bluuebunny/crossref_metadata_2025_split huggingface dataset:
1650. Knowledge and Attitudes Toward Influenza Vaccination Among Hispanics: A Survey Conducted in Latin American Consulates in South Florida
Authors: Soler Hidalgo Maria L , Abbamonte John M , Regalini Laura , Schlesinger Mariana , Alcaide Maria L , Dickinson Gordon M 
Published: October 2019

Abstract

Background
Each year Influenza causes between 12,000 and 56,000 deaths, and over half a million of hospitalizations in the United States. Despite the widespread availability of vaccination, immunization coverage is low. Less than half of American adults receive the influenza vaccine, and there is a disparity between Hispanic and non-Hispanics, with only 35.9% of Hispanic compared with 45.9% of white non-Hispanics receiving the vaccine. In Miami, South Florida, over two-thirds of the population is Hispanic, and rates of influenza vaccination are low. This study aims to identify the knowledge and attitudes toward influenza vaccination among members of the adult Hispanic community in Miami, and to identify barriers to vaccination in this population.

Methods
This is a cross-sectional study conducted during the influenza season in 2017 and 2019 (October to December). A survey was administered in the waiting rooms of participating Latin American Consulates (Argentina, Colombia, Ecuador, Guatemala, Honduras, Mexico, Peru, and Uruguay) in Miami. Participants included were older than 18 years, Hispanic, and with residence in the United States for more than 6 months. The participants accepted the inform consent orally. The survey was voluntary and anonymous.

Results
We enrolled 970 adults. The median age was 43 years, 50% were male, 60% had health insurance, and 67% had completed education of high school or higher. Knowledge regarding influenza and vaccination was low (78% believed asymptomatic individuals could transmit influenza, 14% knew that vaccination is recommended during the winter months, 50% felt not everyone should be vaccinated, 25% believed the vaccine causes influenza, and 7% autism). About one quarter (27%) received the influenza vaccine annually, 35% sometimes, and 38% never. Using multinomial logistic regression, we identified age χ2(2) = 19.38, P < 0.001, consulate χ2(6) = 160.21, P < 0.001, and insurance status χ2(2) = 23.04, P < 0.001 as predictors of receiving vaccination. Neither gender, nor education level found to be associated with vaccination behavior.

Conclusion
Immunization rates in the adult Hispanic population are low. Interventions to improve vaccination among Hispanics who are older and lack of health insurance are urgently needed in the diverse Hispanic community.

Disclosures
All authors: No reported disclosures.
1652. Equivalent HIV Outcomes for Persons with HIV after Re-engagement in HIV Care with Prior or New Provider
Authors: Udeagu Chi-Chi N , Shah Sharmila , Braunstein Sarah 
Published: October 2019

Abstract

Background
New York City (NYC) health department staff assist people with HIV (PWH) deemed out of care (OOC) per NYC HIV Surveillance Registry to re-engage in HIV care with their last known treating provider/parent clinic or, if preferable/necessary (e.g., moved to a new neighborhood), a new NYC provider. We examined retention in care and viral suppression (VS) of PWH re-engaged in care in a group who agreed to return to care and were cared for by either their previous or a new provider.

Methods
We analyzed data from 2009 to 2015 on PWH who had ≥2 CD4 count or viral load (VL) test reports in the NYC HIV Registry who fell out of care and then re-engaged in care. We compared characteristics, timeliness and retention in care (≥2 CD4 or VL, ≥90 days apart) and VS (last VL ≤200 copies/mL) of PWH overall and also according to whether they returned to their last known vs. a new provider in year 2 post re-engagement in care.

Results
From 2009–2015, 882 persons were re-engaged in care by the health department. Most were diagnosed 5–10 (27%) or >10 (67%) years prior, and were OOC for 1–3 years (70%) or >3 years (20%). Most re-engaged PWH were male (63%), black (56%) or Hispanic (34%), US-born (79%), aged 30–49 (48%) or ≥50 (40%) years. Risk factors for HIV included heterosexual transmission (39%), male-sex-with-male (26%) or injection drug use (18%). Twenty-two percent had history of homelessness and 5% incarceration. Fifty-one percent and 49% re-engaged in care with their prior or a new provider, respectively. PWH re-engaged with prior providers vs. new providers had lower rates of prior or current homelessness (17% vs. 28%, P = 0.0001), PWH re-engaged to prior vs. new providers had their first lab reports and achieved VS earlier (1 vs. 2 months, and 4 vs. 5 months, respectively (both P < 0.05). Proportions of PWH re-engaged to prior or new providers and retained in care (92% vs. 91%, respectively) or with VS (73% vs. 75%, respectively) in year 2 did not differ.

