bluuebunny/crossref_metadata_2025_split huggingface dataset:
65. Vaccine Confidence, COVID19, and the Influence of Peer Networks
Authors: Vojtek Ivo , Palsenbarg Vanessa , Smyser Joe 
Published: January 2021

Abstract

Background
An increased appreciation for vaccines could be expected due to COVID-19. However, surveys show a polarization in opinions with about 20% of Americans preemptively rejecting any COVID-19 vaccine, partly due to inconsistent risk communication. While Health Care Professionals (HCPs) will be heavily relied upon to encourage uptake of a COVID-19 vaccine and 70% of Americans receive their vaccine information from HCPs, 84% also rely on peer networks. Understanding that HCPs have an important, but not exclusive, influence on health decision making can signal a new approach. This study provides data on where women, the main decision-makers regarding immunization in most families access information about vaccination.

Methods
Through an online survey conducted in UK, Brazil, Germany, Italy and Canada from 10 to 19-March 2020, we collected data on where, and from whom, women aged 25–54 years access information about vaccination. We set 1000 respondents/country quotas to reflect regional differences with data weighted as necessary.

Results
5,036 women who met inclusion criteria responded: from the UK (1,003), Brazil (1,002), Germany (1,008), Italy (1,007), and Canada (1,016). Though most likely to receive vaccination info via their HCP: in Germany, women are least likely to be influenced by HCPs, with those aged 25–34 years more likely to turn to family members or online sources; in the UK, they are more likely to find info via a health authority’s website; and in Brazil, they are more likely to see info in traditional media and on Facebook. Only 50% ranked vaccine efficacy and disease risk in the Top 5 factors influencing their vaccine decisions, alongside the opinion of an HCP, recommendation of a Public Health Authority and impact of the disease.

Conclusion
HCPs, families and peers are important sources of info regarding vaccination. COVID-19 is unlikely to improve vaccine confidence as the issue becomes increasingly polarized and communications more inconsistent. We can respond by investing in health promotion and harmonized communications through peer networks. Since caregivers, their families and peers have increased weight in vaccination decisions, then they should have increased weight in preventive health strategies.

Disclosures
Ivo Vojtek, PharmD, PhD, MSc, FRSM, RPh, GSK Vaccines (Employee, Shareholder) Vanessa Palsenbarg, MA, GSK Vaccines (Employee, Shareholder) Joe Smyser, PhD, Public Good Project (Board Member, Employee)
66. What Worked (And Didn’t Work): A Survey of COVID-19 Response in Michigan Nursing Homes in the Midst of the Pandemic
Authors: Mantey Julia , Jones Karen , Patel Payal K , Meddings Jennifer , Mody Lona 
Published: January 2021

Abstract

Background
Nursing home (NH) populations are at higher risk for morbidity and mortality due to COVID-19. A March 2020 NH survey indicated improvements in pandemic planning when compared to a similar survey in 2007. We surveyed NHs to evaluate how well pandemic preparedness plans and infection prevention strategies met the reality of COVID-19.

Methods
The first COVID-19 case in Michigan was reported March 10, 2020. In the setting of 46,088 cases and 4,327 deaths statewide as of May 1, we disseminated an online survey to state department-registered NHs to describe their experience of the initial pandemic wave. Responses were collected May 1–12, during which the state averaged 585 cases/day. We were particularly interested in NH preparedness, challenges, testing capacity, and adaptations made.

Results
Of 452 NHs contacted, 145 opened the survey and 143 (32%) responded. A majority (68%) indicated that their facility’s pandemic response plan addressed &gt; 90% of issues they experienced; 29% reported their plan addressed most but not all anticipated concerns (Table 1). As the pandemic evolved, all facilities (100%) provided additional staff education on proper personal protective equipment (PPE) use. 66% reported experiencing shortages of PPE and other supplies. Half of all facilities (50%) lacked sufficient resources to test asymptomatic residents or staff; only 36% were able to test all residents and staff with suspected COVID-19 infection. Half (52%) considered their communication regarding COVID-19 with nearby hospitals “very good.” The majority of facilities (55%) experienced staffing shortages, often relying on remaining staff to work additional hours and/or contracted staff to fill deficits (Table 2). NH staff resignations increased, with 63% of NHs experiencing resignations; staff with greater bedside contact were more likely to leave, including nurses and nurse assistants.

Conclusion
While most NHs had a plan to respond to COVID-19 pandemic in March 2020, many facilities experienced a lack of available resources, less than ideal communication lines with local hospitals, lack of testing capacity and insufficient staff. These shortcomings indicate potential high-yield areas of improvement in pandemic preparedness in the NH setting.

