bluuebunny/crossref_metadata_2025_split huggingface dataset:
1422. Burden of Pertussis in South Korea: Implications for adults
Authors: Mungall Bruce , Kim Hyungwoo , Oh Kyu-Bin 
Published: January 2021

Abstract

Background
There are a limited number of published studies on pertussis disease burden and epidemiology in South Korea, particularly those evaluating the impact in adults.

Methods
We conducted a systematic literature review on pertussis epidemiology and burden of disease in South Korea. The objective was to highlight evidence gaps which could help improve awareness about pertussis disease in adults in South Korea.

Results
Of 940 articles published between January 2000 to December 2019, 19 articles provided data for pertussis epidemiology and 9 provided data in adults. Laboratory confirmation rates in adults varied according to methodology, likely influenced by study/sampling variations. Three studies reported serological evidence of infection in adolescents and adults (33-57%). Among cases, the average cough duration was 16.5 days (range 7-30 days) and over 85% of cases presented with paroxysmal cough, while only 25% of cases or less presented with a characteristic whoop or post-tussive vomiting. Importantly, in 4 studies reporting vaccination status, almost all adult cases had no history of pertussis vaccination since childhood.

Conclusion
Primary childhood vaccination rates in South Korea are among the highest globally, while adult pertussis vaccine uptake appears to be quite low. Our literature review suggests that pertussis is underreported in adults, as evidenced by serology data demonstrating that tetanus antibody levels are low while pertussis toxin antibody levels are relatively high, suggesting continued circulation of community pertussis. These findings highlight the need for strategies such as maternal immunization and decennial revaccination of adults to address the changing epidemiology and waning immunity. Active pertussis testing/reporting and better utilization of adult vaccine registries is required to help provide robust data for vaccine decision-making at the national level. In the current COVID-19 environment, strategies that can reduce clinic or hospital visits will have substantial benefits to authorities managing rapid increases in health care resource utilization, and vaccine preventable diseases provide an easy and immediate target for achieving that goal.

Disclosures
Bruce Mungall, PhD, the GSK group of companies (Employee, Shareholder) Hyungwoo Kim, MD, MPH, the GSK group of companies (Employee) Kyu-Bin Oh, MD, the GSK group of companies (Employee, Shareholder)
1425. Impact of Social Determinants on Racial Differences in Carbapenem-Resistant Enterobacteriaceae Incidence, Atlanta, 2012-2018
Authors: Smith Gillian , Bower Chris W , Fridkin Scott , Jacob Jesse T 
Published: January 2021

Abstract

Background
Public health prioritizes addressing social determinants of health to promote health equity. We hypothesized that social determinants of health, including poverty, are associated with racial disparity in the incidence of carbapenem-resistant Enterobacteriaceae (CRE).

Methods
The Georgia Emerging Infections Program conducted CDC-funded, active population-based CRE surveillance in metropolitan Atlanta (2017 population: 3.9 million) from 2012-2018. CRE cases were defined as Atlanta residents with a urine or normally sterile specimen growing E. coli, Klebsiella spp., or Enterobacter spp. resistant to ≥ 1 carbapenems (excluding ertapenem) and all third generation cephalosporins tested. Poverty, education and insurance levels by census tract of residence were obtained from the US Census Bureau’s 2017 American Community Survey. Race and end-stage renal disease (ESRD) were determined from chart review, and primary care provider (PCP) shortage area was obtained from the Health Resources and Services Administration. Age-adjusted incidence rate ratios were individually calculated using direct age standardization. Covariates were considered for inclusion in a multivariable Poisson regression model for the expected rate of CRE.

