bluuebunny/crossref_metadata_2025_split huggingface dataset:
2712. Safety and Immunogenicity of two Doses of ExPEC4V Vaccine Against Extraintestinal Pathogenic Escherichia coli Disease in Healthy Adult Participants
Authors: B Smith William , Abbanat Darren , Spiessens Bart , Go Oscar , Haazen Wouter , de Rosa Tiziano , Fae Kellen , Poolman Jan , Thoelen Stefan , de Palacios Patricia Ibarra 
Published: October 2019

Abstract

Background
The ExPEC4V vaccine contains 4 Escherichia coli O-antigens (O1A, O2, O6A, O25B) conjugated to exotoxin protein A and is being studied for prevention of Invasive Extraintestinal pathogenic E. coli (ExPEC) Disease (IED). This phase-2 double-blind study assessed safety and immunogenicity of ExPEC4V Clinical Trial Material (CTM), manufactured via a redesigned process (optimized O1A strain).

Methods
Participants (≥18 years) in stable health were randomized (3:1) to receive ExPEC4V dose 4:4:4:8 μg PS/serotype or placebo on Day 1 and second vaccination on Day 181 (6 months after first vaccination). Participants will be followed for safety until end of study at Day 360. Reactogenicity and immunogenicity (by ELISA, opsonophagocytic killing [OPA] assays) were evaluated pre-vaccination, and 15 days after first and second vaccinations (Day 195).

Results
Of 100 participants randomized (mean age 56, 48% males) and vaccinated (ExPEC4V, n = 75; placebo, n = 25), 97 completed Day 30. Solicited local AEs were higher for ExPEC4V (38.7%) than placebo (20%); most frequent was pain/tenderness (38.7% vs 20%). Solicited systemic AEs were higher in ExPEC4V (49.3%) than placebo (20%); most frequent was fatigue (32% vs. 12%). No serious or grade 3 solicited local AEs were reported. One participant in ExPEC4V experienced a grade 3 solicited systemic fatigue considered vaccine-related by investigator. ExPEC4V demonstrated immune responses against all serotypes at Day 15. Geometric mean titer effective concentration rank by serotypes was O2 > O1A > O6 > O25B (Figures 1 and 2). At Day 15, ≥ 82% of participants in ExPEC4V and none in placebo had ≥2-fold increase from baseline of ELISA titer for all serotypes. In ExPEC4V, ≥47% had ≥2-fold increase from baseline of OPA titer for all serotypes, while 8% in placebo had ≥2-fold increase only for O6A. Good correlation was observed between ELISA and OPA across serotypes (r ≥ 0.76).

Conclusion
ExPEC4V elicited robust and functional immune responses across all serotypes and was well tolerated with no vaccine safety findings. This study supports the development of future multivalent ExPEC vaccine to prevent IED.

Disclosures
All authors: No reported disclosures.
2735. Improving Uptake of Maternal Immunizations in the Obstetric Care Setting Through an Adaptation of the CDC’s Immunization Quality Improvement Program (AFIX)
Authors: OLeary Sean T , Ellingson Mallory , Spina Christine , Brewer Sarah E , Quick Lori , Chamberlain Allison , Limaye Rupali , Orenstein Walter , Salmon Daniel , Omer Saad 
Published: October 2019

Abstract

Background
Influenza and Tdap vaccines are recommended for pregnant women in every pregnancy. However, vaccine uptake remains suboptimal. Obstetrics practices need quality improvement models to improve their vaccination delivery programs. CDC’s AFIX program has been shown to be effective at increasing vaccination uptake in primary care settings. Our objective was to adapt and evaluate CDC’s AFIX program in the obstetrical setting (AFIIX-OB).

Methods
An average of 40 charts per practice were randomly reviewed pre- and post-intervention. Baseline immunization rates and vaccine administration practices were collected in the Assessment phase. Feedback was provided at meetings conducted by study staff where baseline immunization rates were shared and practices selected quality improvement measures to implement. Practices were required to implement either standing orders for influenza and Tdap vaccines or improve their vaccine documentation. As an Incentive, providers could receive continuing medical education and maintenance of certification part IV credit. After implementing the practice specific measures for 6 months, practice-wide vaccine rates were assessed and a post-intervention meeting was held with providers and staff at each practice to eXchange the results.