Conclusion
Our results show that health department efforts to re-engage previously OOC-PWH in HIV care resulted in more than 70% achieving VS. Assignment to a new provider resulted in earlier VS but did not affect 2-year VS or care retention. PWH who re-engage in care can safely be given the choice between known or new providers.

Disclosures
All authors: No reported disclosures.
1659. Electronic Consultations Combined with a Video Supported Powerpoint-based Pre-Travel Education Is Equivalent to In-Clinic Face-to-Face Pre-Travel Consultations in Appropriately Selected Travelers
Authors: Kasten Mary J , Virk Abinash , Mandrekar Jayawant , Springer Donna J 
Published: October 2019

Abstract

Background
Pre-travel consultation involves an in-clinic face-to-face consult (F2F) with a Travel Medicine provider. F2F involves education/counseling which is time-consuming for both patients and providers. Although electronic consultations (synchronous and asynchronous) are well established in many subspecialties, pretravel eConsults are not well known. We compared pretravel education via F2F to an innovative hybrid electronic consultation (HeC) combined with a Video Supported PowerPoint (VSP) for selected travelers.

Methods
We conducted a prospective trial comparing HeC-VSP to F2F to determine the quality of pretravel education. Study was approved by the Mayo Clinic IRB. Patients were enrolled from May 2014 through May 2015. Patients in both arms were given pretravel and post-travel surveys. Exclusions included age less than 18 years, first trip to Africa, immunocompromised host, non-English-speaking traveler, or travel for longer than 4 weeks.

Results
194 patients were enrolled; 100 in HeC-VSP and 94 in F2F arm completed pretravel survey. Post-travel survey was completed in 54.2% (51/94) of the F2F, 67% (67/100) in the HeC-VSP group. The groups are similar in demographics and prior travel experience (Table 1). 36.2% of the F2F group felt that the consultation could have been effectively accomplished through a video-based education, while 33% felt that a F2F was needed; in contrast a majority (63.3%) in the HeC-VSP group would not have preferred a F2F consultation. HeC-VSP-based pretravel education was similar compared with that provided via the F2F consults. There were no statistically significant differences in the responses obtained in both groups to knowledge assessment questions (Table 2) except for one question. A higher proportion (76/100; 76%) in the HeC-VSP group compared with 55.4% (51/94) chose the correct response (P = 0.0018) regarding management of bloody diarrhea with fever. Self-reported change in behaviors to prevent travel-related illnesses was reported overall in 53% of the patients with no statistically significant differences between the groups.

Conclusion
Nonsynchronous eConsultation combined with VSP provides a viable solution to provide pretravel education for a select travel population.

Disclosures
All authors: No reported disclosures.
1660. Protective Effect of Living with Animals on Diarrheal Illness Among Children Younger Than Five in Sub-Saharan Africa and South Asia
Authors: Murray Meghan T , Neu Natalie , Neu Natalie , Larson Elaine 
Published: October 2019

Abstract

Background
Diarrheal disease is one of the top three causes of death in children <5 years old, with the majority occurring in sub-Saharan Africa and South Asia. Animals are known reservoirs of diarrheal pathogens. While previous studies have investigated companion animals and livestock as contributors to human diarrheal disease, few have investigated this association in sub-Saharan Africa and/or South Asia among children younger than 5 years old. The aim of this study was to determine the relationship between animals living in or near the home and diarrheal disease in this population.

Methods
We conducted a secondary analysis of the Global Enteric Multicenter Study (GEMS), a case–control study that described the epidemiology of and evaluated the risk factors for diarrheal illness in children <5 years old living in sub-Saharan Africa and South Asia. Children with moderate-to-severe diarrhea (MSD) were matched to community controls without diarrhea. Associations between the predictor of animals present in a child’s living environment and the outcomes of diarrhea and diarrheal pathogens were assessed using multivariable conditional logistic regression with alpha = 0.05. Known risk factors for MSD were assessed for confounding.