Results
Adjusting for age, CRE incidence was three times higher in blacks than whites. Higher CRE incidence was also observed among cases assigned &gt; 40% below poverty level, &gt; 15% below high school education, &gt; 10% uninsured, and in a PCP shortage area (Table 1). CRE incidence was 58 times higher among ESRD cases than non-ESRD cases. In the multivariable model (Figure 1) addition of education, poverty or ESRD (p&lt; 0.001), but not PCP access (p = 0.61) and insurance status (p=0.19), significantly reduced the racial difference in CRE incidence compared to race and age alone. Although controlling for age and either education, poverty level or ESRD reduced CRE among blacks, CRE incidence in blacks remained double that of whites.
Figure 1. Comparison of race CRE incidence rate ratio adjusting for age alone (red line) to adjusting for age and individual social determinants (blue bars)”

Table 1. Social Determinants Distribution and Age-Adjusted CRE Incidence Rate Ratio (N = 378)

Conclusion
Poverty level, ESRD and education only partially account for the racial differences seen in CRE incidence. While ESRD suggests a possible biologic component, persistent racial differences indicate the need for targeted public health interventions to address social determinants of health.

Disclosures
All Authors: No reported disclosures
1426. Increased Visits to Respiratory Protection Webpages during COVID-19
Authors: Lybrand Evan , Micciche Mary , Tienken Burton , Cichowicz Jaclyn , Fries Marisa , Senk Mark , Casey Megan 
Published: January 2021

Abstract

Background
COVID-19 transmission is thought to occur mainly via respiratory droplets produced when an infected person coughs or sneezes. Respiratory protection devices, when properly fitted and used, can prevent this type of illness transmission.

Methods
The Centers for Disease Control and Prevention’s National Personal Protective Technology Laboratory (NPPTL) within the National Institute of Occupational Safety and Health (NIOSH) is responsible for the certification and approval of respirators for use in occupational settings. NPPTL maintains webpages with information on respiratory protection devices. We monitored the number of webpage views for several NPPTL webpages from January 1, 2020 to May 8, 2020. The number of webpage visits was then compared to significant events during the COVID-19 outbreak as well as the previous year’s webpage visits.

Results
The landing page for NIOSH-approved N95 respirators received the most visits. This page received a total of 1,637,250 webpage visits with a peak of 63,715 on February 26, 2020, a 38,989% increase from the average daily page visits for that same month in 2019. This occurred on the same day as the White House gave its first televised briefing on COVID-19. The page providing general information on filtering facepiece respirators, including N95 respirators received 834,186 webpage visits with a peak of 20,520 on April 3, 2020, a 13,659% increase from the average daily webpage visits for that same month in 2019. This occurred on the same date as new CDC recommendations were provided for using cloth face masks in public places. The counterfeit respirator page maintained a steady, but small number of webpage visits, but increased from 4,261 on March 27, 2020 to 68,145 on March 29, 2020. This occurred as the first reports of fraudulent respirators were being published in the media. It then fell to 18,562 on March 30, 2020 and 13,093 on March 31, 2020. While most webpage visits were from the United States, visits from China, and Canada were higher than previous years.

Conclusion
During COVID-19 there was a large increase in the number of webpage visits for respiratory protection information which coincided with major events and media reports. Accurate, accessible respiratory protection information is an important resource during public health emergencies.

Disclosures
All Authors: No reported disclosures
1428. Lyme Disease Treatment in the United States: Prescribing Patterns from a Nationwide Commercial Insurance Database, 2016-2018
Authors: Beeson Amy M , Marx Grace E , Schwartz Amy M , Hinckley Alison F 
Published: January 2021

Abstract

Background
Lyme disease (LD) is the most common vector-borne disease in the United States and is a significant public health problem. The use of non-standard antibiotic treatment regimens for LD has been associated with adverse effects; however, the overall landscape of treatment has not been described previously. We aimed to describe real-world antibiotic prescribing patterns for LD.

Methods
We performed a retrospective analysis of the MarketScan commercial claims database of outpatient encounters from 2016-2018 in the United States. We identified all individuals with a visit that included an LD diagnosis code and a prescription within 30 days of the visit for one or more of 12 antibiotics that may be prescribed for LD. We then categorized each individual as having received either standard or non-standard treatment during the two-year period. Standard treatment was defined as treatment with a first, second or third-line antibiotic for LD, for no longer than 30 days, and for no more than two episodes during the study period. Descriptive and multivariable analyses were performed to compare characteristics of people who received standard vs non-standard treatment for LD.