Results
AFIX-OB was implemented in 11 obstetric practices: 5 in Georgia and 6 in Colorado. Practices were primarily urban, their patients largely Caucasian and African American and most patients carried private insurance. Baseline practice-level immunization rates ranged from 10% to 82.9% for influenza vaccine and 12.5% to 97.6% for Tdap. 4 practices implemened standing orders, 6 improved their vaccine documentation and 1 did both. After the 6 month follow-up period, all 11 practices saw improvements in their overall Tdap vaccine acceptance (3 with statistically significant increases, P < 0.05) with final rates ranging from 25% to 100%. 9 practices either maintained or improved their influenza vaccination rates (4 with statistically significant increases, P < 0.05) with final rates ranging from 32.5% to 85.0%.

Conclusion
The AFIX-OB model provides a promising intervention to improve maternal immunization uptake that can be administered widely but still be tailored to the needs of individual clinics.

Disclosures
All authors: No reported disclosures.
2741. Seasonal Influenza Vaccine Timing in Children and Adults Hospitalized with Influenza in the United States, FluSurv-NET, 2013–2017
Authors: Haston Julia C , Garg Shikha , Campbell Angela P , Ferdinands Jill , O’Halloran Alissa , Cummings Charisse N , Kirley Pam Daily , Stephens Samantha , Yousey-Hindes Kim , Openo Kyle P , Fawcett Emily , Farley Monica M , Monroe Maya , Kim Sue , McMahon Melissa , Irizarry Lourdes , Dufort Elizabeth , Bennett Nancy M , Billing Laurie M , Thomas Ann , Talbot Keipp , Spencer Melanie , Anderson Evan J 
Published: October 2019

Abstract

Background
Seasonal influenza vaccine may attenuate disease severity among people infected with influenza despite vaccination, but vaccine effectiveness may decrease with increasing time between vaccination and infection. Patient characteristics may play a role in the timing of vaccine receipt.

Methods
We used data from the Influenza Hospitalization Surveillance Network (FluSurv-NET) and included patients ≥ 9 years hospitalized with laboratory-confirmed influenza during October 1–April 30 of influenza seasons 2013–2014 through 2016–2017 who received seasonal influenza vaccine ≥ 14 days prior to admission. Vaccine history was obtained from vaccine registries, medical charts, and patient interviews. We defined “early vaccination” as vaccine receipt before October 15 and “late vaccination” as receipt after (date selected using typical season onset and median vaccination dates). Early and late groups were compared using Chi-square or Fisher exact tests.

Results
Among 21,751 vaccinated patients, 61% received vaccine before October 15, and distribution of vaccination date was similar across seasons (figure). Vaccination occurred earlier with increasing age (45% were vaccinated early among those 9–17 years but 65% in those ≥ 80 years, P < 0.01). White non-Hispanic patients were more likely to receive vaccine early compared with black non-Hispanic and Hispanic patients (63% vs. 55% and 54%; P < 0.01). Those with metabolic disorders, cardiovascular disease, kidney disease, and cancer were vaccinated earlier whereas those with HIV and liver disease were vaccinated later. Vaccine timing also varied by state (P < 0.01) but not by sex.

Conclusion
Among influenza-vaccinated older children and adults hospitalized with influenza, older age, white race, and certain medical conditions were associated with early receipt of influenza vaccination in unadjusted analysis. This may be due to frequent healthcare encounters and targeted public health strategies in high-risk groups. Understanding how timing of vaccine receipt varies among populations can provide insights into variables that must be controlled for in studying possible vaccine effectiveness waning and attenuation of disease among those who are infected despite vaccination.

Disclosures
All authors: No reported disclosures.
2743. Safety of Recombinant Influenza Vaccine Compared with Inactivated Influenza Vaccine in Adults
Authors: Hansen John , Goddard Kristin , Timbol Julius , Zhang Lea , Lewis Ned , Klein Nicola 
Published: October 2019

Abstract

Background
In 2013, a recombinant trivalent influenza vaccine (RIV, Flublok®, Sanofi Pasteur) was licensed for use against influenza virus subtypes A and B contained in the vaccine for persons 18–49 years of age and approved for all adults ≥18 years of age in 2014. The study aim was to evaluate the safety of RIV compared with trivalent standard-dose, inactivated influenza vaccine (IIV3) in Kaiser Permanente Northern California (KPNC).

