bluuebunny/crossref_metadata_2025_split huggingface dataset:
1516. Outbreak of SARS-CoV-2 among Migrant Farm Workers in North Florida
Authors: Nasser Khalil , Tabon Vanneza , Jayaweera Dushyantha , Elias Tiffany , Jasti Kavya , Talati Raja , Ramgopal Moti 
Published: January 2021

Abstract

Background
Migrant farmworkers have been identified as a vulnerable population for Severe Acute Respiratory Syndrome Novel Coronavirus-2 infection (SARS-CoV-2). The objectives of this study were to detect the SARS-CoV-2 infection (COV19) status among 262 migrant farmworkers in North Florida.

Methods
This is a retrospective analysis of the information gathered from migrant workers referred by the Florida Dept. of Health for evaluation. Due to the urgency of returning to Mexico, subjects with which COV19 was detected were reevaluated for detailed medical history. Therefore, subjects that tested negative were later released following CDC guidelines. COV19 status was determined using an RNA qualitative nucleic acid amplification test (NAAT) from nasopharyngeal swabs collected over a three-day period. Variables collected include demography, symptoms, temperature, comorbidities, medication use, and vaccine status. Statistical significance for categorical variables was assessed using χ 2 test or Fisher’s exact test where appropriate. Remaining variables were assessed using basic descriptive analysis.

Results
From the 262 subjects tested, 6 missed the follow up visit and data was unavailable. All were Mexican males, age 18-67 years, with positivity rate of 35.1%. Among the 92 (+) subjects, the average age was 34.1 years and 34.5 among the 164 (-) subjects, (p=&lt; 0.77). The symptoms and temperatures are in Table 1. Three of the 92 COV19 (+) subjects were hospitalized, non-ICU and made an uneventful recovery. 59.8% of COV19 (+) subjects were asymptomatic. Among the 92 (+) subjects, 20.7% reported using acetaminophen within the last 60 days. The most common reported comorbidity was being a former smoker or current smoker, at 12.0% and 4.3% respectively.

Conclusion
The COVID-19 pandemic has highlighted migrant workers as a vulnerable population with astronomical COV19 rates, compared to others in FL (14/100,000). They are impoverished, uneducated, undocumented, uninsured and employed to perform arduous physical labor and it is essential to provide basic healthcare to prevent the spread of COV19.

Disclosures
All Authors: No reported disclosures
1517. Outcomes of Influenza Infection among Vaccinated and Un-Vaccinated Patients presenting to a Suburban hospital in Perth, Western Australia (WA), 2019 Southern Hemisphere Influenza Season
Authors: Otome Ohide , Fysh Ed , Shariar Afsin , Yuan Andrew Chin Hock , Brownell Phoebe , Abu-Sharifa Aysha , Bailey Claire , Hall Victoria , Courtney Aiofe Tarrant , O’Reilly Marese 
Published: January 2021

Abstract

Background
Influenza season started in April, earlier than any previous season. WA immunization registry showed a higher than average vaccine uptake. By October 22,770 cases and 80 influenza related deaths were recorded (in 2018: 3,679 cases and 13 deaths). We aimed to characterize clinical presentation and outcomes of laboratory confirmed Influenza, comparing vaccinated with unvaccinated controls.Hypothesis; vaccination would result in less severe disease and better outcomes. Primary objective: length of stay (LOS); Secondary objective: prevalence of severe respiratory illness, ICU admission and death.

Methods
Retrospective study, April to October 2019. Eligible patients had a telephone-based questionnaire for clinical and immunization data verification. Excluded; &lt; 18 years; deceased; dementia; nursing home and unable to consent. Continuous and categorical data of cases (vaccinated) and controls (unvaccinated) were compared using Mann-Whitney U test (non parametric), student t-test (parametric). Correlation and multilinear regression analyses were undertaken to determine the effects of vaccination status and identified confounders on the primary outcome. Based on previous average LOS (5 days, SD 1.5) the sample required to detect a difference of 1 day with 80% power was 70 patients. This study was approved by the SJGHC HREC.

Results
Of 163 eligible, 83 completed the questionnaire. 8 were excluded. 75 underwent analysis (50 vaccinated and 25 unvaccinated). Median age was 75 (23-83) and 63 (33-70) respectively (p&lt; 0.01). 76% vs 48% reported &gt;1 comorbidity (p =0.02). 10% vs 0% were admitted to ICU (p =0.16). Higher vaccination uptake was seen in older patients and those with comorbid conditions. There was a strong correlation (Spearman r= 0.54 (0.34 to 0.68, p&lt; 0.001) between age and length of stay, but none was found between comorbidity or vaccination and length of stay. Neither age (p &gt;0.05), comorbidity status (yes/no; p=0.99), vaccination status (p=0.61) nor any combination of these variables were significantly associated with a dichotomised outcome of acute hospital stay &gt; 3 days.

