bluuebunny/crossref_metadata_2025_split huggingface dataset:
1654. Chickenpox Outbreak in a Tribal District Rayagada, Odisha, India: Warrants Need for Vaccination
Authors: Salomi. Kerketta Anna , Somalkar Nilam , Dwibedi Bhagirathi , Sabat Jyotsnamayee , Subudhi Pradeepta 
Published: October 2019

Abstract

Background
Chickenpox or varicella is caused by Varicella zoster virus. In India chickenpox outbreak is not uncommon as the vaccination against varicella is not included in the program. We report, chickenpox outbreak in a tribal district Rayagada, Odisha state of India a South Asian country. The outbreak investigation was undertaken to assess the characteristics and determinants of the outbreak and make appropriate recommendations for control and prevention of further transmission.

Methods
A door to door survey was made for case finding and line listing with detailed travel, exposure and vaccination history. Qualitative research tools including key informant’s interview and focus group discussion were undertaken to understand community behavior and practice. Intravenous blood samples were collected for serological test to detect antibody to varicella-zoster virus.

Results
A total of 59 individuals out of 767 residents were affected with chickenpox in this outbreak with an attack rate of 8.73 per 100 populations. Age distribution indicated 69.5% belonged to the age group less than 14 years. No severe complication was reported. Blood sample of 33 case-patients was tested for Varicella zoster virus IgM antibodies and 24 (72.7%) found seropositive. The primary case was an 11-year-old girl who contracted infection in her residential school. None of the community members had received vaccination against chickenpox. Qualitative research indicated traditional beliefs and remedies prevailing in the communities that prevented case isolation and the modern treatment.

Conclusion
The study highlights the need for regular training of peripheral health workers for an effective awareness campaign to change beliefs and traditional practice and vaccination against Varicella zoster virus for prevention of such outbreaks.

Disclosures
All authors: No reported disclosures.
1661. Using Social Media to Enhance an STI Screening Program in Wuhan, China
Authors: Newman McCort Margaret E , Feng Yanmeng , Huang Haojie , Lio Jonathan , Sherer Renslow 
Published: October 2019

Abstract

Background
357 million people between the ages of 19 and 49 are infected each year with a sexually transmitted infection (STI). Wuhan, China is a unique setting for STI intervention as it has over 900,000 college students, a population at high risk for contracting HIV. Cultural attitudes toward premarital sex and homosexuality and poor sexual education are barriers to lowering STI rates. Additionally, 90% of Chinese healthcare is provided at large public hospitals with minimal privacy. Anonymous STI screening outside of the public hospital setting is highly desired by young adults and MSM populations.

Methods
Study investigators partnered with dating app Blued to advertise a nontraditional testing site where high-risk individuals were offered anonymous STI/HIV screening. With the assistance of the regional CDC and a community-based organization (CBO), rapid STI results were provided in a convenient and nonjudgmental setting. Information on sexual behavior and knowledge of STIs was surveyed for future public health interventions.

Results
Of 200 individuals screened for HIV, syphilis, gonorrhea, and chlamydia, 51 (25.5%) had a positive test result. Over 10% of rectal and pharyngeal tests were positive, compared with 1% of urine tests. 3/200 (1.5%) of had positive rapid HIV test results; all were connected to treatment. Among 41 (20.5%) who learned about the study through Blued, STI prevalence was higher (31.7% vs. 23.9%, P = 0.3), compared with participants recruited through advertisement by the CBO. Most (67.5%) identified as MSM. Survey data confirmed low underlying knowledge of STI transmission and risk factors, especially regarding pre-exposure prophylaxis (PrEP).

Conclusion
A discreet screening service at a nontraditional site, facilitated through dating application and social media advertisement, was well received by young adult and MSM communities in Wuhan, China. Triple-site STI screening found a significant number of infections among this population and should be routinely offered by public health services. The use of real-time, convenient diagnostic testing presents an opportunity to lower HIV incidence in Wuhan, a city with a large at-risk population.