Methods
This was an observational, retrospective cohort study including all persons ≥18 years vaccinated in KPNC facilities with RIV or IIV3 during the 2015–2016 influenza season as part of routine clinical care. We compared the rates of pre-specified diagnoses of interest (Guillain-Barré Syndrome, pericarditis, pleural effusion, narcolepsy/cataplexy, asthma, acute hypersensitivity reactions and fever) using International Classification of Diseases codes during post-vaccination risk intervals 0–2, 0–13, 0–41, and 0–180 days, as well as all-cause hospitalization rates 0–180 days following vaccination. Comparing cohorts, we estimated odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression analyses adjusted for age, sex, race/ethnicity, month of vaccination, and concomitant receipt of other vaccinations.

Results
During the study period, 21,976 persons received RIV and 283,683 received IIV3. Comparing RIV with IIV3, there were no statistically significantly elevated outcomes. RIV vaccination was associated with significantly decreased fever in the 0–41 day risk interval (OR 0.38, 95% CI 0.14–0.86) and all-cause hospitalization (OR 0.66, 95% CI 0.61–0.73) in the 0–180 day risk interval. Further analyses found that the lower rates of hospitalization in RIV recipients was mostly, though not fully, related to pregnancy-related hospital events in the IIV3 cohort and to the presence of additional unmeasured confounding. There were no serious adverse events or deaths related to RIV or IIV3.

Conclusion
This study did not identify any safety concerns regarding the use of RIV in adults. Understanding the observed reduction in all-cause hospitalization will need additional studies.

Disclosures
All authors: No reported disclosures.
2771. Seroprotection against Measles, Rubella, Tetanus, and Diphtheria Among Children in Haiti—2017
Authors: Minta Anna A , Andre-Alboth Jocelyne , Childs Lana , Nace Doug , Rey-Benito Gloria , Boncy Jacques , Adrien Paul , François Jeannot , Jn Charles Nadia Phaïmyr , Blot Valery , Vanden Eng Jodi L , Priest Jeffrey W , Rogier Eric , Tohme Rania A 
Published: October 2019

Abstract

Background
Measles, rubella, and maternal and neonatal tetanus have been verified to be eliminated in Haiti, but a diphtheria outbreak has been ongoing since 2014. To evaluate progress toward maintaining vaccine preventable disease (VPD) elimination and control, we conducted the first survey to estimate immunity to these VPDs among children in Haiti.

Methods
We conducted a nationally representative, two-stage cluster survey in 2017, stratifying Haiti into 2 regions: (1) West Region, the highly urban West department that includes one-third of Haiti’s population; (2) Non-West Region (all other departments). We sampled 4,286 households to recruit at least 910 children aged 5–7 years. We obtained vaccination history and dried blood spots from one eligible child per household. Antibody concentrations to VPDs were measured on a multiplex bead assay. We compared seroprotection and vaccination coverage estimates.

Results
Among 1146 enrolled children, tetanus (83%, 95% CI: 80%–86%) and diphtheria (83%, 95% CI: 81%–85%) seroprotection were higher than coverage with ≥3 doses of tetanus and diphtheria containing vaccine (DTP3) (68%, 95% CI: 61%–74%). No participants had antibody concentrations consistent with long-term immunity to tetanus or diphtheria. Measles (87%, 95% CI: 85%–89%) and rubella (84%, 95% CI: 81%–87%) seroprotection were higher than or similar to coverage with at least one dose of measles-rubella (MR) vaccine (84%, 95% CI: 80%–87%) (Figure 1). MR second-dose coverage was 20% (95% CI: 16%–24%). Seroprotection in the West Region was lower than in the non-West region for all VPDs.

Conclusion
Discordance between DTP3 coverage and seroprotection might be due to underestimating vaccination coverage by recall. Lack of long-term protection against tetanus or diphtheria is consistent with declining antibody concentrations by school-age after the primary DTP series, indicating the need for a booster dose. Seroprotection against measles and rubella viruses was lower than levels needed to prevent transmission, particularly in the West region; re-introduction of either virus could lead to an epidemic. Haiti should reach ≥95% DTP3 and two-dose MR coverage and add tetanus and diphtheria vaccine booster doses per global recommendations.