Results
From December 1, 2007 to March 3, 2011, there were 9,439 cases with MSD and 13,128 controls enrolled in GEMS. 87% of children had at least 1 animal present at their home. When controlling for exclusive breastfeeding, access to an improved water source, access to a private improved sanitation facility, and the number of children <5 living in the home, children were less likely to have MSD if there was at least one animal present at their home (aOR 0.66, CI95 0.59 – 0.74). Children living with an animal were also 15% less likely to be colonized or infected with a viral diarrheal pathogen (aOR 0.85, CI95 0.72–0.99), when controlling for exclusive breastfeeding. There were no significant differences in the presence of bacterial or protozoal pathogens in the stool of children with and without animals present at their home.

Conclusion
In contrast to prior research, having an animal present at the home does not appear to increase the risk of childhood diarrhea. Furthermore, the presence of animals may have a protective effect against viral diarrheal disease in young children. Additional research is needed to gain greater understanding of this relationship.

Disclosures
All authors: No reported disclosures.
1664. Maternal Hookworm Infection and Its Effect on Maternal/Child Health: A Systematic Review and Meta-Analysis
Authors: Ness Tara , Bedard Kathryn R , Hotez Peter J , Weatherhead Jill 
Published: October 2019

Abstract

Background
Hookworm is an intestinal parasite that infects 500 million people, with another 5.1 billion at risk, especially in poverty-stricken, tropical and subtropical regions. In 2005, an estimated 6.9 million pregnant women living in Sub-Saharan Africa were infected with hookworm, despite efforts for mass drug administration (MDA) being recommended. This study aimed to investigate the health impact of hookworm infection in pregnant women in order to guide public health interventions.

Methods
A systematic review and meta-analysis were conducted using Medline OVID for the creation of MeSH terms, with subsequent translation to EMBASE and Cochrane Library. We performed a meta-analysis on the association between maternal hookworm and maternal anemia, as well as maternal hookworm co-infection with malaria. Other effects on maternal/child health were investigated and summarized without a meta-analysis due to the limited study numbers.

Results
Our search resulted in 471 studies for the meta-analysis, of which 23 met inclusion criteria. The prevalence of hookworm ranged from 1% to 67% in pregnant women, while malaria prevalence ranged from 11 to 81%. Pregnant women with anemia were more likely to have concurrent hookworm infection (combined odds ratio (cOR) 2.21 [1.94, 2.51], P < 0.001). Additionally, pregnant woman with malaria were more likely to have hookworm infection (cOR 1.71 [1.43, 2.03], P < 0.001). Our investigation also showed an association between maternal hookworm and infant cognitive development (one study), maternal co-infection with HIV (two studies), and infant birth weight (significant in three of four studies). Infant vaccine response did not show an association (four studies).

Conclusion
Hookworm infection in pregnant women is an important global health issue associated with significant maternal anemia and concurrent parasitic infections, such as malaria. Despite current MDA strategies in pregnant women, heavy hookworm burden, co-infection with malaria, and subsequent anemia persists. Further investigation on maternal-child outcomes of hookworm infection on maternal anemia, maternal malaria co-infection, and other areas, such as infant cognitive outcomes, will provide potential public health interventional targets to reduce morbidity.

Disclosures
All authors: No reported disclosures.
1668. No Impact of Nutritional Status on Oral Polio Vaccine shedding after Vaccination of Under 5 Children in Rural Mexico
Authors: Nino-Tapias Gianna J , Altamirano Jonathan , Sarnquist Clea , Behl Rasika , Leary Sean , Sommer Marvin , Maldonado Yvonne 
Published: October 2019

Abstract

Background
As wild poliovirus is nearing global eradication and countries switch from Oral Polio Vaccine (OPV) to Inactivated Polio Vaccine (IPV), preventing circulating vaccine-derived poliovirus is a top priority. However, the circulation of OPV serotypes remains a concern in undervaccinated communities. We sought to examine the relationship between pediatric nutritional status and OPV shedding based on length-for-age categorizations. Mexico provides a natural environment to study these patterns as it provides routine IPV immunization and bi-annual OPV campaigns.