Results
A total of 84,769 prescriptions met criteria for inclusion, written for 45,926 unique patients. The mean duration of prescriptions was 21.4 days (SD 10.8). Most individuals (84.5%) treated for LD received standard treatment during the study period. Female gender (OR 1.5, p&lt; 0.0001) and age 19-45 (p=0.0003) were significantly associated with being prescribed non-standard LD treatment. Treatment in low-incidence states (OR 2.2 compared to high-incidence states, p&lt; 0.0001) and during non-summer months (OR 2.2, p&lt; 0.0001) was more likely to be non-standard.
Age distribution of patients receiving treatment for Lyme disease, by gender and age at first prescription

Seasonality of standard versus non-standard treatment of Lyme disease

Conclusion
In this population of employed, young, and insured patients, young and middle-aged women were at the highest risk of receiving non-standard LD treatment. Treatments prescribed in states with low incidence of LD or during non-summer months were also more likely to be non-standard, a trend which likely reflects misdiagnosis or overtreatment of LD. Future studies are needed to further define prescriber and patient factors associated with non-standard LD treatment and related adverse outcomes.

Disclosures
All Authors: No reported disclosures
1430. Novel Transmission of Burkholderia pseudomallei from a Freshwater Aquarium to a Human — Maryland, 2019
Authors: Dawson Patrick , Duwell Monique M , Thompson Ruth J , Crum David A , Blythe David , Jacobs Ruth , Elrod Mindy G , Gee Jay E , Liu Lindy , Blaney David D , Weiner Zachary , Bower William A , Hoffmaster Alex R , Salzer Johanna S 
Published: January 2021

Abstract

Background
Nearly all U.S. cases of melioidosis, a potentially fatal disease caused by Burkholderia pseudomallei, are associated with travel to endemic areas. In September 2019, a patient in Maryland with no international travel history developed melioidosis and whole genome sequencing (WGS) of the patient’s clinical isolate showed it clustered most closely with isolates from Southeast Asia. CDC and Maryland Department of Health (MDH) investigated possible sources of B. pseudomallei exposure to identify the source and route of transmission and evaluate risk to others.

Methods
MDH interviewed the patient and household members during October–December 2019. In consultation with CDC, MDH conducted environmental sampling of the patient’s home including drains, faucets, potted and ground soil, imported products, and two freshwater aquariums. Samples were tested for B. pseudomallei at CDC by PCR and culture. B. pseudomallei isolates underwent WGS and were analyzed along with a reference panel of geographically diverse, publicly available genomes.

Results
Three environmental samples, all from aquarium #2, were positive for B. pseudomallei. These isolates matched the patient’s clinical isolate by WGS, suggesting the aquarium was the source of exposure. According to interviews, the patient set up both aquariums in July 2019 and all the fish in aquarium #2 died in August 2019. The patient recalled reaching her bare hands and arms into the aquarium in August 2019, one month prior to illness onset.

Conclusion
This investigation led to the first documentation of transmission of B. pseudomallei from a freshwater aquarium to a human. Many freshwater ornamental fish are imported from Southeast Asia, so this newly recognized transmission route may have significant implications for the freshwater aquatics trade. Further investigations are underway at the retail location that sold the fish and the commercial vendors that supplied the freshwater animals and plants imported from Southeast Asia.

Disclosures
All Authors: No reported disclosures
1431. Occurrence of Sporadic Human Ascariasis in Non-Endemic Regions: The Importance of Zoonotic Transmission from Swine
Authors: Fritsche Thomas R , Meece Jennifer K , Meyer Susan K , Ortega Kelly L , Wolff Nicolette S , Hall Matthew C 
Published: January 2021

Abstract

Background
Ascariasis in developed countries occurs only sporadically, and usually in travelers or in children in rural settings with exposure to Ascaris suum from swine. Reciprocal transmission between humans and swine is possible given A. suum and A. lumbricoides are considered conspecific based on published mtDNA and nuclear ribosomal ITS-1 studies with recognized phenotypic/genotypic differences reflecting host-specific adaptive changes. Here we evaluated 15 cases of human ascariasis detected over 6 a year period in a non-endemic region of the Upper Midwest USA.

Methods
Helminth specimens (n=15) spontaneously passed per rectum were submitted for laboratory identification during 2013-19 and identified morphologically as A. lumbricoides/suum (undifferentiated). All patients attended local clinics and brought specimens in for identification. Clinical records were available for 13 patients.