Disclosures
All authors: No reported disclosures.
170. Predictors of Recurrent Infective Endocarditis in Intravenous Drug Users
Authors: Kongpakpaisarn Kullatham , Aslam Sadaf , Tariq Musaab , Mhaskar Rahul , Shin Doosup , Bohra Chandrashekar , Somboonwit Charurut 
Published: October 2019

Abstract

Background
Caring for hospitalized patients with infective endocarditis (IE) can be challenging due to the nature of the disease and its complications, underlying medical and psychiatric problems, socioeconomic status and environmental factors.Some of these patients develop recurrent IE after the first episode treated. On-going intravenous (IV) drug use after hospital discharge is the highest predictive factor for recurrent IE. Besides IV drug use, there are limited data of other contributing factors to recurrent IE. Those factors may be modifiable during the first hospitalization to reduce the incidence of recurrent IE.

Methods
A retrospective cohort study was conducted at a large tertiary acute care medical center in Tampa, Florida. All consecutive patients with IE with history of IV drug use from January, 2011 to December, 2017 were included. Basic demographic information, co-morbidities (diabetes, hypertension, chronic lung and kidney diseases, HIV, Hepatitis B and C status, coronary artery diseases), valves involved, length of stay, complications at their first IE episode such as septic shock and stroke were included. Groups were identified based on the first episode, first recurrence and second or more recurrences of IE.

Results
A total of 106 patients were identified based on the inclusion criteria. The association between the type of valve infection (right side and left side) and IE recurrence was found to be statistically significant. (P = 0.003). Right side valves are prone to have recurrent IE episodes. People with recurrent IE were more likely to have septic shock (P = 0.02) and requiring intensive care unit (ICU) admissions (P < 0.001) during their first episode There was no statistically significant difference between other demographic information and recurrent endocarditis as well as other parameters such as organisms or type of substance used. (Table 1)

Conclusion
Right-sided IE and presence of septic shock during their first episode of IE may be the predictors for recurrent IE. Interventions including closer follow-up, more aggressive septic shock recognition and management, socioeconomic assessment in addition to substance abuse treatments after discharge should be considered to prevent recurrent IE.

Disclosures
All authors: No reported disclosures.
2791. Burden of Respiratory Infections in Trainees Higher Than Healthcare Records Indicate: Results from an Anonymous Survey
Authors: Richard Stephanie , Danaher Patrick , White Brian , Mende Katrin , Burgess Timothy , Coles Christian L 
Published: October 2019

Abstract

Background
Influenza-like illnesses (ILIs) are common in military populations, particularly among trainees, and can impair mission-readiness. To develop effective preventive measures against ILIs, it is vital to understand the ILI burden in the military population and identify potential risk factors for infection.

Methods
Anonymous ILI surveys were administered from January 2017 to March 2019 to military medical trainees living in a congregated setting on Fort Sam Houston (JBSA-FSH), TX. The surveys included questions about sociodemographic characteristics, weight, height, smoking status, activity level, as well as some basic questions about ILI and potential risk factors. Factors associated with ILI were identified using chi-square, t-tests, and multivariate models.

Results
2,381 surveys were returned that included age, sex, and ILI information. Respondents were 16–54 years old, 1,301 (55%) were male, 782 (33%) were Air Force, 817 (34%) were Army, and 763 (32%) were Navy/Marines. 39% of those surveyed (929) reported having experienced an ILI during their training with 40% (370) seeking healthcare for those symptoms. The primary reasons for seeking healthcare included the severity of the illness (59%), concern about spreading the illness (50%), and the accessibility of healthcare (41%). 53% of the respondents reported that ILI had an impact on their performance, among whom 77% stated reduced study time, 66% missing physical training, and 53% missed class. The final multivariate model indicates that men and participants 30+ years old were less likely to report ILI (OR 0.69 (0.58, 0.82); OR 0.65, (0.45, 0.94)) (Figure 1). In addition, participants who reported washing their hands after they coughed or sneezed were less likely to report having had an ILI (OR 0.73 (0.61, 0.89)).

Conclusion
Although 39% of respondents reported having an ILI during their training, only 40% sought healthcare, indicating that ILIs are more common during training than healthcare records indicate. More information is needed regarding how training outcomes vary among those with ILI who seek care, those with ILI who do not seek care and those without ILI during training, to allow a better estimate of the impact of ILI and development of ILI mitigation strategies.

Disclosures
All authors: No reported disclosures.
489. Risk Factors for Mortality in Patients with Elizabethkingia and Clinical Impact of Antimicrobial Susceptibility Patterns
Authors: Seong Hye , Ho Kim Jung , Choi Heun , young Ahn Jin , su Ku Nam , yong Choi Jun , Yeom Joon-Sup , Myung Kim June , Jin Jeong Su 
Published: October 2019

Abstract

Background
Elizabethkingia spp. is a non-fermenting, non-motile, oxidase-positive gram-negative aerobic bacilli that is ubiquitous in the environment, found in freshwater, saltwater and soil. Nowadays, they are emerging as nosocomial pathogens. In this study, we analyzed Elizabethkingia spp infected cases clinically and microbiologically.