Disclosures
All Authors: No reported disclosures
79. Detroit’s Response to COVID-19 in Homeless Shelters
Authors: Maki Gina , Bowser David , Shallal Anita , Prentiss Tyler , Zervos Marcus , Rehman Najibah K 
Published: January 2021

Abstract

Background
Detroit, Michigan has a poverty rate nearly three times the national average. Homeless shelters are at risk for infectious outbreaks due to reduced healthcare access for residents, compounded by overcrowding, hygienic challenges, lack of resources, and transient nature of residents. Prior to the first reported COVID-19 case in Michigan, the Detroit Health Department prioritized screening of both asymptomatic and symptomatic homeless residents residing in the city’s shelters. Early identification of COVID-19 positive cases allowed for implementation of strategies to halt further spread.

Methods
A surveillance strategy was implemented prior to the first confirmed COVID-19 case in Michigan. Surveillance involved temperature and symptom checks at each homeless shelter, three times weekly. 24 shelters were screened for symptoms, 13 shelters had universal testing performed. Two city-operated quarantine sites for COVID-positive and –suspected homeless individuals were organized. If a shelter resident tested positive, that shelter was placed in quarantine, and new referrals stopped for 14 days. Temperature and symptom check frequency increased to daily for 14 days. If a patient was positive for fever or symptoms, they were transferred to the quarantine center for testing and isolation.

Results
Over 23,000 temperature and symptom checks occurred in 24 shelters across Detroit since February 22. This identified 15 patients who were referred to the quarantine site. From April 11 to May 31, 721 residents from 13 homeless shelters were screened with universal testing for COVID-19, and 93 (12.9%) tested positive (Figure 1). Of 95 homeless residents who were referred through shelter surveillance, from the local hospital system and via unsheltered street outreach, and tested on-site at the quarantine and isolation shelter, 29 (31%) tested positive for COVID-19, and 66 (69%) tested negative.
Figure 1. System-wide homeless shelter testing of COVID-19

Conclusion
Homeless populations across the US are especially vulnerable to COVID-19, with high risk for rapid spread due to crowding and difficulty with physical distancing. The need for increased testing- and prevention-based strategies in this population is crucial. The process performed in Detroit’s homeless shelters can be a model for other communities at risk for COVID-19 outbreaks.

Disclosures
Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)
81. Children and COVID-19 in Colorado: The Children’s Hospital Colorado Experience
Authors: Graff Kelly E , Silveira Lori , Jarjour Jane , Curran-Hays Shane , Carpenter Lauren , Pickard Kasey , Mattiucci Michael , Smith-Anderson Christiana , Abuogi Lisa 
Published: January 2021

Abstract

Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease of 2019 (COVID-19) and has been reported in &gt; 98,000 children in the U.S (5% of reported cases) as of early June 2020. Most published literature focuses on adults with COVID-19, but little is understood on the impact of SARS-CoV-2 in children. We created a database for children with COVID-19 at Children’s Hospital Colorado (CHCO), a large tertiary care pediatric hospital, to better understand the epidemiology and clinical outcomes of this disease in children.

Methods
We retrospectively reviewed the medical records of all pediatric and youth patients with positive SARS-CoV-2 PCR test results from March-May 2020. Univariate logistic regression models were used to identify predictors of hospital admission, need for critical care, and need for respiratory support among symptomatic patients, with p-values &lt; 0.05 considered statistically significant.

Results
We identified 246 patients with SARS-CoV-2 (age range: 17 days-25 years). We noted a Hispanic predominance with 68% of all patients with SARS-CoV-2 identifying as Hispanic or Latino, compared to 29% among all CHCO visits in 2019 (Figure 1). The most common symptoms at presentation were fever, cough, or shortness of breath in 94% of symptomatic patients. Sixty-eight patients (28%) were admitted, of which 7 (10%) required admission to the pediatric intensive care unit (PICU) for symptomatic COVID-19 disease (Figure 2). Age 0–3 months, certain symptoms at presentation, and several types of underlying medical conditions were predictors for both hospital admission and need for respiratory support (Figure 3). Initial and peak C-reactive protein (CRP) values were predictors for PICU admission with median peaks of 24.8mg/dL vs. 2.0mg/dL among PICU vs. non-PICU patients (OR 1.27, p=0.004).