Disclosures
All authors: No reported disclosures.
1662. Pushing the Dose: Miltefosine Treatment for a Supersized American with Cutaneous Leishmaniasis
Authors: Aronson Naomi E , Roseboom Ignace , Digby Michael , Bravos Christina , Selig Daniel , Farmer Aaron , AM van Thiel Pieter-Paul , Dorlo Thomas 
Published: October 2019

Abstract

Background
Miltefosine (Profounda, FL) is an oral alkylphospholipid drug which is approved by the Food and Drug Administration for the treatment of some species of New World cutaneous leishmaniasis. The maximal daily recommended dosage is 50 mg t.i.d for 28 days; yet there is some evidence that doses <2.5 mg/kg/day may be associated with lesser efficacy. We treated a healthy 30-year-old, 117 kg, 78 inches (low body fat) male with cutaneous Leishmania tropica infection with miltefosine after multiple unsuccessful treatment regimens. This presentation will provide the background considerations and the outcome of our approach of using higher daily dosages of miltefosine.

Methods
We used a miltefosine dose escalation of 50 mg t.i.d (1.28 mg/kg/day) for days 1–5 with fatty food, increasing to 50 mg. q.i.d. (1.71 mg/kg/day) for days 6–15. For days 16–28, the patient received 250 mg daily (2.13 mg/kg/day). Weekly blood testing was done for complete blood count, metabolic panel, and miltefosine pharmacokinetics. Plasma concentrations were assayed using a validated liquid chromatography coupled to tandem mass spectrometry methodology.

Results
The patient experienced a good clinical result with his two ulcerative lesions on the left leg healing with full epithelialization by day 28. He tolerated miltefosine well until he escalated to 250 mg daily when he noted 2 hours of fatigue and dizziness after the dose, nausea and after the fourth day he developed epididymitis. His serum creatinine was elevated (1.4 mg/dL). The epididymitis resolved after approximately a week, his other symptoms resolved soon after completing the day 28 dose. Serial miltefosine plasma levels accumulated during treatment to 30, 34, 44, and 53 μg/mL on days 7, 14, 21, and 27 after the start of treatment (dropping to 27 μg/mL 8 days post), with an apparent distribution half-life of 7 days.

Conclusion
Miltefosine yielded healing of recalcitrant L. tropica infection but was associated with adverse effects at the 250 mg daily dose that severely limited the activity of the patient for the final 8 days of therapy; however, they were not dose-limiting. Miltefosine accumulation appeared to be dose-proportional compared with reported concentrations with a median 1.8 mg/kg/day dose in Dutch cutaneous leishmaniasis patients (median weight 85 kg).

Disclosures
All authors: No reported disclosures.
1667. Influenza A and B Co-Circulation and Burden: A 2018–2019 Influenza Season Analysis Using the National Active Surveillance Database in Mexico
Authors: Guzman Holst Adriana , Gilberto Gomez Luis , Yolanda Cervantes Apolinar Maria , Huerta Gloria 
Published: October 2019

Abstract

Background
Seasonal influenza is a prevalent respiratory infection for children and adults in Mexico. Influenza A and B viruses co-circulate and there is a need to better understand local epidemiology to inform vaccination recommendations (tri- vs. quadrivalent vaccines). We describe the 2018–2019 influenza season to estimate influenza burden, virus co-circulation and understand the vaccine match in Mexico.

Methods
We reviewed preliminary sentinel surveillance data for the influenza season (October 2018–May 2019) from the Mexican Health Secretariat and World Health Organization’s (WHO) FluNet databases. We performed a descriptive analysis of cases and deaths due to influenza-like illness (ILI), severe acute respiratory infections (SARI) and lab-confirmed influenza to estimate the prevalence of influenza A and B circulating strains, per state and age group, and determine B strain vaccine match.

Results
During the 2018–2019 season in Mexico, there were 52,525 reported cases of ILI/SARI with 6,997 lab-confirmed influenza cases (28% positivity rate among ILI/SARI) and 787 (11%) deaths (Figures 1 and 2). The states with 36% of cases were Mexico City, State of Mexico, Hidalgo, Tlaxcala, and Guanajuato. More than half of the Mexican states had a high (10–14.9%) to intense (≥15%) accumulated case positivity rate of confirmed influenza in relation to ILI/SARI cases (Figure 3). Most cases were reported among the 1–9 and > 60-year-old groups. 45% of deaths occurred in State of Mexico, Hidalgo, Mexico City, Puebla, and Guanajuato. The seasonal viral profile was dominated by A/H1N1 (68%), followed by B (16%) and A/H3N2 (12%), with 90% of deaths attributed to A/H1N1. FluNet’s influenza B data show Yamagata (55%) and Victoria (27%) co-circulation (Figure 1).