Results
Ages ranged from 14 months to 41 years with 13 cases (87%) occurring in children &lt; =12 years and 2 (13%) &gt;30 years; 9 patients (60%) were female. Thirteen (87%) of the A. lumbricoides/suum specimens were adults and 2 (13%) were juveniles. Individuals with records available either lived on or had visited a farm (5) or hobby farm (2) where pigs were currently or likely historically present; lived at a rural address (4); used animal manure for gardening (1); or lacked discernable farm connections though was active outdoors (1). International travel history was lacking in all cases. One 2-year old child from a rural address had passed 2 worms 6 months apart. All 13 patients were treated with albendazole per guideline without complication.

Conclusion
Ascariasis attributable to poor sanitation has been largely eradicated from the USA since the early 1980s. Sporadic infections in non-travelers have continued to be recognized and likely represent zoonotic transmission from domesticated swine. While human and pig Ascaris have long been considered distinct species, recently published molecular and cross-transmission experiments point to conspecificity. This case series is a reminder of the zoonotic disease risks posed by swine-origin Ascaris, especially in young children, and reinforces the need for proper herd management and attention to personal hygiene for at-risk individuals.

Disclosures
All Authors: No reported disclosures
1433. Promoting Vaccination of Vaccine Preventable Diseases in Newly Employed Nurses and Doctors Guided by Serological Study
Authors: Lee Seungjae , Son Hyo-Ju , Lee Eunjung , Park Se Yoon , Choo Eun Ju , Kim Tark , Yu Shinae , Park Jung Wan , Kim Tae Hyong 
Published: January 2021

Abstract

Background
Vaccination after serological evaluation of healthcare workers is key component of vaccine preventable diseases (VPDs) preparedness in hospital. The aim of this study is to determine the seroprevalence of VPDs and the vaccination rates among newly employed nurses and doctors.

Methods
A cross-sectional study was conducted at a referral university hospital in the Republic of Korea. All newly employed nurses and doctors without immunity were recommended to have the hepatitis B virus (HBV), varicella zoster virus (VZV), measles, mumps, and rubella (MMR), hepatitis A virus (HAV) and tetanus-diphtheria-pertussis (Tdap) vaccination. HBV, VZV, MMR vaccinations were financially supported and Tdap vaccination was recommended without testing. We investigated the seroprevalence of HAV, HBV, and VZV and vaccination rate of recommended vaccination (HAV, HBV, MMR, VZV, and Tdap) from Jan 1st, 2017 to March 31th, 2020.

Results
A total of 668 (527 female, 141 male) newly employed nurses and doctors were identified. The median age (IQR) is 25 (24-27). Seroprevalence were 59.1% (95% confidence interval [CI] 55.4-62.8) for HAV, 86.1% (95% CI 83.5-88.7) for HBV, and 92.4% (95% CI 90.4-94.4) for VZV. Vaccination rate of recommended vaccination were 24.5% (95% CI 18.5-30.5) for HAV, 23.3% (95% CI 13.6-33.0) for HBV, 48.7% (95% CI 33.0-64.4) for VZV, 30.0% (95% CI 25.5-34.5) for MMR and 33.1% (95% CI 29.0-37.2) for Tdap respectively.

Conclusion
Seroprevalence of HAV was lower than HBV and varicella in newly employed nurses and doctors. Although persistent effort to improve the healthcare worker’s vaccination, the actual rates were low. Further strategy promoting vaccination of newly employed nurses and doctors are needed.

Disclosures
All Authors: No reported disclosures
1434. Rickettsial Infections Complicated With Acute Renal Failure
Authors: Hammami Fatma , Koubaa Makram , Chakroun Amal , Rekik Khaoula , Smaoui Fatma , Elleuch Emna , Marrakchi Chakib , Jemaa Mounir Ben 
Published: January 2021

Abstract

Background
Rickettsiosis, an acute febrile illness, is generally considered as a benign disease. However, severe cases were reported, among which acute renal failure (ARF) represented 13 to 18% of the cases. We aimed to study the clinical and evolutionary features of rickettsiosis complicated with ARF, when compared with all rickettsial infections.