Figure 3: Predictors for Admission and Respiratory Support Requirement in CHCO Patients with SARS-CoV-2

Conclusion
There is a wide spectrum of illness in children with SARS-CoV-2, ranging from asymptomatic to critical illness. Hispanic ethnicity was disproportionately represented in our cohort, which requires further evaluation. We found that young age, comorbid conditions, and CRP appear to be risk factors for severe disease in children.

Disclosures
Kelly E. Graff, MD, BioFire Diagnostics, LLC (Grant/Research Support)
85. Characterization of Group B streptococcus Strains with Reduced Susceptibility to Beta-lactam Antibiotics, Active Bacterial Core Surveillance, 1998–2017
Authors: Kobayashi Miwako , McGee Lesley , Chochua Sopio , Apostol Mirasol , Alden Nisha B , Farley Monica M , Harrison Lee , Holtzman Corinne , Torres Salina , Thomas Ann , Beall Bernard , Schrag Stephanie 
Published: January 2021

Abstract

Background
In the United States, approximately 30,000 invasive group B Streptococcus (iGBS) infections occur annually; beta-lactam antibiotics (BL) are the first choice for prevention in young infants and treatment in all age groups. We obtained phenotypic and genotypic data for iGBS isolates from U.S. population-based surveillance sites to describe the emergence and characteristics of strains with reduced beta-lactam susceptibility (RS) over a 20-year period.

Methods
We analyzed RS iGBS isolates from eight Active Bacterial Core surveillance sites from 1998–2017. Through 2014, minimum inhibitory concentrations (MIC) for six BL were determined by broth microdilution, followed by whole genome sequencing (WGS) of RS isolates exceeding pre-defined breakpoints (Table 1). In 2015, WGS and MIC testing were performed for all isolates. After 2015, all isolates underwent WGS. MIC testing was continued on approximately 25% of isolates; otherwise, only those with modified penicillin binding protein (PBP) 2x transpeptidase amino acid sequence types or suboptimal WGS (&lt; 1 % of isolates) underwent MIC testing. Clinical information on RS cases was abstracted from medical charts.

Results
Of 26,058 out of 27,269 iGBS isolates (95.6%) tested to date, 107 (0.4%) exhibited RS, increasing from 0% in 1998 to a peak of 1.1% in 2016 (P&lt; 0.05 for trend) (Figure 1). Seven (6.5%) RS strains were from infants aged &lt; 90 days; the rest were from adults aged ≥30 years (Table 2). RS strains consisted of 52 PBP2x types with diverse susceptibility patterns (Table 1). Seven RS strains (6.5%) had wild-type (non-modified) PBP2x; all met the RS criteria based on a single cephalosporin with a confirmed (repeated) MIC value at the break point (Table 1). Compared to non-RS strains, RS strains were more common in patients who presented with cellulitis and osteomyelitis and with underlying conditions such as diabetes or chronic skin breakdown (Table 2). Of 82 (85.4%) patients with RS strains and additional clinical information, 8.3% had known prior GBS infection; 26.8% had known BL exposure in the preceding year.

Conclusion
Preliminary results show that RS increased in recent years; strains RS to penicillin and ampicillin remain low. Variable pbp2x mutations have emerged and predominant strains have not yet been identified.

Disclosures
Nisha B. Alden, MPH, CDC (Grant/Research Support) Lee Harrison, MD, Dynavax (Consultant)GSK (Consultant)Merck (Consultant)OMVax (Consultant)Pfizer (Consultant)Sanofi Pasteur (Consultant)
86. Health Resource Burden of Influenza Among the Elderly with Underlying Conditions in the United States
Authors: Near Aimee , Tse Jenny , Young-Xu Yinong , Hong David K , Reyes Carolina M 
Published: January 2021

Abstract

Background
Seasonal influenza poses a substantial clinical and economic burden, despite influenza vaccination efforts. This study evaluates healthcare resource utilization attributable to influenza in elderly populations at increased risk of influenza-related complications.

Methods
Elderly (≥ 65 years of age) patients (pts) with ≥ 1 influenza diagnosis (Dx) during influenza seasons from October 1, 2014 – March 1, 2019 were identified in the IQVIA PharMetrics® Plus claims database. The earliest influenza Dx was the index date and pts had evidence of pulmonary, cardiovascular, or renal disease before index. Pts had ≥ 12 months continuous enrollment (baseline before index) and ≥ 30 days follow-up after index. Medically-attended influenza cases were identified by primary influenza Dx codes or any influenza Dx with a record of an influenza test within ±14 days. Influenza pts were 1:1 propensity score matched to pts without influenza using baseline demographic and clinical characteristics and baseline healthcare costs. All-cause hospital and emergency department (ED) visits and total healthcare costs during follow-up (30-day and in the index influenza season) were compared in the matched cohorts.