Methods
We enrolled 466 households with children eligible for OPV before the February 2015 national health week from 3 semi-rural Indigenous communities near Orizaba, Mexico. In each community, a different proportion of eligible children received OPV (10%, 30%, 70%), with a total of 155 vaccinated children. OPV shedding was measured by RT-qPCR detection of OPV in samples collected serially over 10 weeks. Anthropometric measurements were collected and compared with the WHO Multicenter Growth Reference Study growth curves to assign stunting. Associations between stunting, OPV shedding, and shedding duration were tested by Fisher exact test and Wilcoxon-Man-Whitney Test (α = 0.05).

Results
Samples of fecal OPV isolates were collected over time and analyzed from 148 vaccinees. 25 (17%) of the vaccinees were stunted. There was no relationship between pediatric stunting and likelihood of ever shedding any serotype of OPV (P = 0.82). The mean duration of OPV shedding by stunted and non-stunted children differed, but not significantly (10.9 days vs. 9.3 days, respectively, P = 0.32). We did not find any statistically significant differences between stunting status and shedding of any individual OPV serotype.

Conclusion
Further understanding of factors related to OPV shedding is necessary to approach efficient worldwide poliovirus control. We found no relationship between stunting status and both OPV shedding and shedding duration post-vaccination, suggesting that nutritional status does not play a role in OPV shedding. The ongoing analysis includes longitudinal analysis of OPV shedding patterns by nutritional status, and the impact of stunting on viral load and reversion of OPV to vaccine-associated paralytic polio mutants.

Disclosures
All authors: No reported disclosures.
1669. Trends in Authorship for Infectious Disease Research Conducted in Low-Income Countries
Authors: Modlin Chelsea E , Powell Kimberly , Kempker Russell R 
Published: October 2019

Abstract

Background
Research capacity in low-income countries (LICs) plays an important role in strengthening national healthcare systems and addressing local health priorities. Research in infectious diseases is especially important as they comprise five of the top 10 causes of death in LICs. While academic collaborations between high-income countries (HICs) and LICs offer many benefits, they also risk structural and professional imbalances. This study explores research capacity as a function of first or last authorship and funding for research conducted in LICs that is published in high-impact infectious disease journals.

Methods
A literature search using the abstract database Scopus was completed for original research conducted within LICs or using samples collected from LIC subjects published between 1998 – 2017 in Clinical Infectious Diseases, Journal of Infectious Diseases, and Open Forum Infectious Diseases. Primary outcomes included the number of LIC first and last authors compared with HIC authors over time. Secondary outcomes included the geographic distribution of research and the proportion of research financed by LICs.

Results
A total of 1380 articles were identified of which 20% had LIC first authors and 21% had first authors with dual LIC/HIC affiliations. For last authors, 13% were affiliated with a LIC and 15% had dual LIC/HIC affiliation. HIC researchers compiled the majority of first and last authors regardless of geography (Figure 1). The number of studies conducted in LICs increased over the 20-year timeframe (Figure 2) but is attributed to an increase in articles with HIC authors. The number of LIC authors remained unchanged resulting in a decreasing proportion of LIC authors. Only 4% of articles received funding from a LIC; however, 79% of these studies were authored by LIC researchers vs. 39% of studies funded by HIC sources.

Conclusion
There is a growing appreciation for international HIC/LIC research collaborations with the objective to reduce the burden of infectious diseases that disproportionately affect low-income settings. However, with this increased attention comes the responsibility to improve LIC research capacity. This includes promoting LIC researchers via authorship and supporting sustainability with funding that highlights LIC priorities.

Disclosures
All authors: No reported disclosures.
1673. Gendered Patterns of HIV, TB, and Other Primary Care Referrals in Rural South Africa
Authors: Choi Koeun , Moll Anthony , Shenoi Sheela 
Published: October 2019

Abstract

Background
Men’s lack of engagement in healthcare hinders HIV efforts in sub-Saharan Africa. Masculine norms and lack of accessibility in a female-dominated healthcare system deter male health-seeking behavior. Community interventions combat the gender gap. In South Africa (SA), alcohol-based venues (ABV) are common locales for men. We created an ABV community health screening to determine the need.

