bluuebunny/crossref_metadata_2025_split huggingface dataset:
1624. Primary Care Physician Knowledge, Attitudes, and Diagnostic Testing Practices for Norovirus and Acute Gastroenteritis
Authors: Cardemil Cristina , O’Leary Sean , Beaty Brenda , Ivey Kathryn , Lindley Megan , Kempe Allison , Crane Lori , Hurley Laura , Brtnikova Michaela , Hall Aron 
Published: October 2019

Abstract

Background
Norovirus is a leading cause of acute gastroenteritis (AGE) across the age spectrum; candidate vaccines are in clinical trials. While norovirus diagnostic testing is increasingly available, stool testing may not be performed routinely, which can hamper surveillance and burden of disease estimates. Our objectives were to understand physicians’ stool testing practices in outpatients with AGE, and physician knowledge of norovirus, in order to improve surveillance and prepare for vaccine introduction.

Methods
Internet and mail survey on AGE and norovirus conducted January to March 2018 among national networks of primary care pediatricians (Peds), family practice (FP) and general internal medicine (GIM) physicians.

Results
The response rate was 59% (820/1,383). During peak AGE season, physicians estimated they ordered stool tests for a median of 15% (interquartile range: 5–33%) of their outpatients with AGE. Stool tests were more often available for ova and parasites, Clostridioides difficile, and bacterial culture (>95% for all specialties) than for norovirus (6–33% across specialties); even when available, norovirus-specific tests were infrequently ordered. Most providers were unaware that norovirus is a leading cause of AGE across all age groups (Peds 80%, FP 86%, GIM 89%) or that alcohol-based hand sanitizers are ineffective against norovirus (Peds 51%, FP 66%, GIM 62%).

Conclusion
Physicians infrequently order stool tests for outpatients with AGE, and have knowledge gaps on norovirus prevalence and hand hygiene for prevention. Understanding the limitations of surveillance that relies on physician-ordered stool diagnostics, and closing physician knowledge gaps, can help support norovirus vaccine introduction.

Disclosures
All authors: No reported disclosures.
1626. A Primary Amebic Meningoencephalitis Case Associated with Surfing in an Inland Surf Park
Authors: Cope Jennifer R , Mattioli Mia , Shah Vaidehi , Greeley Rebecca , Hlavsa Michele , Hill Vincent 
Published: October 2019

Abstract

Background
Naegleria fowleri is a thermophilic ameba that is found in freshwater and causes primary amebic meningoencephalitis (PAM; 0–8 infections per year in the United States) when it enters the nose and migrates to the brain. Patient exposure to water containing the ameba typically occurs in warm freshwater lakes and ponds during recreational water activities. In September 2018, a 29-year-old man died of PAM after visiting a Texas inland surf park.

Methods
To determine water exposures, we reviewed medical records and conducted interviews with family and individuals who had traveled with the patient. To further investigate the inland surf park as a possible exposure source, we visited the facility and collected water, biofilm, and sediment samples from the surf park and other venues (water slides, lazy river, and cable park) within the facility. We assessed water sources and treatment practices, performed water quality tests, and tested for the presence of N. fowleri by culture and real-time PCR.

Results
Interviews revealed that the case-patient’s most probable water exposure in the 10 days before becoming ill occurred while surfing in an inland freshwater surf park where he fell off the surfboard into the water multiple times. The on-site investigation of the facility revealed a practice of manual chlorine treatment with monitoring, but no water filtering or record keeping to document water quality. Surf park water temperature was warm (25°C) and chlorine residual was negligible. N. fowleri was detected in 1 water and 1 sediment sample collected at the cable park venue, and viable thermophilic amebae were detected in all samples collected from the surf park, water slide, and cable park venues, as well from the sediment in the open-air groundwater reservoir feeding the venues.

Conclusion
This investigation documents a novel exposure in an inland surf park as the likely exposure causing PAM. Conditions in the surf park were conducive to amebic growth. Novel types of recreational water venues that do not meet traditional definitions of swimming pools, such as this surf park, might not meet the water quality standards for pools or similar treated venues. Clinicians and public health officials should remain vigilant for nontraditional exposures to water.

Disclosures
All authors: No reported disclosures.
1632. Different Healthcare Utilization Pattern in Vaccine Hesitant Children
Authors: Sohn Sangho , Hong Kwan , Hwang Hari , Chul Chun Byung 
Published: October 2019

Abstract

Background
National Immunization Program (NIP) in Korea provides 17 types of mandatory vaccines for all children free of charge. However, vaccine-hesitant group refusing the NIP are being a major threat to public health. We analyzed the healthcare utilization pattern observed in NIP eligible children and sought to identify those who remain unvaccinated using national population data.

Methods
History of receiving protein conjugate pneumococcal vaccine (PCV) was reviewed to determine the vaccination status of children born between 2013 and 2015. Children who had 3-doses or more out of 3 + 1 schedule were defined vaccinated, while those with no record of vaccination were defined unvaccinated. Their healthcare utilization records, including a number of visits, total duration, type of institution (hospitals, complementary and alternative medicine [CAM]), and purpose of visits (outpatient care, hospitalization), were retrieved from the National Health Insurance (NHI) Review and Assessment Service. Annual healthcare utilization rate and incidence of pneumococcal infections were estimated with Poisson regression and compared between study arm. The proportion of CAM out of total healthcare utilization was also compared.

Results
Among 1,272,685 children, 51% were boys and median age was 29.4-months. Two-percent of the cohort remained unvaccinated until study end. Annual hospital visiting rates were 26.9 times (95% confidence interval [CI] 26.9–27.0) for vaccinated and 3.4 (95% CI 3.4–3.5) for unvaccinated. Average NHI benefit period per year was 28.8 days (95% CI 28.8–29.0) for vaccinated and 3.9 (95% CI 3.8–3.9) for unvaccinated. The discrepancy resulted in under-detection of pneumococcal incidence in unvaccinated with 10.1 cases (95% CI 9.9–10.4) per 1,000 child-months whereas that of vaccinated was 42.5 (95% CI 42.4–42.6). Vaccine hesitant children preferred CAM at least 3-times more than vaccinated children (CAM proportion 3.5% in hesitant group vs. 1.07% in vaccinated group, P < 0.001).

Conclusion
Vaccine hesitant group not only refuses vaccination but also tends to opt-out from the entire medical attention and prefer CAM. Active detection considering this different pattern should be implemented in order to ensure the public benefits from the vaccination program.

Disclosures
All authors: No reported disclosures.
1657. Notes From the Field: A Survey of Mobile Device Usage Among Individuals in KwaZulu-Natal, South Africa
Authors: Campbell Breanna R , Choi Koeun , Gray Megan , Canan Chelsea , Moll Anthony , Dillingham Rebecca , Shenoi Sheela 
Published: October 2019

Abstract

Background
mHealth (mobile health) is a promising tool to deliver healthcare interventions to underserved populations. Across low- and middle-income countries (LMIC), the prevalence of smartphones has risen to 42%. Effective mHealth deployment in LMIC requires an understanding of how LMIC populations use mobile technology. We characterized the use of mobile devices in rural KwaZulu-Natal, South Africa to tailor mHealth interventions for people living with HIV and at risk for acquiring HIV.

Methods
We surveyed participants in community settings and offered free HIV counseling and testing. Participants self-reported their gender, age, relationship status, living distance from preferred clinic, receipt of monthly grant, condomless sex frequency, and circumcision status (if male). Outcomes included cell phone and smartphone ownership, private data access, health information seeking, and willingness to receive healthcare messages. We performed multivariable logistic regression to assess the relationship between demographic factors and outcomes.

Results
Among 788 individuals surveyed, the median age was 28 (IQR 22–40) years, 75% were male, and 86% owned personal cell phones, of which 43% were smartphones. The majority (59%) reported having condomless sex and most (59%) males reported being circumcised. Although only 10% used the phone to seek health information, 93% of cell phone owners were willing to receive healthcare messages. Being young, female, and in a relationship were associated with cell phone ownership. Smartphone owners were more likely to be young and female, less likely to live 10–30 minutes from preferred clinic, and less likely to receive a monthly grant. Those reporting condomless sex or lack of circumcision were significantly less likely to have private data access.

Conclusion
Most participants were willing to receive healthcare messages via phone, indicating that mHealth interventions may be feasible in rural KwaZulu-Natal. Smartphone-based mHealth interventions specifically geared to prevent or support the care of HIV in young women in KwaZulu-Natal may be feasible. mHealth interventions encouraging condom use and medical male circumcision should consider the use of non-smartphone SMS and be attuned to mobile data limitations.

Disclosures
All authors: No reported disclosures.
1658. Lipase and Factor V (but not Viral Load) Are Prognostic Factors for the Evolution of Severe Yellow Fever Cases
Authors: Casadio Luciana Vilas Boas , Salles Ana Paula , Malta Fernanda , Fialkovitz Gabriel , Ho Yeh-Li , Gomes-Gouvêa Michele , Malbouisson Luiz Marcelo , Levin Anna S , Azevedo Raymundo , Carrilho Flair , Nastri Ana Catharina , Renato Rebello Pinho João 
Published: October 2019

Abstract

Background
Yellow Fever (YF) is still a major threat in developing countries and a cause of outbreaks in Africa and Latin America, despite a highly efficacious vaccine. In 2018, the Brazilian state of São Paulo witnessed a new YF outbreak in areas where the virus has not been detected before. In our study, we included all patients who were admitted to Intensive Care Units of Hospital das Clínicas, University of São Paulo Medical School during the 2018 YF outbreak. The aim is to describe the clinical and laboratorial characteristics of severe cases of YF, evaluate viral parameters such as viral load and genotype among these cases, and determine markers associated with fatal outcome.

Methods
Acute severe YF cases (n = 62) were admitted to the Intensive Care Unit of a reference hospital and submitted to routine laboratorial evaluation on admission. YFV-RNA was detected in serum and urine by RT–qPCR and then sequenced. Patients were classified in two groups: survival or death.

Results
In the univariate analysis the following variables were associated with outcome: ALT, AST, AST/ALT ratio, total bilirubin, CKD-EPI, ammonia, lipase, factor V, INR, lactate, and bicarbonate. Logistic regression model showed two independent variables associated with death: lipase (OR 1.018, 95% CI 1.007 to 1.030, P = 0.002), and factor V (OR −0.955, 95% CI 0.929 to 0.982, P = 0.001). The estimated lipase and factor V cut-off values that maximized sensitivity and specificity for death prediction were 147.5 U/L (AUC = 0.879), and 56.5% (AUC = 0.913). Patients who were discharged from the hospital continued to be followed-up in the outpatient clinic. Seven patients had their urine and blood screened weekly for YFV until the test was negative. After the onset of symptoms, viremia and viruria were present for a maximum period of 28 days and 47 days, respectively.

Conclusion
YF acute severe cases show a generalized involvement of different organs (liver, spleen, heart, kidneys, intestines, and pancreas), and different parameters were related to outcome. Factor V and lipase are independent variables associated with death, reinforcing the importance of hemorrhagic events due to fulminant liver failure and pointing to pancreatitis as a relevant event in the outcome of the disease.

Disclosures
All authors: No reported disclosures.
1677. Prevalence and Patterns of Outpatient Antibiotic Prescription at a Public Tertiary Medical Center in Southern Province, Sri Lanka
Authors: Zhang Helen L , Wijayaratne Gaya B , Jayatissa Pasangi , Piyasiri Bhagya , Sheng Tianchen , Bodinayake Champica K , Nagahawatte Ajith , Woods Chris W , Tillekeratne L Gayani 
Published: October 2019

Abstract

Background
The global emergence of antimicrobial resistance poses a major public health threat. However, there are little data regarding antimicrobial use from many low- or middle-income countries. In this study, we determined the prevalence and patterns of antibiotic prescription among outpatients at a tertiary healthcare facility in Sri Lanka.

Methods
The study was conducted at the Outpatient Department (OPD) of the largest public tertiary care center in Southern Province, Sri Lanka. This is a free walk-in clinic serving upwards of 1,000 patients per day. Adult and pediatric OPD patients were recruited for a cross-sectional survey in February–April 2019. Pre-visit and post-visit questionnaires were verbally administered to obtain information regarding participants’ demographics and presenting illness. The OPD pharmacy’s electronic prescribing system was queried to calculate the prevalence of antibiotic prescriptions among enrolled patients. Logistic regression was performed to identify features associated with antibiotic prescription.

Results
Of 408 patients surveyed, 246 (62.9%) were female and 88 (21.7%) were children <18 years. Median age was 38 (IQR 19–54) years, and median duration of illness at enrollment was 7 (IQR 3–30) days. Medications were prescribed for 291 (72.4%) patients during the OPD visit, with 146 (35.8% of all patients) receiving an antibiotic. The most frequently prescribed antibiotics were amoxicillin (41, 28.1%), first-generation cephalosporins (38, 26.0%), and amoxicillin/clavulanate (30, 20.5%). The most frequent chief complaints among antibiotic recipients were cough (35, 24.0%), rhinorrhea/congestion (26, 17.8%), and fever (18, 12.3%). Diagnostic investigations were ordered for 38 (26.0%) antibiotic recipients. On bivariable analysis, younger age (P = 0.01), shorter duration of illness (P < 0.001), and lack of prior evaluation (P = 0.001) were positively associated with antibiotic prescription.

Conclusion
We show a high prevalence of outpatient antibiotic prescription despite limited diagnostic evaluation at a tertiary medical facility in Southern Province, Sri Lanka. Antibiotic stewardship efforts, especially targeting respiratory illness, may help improve antibiotic use in this setting.

Disclosures
All authors: No reported disclosures.
1679. Brucellosis in rural Narok County, Kenya: A Retrospective Review
Authors: Bailey Pamela , Doern Christopher 
Published: October 2019

Abstract

Background
It is well-documented that the country of Kenya is confronted with a heavy burden of brucellosis, presumably related to consumption of unboiled or fermented milk products (maziwa lala). As a developing country, epidemiologic data defining the prevalence of brucellosis is incomplete and particularly lacking in rural areas of the country. The objective of this study was to establish the rate of brucellosis in patients seen in a rural health clinic in Narok County, an area which has not been previously studied.

Methods
This study was performed at the Ewaso Ngiro Health Center, Narok County, Kenya, which serves a catchment area of 6,573 citizens. A retrospective chart review was conducted for 241 patients seen in December 2018 for acute visits. Medical records were reviewed for evidence of joint pain and other symptoms of brucellosis at the time of presentation and for brucellosis antigen testing results.

Results
Of the 241 patient charts reviewed, 78 (71 adult, 7 pediatric) patients had joint pain. Of the 71 adult patients, 21 were male and 49 were female (1 with no gender recorded). 50 patients had Brucella testing performed via serum agglutination, and yielded 14 positive results (13 adult, 1 pediatric). Confirmed brucellosis accounted for 5.8% of all acute visits in December 2018, and 26% of patients presenting with joint pain. In patients with confirmed brucellosis, the average age was 50.2 years (ranging 15–80). There were 8 female cases, 5 male, 1 with gender not recorded. Generalized joint pain was the most common complaint (n = 14), followed by back (n = 6), knee (n = 1), and neck pain (n = 1).

Conclusion
The prevalence of Brucella disease in rural areas of Kenya, specifically Narok County, is not well studied. This study provides insight into the prevalence of brucellosis and shows that over 25% of patients presenting with joint pain, have brucellosis. Furthermore, 5.8% of all patients seen at the Ewaso Ngiro Health Center during the study period had brucellosis and the overall prevalence of disease in patients who were tested specifically for brucellosis (n = 50), was 28%. This study provides preliminary evidence of a heavy burden of Brucella disease in Narok County and suggests that a follow-up study in this area is warranted to be defined the true prevalence of disease over a longer time frame.

Disclosures
All authors: No reported disclosures.
1682. Dengue Fever Outbreak Investigation in Upper Egypt in 2015
Authors: Mohammed. Ibrahim Hamdi , Khalil Mahmoud , Elsawy Mohamed , Samir. Ismail Mohamed , Alfishawy Mostafa 
Published: October 2019

Abstract

Background
Surveillance is the backbone of infectious diseases control but an outbreak of a new pathogen to a developing country may have devastating consequences given less prepared healthcare systems in such countries. In October 2015, there was a sharp rise of febrile illnesses reported in Dairot Fever Hospital which prompted the general department for fever hospitals in the Egyptian ministry of health (MOH) to constitute a scientific committee for field visit study in Dairot fever hospital.

Methods
The committee held meetings at Dairot fever hospital, educated local healthcare providers, examined all isolated patients and requested samples of 118 isolated patients to be sent to central laboratories of MOH. Entomological services were also part of the committee and surveillance was started in the affected area.

Results
Out of 118 samples, 28 came back positive for Dengue virus type 1 by ELISA and PCR. Entomological surveillance revealed the presence of Aedes aegypti larvae and adult mosquito at the sites where cases were living; consequently, entomological control measures for dengue vector were immediately set leading to a dramatic decline in the density of adult mosquito (from 23% to 0%) and larvae (from 25% to 0.5%).

Conclusion
The prompt response of the MOH in Egypt led to rapid control of Dengue fever outbreak but educating healthcare workers about possible imported infectious diseases would have halted the outbreak much earlier which shows the importance of Infectious Diseases training in developing countries.

Disclosures
All authors: No reported disclosures.
1688. Invasive Ocular Candidiasis: Who Is Really at Risk?
Authors: Seidelman Jessica , Fleece Molly E , Yang Wesley Z , Bloom Allison , Lydon Emily , Arnold Christopher , Weber David J , Okeke Nwora L 
Published: October 2019

Abstract

Background
The Infectious Disease Society of America recommends that all patients with candidemia undergo a dilated retinal examination to exclude invasive ocular candidiasis. However, it remains unclear whether there are patients with candidemia who do not warrant routine surveillance because the risk of ocular infection is low.

Methods
We conducted a retrospective cohort study of all patients with candidemia diagnosed at three academic medical centers (Duke, University of North Carolina and University of Virginia) from 2012 to 2017. We collected risk factors for invasive ocular candidiasis based on previous literature and compared them between patients with and without invasive ocular candidiasis. We then built a multivariate logistic regression model to assess which risk factors were significant for developing invasive ocular candidiasis.

Results
Overall, 942 patients were diagnosed with candidemia over the study period. The mean age was 55.9 years, 56% were men, 25% were non-White. Among these patients, 120 (13%) were also diagnosed with invasive ocular candidiasis, 10% with chorioretinitis and 3% with vitreous involvement. In our logistic regression analysis, central venous catheter presence [OR 8.35 (3.53, 19.77)], intravenous drug use [OR 5.02 (2.63, 9.58)], immunosuppression [OR 2.40 (1.55, 3.70)], total parenteral nutrition [OR 2.28 (1.42, 3.66)], non-White race [OR 1.65 (1.07, 2.55)], older age [OR 1.02 (1.01, 1.03)],and female gender [OR 0.57 (0.37, 0.89)] were risk factors for developing invasive ocular candidiasis. In addition, we found that persons with candidemia due to C. albicans were more likely to have invasive ocular candidiasis [OR 1.86 (1.22, 2.85)].

Conclusion
This cohort represents the largest study of patients with candidemia who developed invasive ocular candidiasis to date. Based on our findings, clinicians should develop targeted and cost-effective strategies for endophthalmitis screening.

Disclosures
All authors: No reported disclosures.
1689. Active, Invasive Fungal Infection, and Hematopoietic Cell Transplantation (HCT) in Chronic Granulomatous Disease (CGD): Presentation, Procedure, and Outcomes
Authors: Parta Mark , Zerbe Christa , Holland Steven M , Malech Harry , Kang Elizabeth M 
Published: October 2019

Abstract

Background
Individuals with CGD develop invasive fungal infections which are often refractory to medical therapy. Disease caused by Aspergillus nidulans (An), Scedosporium apiospermum (Sa), and Aspergillus viridinutans (Av), can be fatal due to involvement of structures contiguous to the primary pulmonary infection. Protocols for managing an active fungal infection during HCT are lacking. Here we describe 5 patients transplanted with active fungal infection and the treatments ancillary to HCT that led to successful outcomes.

Methods
Four males and one female underwent peripheral blood HCT utilizing 3 different transplant platforms. Granulocyte transfusions (GCT) were used in 4 cases.

Results
Antifungal treatment and transplant outcomes are reported in Table 1. Patients 1 (Figure 1) and 4 (previously reported) had Sa infection of the lung and spine and lung and pericardium, respectively. Patients 2 (Figure 2) and 5 had An pneumonia with spinal and sternal involvement, respectively. Patient 3 had Av pneumonia involving the lower lung and diaphragm (Figure 3). The transplant protocol was modified to include a high stem cell dose to facilitate engraftment and post-transplant cyclophosphamide GVHD prophylaxis. No GCTs were used proximal to or during HCT due to the development of antineutrophil antibodies.

Conclusion
Active fungal infection can be managed during HCT. Combination therapy (GCTs and antifungals) lessened the burden of disease prior to and during HCT. All patients had clinical resolution of their infection post-HCT and successful engraftment. Bone disease stabilized post-HCT and remineralization occurred. One patient was successfully transplanted without GCT and its potential complications.
The authors have no conflicts to report.

Disclosures
All authors: No reported disclosures.