Results
Baseline characteristics were balanced after matching. Elderly influenza pts had 3 to 7 times higher 30-day hospitalization rates compared to pts without influenza, including pts with congestive heart failure (41% vs. 8%), chronic obstructive pulmonary disease (35% vs. 6%), coronary artery disease (23% vs. 4%), and stage 5/end stage renal disease (ESRD)/dialysis (44% vs. 13%; all p&lt; .05; Figure). Hospital and ED visit rates in the influenza season were 2 to 3 times higher in pts with vs. without influenza; ED visit rates were 49% vs. 23%, 44% vs. 18%, 37% vs. 14%, and 60% vs. 28% for the above cohorts, respectively (all p&lt; .05). Mean total healthcare costs per patient per season were $3,299 to $12,398 higher in pts with vs. without influenza (all p&lt; .05, except myocardial infarction and stage 5/ESRD/dialysis pts).
Figure. All-cause 30-day hospitalization rates in matched cohorts of elderly patients with baseline comorbidities with and without influenza

Conclusion
Hospitalizations, ED visits, and total healthcare costs are elevated in the elderly after evidence of medically-attended influenza, but to varying degrees depending on baseline comorbidities. Continued efforts to reduce influenza burden in high-risk populations are needed.

Disclosures
Aimee Near, MPH, Employee of IQVIA; IQVIA paid by VIR Bio to complete research project (Consultant) Jenny Tse, MS, Vir Biotechnology, Inc. (Other Financial or Material Support, I am employed by IQVIA which was paid by Vir Biotechnology, Inc. to complete this study.) David K. Hong, MD, Vir Biotechnology (Employee) Carolina M. Reyes, PhD, Vir Biotechnology (Employee, Shareholder)
101. Who Does Not Show up for Followup in an HIV Prep Clinic?
Authors: Williams Robert , Flanigan Timothy P , Bazerman Lauri , Tao Jun , Chu Christina , Silva Elizabeth S , Almonte Alexi , Montgomery Madeline , Chan Philip 
Published: January 2021

Abstract

Background
Understanding real-life HIV pre-exposure prophylaxis (PrEP) care is key to address HIV infection. An HIV PrEP clinic was started in Providence, RI in 2013, performing outreach to men who have sex with men (MSM) and other high-risk individuals. Our prior clinical studies and other literature have shown that many high-risk patients do not return for followup PrEP visits. We sought to better identify correlates of patients who were lost to follow up (LTFU), with implications for improving PrEP care retention.

Methods
Data was collected from all cis-gender patients who first presented to the RI PrEP Clinic from 2013 to mid-2019. Correlations in demographic information and behaviors related to PrEP care were demonstrated through descriptive analysis. A multivariate analysis was then performed to elucidate possible predictors. LTFU was defined as having no subsequent visit within six months of the initial appointment after being prescribed PrEP.

Results
Of 570 patients, most identified as male (96%), White (65%), and non-Hispanic (82%). 65% of patients made one followup appointment within six months of intake, and 35% were LTFU. The following characteristics correlated with higher rates of LTFU: being below 25 years of age (17% vs 27%; p=0.002), illicit drug use (42% vs 53%; p=0.02), and having both same and opposite-sex partners (7% vs 16%). Characteristics which correlated with lower rates of LTFU included only having same-sex partners (88% vs 74%; p&lt; 0.001), alcohol use (86% vs 80%; p=0.04), and bachelor’s degree completion (71% vs 49%; p&lt; 0.001). Race, gender, and risk behavior showed no correlation.

Conclusion
A clear understanding of mechanisms of retention is high priority for forming care protocol interventions. Given trends with age, education, and PrEP indication, targeted interventions are needed to improve retention in HIV PrEP care and reduce incidence in at-risk communities.

Disclosures
All Authors: No reported disclosures
102. Improving Implementation of HIV Pre-exposure Prophylaxis: Lessons Learned from Young Women in Rural South Africa
Authors: Hannaford Alisse , Khumalo Noxolo , Norton Sarah , Moll Anthony , Shenoi Sheela 
Published: January 2021

Abstract

Background
Young women in South Africa are at particularly high risk for acquiring HIV, yet implementation of HIV prevention programmes in rural settings lags. We examined the experiences and perceptions of young women initiating pre-exposure prophylaxis (PrEP) in a rural setting under real-world programmatic conditions, in order to strengthen future PrEP delivery to this population.

Methods
Young women initiating PrEP in Msinga, a municipality in KwaZulu-Natal province, were interviewed about their motivation to start PrEP and their experiences in taking PrEP. Interviews were conducted at PrEP initiation and longitudinally as they returned to clinic monthly for medication refills.

Results
Among seventeen sexually active at-risk young women (IQR 18–22.5 years old) who initiated PrEP, 71% lived in a household receiving a government grant, 24% had history of an STI and 71% reported inconsistent condom use. All participants disclosed PrEP use to a family member, but only 20% informed their male sexual partner. All expressed uncertainty regarding their partners’ sexual activities as a primary motivation for PrEP initiation. Social support from family and friends as well as interacting with other young women taking PrEP were identified as important facilitators. Barriers to PrEP included lack of community awareness about PrEP, limited clinics offering PrEP, HIV stigma, and logistics of accessing healthcare facilities. Young women valued a peer PrEP champion to facilitate and maintain successful engagement in care, as well as patient-centered PrEP delivery models that allow for care outside traditional clinic facilities.

Conclusion
Input from young women has the potential to significantly enhance and expand PrEP implementation. Tailored implementation efforts should include strengthening the role of community health workers, improving community-wide PrEP education, empowering women within their relationships, facilitating skill building for PrEP disclosure to partners, incorporating community PrEP champions, and developing alternative PrEP delivery models including community-based delivery.

Disclosures
All Authors: No reported disclosures
103. Persistence on F/TDF for HIV Pre-exposure Prophylaxis: Insights from Real-world Evidence
Authors: Tao Li , Shvachko Valentina , Mera Robertino , Das Moupali , Carter Christoph , Magnuson David 
Published: January 2021

Abstract

Background
Background: Daily F/TDF is highly effective for HIV pre-exposure prophylaxis (PrEP). Prior studies have found that women and people of younger age have lower adherence and lower persistence on PrEP, yet real-world evidence describing persistence associated with other clinical characteristics and the patterns of persistence is limited.

Methods
Methods: We identified 313,526 HIV-1 negative individuals in the United States who initiated F/TDF for PrEP between January 1, 2012 and December 31, 2019 from a de-identified prescription claims database. PrEP users were defined as non-persistent if a gap in prescription fills &gt;30 days was detected. We used survival analyses to estimate the persistence rate by year of PrEP initiation, and Cox regressions adjusting for multiple demographic and clinical characteristics to determine hazard ratios and corresponding 95% confidence interval of non-persistence for PrEP.

Results
Results: Among the 313,526 PrEP users with a median age at PrEP initiation of 35 years of age (interquartile range, IQR, 26−43), 88% were men (median days of persistence = 118, IQR 30−316 days) and 12% were women (median 30 days, IQR 30−92 days). PrEP persistence at 30, 60 and 90 days increased over time, reaching the highest levels in 2019 (Figure). In a multivariate analysis, younger age, female sex, and non-white race were associated with higher risk of non-persistence (Table). We also observed associations of a 5% lower rate of non-persistence if PrEP was prescribed by internal medicine or infectious disease physicians than by family medicine physicians, and a 13% lower rate of non-persistence associated prescriptions ordered from mail-order pharmacies than prescriptions of retail pharmacies. Finally, history of bone fracture or renal dysfunction prior to PrEP initiation were associated with a 13% and 9% higher rate of non-persistence, respectively.
Figure. F/TDF for PrEP persistence rates over time.

Table. Hazard ratios and corresponding 95% confidence intervals of non-persistence on F/TDF PrEP since initiation, 2012–2019

Conclusion
This study demonstrates that persistence on F/TDF for PrEP has improved over time, and identifies several characteristics associated with non-persistence, including age, sex, race/ethnicity, prescriber specialty, type of pharmacy, and history of bone fracture or renal dysfunction. These findings can help to inform interventions aimed at improving PrEP persistence in people at risk of HIV.

Disclosures
Li Tao, MD, PhD, Gilead Sciences Inc (Employee) Valentina Shvachko, n/a, Gilead Sciences Inc (Employee) Robertino Mera, MD, PhD, Gilead Sciences Inc (Employee) Moupali Das, MD, MPH, Gilead Sciences Inc (Employee) Christoph Carter, MD, PhD, Gilead Sciences Inc (Employee) David Magnuson, PharmD, Gilead Sciences Inc (Employee)