Conclusion
The 2018–2019 seasonal co-circulation of influenza A and B viruses in Mexico showed significant nation-wide morbi-mortality burden, with A/H1N1 and B/Yamagata dominance. Stronger B lineage determination is needed in Mexico to understand associated burden and prevent vaccine mismatch, considering the trivalent vaccine does not contain both B strains. Given the circulation of both influenza B lineages and the recommendation of the WHO, Mexico could enhance quadrivalent vaccine use in coming seasons to optimize protection.

Disclosures
All authors: No reported disclosures.
1671. Impact of Zika Syndrome on Brazilian Infant Mortality Rate
Authors: Nogueira Mendes Neto Nilson , da S. Maia Jessika T , Zacarkim Marcelo , Queiroz Igor T , Rosa Gleyson , Labeaud A Desiree , Aronoff David 
Published: October 2019

Abstract

Background
Infant mortality in Brazil has increased for the first time in 26 years. This study aimed to define the Zika Syndrome (ZS) perinatal case fatality rate (PCF) since the 2015 Zika outbreak in a Brazilian northeast state highly impacted by the virus.

Methods
Cross-sectional study conducted using data obtained through the State Health Department for cases of microcephaly (MCP) and congenital abnormalities (CA) in Rio Grande do Norte State (RN) from April 2015 to March 2, 2019. Perinatal period: commencing at 22 completed weeks (154 days) of gestation until 7 days after birth. PCF was defined as the number of deaths as a fraction of the number of sick persons with the specific disease (×100).

Results
There were 535 reported cases of MCP and others CA notified in RN during this period: 4 in 2014, 337 in 2015, 157 in 2016, 21 in 2017, 14 in 2018, and 2 in 2019. Of these, 151 were confirmed and 135 remain under investigation. The remaining 247 cases were ruled out by normal physical exams or due to noninfectious cause of MCP. Of the total confirmed cases, 35.8% (54/151) died after birth or during pregnancy. Zika virus infection during pregnancy was confirmed in 55.5% (30/54) of deaths and 1.8% (01/54) had a positive TORCH blood test. The odds ratio for the Zika PCF was found to be 1.57 (95% CI: 0.7940–3.1398; P = 0.1928). Deaths related to Zika were confirmed using a combination of clinical and epidemiological findings paired with either radiological information or molecular/serological data (RT–PCR and/or IgM/IgG antibodies against Zika). Twelve cases remain under investigation and 7 were ruled out as MCP. The highest number of confirmed MCP cases occurred between August 2015 and February 2016. The prevalence increased in September, with a peak in November 2015 (20.1 cases per 1,000 live births).

Conclusion
Before the recent Brazilian Zika outbreak, the incidence of MCP in RN between 2010 and 2014 was 1.8 cases/year. The real incidence and prevalence might be higher due to the underreporting and lack of resources for confirmatory diagnostic tests (laboratory and imaging). This study indicates that Zika virus accounted for a substantial proportion of MCP cases seen during the years studied, and suggests that ZS contributed to an increase in infant mortality in Brazil.

Disclosures
All authors: No reported disclosures.
1676. Incidence and Outcomes of Pulmonary Involvement in Patients with Scrub Typhus: A Clinical Study from India
Authors: Nangia Vivek , Mobashir Amina 
Published: October 2019

Abstract

Background
Scrub typhus is a tropical fever caused by orrientia tsutsugamushi and is probably the most under-recognized of all the febrile illnesses leading to hospitalization, especially in India. Although the most common presenting symptoms are fever, myalgia, lymphadenopathy and rash, a significant percentage of patients also present with respiratory complaints.

Methods
December 2018 at a tertiary care center, in Delhi, India. The primary objective was to determine the incidence of respiratory involvement in patients with scrub typhus on the basis of radiological findings. Secondary objective was to compare the length of hospital stay, clinical presentation, and severity of illness as indicated by transaminitis, thrombocytopenia, inotropic requirement, and lactate levels. Also compared was the difference in mortality between the two groups.

Results
Pulmonary involvement was seen in 28.9% (22/76) patients which included varied radiological pictures. 5 patients required mechanical and 2 noninvasive ventilation. Eschar was seen in 44.7% out of which 20 had pulmonary involvement. Patients with pulmonary involvement had a significantly greater length of hospital stay (5.82 days vs. 2.56, P < 0.001), more severe transaminitis (P < 0.001), thrombocytopenia (P < 0.001), hyperlactatemia (P < 0.001), higher ionotropic requirement (P < 0.001) and mortality (P = 0.006).

Conclusion
Pulmonary involvement was seen in almost one-third of the patients with scrub typhus and was associated with higher morbidity and mortality. These patients were sicker, often required intensive care admissions, inotropic support, noninvasive and invasive mechanical ventilation and a significantly prolonged hospitalization. Chest radiographs should be a part of routine evaluation of all patients suspected to have scrub typhus. With such high pulmonary involvement, scrub typhus forms an important differential diagnosis in patients with lung infection residing in endemic areas and in those with a history of travel to such areas

Disclosures
All authors: No reported disclosures.
1683. Empathy Scale Validation Among Expectant Seroconcordant Couples Enrolled in HIV Care and Treatment in Zambézia Province, Mozambique
Authors: Sack Daniel , DeSchacht Caroline , Erin Graves , Aaron Kipp , Barreto Ezequiel , Van Rompaey Sara , Audet Carolyn 
Published: October 2019

Abstract

Background
Among patients enrolled in HIV care and treatment in rural Mozambique, 30% abandon treatment within a year. A cluster randomized controlled trial assessing the impact of couple-based vs. individual treatment for concordant couples on viral suppression (the HoPS+ trial) hypothesizes that harnessing family support will improve patient outcomes. Individuals with high levels of empathy will likely provide greater social support for treatment retention and adherence. This study validates a locally tailored version of the interpersonal reactivity index (IRI)—cognitive empathy (CE) and affective empathy (AE)—among expectant parents living with HIV in Zambézia province, Mozambique.

Methods
Using baseline data from 558 participants from the HOPS+ trial, we used a maximum likelihood exploratory factor analysis with a promax oblique rotation to assess the culturally relevant questions from the IRI. We examined discriminant and construct validity through analysis of subscale relationships by sex, age, education, and depression and intra-person reliability over time with an interclass correlation model (n = 119).

Results
Our participants live in 6 districts and receive health care at 24 health facilities. The median age was 25 (IQR: 22 to 30), 50% were female, and 44% were single. Participants had a median of 5 years of formal education (IQR: 2–7). Half of them report their occupation as “farmer” and 17% screened positive for depression. On a scale of 0–4, the median baseline CE score was 2.6 (IQR: 1.9–3.2) and the median baseline AE score was 1.9 (IQR: 1–2.6). Males (2.6 vs. 2.4, P < 0.01), participants who finished primary school (2.7 vs. 2.5, P < 0.01), and older participants (2.6 vs. 2.5, P = 0.04) had higher CE scores, while depressed participants had higher AE scores (2.3 vs. 1.8, P < 0.01). We found moderate stability over time (CE ICC: 0.63, AE ICC: 0.54) in a subset of 119 study participants.

Conclusion
While depression is associated with 12.5% higher AE scores, older participants, males, and those high levels of education had higher scores on the CS scale. This preliminary work will inform future work on the HoPS+ trial and guide future interventions aimed at increasing retention in and adherence to treatment in people living with HIV.

Disclosures
All authors: No reported disclosures.
1685. Retrospective Analysis of Strongyloides Hyperinfection-Dissemination Syndrome Risk Factors in a County Hospital
Authors: Xu Teena H , Onyewuenyi Chinma , Woc-Colburn Laila , Weatherhead Jill 
Published: October 2019

Abstract

Background
Strongyloides stercoralis is a parasitic infection endemic to tropic, subtropic, and temperate regions globally, affecting nearly 100 million people. Clinical disease ranges from asymptomatic strongyloidiasis (AS) to hyperinfection-dissemination syndromes (HDS), a syndrome of accelerated autoinfection and fulminant illness. This study aims to identify risk factors for HDS in a county hospital.

Methods
Subjects admitted to Ben Taub Hospital in Houston, TX, a safety net facility providing care to uninsured and underinsured Harris County residents, from 2012–2016 were identified by ICD-9 and -10 codes. Charts were retrospectively reviewed, and statistical analysis was completed using chi-square with R-software.

Results
15 subjects with strongyloidiasis were identified, 9 (60%) with AS and 6 (40%) with HDS. There was no statistical demographic difference between the groups in terms of age, country of origin, or presence of co-morbidities, including chronic T-cell-mediated immunosuppressed states, such as HIV, diabetes mellitus, chronic kidney disease, malignancy, and malnutrition. When compared with patients with AS, patients with HDS were more likely to have acutely received immunosuppressant medications, such as corticosteroids or chemotherapy, prior to admission (P = 0.009). Common presenting symptoms, including abdominal pain, diarrhea, cough/dyspnea, and rash, were similar between the groups. Subjects with HDS were more likely to present with hypotension (P = 0.017) and have concurrent severe infections (P = 0.0361) at the time of presentation, reflecting the subjects’ underlying immunosuppressed status. Additionally, there was no difference in levels of peripheral eosinophils in subjects with AS vs. HDS. However, subjects with AS were more likely to have a positive serum S. stercoralis IgG (P = 0.002).

Conclusion
HDS should be considered in all individuals from endemic regions who have acutely received immunosuppressive medications presenting with hypotension, irrespective of chronic underlying co-morbidities. Recognizing the high likelihood of co-infection with virulent pathogens is of particular importance in subjects with HDS. As diagnostic tests are unreliable in subjects with HDS, empiric treatment is imperative.

Disclosures
All authors: No reported disclosures.
1698. Epidemiology and Antifungal Susceptibility of Candidemia Among Adult Patients at a Tertiary Care Hospital in South Korea During an 8-Year Period
Authors: Hun Kim Jong , Woong Suh Jin , Yeon Kim Jeong , Lee Hojin , Bean Kim Sun , Wook Sohn Jang , Ja Kim Min 
Published: October 2019

Abstract

Background
Candidemia continues to contribute to significant morbidity and mortality in the hospital. This study aimed to evaluate the epidemiology and antifungal susceptibility at a tertiary care hospital in South Korea during an 8-year period.

Methods
Adult patients ≥19 years with candidemia at a tertiary care hospital in South Korea from 2006 to 2018 were reviewed, and cases of candidemia with antifungal susceptibility data were included for the analysis.

Results
There were 270 cases of candidemia with fluconazole susceptibility data from 2011 to 2018. Overall, fluconazole resistance rate of candidemia was 8.5%. Between period 1 (2011–2015) and period 2 (2016–2018), fluconazole resistance rate was significantly higher in the period 2 (14.3%) than in the period 1 (0.9%), P < 0.001. Among candidemia caused by different Candida spp., a significant increase of fluconazole-resistant C. parapsilosis candidemia was noted in the period 2 (12 out of 34 cases; 35.3%) when compared with the period 1 (0 out of 17 cases; 0.0%), P = 0.004. Although there was a trend of higher fluconazole resistance rate for candidemia caused by C. albicans (9.1% vs. 1.8%), C. tropicalis (2.7% vs. 0.0%), and C. glabrata (11.1% vs. 0.0%) in the period 2 than in the period 1, no statistical significance was observed. Echinocandin (caspofungin and micafungin) susceptibility data were available for 211 cases of candidemia from 2013 to 2018. There were no cases of caspofungin-resistant candidemia except for 2 cases of C. utilis candidemia. However, there were 9 cases of micafungin-resistant candidemia (1 case of C. tropicalis candidemia out of 51 cases [2.0%], 6 cases of C. glabrata candidemia out of 18 cases [33.3%], and 2 cases of C. utilis candidemia out of 2 cases [100.0%]). Micafungin-resistant C. tropicalis and C. glabrata candidemia cases were susceptible to caspofungin.

Conclusion
A significant increase of fluconazole-resistant candidemia in recent years was noted, particularly among C. parapsilosis candidemia cases. Echinocandin resistance among candidemia cases is rare. However, close monitoring needs to be considered for the possible emergence of differential echinocandin resistance.

Disclosures
All authors: No reported disclosures.