bluuebunny/crossref_metadata_2025_split huggingface dataset:
1499. Incidence of Community Acquired Pneumonia by Age and Comorbid Conditions in the Veterans Health Administration (VHA)
Authors: Bej Taissa A , Song Sunah , Wilson Brigid , Banks Richard , Briggs Janet , Jump Robin , Perez Federico 
Published: January 2021

Abstract

Background
Community acquired pneumonia (CAP) remains a major cause of morbidity and mortality. Risk factors for CAP are often grouped as moderate- (e.g., diabetes mellitus, chronic liver, lung, or heart disease) and high-risk (e.g., immunosuppressive) conditions, which in turn influences preventative strategies, notably pneumococcal vaccination. Here, we use the national VHA databases to assess the risk of CAP among adults, expanding on previous work by using administrative data to assess the incidence of CAP among people with &gt; 1 moderate risk condition

Methods
We used the national VHA databases merged with claims summaries from the Centers for Medicare and Medicaid Services (CMS) to identify patients receiving clinical care in the VHA without clinical Medicare claims in 2016-2017. Within this population, we identified CAP cases defined by the presence of a diagnostic code for pneumonia, chest X-ray, and antibiotics as well as the absence of healthcare exposure or antibiotics in prior 90 days. We determined the total patient years at risk and calculated incidence rates by age group and by moderate- and high-risk comorbid conditions.

Results
We identified 37,348 CAP cases in 7.9 million person-years at risk and observed similar annual rates in 2016 and 2017 (468.9 and 472.2 cases/100,000 person-years, respectively). The prevalence of high-risk conditions and incidence of CAP increased with age whereas the prevalence of &gt;1 moderate-risk condition peaked for ages 50-64 and 65-74 years (Table). The incidence of CAP among those with &gt; 1 moderate-risk condition exceeded that of patients with high-risk conditions across all age strata (Figure).
Table

Figure

Conclusion
Age-adjusted analysis revealed that the greatest burden of CAP occurs in patients with &gt; 1 moderate-risk condition, even compared to those with a high-risk condition. Our analysis of CAP based on national VHA data suggest that additional preventative health measures directed at individuals older than 50 years with &gt; 1 moderate-risk condition may help to reduce the burden of CAP and limit its morbidity and mortality.

Disclosures
Robin Jump, MD, PhD, Accelerate (Grant/Research Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support, Advisor or Review Panel member)Roche (Advisor or Review Panel member) Federico Perez, MD, MS, Accelerate (Research Grant or Support)Merck (Research Grant or Support)Pfizer (Research Grant or Support)
1501. Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED): Updates from Year 2 of multi-site trial
Authors: Richard Stephanie A , Burgess Timothy , Burgess Timothy , Collins Limone , Colombo Rhonda , Ganesan Anuradha , Geaney Casey , Hrncir David , Lalani Tahaniyat , Markelz Ana E , Maves Ryan C , McClenathan Bruce , Mende Katrin , Modi Jitendrakumar , Montgomery Jay R , Schofield Christina , Seshadri Srihari , Skerrett Catherine , Spooner Christina , Utz Gregory , Warkentien Tyler , Coles Christian L 
Published: January 2021

Abstract

Background
Despite nearly universal influenza vaccination for active duty military personnel, breakthrough influenza infections occur. We are reporting on the second year of the Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED), comparing three FDA-licensed influenza vaccine types (egg-based, cell -based, and recombinant) to assess differences in immunogenicity and effectiveness.

Methods
Participants in the second year of PAIVED were enrolled from Oct 2019 through Jan 2020 at 9 military facilities. Participants received weekly inquiries about influenza-like-illnesses (ILI) experienced in the past week, and if the participant reported having a cough or sore throat and a) muscle/body aches or fatigue and/or b) being feverish or having chills, they were scheduled for a clinic visit. During this visit, a blood sample and a nasal swab were collected, as well as information about symptom duration and severity. A second (convalescent) visit was conducted approximately 4 weeks later, which involved collecting additional information about the duration of symptoms and illness burden, as well as a second blood draw. Due to the COVID-19 pandemic, acute and convalescent visits were disrupted at most sites in March and April due to COVID-19 precautions.

Results
PAIVED year 2 enrolled 5,892 participants who completed demographic forms (Table 1). Among those who reported any ILIs, most reported one ILI (1,345), while 264 reported two ILIs, and 42 reported three ILIs. Nasal swabs were processed from 273 ILIs at four sites (Fig 1), and 14 cases of influenza were identified thus far. The median duration of ILIs was ten days, with a median of three days of limited activity, and two days with fever. Nine individuals were hospitalized.
Table 1. Demographic characteristics of individuals enrolled in PAIVED 2019/20

Figure 1. Lab results as of 5/15 (N=273 samples)

Conclusion
Over 25% of participants reported an ILI, and 5% of the nasal swabs that have been tested thus far have been positive for influenza. While most samples have not yet been analyzed, we have identified some breakthrough cases of influenza among vaccinated participants. Planned analyses include comparative vaccine effectiveness in order to inform future vaccine purchasing decisions.
Disclaimer

Disclosures
All Authors: No reported disclosures
1502. Psychological Stress and Anxiety among Parents of Children Younger than 5 Years Hospitalized with RSV
Authors: Ampofo Krow , Choi Yoonyoung , Heller Evan G , Platt-Koch Alexander G , Gesteland Per H , Adua Lazarus , Finelli Lyn 
Published: January 2021

Abstract

Background
Respiratory Syncytial Virus (RSV) is one of the most common causes of childhood lower respiratory tract infection (LRTI) worldwide. While financial burdens have been documented, there are few data on parental psychological stress associated with RSV hospitalizations. We evaluated the psychological stress and anxiety of parents whose children were hospitalized with RSV.

Methods
During the 2019-2020 RSV season, parents with children &lt; 5 years of age hospitalized with laboratory-confirmed RSV LRTI at Primary Children’s and Riverton Hospitals in Salt Lake City, Utah, were surveyed in person, and online after discharge. As part of the survey, parents completed the State-Trait Anxiety Inventory for Adults (STAIAD) instrument (short form) and the parental stressor scale (PSS). We evaluated the difference in parental stress and anxiety reported during hospitalization and at 2-weeks post-discharge using a paired t-test.

Results
Among 284 Salt Lake County resident children &lt; 5 years, and hospitalized with RSV LRTI, 75 (26%) and 57 (20%) parents completed both surveys on admission and at 2-weeks post-discharge respectively. In 11 of 20 STAIAD items gauging stress and anxiety, parents reported higher levels of stress and anxiety whilst their children were admitted compared to post-discharge (Table 1). Parents’ average score on several items associated with a “positive outlook,” e.g. I feel calm, significantly improved (p &lt; 0.05) at 2-weeks post-discharge. Similarly, several items associated with a “negative outlook,” e.g. I am worried, significantly decreased (p &lt; 0.05) at 2-weeks post-discharge (Table 1). For the PSS items, ≥ 50% of parents rated 15 out of 25 as being “very or extremely stressful”, including: feeling helpless about how to help my baby; my baby’s unusual or abnormal breathing; and when my baby seemed to be in pain (Table 2).
Estimates of Psychological Burden of RSV lower respiratory tract infection (LRTI) Hospitalization of Children &lt;5 Years of Age on Parents: State-Trait Anxiety Inventory for Adults (STAIAD)

Estimates of Psychological Burden of RSV lower respiratory tract infection (LRTI) Hospitalization of Children &lt;5 Years of Age on Parents: Parental Stressor Scale (PSS)

Conclusion
RSV LRTI hospitalization among children &lt; 5 years of age, imposed a significant psychological stress and anxiety on parents, which generally persisted up to 2-weeks post-discharge. Prevention of RSV infection through vaccines and immunoprophylaxis will help ease parental psychological burden associated with RSV hospitalization.

Disclosures
Krow Ampofo, MBChB, Merck (Grant/Research Support) Yoonyoung Choi, PhD, MS, RPh, Merck (Employee) Lyn Finelli, DrPH, MS, Merck & Co Inc, (Employee)
1503. Risk Factors for Contracting Infection with SARS-CoV-2: a Prospective Case-control Study
Authors: Shoar Saeed , Khavandi Siamak , Tabibzadeh Elsa , Vaez Aydin , Oskouei Ali Khabbazi , Maleki Armin Nehzati , Shoar Nasrin 
Published: January 2021

Abstract

Background
As the COVID-19 pandemic has exhausted the healthcare system and economic infrastructures, controlling measures are directed toward population-based strategies including individual’s hygiene and safe socializing. We conducted this study to identify individual’s factors at the population level which are associated with the risk of infection with SARS-CoV-2 in a middle-to-low income country.

Methods
A prospective case-control study was conducted to compare the demographics, socioeconomics, and individual’s behavior between patients with COVID-19 and randomly selected healthy controls from the same population referring to a general hospital in northwest Iran.

Results
Data of 250 patients with a positive RT-PCR test for COVID-19 was compared with 250 healthy controls between March 1st and May 15th (Table1). Higher education, better socioeconomic status, having access to the internet or following relevant news, having an obsession for cleanliness especially regular hands washing with alcohol-based disinfectants, wearing masks in public especially those with an N-95 filter, complying with stay-home orders, and receiving the flu shot over the past season were protective against contracting COVID-19. On the contrary, cigarette smoking or opium consumption, a history of recent travel, having an individual with infection with SARS-CoV-2 within the household, and recent hospitalization were associated with COVID-19.
Table1. Comparison of individual’s factors between COVID-19 positive and negative patients

Conclusion
Individuals’ characteristics at a family or public level can guide healthcare authorities and lawmakers in their ongoing endeavors toward controlling the COVID-19 pandemics, especially in low-to-middle income regions.

Disclosures
All Authors: No reported disclosures
1508. Hospitalizations and Emergency Department Visits for Respiratory Syncytial Virus Among Infants Aged &lt; 1 year in the United States: An Analysis of Nationwide Inpatient and Emergency Room Data
Authors: Suh Mina , Jiang Xiaohui , Movva Naimisha , Frysek Joh , Bylsma Lauren , Rizzo Christopher , Nelson Christopher 
Published: January 2021

Abstract

Background
Respiratory syncytial virus (RSV) is a common cause of illness and hospitalization for infants and children globally. The objective of this study was to characterize the burden of RSV and all-cause bronchiolitis (ACB) inpatient hospitalizations and emergency room department (ED) visits in U.S. infants aged &lt; 1 year with the most recent years of data available.
Figure 1. RSV and ACB hospitalizations among US infants &lt;1 year old (NIS 2016)

Figure 2. ED visits due to RSV and ACB among US infants &lt; 1 year old (NEDS 2016)

Methods
The National (Nationwide) Inpatient Sample (NIS) and the Nationwide Emergency Department Sample (NEDS), which are large national publicly available all-payer databases in the U.S., were used to estimate the burden of RSV in 2016 based on ICD-9 and 10 codes. The proportions of hospitalizations or ED visits due to RSV in infants aged &lt; 1 year were quantified. Due to the potential of missing RSV encounters based on coding practices, ACB was also evaluated. Based on availability of variables and data recency, 2011 NIS data were used to describe RSV burden by age in months. Sensitivity analyses were conducted with NIS and NEDS data from other years (2011-2015).

Results
A clear seasonal pattern was observed for RSV hospitalizations and RSV ED visits with a peak in December-February and a trough in June-August in 2016. During the RSV season and peak months, RSV was a leading cause of hospitalization (12065/45490=27% in Jan and 12050/45080=27% in Feb) and ED visits (26423/316709=8% in Jan and 24721/306397=8% in Feb)) among U.S. infants under 1 year of age. Similar patterns were seen for ACB in 2016 (38% hospitalization and 17-18% ED visits in Jan and Feb) and for RSV and ACB in the other years. For the inpatient setting in 2011, RSV hospitalizations were the highest among the youngest patients (except those aged &lt;1 month) and decreased with age during the RSV season and peak months.

Conclusion
These results show that during the RSV season, RSV and ACB were a leading cause of hospitalization and ED visit among US infants under 1 year of age. Current policy does not support routine RSV testing of clinical lower respiratory tract infections (LRTIs) among infants. In that context, as an approximation of RSV LRTI visits in each setting, ACB can be considered an upper bound and RSV can be considered a lower bound of the true proportion of hospital encounters associated with RSV in these settings..

Disclosures
Mina Suh, MPH, International Health, EpidStrategies (Employee) Xiaohui Jiang, MS, EpidStrategies (Employee)
1509. Impact of Respiratory Viral Infection on Outcomes of Congenital Heart Repair Surgery
Authors: Srivastava Namun , Kuriakose Emy , Sowinski Heather , Khuon Daliya 
Published: January 2021

Abstract

Background
Respiratory viral infections are common in the pediatric population and can range from mild to life-threatening. Given the risk factors that accompany these infections, some pediatric cardiothoracic surgeons in the United States avoid performing surgery for patients with congenital heart disease when there is a possibility of concurrent viral respiratory illness. Studies in this patient population have been limited either by small study populations, or a study focus that is too narrow. The impact of respiratory infections on patient outcomes based on previous literature is also unclear.

Methods
This retrospective chart review study aimed to compare outcomes after congenital heart repair surgery in patients with positive respiratory viral testing to those with negative testing over a five-year period, to determine if there are significant differences related to post-operative hospital course or morbidity.
Patient Inclusion Flowchart

Results
This study included 120 patients, of whom 43 tested positive for respiratory viruses and 77 tested negative. Patients were additionally divided based on the presence or absence of symptoms of respiratory infection, with 79 patients demonstrating respiratory symptoms and 41 who did not. Results demonstrate that negative respiratory viral testing is associated with a significant increase in post-operative ICU LOS (p = 0.01), hospital LOS (p &lt; 0.01), and duration of post-operative respiratory support (p &lt; 0.01), compared to positive testing. Additionally, an absence of respiratory symptoms at the time of testing was associated with a significant increase in post-operative ICU LOS (p = 0.01) and hospital LOS (p &lt; 0.01), compared to patients who were symptomatic.
Outcomes by Positive vs. Negative FilmArray

Outcomes by Symptomatic vs. Asymptomatic

Conclusion
These results suggest that negative respiratory viral testing or lack of respiratory infectious symptoms should not be a reassuring factor in patients scheduled for repair of congenital heart disease, and positive testing does not appear to result in worse outcomes after surgery. Based on this data, we would recommend that respiratory viral testing should not be a routine component of preoperative planning for patients scheduled to undergo congenital heart repair surgery, which would reduce the burdens of unnecessary testing and delays in definitive heart repair.

Disclosures
All Authors: No reported disclosures
1511. Influenza antiviral use in patients hospitalized with laboratory-confirmed influenza in the United States, FluSurv-NET, 2015 – 2019
Authors: Tenforde Mark W , Cummings Charisse N , Sutton Melissa , Kim Sue , Maslar Amber , Alden Nisha B , Spina Nancy , Price Andrea , Monroe Maya , Rothrock Gretchen , McMahon Melissa , Talbot Helen , Openo Kyle P , McMullen Chelsea L , Billing Laurie M , Garg Shikha 
Published: January 2021

Abstract

Background
Antiviral therapy is recommended for all patients hospitalized with influenza to reduce morbidity and mortality. We used data from the population-based Influenza Hospitalization Surveillance Network (FluSurv-NET) to evaluate trends in influenza antiviral use in patients hospitalized with influenza over 4 seasons in the United States.

Methods
We included cases residing within the FluSurv-NET catchment area and hospitalized with laboratory-confirmed influenza from October 1 – April 30 during 2015-16 through 2018-19 seasons. For 2015-16 and 2016-17, chart abstraction of demographic and clinical characteristics and antiviral use was performed on all cases; for 2017-18 and 2018-19, all patients &lt; 50-years and an age-stratified random sample of older adults were sampled. Data were weighted to reflect the probability of selection. We assessed the frequency of treatment, by season and age group, and evaluated trends by season using the Cochran-Armitage test. Among those receiving antivirals, we used multivariable logistic regression to assess the association between the days from symptom onset to admission and receipt of early (0-2 days from symptom onset) versus late (&gt; 2 days) treatment, adjusting for age, sex, race/ethnicity, and underlying medical conditions.

Results
Over 4 seasons, we sampled 62,182 patients; 54% female and 63% non-Hispanic white. Overall, 92% of patients received antivirals, increasing from 86% in 2015-16 to 94% in 2018-19; use increased by season in all age strata (p &lt; 0.001) [Figure]. Most received oseltamivir (99%); in 2018-19, 2% received baloxavir. Of those who received antivirals, 38% received early treatment. The median days from symptom onset to admission was 1 day (interquartile range [IQR] 1-3) for those who received early treatment and 4 days (IQR 3-6) for those who received late treatment. Ninety-three percent who received antivirals started within 1 day of admission. For each additional day from symptom onset to admission, the adjusted odds of late treatment was 8.56 (95% confidence interval: 7.83-9.35).
Figure. Weighted percentage of hospitalized patients receiving influenza antivirals by influenza season and age strata, FluSurv-NET, 2015-16 through 2018-19.

Conclusion
In patients hospitalized with influenza, most received antiviral treatment within 1 day of admission. However, a majority had delays from symptoms onset to initiation, due to late presentation of illness.

Disclosures
Melissa Sutton, MD, MPH, CDC funding (Emerging Infections Program) (Grant/Research Support) Sue Kim, MPH, Council of State and Territorial Epidemiologists (CSTE) (Grant/Research Support) Nisha B. Alden, MPH, CDC (Grant/Research Support)
1513. Medically Attended Respiratory Syncytial Virus Hospitalizations (RSVH) and All-Cause Bronchiolitis Hospitalizations (BH) Among Children Aged ≤ 24 Months at RSV Season Start With Higher-Risk Congenital Heart Disease (CHD) Before and After the 2014 American Academy of Pediatrics (AAP) Policy
Authors: Fergie Jaime , Gonzales Tara , Suh Mina , Jiang Xiaohui , Fryzek Jon , Howard Ashley , Bloomfield Adam 
Published: January 2021

Abstract

Background
In 2014, the AAP stopped recommending palivizumab for use in children with hemodynamically significant CHD (hs-CHD) aged 12 to 24 months at the RSV season start. This analysis investigates the impact of the 2014 AAP policy on the contemporary burden of RSVH and BH in children with CHD for whom palivizumab immunoprophylaxis is no longer recommended.

Methods
All children with CHD aged ≤ 24 months at the start of the RSV season and hospitalized for RSV or BH during the 2010-2017 RSV seasons (November-March) were studied. RSVH and BH were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes. As there are no ICD codes for hs-CHD, we evaluated the effect of the guidance on higher-risk CHD as defined by ICD codes.1 Frequency and characteristics of RSVH and BH and disease severity (including intensive care unit [ICU] admission and mechincal ventilation) for these children before and after the 2014 AAP guidance using the Children’s Hospital Association’s Pediatric Health Information System® (PHIS) data set were described. SAS version 9.4 was used for statistical analysis of this data, with z-tests method used to determine statistical significance.

Results
RSVH significantly increased after 2014 for all higher-risk CHD children aged ≤ 24 months (3.4% [1992 RSVH CHD/59,217 RSVH] before the 2014 guidance and 4.0% [1798 RSVH CHD/45,470 RSVH] after; P&lt; 0.0001) and for the subgroup of children aged 12 to 24 months at the start of the RSV season (0.5% before the guidance and 0.8% after; P&lt; 0.0001). Disease severity as measured by ICU admissions in the 12 to 24 months subgroup also significantly increased after the 2014 guidance (0.2% before the guidance and 0.3% after; P&lt; 0.0001). Mechanical ventilation usage was not statistically significantly increased after the 2014 guidance (P=0.188). A similar pattern of results was found for BH.

Conclusion
RSVH, BH, and associated disease severity significantly increased among higher-risk CHD children aged 12 to 24 months, within the PHIS health system, after the 3 RSV seasons following the 2014 AAP RSV immunoprophylaxis recommendations.

Disclosures
Jaime Fergie, MD, AstraZeneca (Speaker’s Bureau)Sobi, Inc. (Speaker’s Bureau) Tara Gonzales, MD, Sobi, Inc. (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Xiaohui Jiang, MS, EpidStrategies (Employee) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Adam Bloomfield, MD, FAAP, Sobi, Inc. (Employee)
1515. Nationwide trends of invasive pneumococcal disease in Spain for the period 2009-2019
Authors: de Miguel Sara , Domenech Miriam , Sempere Julio , González-Camacho Fernando , Yuste Jose 
Published: January 2021

Abstract

Background
Introduction of pneumococcal conjugate vaccines (PCV) is an effective measure to control the invasive pneumococcal disease (IPD) although the emergence of non-vaccine serotypes is of great concern worldwide.

Methods
This study includes national data from IPD cases affecting pediatric and adult population for the period (2009-2019). Data contain 25341 laboratory-confirmed clinical isolates of Streptococcus pneumoniae causing IPD in Spain.

Results
The overall reduction of IPD cases by serotypes included in PCV13 was 88% for children and 67% in adults with a constant increase of IPD cases by serotype 8 in adults since 2015. In children, serotypes 24F (12%), 8 (10%) and 3 (9%) were the most frequent in 2019 whereas in adults, serotypes 3 and 8 accounted for 37% of IPD cases. IPD cases in adults by additional serotypes covered by the 23-valent polysaccharide vaccine (PPV23) have risen constantly within the years, increasing from 19% in 2009 to 52% in 2019. IPD cases by Non-vaccine types in adults (not covered by PCV13 or PPV23) show a moderate increase from 14% in 2009 to 24% in 2019.

Conclusion
Emerging serotypes are observed in Spain with the rise of serotype 24F in children and 8 in adults as a worrisome event.

Disclosures
Jose Yuste, n/a, GSK (Consultant)MSD (Consultant, Research Grant or Support)Pfizer (Consultant)