee)