bluuebunny/crossref_metadata_2025_split huggingface dataset:
770. Otherwise Unavailable Non-Malarial Parasitic Disease Treatment Drugs in the United States: an Update from CDC Parasitic Diseases Drug Service
Authors: Chancey Rebecca J , Yu Yon , Yu Patricia , Jolly Julian , Montgomery Susan 
Published: January 2021

Abstract

Background
The Centers for Disease Control and Prevention’s (CDC) support to clinicians includes providing access to certain drugs exclusively available through CDC for diseases that lack, or have limited market availability of, FDA-approved therapeutics in the U.S. These drugs are provided by CDC under expanded access Investigational New Drug (IND) applications, authorized by the FDA, to treating physicians. The CDC Parasitic Diseases Drug Service provides treatment drugs for patients with parasitic diseases, including travelers, immigrants and refugees from endemic countries.

Methods
CDC’s records for patients for whom drug was released over a 10-year period were reviewed.

Results
From 2010–2019, the annual number of drug releases for patient treatment ranged from 21–113 (median 99). Benznidazole, a treatment for Chagas disease, was the most common drug released for patients between 2012–2018, ranging from 42–63% of total drug releases annually. Sodium stibogluconate (Pentostam® 1), for treatment of certain presentations of cutaneous, visceral, and mucocutaneous leishmaniasis, accounted for 6–22% of annual releases over the last 10 years. While requests for treatment for human African trypanosomiasis are rare, in 2019 CDC released eflornithine and nifurtimox for one patient who met criteria for treatment according to the 2019 WHO recommendations.2

Conclusion
Recent changes to release frequency of triclabendazole, benznidazole, nifurtimox, and sodium stibogluconate are likely due to FDA-approval and commercial availability of previously investigational drugs. Triclabendazole is now FDA approved for treatment of Fasciola infection in persons ≥6 years old and benznidazole is now FDA approved for treatment of Chagas disease in children 2–12 years old. Miltefosine has also been approved by FDA for treatment of certain leishmaniasis infections. CDC has successfully pursued expiry extensions of drugs with manufacturers, FDA, and other partners to ensure continued domestic availability of treatment options when there has been no or limited production of newer lots. CDC’s Parasitic Diseases Branch can be reached by telephone: 404-718-4745 or email: parasites@cdc.gov.
1 Pentostam® is made by GlaxoSmithKline
2 WHO interim guidelines for treatment of gambiense HAT. Geneva: 2019.

Disclosures
All Authors: No reported disclosures
773. Screening for Chagas disease in East Boston, Massachusetts from 2017 – 2020 reveals 0.9% prevalence
Authors: Manne-Goehler Jennifer , Davis Jillian , Perez Juan Huanuco , Salazar Jaime Gallegos , Gomes Jim , Salazar Alejandra , Camelo Ingrid , Collins Katie , Park Hong-Sun , Hochberg Natasha , Hamer Davidson , Barnett Elizabeth , Barnett Elizabeth , Koehler Julia 
Published: January 2021

Abstract

Background
This study reports on the results of a screening program for Chagas disease in East Boston.

Methods
Based at the East Boston Neighborhood Health Center, the Strong Hearts Program offers continuing medical education sessions on Chagas disease to providers in Adult Medicine, Pediatrics, Family Medicine and Obstetrics. Providers are encouraged to offer one-time screening for Chagas disease for all patients who lived in Mexico, South or Central America for ≥6 months, at their discretion. A commercial lab performs the initial screening test using the Hemagen ELISA while confirmatory testing is performed at the US CDC. For each patient, completion of screening requires a multi-step process consisting of splitting the serum sample to save a frozen aliquot for send out to CDC if the ELISA is positive/indeterminate, monitoring screening results to send the saved aliquot to the CDC if indicated, filling out the CDC requisition, shipping the serum aliquot, and monitoring the result returning from the CDC. Patients diagnosed with confirmed Chagas disease are referred to Boston Medical Center for further evaluation and treatment if indicated.

Results
From 3/21/2017 – 5/18/2020, 8,142 patients were screened. 423 (5.2%) patients had an initial positive test, 7,669 (94.2%) initially tested negative and 50 were indeterminate (0.6%). Among those with a positive screening result, 76 were confirmed to have T. cruzi infection for an overall prevalence of 0.93% in this population. 293 (69.3%) patients with positive screening tests had a negative (discordant) confirmatory test, 18 (4.3%) had an indeterminate test, and 36 (8.5%) had results that were unavailable or pending as of this analysis. None of the indeterminate screening tests were positive upon confirmation.

Conclusion
Prevalence of infection with T. cruzi was nearly 1% among patients in East Boston who had lived in Latin America. Diagnosis of Chagas was challenging due to a large number of false positive screening tests. The resource burden imposed by current screening options is itself a barrier to addressing Chagas disease. Given the significant prevalence of Chagas disease in the US, increased access to tests (i.e., two-step screening conducted through commercial laboratories) and screening assays with improved specificity are needed.

Disclosures
All Authors: No reported disclosures
774. Sexual Behaviors and Attitudes of Intimate Partners of Ebola Survivors
Authors: Cunningham Hannah M , Wohl David , Tozay Sam , Reeves Edwina , Pewu Korto , Johnson Harrieta , Williams Gerald , Conneh Tonia , DeMarco Jean , Fischer William , Brown Jerry 
Published: January 2021

Abstract

Background
Sexual transmission of the Ebola virus (EBOV) from male survivors to their partners has been well-documented. While studies have characterized the sexual behaviors of male survivors of Ebola Virus Disease (EVD), there is little focus on their intimate partners. This study seeks to describe the attitudes and sexual behaviors of women who have had condomless sex with male survivors of the 2014-16 Ebola outbreak in Liberia, West Africa.

Methods
Participants were recruited through voluntary referral by their sexual partners, all of whom were participants in a longitudinal EVD survivor cohort. From February to March 2020, 30 women (age range: 19-53 years) were enrolled and surveyed regarding their sexual behaviors with a focus on perceptions of risk for acquisition of Ebola from their partners and the measures taken to address this risk. Mix method quantitative and qualitative assessment of survey responses was completed. Content analysis was used to consider open-ended questionnaire responses.

Results
Few women reported full compliance with the 2016 World Health Organization (WHO) recommendations for safer sex with EVD survivor partners, but 50% described utilization of a safer se x strategy to reduce risk of transmission. Major themes identified include: (1) an inaccurate perception of no or low risk of sexual transmission of Ebola virus, (2) negative attitudes towards condoms, (3) a preference for abstinence among those seeking to avoid infection, and (4) positive attitudes towards health care worker advice.

Conclusions
Future outbreaks will benefit from intervention programs to address knowledge gaps among women and their male survivor partner regarding the risk of sexual transmission of Ebola and clear communication about effective strategies to reduce this risk.

Disclosures
All Authors: No reported disclosures
775. The Burden of Arboviral Infection in the Military Health System, 2011-2019
Authors: Wellington Trevor , Fraser Jamie , Hickey Patrick , Lindholm David 
Published: January 2021

Abstract

Background
Travel-related arboviral infections are important preventable, emerging infectious diseases, with an estimated annual global toll of US$950 million. We investigated the burden of arboviral infections in the military health system (MHS).

Methods
KAPOS (Deployment and Travel Health: Knowledge, Attitudes, Practices, and Outcomes Study) is a multi-cohort study evaluating the burden of travel-associated diseases in the MHS. The MHS Data Repository was searched for International Classification of Diseases (ICD)-9/10 codes for arboviral infection in military beneficiaries receiving care in military treatment facilities (direct care) or civilian centers (purchased care) for fiscal years 2011-2019. Diagnostic codes were classified as Dengue, Chikungunya, Zika, or other arboviral infection. 755 outpatient charts in the direct-care system were randomly selected for diagnostic validation using Armed Forces Health Surveillance Center case definitions, and review of travel history, medical comorbidities, and pre-travel counseling.

Results
11,066 unique-patient ICD codes for arboviral infections were identified; 6356 (57.4%) were direct care; 4710 (42.6%) were purchased care; 889 (8.0%) were inpatient. Median age was 31 years; 5110 (46.2%) were active duty. The most frequent ICD codes for arboviral infection were Japanese encephalitis virus (JEV) (n=4483), dengue (DENV) (n=1786), yellow fever (YF) (n=230), Zika virus (ZIKV) (n=217), West Nile virus (WNV) (n=171), and chikungunya virus (CHIKV) (n=91). DENV codes were confirmed in 166/249 (66.7%) charts; CHIKV in 23/41 (56.1%), and ZIKV in 15/129 (11.6%). No cases of JEV were confirmed in 171 encounters; all codes referred to JEV vaccine administration. 173/204 (84.8%) of confirmed arboviral cases did not undergo pre-travel counseling.

Conclusion
Arboviral infections constitute a substantial burden of preventable infections within the MHS. Dengue contributed the largest burden of arboviral infection when corrected for accuracy. Coding for ZIKV and JEV likely overestimated the burden of these diseases in the MHS. Low rates of pre-travel counseling among patients with confirmed, non-endemic arboviral infections represent an opportunity for increased emphasis on travel counseling and insect-avoidance precautions.

Disclosures
All Authors: No reported disclosures
776. The prevalence of HIV among hospitalized persons with acute febrile illness in rural Uganda, August 2019-June 2020
Authors: Blair Paul W , Kobba Kenneth , Robinson Matthew , Candia Emmanuel , Aniku Gilbert , Matovu Alphonsus , Kakooza Francis , Walwema Richard , Lamorde Mohammed , Manabe Yukari C 
Published: January 2021

Abstract

Background
In Uganda, in the early PEPFAR era, HIV coinfections were responsible for most hospitalizations with febrile illness (as high as 85% in 2006). Currently, national guidelines recommend universal antiretroviral therapy ideally before the development of AIDS. We evaluated the prevalence of HIV among patients admitted to two regional referral hospitals with febrile illness in the era of ‘Treat All.’

Methods
Participants admitted to two regional referral hospitals in Uganda were enrolled at emergency departments or medical wards. Participants uniformly received blood cultures, malaria (rapid diagnostic test), and tuberculosis (Xpert MTB/RIF Ultra), hepatitis A IgM, hepatitis B sAg, and HIV fourth generation testing were performed. Among participants with HIV, cryptococcal antigen testing and urine lipoarabinomannan (LAM) were performed.

Results
From August 2019-June 2020, 95 participants (58% female) with an average age of 36.2 (SD 14.1) years, presented from 11 districts in Uganda. Participants presented at facilities 4.9 days (SD: 2.5) after onset of symptoms. Additionally, 16.1% of participants had a qSOFA (quick Sepsis Related Organ Failure Assessment) severity score of 2 or greater. By 28 days, 11.0% (n=7) died and 10.8% were lost to follow-up. On admission, 25.3% (n=24) of participants had a known history of HIV, the majority (87.5%) were on ART on hospital presentation. Of the 9.5% (n=9) who were newly diagnosed with HIV during the admission 6 were started on ART during hospitalization or within a month after hospitalization. Microbiologic and rapid diagnostic test results included positive results for tuberculosis (2.1%, 2/95 PCR; 3/16 urine LAM), malaria (29.5%, 28/95), cryptococcal antigen positive (12.5%; 2/15), hepatitis A (1.1%, 1/95), and hepatitis B (5.3%, 5/95). Blood cultures were positive in 11.1% of patients (10/90) with S. pneumoniae being most common isolate (N=4).

Conclusion
In the universal ART era, the proportion of hospitalized febrile patients with HIV has decreased. Overall, 10% have newly diagnosed infection emphasizing the importance of continuing to test all hospitalized febrile patients. Diagnostic evaluations are needed to assess the burden of other causes of febrile illness in order to reprioritize potential differential diagnoses.

Disclosures
All Authors: No reported disclosures
777. Travel Destination, Demographics, and Underlying Medical Conditions Among Travelers Seeking Yellow Fever Vaccination at a Large Academic Medical Center in the U.S
Authors: Bandali Mehdi , Than Kimlien , Schultz Jonathan , McGregor Donna V , Archuleta Solana , Chadalawada Sindhu , Mundo William , Chastain Daniel B , Franco-Paredes Carlos , Reno Elaine , Henao-Martinez Andres 
Published: January 2021

Abstract

Background
Yellow fever (YF) vaccine has the potential to cause viscerotropic and neurotropic disease in at-risk individuals. Screening patients is necessary to prevent vaccine-related life-threatening complications. We lack data on the clinical features of patients seeking YF vaccination. We aim to describe the characteristics of a cohort of patients receiving the YF vaccine before travel.

Methods
A retrospective analysis of 964 patients receiving the YF vaccine (Stamaril®) from Oct 2016 to Jul 2019 was performed at the University of Colorado Hospital in the United States. Percentages, means, and standard deviations were calculated. A multivariate logistic regression model was built to evaluate the association between receiving YF vaccination less than 10 days before departure and visiting friends and relatives (VFR).