Methods
This study was performed to evaluate the risk factors for mortality and to study the impact of microbiologic response on clinical outcomes in patient with Elizabethkingia spp Data on 210 patient of Elizabethkingia pneumonia and bacteremia that have occurred between November 1, 2005, and May 31, 2016, in a teaching hospital (2000 beds) in Seoul, Korea, were analyzed. Furthermore, antimicrobial susceptibility testing of Elizabethkingia from sputum and blood cultures was performed by E test for rifampin, moxifloxacin and vancomycin.

Results
Among 210 patients, there were 157(74.8%) survivor and 53(25.2%) non-survivor. Among these patients, 129 patients (61.4%) were male and the median age was 66.5 years. There were no significant differences in the Charlson comorbidity index between survivor and non-survivor groups (P = 0.413). In the multivariate logistic regression, microbiologic failure (odds ratio [OR], 7.862; 95% confidence interval [CI], 3.448–17.931; pElizabethkingia infection (OR, 1.032; 95% CI, 1.013–1.051; P = 0.001), previous use of immunosuppressants (OR, 3.309; 95% CI, 1.334–8.210; P = 0.010), and Percutaneous cardiopulmonary support system use at the time of Elizabethkingia infection (OR, 7.439; 95% CI,1.180–46.900; P = 0.033) were significantly associated with 28day mortality. Patients with moxifloxacin-resistant and vancomycin-resistant showed higher mortality rate but no statistically significant difference.

Conclusion
The early identification of these clinical factors in patients with Elizabethkingia infection is important to improve prognosis

Disclosures
All authors: No reported disclosures.
1708. Epidemiology of Coccidioidomycosis-Associated Hospitalizations and In-hospital Deaths, California, 2000–2017
Authors: Sondermeyer Cooksey Gail L , Kamali Amanda , Vugia Duc , Jain Seema 
Published: October 2019

Abstract

Background
Coccidioidomycosis (CM) is caused by inhalation of spores of the soil-dwelling Coccidioides spp. fungus; infection can lead to severe respiratory or disseminated disease. In California, reported cases increased 222% since 2014 (2,316 cases) peaking in 2017 with 7,466 cases (rate 18.1/100,000 population), the highest annual reported cases on record. We reviewed the California hospital CM data to describe trends, demographics, comorbidities, and risk factors for in-hospital death.

Methods
Using 2000–2017 California administrative hospital discharge data, we identified hospitalizations with ≥1 CM-associated International Classification of Diseases, Ninth or Tenth diagnosis code. We calculated incidence rates per 100,000 population, assessed trends by negative binomial regression, and compared patient characteristics for potential risk factors for in-hospital death by calculating age-adjusted odds ratios (aOR) using bivariate logistic regression (significance, P < 0.05).

Results
From 2000 to 2017, 25,372 patients were hospitalized with a CM discharge code in California, and hospitalization rates increased significantly from 2.3 to 5.8/100,000 population (P < 0.01) (Figure 1). Most patients were male (69%), >40 years old (69%), white (40%) or Hispanic (38%), and residents of the higher incidence CM regions in California (52%). Most (83%) were not immunocompromised; only 3% had a human immunodeficiency virus (HIV) diagnosis. A total of 1,951 (8%) patients died in-hospital with more deaths among those with disseminated CM (15%), particularly meningitis (17%), than with pulmonary disease (7%). Frequency of death increased with increasing age (0–19 years [2%], 20–39 years [5%], 40–59 years [7%], 60+ years [13%]). Odds of in-hospital death was highest among patients with HIV (aOR 6.4, 95% CI 5.3–7.7) or chronic kidney disease (aOR 2.6, 95% CI 2.3–2.8) (Figure 2).

Conclusion
CM-associated hospitalization rates have increased in California in the last 18 years, peaking in 2017, with 1 in 12 patients dying in-hospital. Risk factors for death include disseminated CM, older age, HIV infection, and chronic kidney disease. Clinicians should be aware of these risks in caring for patients hospitalized with CM.

Disclosures
All Authors: No reported disclosures.