Methods
We conducted a retrospective study including all patients hospitalized for rickettsiosis in the infectious diseases department between 1995 and 2018. The diagnosis was confirmed by serologies (seroconversion).

Results
Overall, we encountered 28 patients (6.4%) with ARF among 440 patients with rickettsiosis. There were 19 males (67.9%). Patients with ARF were significantly older (53±16 vs 38±17 years; p&lt; 0.001). They consulted for eruptive fever (78.6%), febrile cephalalgia (10.7%) or isolated fever (10.7%). Arthralgia and vomiting were noted in 75% and 35.7% of the cases, respectively. There were 4 cases (14.3%) of meningitis and 2 cases (7.1%) of meningoencephalitis. The mean creatinine levels were 158 µmol/L [120-444 µmol/L]. In comparison with all rickettsial infections, eschars were more frequently noted among patients with ARF (46.4% vs 23.8%; p=0.008). They were more frequently diagnosed with septic shock (14.3% vs 0.5%; p&lt; 0.001) and retinitis (10.7% vs 1.5%; p=0.015). Comparison of the disease evolution showed that death was significantly more frequent among cases with ARF (7.1% vs 0.2%; p=0.011). The mean length of hospital stay was significantly longer among patients with ARF (8.7±4.7 vs 5.3±3.5 days; p=0.001). As to gender and the revealing symptoms, no significant difference was noted.

Conclusion
Rickettsial infections complicated with ARF had a poor prognosis, especially among the elderly. Prompt empiric antibiotic therapy might improve the prognosis.

Disclosures
All Authors: No reported disclosures
1437. Biochemical characterization of L1 and L2 β-lactamases from clinical isolates of Stenotrophomonas maltophilia
Authors: Mojica Maria F , Rutter Joseph , Taracila Magdalena A , Papp-Wallce Krisztina M , Spencer James , Vila Alejandro J , Bonomo Robert A 
Published: January 2021

Abstract

Background
Stenotrophomonas maltophilia is a Gram-negative, non-fermenting opportunistic pathogen. Two β-lactamases provide intrinsic resistance to β-lactams: a class B Metallo- β-lactamase L1, and a class A serine β-lactamase (SβL) L2. Recently, we described novel variants of the L1 and L2 in a collection of clinical S. maltophilia isolates collected in the US, and showed through analyses of the amino acid sequences that L1 and L2 grouped into 4 (A-D, B, C, and E) and 2 (A and D) clades, respectively. We aimed to characterize the new L1 and L2 clinical variants biochemically.

Methods
Representative blaL1 and blaL2 genes from each of the identified clades were cloned into pBC-SK and pET24 vectors and transformed into E. coli DH10B and BL21 (DE3) cells, respectively. Minimal inhibitory concentrations (MICs) were determined using CLSI approved methods. Cell-based assays and biochemical characterization performed on purified enzymes, including circular dichroism (CD), thermal stability, and steady-state kinetics assays, were performed.

Results
Susceptibility testing results using DH10-B E. coli strains expressing the L1 and L2 variants are shown in Table 1. Remarkably, while all L1 variants confer the same level of resistance to carbapenems, L2B conferred higher MICs to 3rd gen cephalosporins and aztreonam than L2D. Kinetics assays confirmed differences in the kcat of both enzymes to ceftazidime (32s-1 for L2B vs. 7s-1 for L2D) and avibactam inhibition constant Ki (1.7 μM for L2B vs. 4.5 μM for L2D). Structurally, L2B and L2D present distinctive CD spectra and thermal stabilities (ΔTm 5°C).
Table 1

Conclusion
As opposed to the L2 variants, our results suggest that the L1 variants may not be functionally nor structurally different. Differences between L2B and L2D might have arisen due to the use of cephalosporins and SβL inhibitors. Further experiments are on the way to determine the structural basis of these observations and the implication of these for the design of novel β-lactamase inhibitors.

Disclosures
Krisztina M. Papp-Wallce, PhD, Entasis (Grant/Research Support)Merck (Grant/Research Support)Venatorx (Grant/Research Support) Robert A. Bonomo, MD, Entasis, Merck, Venatorx (Research Grant or Support)