Results
The average age of patients was 39 ± 18 years with a range of 9 months to 83 years. Patients who were 60 years of age and older represented 17%. Women consisted of 52%, and most of the patients were Caucasians (64%). Patients reported traveling to Africa (57%) or South America (40%). The primary destination for patients overall was Kenya (19%), Uganda (11%), and Tanzania (11%) in Africa; and Peru (14%) and Brazil (13%) in South America. The most common reasons for travel included leisure (44%), VFR (18%), and mission trips (10%). Comorbidities included a history of hematologic disorders (4%), HIV infection (2%), and diabetes mellitus (3%). The average duration between vaccine administration and travel was 43 days. Those visiting friends and relatives were 2 times more likely to receive the YF vaccination less than 10 days before departure.
Table 1. A cohort of patients receiving the Yellow Fever vaccine at the University of Colorado Hospital.

Figure 1. Heat map of destinations among patients receiving the YF vaccine.

Figure 2. Reasons for travel among patients receiving the YF vaccine (n=964).

Conclusion
Identifying the type of travel, itinerary, and underlying medical conditions allows providers to administer the YF vaccine to travelers safely. There is a need to identify strategies to improve the timing of YF vaccination among travelers visiting friends and relatives.

Disclosures
All Authors: No reported disclosures
780. How Much Does Prior Hospitalization Contribute to Readmission with Community-onset Clostridioides difficile Infection?
Authors: Guh Alice , Korhonen Lauren C , Winston Lisa Gail , Martin Brittany , Johnston Helen , Brousseau Geoffrey , Basiliere Elizabeth , Olson Danyel M , Fridkin Scott , Wilson Lucy E , Perlmutter Rebecca , Holzbauer Stacy , Bye Maria , Phipps Erin C , Flores Kristina , Dumyati Ghinwa , Nelson Deborah , Hatwar Trupti , Ocampo Valerie , Kainer Marion , McDonald Clifford 
Published: January 2021

Abstract

Background
Interventions to reduce community-onset (CO) Clostridioides difficile Infection (CDI) are not usually hospital-based due to the perception that they are often acquired outside the hospital. We determined the proportion of admitted CO CDI that might be associated with previous hospitalization.

Methods
The CDC’s Emerging Infections Program conducts population-based CDI surveillance in 10 US sites. We defined an incident case as a C. difficile-positive stool collected in 2017 from a person aged ≥ 1 year admitted to a hospital with no positive tests in the prior 8 weeks. Cases were defined as CO if stool was collected within 3 days of hospitalization. CO cases were classified into four categories: long-term care facility (LTCF)-onset if patient was admitted from an LTCF; long-term acute care hospital (LTACH)-onset if patient was admitted from an LTACH; CO-healthcare-facility associated (CO-HCFA) if patient was admitted from a private residence but had a prior healthcare-facility admission in the past 12 weeks; or community-associated (CA) if there was no admission to a healthcare facility in the prior 12 weeks. We excluded hospitals with &lt; 10 cases among admitted catchment-area residents.

Results
Of 4724 cases in 86 hospitals, 2984 (63.2%) were CO (median per hospital: 65.8%; interquartile range [IQR]: 58.3%-70.7%). Among the CO cases, 1424 (47.7%) were CA (median per hospital: 48.1%; IQR: 40.3%-57.7%), 1201 (40.3%) were CO-HCFA (median per hospital: 41.0%; IQR: 32.9%-47.8%), 350 (11.7%) were LTCF-onset (median per hospital: 10.0%; IQR: 0.6%-14.4%), and 9 (0.3%) were LTACH-onset. Of 1201 CO-HCFA cases, 1174 (97.8%) had a prior hospitalization; among these, 978 (83.3%) (median per hospital: 83.3%; IQR: 69.2%-90.6%), which consists of 32.8% of all hospitalized CO cases, had been discharged from the same hospital (Figure), and 84.4% of the 978 cases (median per hospital: 88.2%: IQR: 76.5%-100.0%) had received antibiotics sometime in the prior 12 weeks.
Figure. Frequency of Cases Discharged in the 12 Weeks Prior to Readmission with Clostridioides difficile Infection (N=1138*)

Conclusion
A third of hospitalized CO CDI had been recently discharged from the same hospital, and most had received antibiotics during or soon after the last admission. Hospital-based and post-discharge antibiotic stewardship interventions could help reduce subsequent CDI hospitalizations.

Disclosures
Ghinwa Dumyati, MD, Roche Diagnostics (Consultant)
781. C.difficile PCR+/ Toxin EIA- treat or not treat? A clinician survey
Authors: Nath Sarath G , Lee Francesca , Bararia Anjali , Nijhawan Ank E 
Published: January 2021

Abstract

Background
C.difficile Toxin Polymerase Chain Reaction (C.diff PCR) and C.difficile Toxin Enzyme Immunoassays (toxin EIA) are commonly used tests to diagnose Clostridoides difficile infection (CDI). C.diff PCR cannot differentiate between colonization and infection, leading to a higher false-positive diagnosis of CDI. Toxin EIA has low sensitivity leading to a missed diagnosis of CDI. In patients with C.diff PCR positive(+) and Toxin EIA negative(-), clinical judgment is often needed regarding the decision to treat or not to treat. C.diff cytotoxic assay (CCA), is a more sensitive method to detect the toxin but is time-consuming and not readily available.

Methods
Between 6/2019 and 12/2019, 83 patients who were admitted to the hospital, met our inclusion criteria (C.diff PCR+/EIA-). Clinicians who cared for these patients were contacted and surveyed with a predesigned questionnaire evaluating the rationale of treatment. Also, a simultaneous medical records review was done to ensure consistency. Along with this C.diff PCR+/EIA- stool samples were sent to ARUP laboratories for CCA. The CCA results were not available for clinicians and did not impact clinical care. Average cost for a CCA assay was $29

Results
Demographics of the clinicians were variable (Table 1). Several parameters were considered when making decisions regarding treatment and GI/ID were frequently involved (figure 1). Among the 83 patients, 41(49%) were CCA (+) and 42(51%) were CCA (-). 48 of 83 (58%) patients received treatment for CDI. 25 of 48 (52%) patients who were treated were CCA positive while 23 of 48 (48%) patients were CCA negative. Among the untreated patients, 16/35 (46%) were CCA+ while 19/35(54%) were CCA-. There was no statistically significant correlation between clinical judgment and CCA assay results (p: 0.56 on the Chi test).
Demographics of the clinicians

Clinician survey responses

CDI Treatment and by CCA positivity

Conclusion
Clinicians regardless of their background and training face challenges with the treatment of C.diff PCR+/EIA- patients. Patient outcomes based on the incorporation of CCA assay into an algorithm for C.diff PCR+/EIA- patients, need to be evaluated. But it has a potential role in stopping unnecessary CDI treatment as well as avoidance of missed treatment opportunities while possibly also being cost-effective.

Disclosures
Ank E. Nijhawan, MD, MPH, Gilead (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)
783. Clostridioides difficile Infection among Maintenance Hemodialysis Patients
Authors: Radhakrishnan Parvathi , Vishwanath Manini , Shemin Douglas , Monteiro Joao Filipe G , D’Agata Erika M C 
Published: January 2021

Abstract

Background
Patients on maintenance hemodialysis (MHD) are 2-2.5 times more likely to develop Clostridioides difficile infection (CDI) with mortality rates 2-fold higher compared to the general population. The goal of this study was to determine factors and outcomes associated with severe/fulminant CDI among MHD patients.

Methods
A retrospective cohort study was performed among MHD patients admitted to 2 tertiary care hospitals, with first episodes of CDI between January 2015 and December 2018. MHD patients who had CDI at admission were identified through Theradoc® and confirmed by electronic medical records review. Using the Infectious Diseases Society of America criteria, non-severe CDI was defined as a white blood cell count ≤ 15000 cells/mL and severe/fulminant CDI was defined as a white blood cell count of ≥ 15000 cells/mL, hypotension, shock, megacolon and/or ileus. Creatinine values were not included. Patient demographics, comorbidities, antimicrobial exposure and 60-day mortality were collected on all patients.

Results
A total of 103 MHD patients with CDI were identified during the study period, of whom 68 (66%) had non-severe CDI and 35 (34%) had severe/fulminant CDI. The average age at admission was 65.3 years, 48.5% were female, and 59.2% were Caucasian. The average albumin level was 3.1 g/dL, and the average Charlson comorbidity index was 6.8. On univariate analyses, risk factors associated with severe/fulminant CDI as compared to non-severe CDI were older age at admission, elevated white blood cell count, exposure to extended-spectrum penicillins in the previous 90 days, and 60-day mortality after the first CDI (p-value ≤0.05). On multivariable logistic regression analysis, three factors remained significantly associated with severe/fulminant CDI (adjusted odds ratio [aOR], 95% confidence interval): 1] age ≥65 years (aOR=6.3 [2.25-17.45]), 2] extended-spectrum penicillins (aOR=2.7 [1.05-6.85], and 3] 60-day mortality after the first CDI (aOR=3.6 [1.11-11.74]).

Conclusion
A substantial proportion of patients requiring MHD with CDI present with severe/fulminant disease and are at increased risk of death. Reducing exposure to extended-spectrum penicillins may prevent severe/fulminant CDI in this patient population.

Disclosures
Joao Filipe G Monteiro, PhD, Brown Medicine (Consultant)