Methods
Community Health Workers targeted ABV in rural SA, offering screenings for HIV, TB, Isoniazid Preventive Therapy, STI, hypertension, diabetes, circumcision, with referral to primary care services (PCS) for any positive screenings. Participants completed questionnaires, including socioeconomic (SE), healthcare use, and alcohol use evaluated by AUDIT scores. Multivariable logistic regression identified factors associated with referral to PCS.

Results
From July 2018 to March 2019, 1356 were screened, 74% were men, median age was 30 (IQR 22–46), 26% employed and 30% had running water. Men are more likely to have never gone to a PCS compared with women (15.9% vs. 9.7%, P = 0.004) and have lengthier time since the last clinic visit (1.4 years vs. 0.6 years, P < 0.001). Men are significantly more likely than women to report hazardous drinking (49% vs. 28%, P < 0.001) Overall, positive screenings were noted in 537 (53.9%) community members, and χ 2 analysis show men more likely to require referrals after screening (P = 0.08). Multivariate analysis shows among men, referrals were associated with older age, hazardous drinking, any health concerns; while higher SE was protective. For women, only age and health concerns were associated with referral. Similarly, alcohol contributed to HIV and TB referrals for men, while higher SE was protective of TB referrals for men (Table 1).

Conclusion
ABV males in this rural community, although disengaged from health care, required more referrals than women. HIV, TB, and any referrals for men screened at ABV in rural SA were associated with lower SE and hazardous drinking, highlighting the challenges that this population faces in seeking health care. Differentiated and targeted community-based services may facilitate care for these hard to reach men in sub-Saharan Africa. Next steps include determining clinical outcomes of referrals.

Disclosures
All authors: No reported disclosures.
1675. Implementation of Electronic Travel History Screening at an Urban Medical Center
Authors: de St. Maurice Annabelle M , Martinez Sandra , Sweeney Sarah , Genta Elizabeth , Walton Shaunte , Rubin Zachary A , Uslan Daniel 
Published: October 2019

Abstract

Background
Middle East Respiratory Syndrome (MERS), caused by a novel coronavirus, can lead to severe respiratory failure and death. CDC recommends screening patients who traveled to endemic countries for fever, respiratory symptoms, and exposure to MERS-positive contacts and healthcare facilities. UCLA is a large, academic, medical center located in a diverse city with frequent international travel. We implemented a travel screening (TS) questionnaire in our electronic medical record (EMR) (Figure 1) to identify high-risk patients in order to implement early isolation practices and testing. This study describes the use and performance of our TS for identifying suspect MERS cases.

Methods
An EMR-based tool prompts nurses to ask patients at triage or admission whether they have traveled out of the country in the past 30 days (Figure 1). If patients answer affirmatively, the EMR prompts nurses to inquire about travel to specific high-risk countries and to review symptoms and exposure risks. Upon notification of a potential MERS case, the EID physician on-call reviews the TS, clinical history, epidemiologic risks, and makes a determination whether further evaluation and/or isolation for suspect MERS is necessary. We reviewed travel history, demographics, and symptoms of patients who triggered a positive TS from April 2017 to September 2018.

Results
The ED completed 115,815 distinct TS on 81,197 individuals during this time period. The median time from ED arrival to TS completion was 6.4 minutes. 308 ED encounters triggered a positive TS; an additional 257 encounters in other units triggered a positive TS, resulting in 565 positive TS (Table 1). 122 (22%) expressed ≥1 MERS symptom and 29 (24%) expressed both fever and respiratory symptoms. Of these symptomatic patients, 0 had a history of contact with a MERS case; 3 had a history of contact with a healthcare facility while traveling; and 4 had a history of contact with camels. No patients were diagnosed with MERS (Table 2).

Conclusion
A history of travel to the MERS endemic countries is relatively common at a large urban hospital. Routine electronic screening of patients is an efficient way to identify high-risk travelers. This EMR tool could be modified for other emerging pathogens, such as measles or Ebola, to identify high-risk patients.

Disclosures
All authors: No reported disclosures.