Conclusion
Vaccination with the 2019 influenza vaccine had no significant effect on hospital length of stay, mortality or critical care requirement in patients admitted to hospital with influenza.

Disclosures
All Authors: No reported disclosures
1524. Sex Differences in Influenza: The Challenge Study Experience
Authors: Giurgea Luca , Cervantes-Medina Adriana , Han Alison , Czajkowski Lindsay , Baus Holly , Memoli Matthew J 
Published: January 2021

Abstract

Background
Our understanding of the impact of biological sex on influenza-associated disease and the mechanisms that underpin it is still incomplete. Further investigation of sex-linked effects on influenza pathogenesis and clinical outcomes may help tailor vaccine strategies. Animal studies have shown female mice experience more symptoms than male mice during influenza infection. Similarly, human females of reproductive age have higher rates of influenza and influenza-related hospitalizations. However, data is sometimes conflicting and may be confounded by other important differences in baseline characteristics. Human challenge studies have demonstrated the importance of NAI titers as a correlate of protection and may also provide an ideal opportunity to study sex differences in a homogenous group of participants controlled for confounders.

Methods
Data from 168 volunteers who underwent Influenza A/California/04/2009/H1N1 challenge studies affiliated with NIAID’s LID Clinical Studies Unit were compiled to compare differences between sexes. Participants were included in the analysis if they received a challenge dose of virus of 107 TCID50 and were excluded if they had received any vaccines or experimental therapy during the study period.

Results
Baseline differences between male and female participants were observed in NAI titers but not HAI titers or age. Outcomes of interest included presence of viral shedding/duration which were similar among sexes. However, symptom number and duration were higher among female participants (p=0.008 and p=0.045 respectively). Ongoing data analysis also shows females have lower post-challenge NAI titers than males.

Conclusion
Female participants in our H1N1 challenge studies had more symptoms and a longer duration of symptoms compared to their male counterparts. Differences in NAI titers may potentially explain the observed relationship between sex and symptoms associated with influenza.

Disclosures
All Authors: No reported disclosures
1527. Incident Sexually Transmitted Infections among Southern Men Who Have Sex with Men Living with HIV in the Era of Biomedical Prevention
Authors: Gravett Ronnie M , Cleveland John D , Overton Edgar T , Marrazzo Jeanne , Marrazzo Jeanne 
Published: January 2021

Abstract

Background
Sexually transmitted infections (STI) and HIV disproportionately affect men who have sex with men (MSM) in the U.S. Deep South. The South also continues to bear the majority of incident HIV in the U.S.; concomitantly, STIs have increased among MSM in this region. HIV virologic suppression effectively prevents sexual transmission of HIV (treatment as prevention, TasP), but STIs occur commonly in MSM living with HIV despite this. Here, we describe the incidence of gonorrhea and chlamydia in MSM living with HIV in the context of their viral load (VL) management from 2016 to 2019.

Methods
We analyzed data from adult MSM living with HIV from 2016-2019 in HIV care in Birmingham, AL. Eligible MSM were prospectively enrolled in the CFAR Network of Integrated Clinical Sites (CNICS) and had documentation of at least one HIV viral load and one STI test (gonorrhea or chlamydia at any anatomic site) in the same calendar year. Demographic data is presented by year. STI incident rates were calculated by year by viral load (VL) category, suppressed (VL &lt; 200 copies/ml) and unsuppressed (VL ≥ 200 copies/ml), with incident rate ratios (IRR) and 95% confidence intervals for comparing suppressed VL to unsuppressed VL.

Results
The study cohort included 943, 1084, 1080, and 1106 MSM in each year from 2016-2019, respectively. Of these men, 551 (58%), 623 (58%), 639 (63%), and 676 (61%) were Black or African American with a median age (years) of 46, 45, 44, and 43 from 2016-2019. Most had VL &lt; 200 (79%, 81%, 82%, and 80% from 2016-2019). There were 100, 131, 139, and 168 men with positive GC or CT results per year from 2016-2019. The annual incident rates per 100 person years (PY) for MSM by suppressed and unsuppressed VL as well as IRR are presented in Table 1; the IRR ranged from 3.00-4.34 through the study period. Figure 1 shows incidence rate by VL category.

Figure 1. Incidence Rate by Viral Load Category. PY, person years.

Conclusion
In this cohort, incident bacterial STIs were common and increased each year in this analysis for both groups, reflecting national STI trends. MSM with suppressed VL had higher bacterial STI incidence rates and higher risk for incident STI compared to MSM with unsuppressed VL. Novel approaches to STI prevention, such as pre- and post-exposure prophylaxis or vaccines, are necessary to alter the STI epidemic in this population and limit its impact on HIV transmission.

Disclosures
All Authors: No reported disclosures
1532. Demographics and Population Epidemiology of Mycoplasma genitalium infection: Correlation to Co-Infection and prior STI history
Authors: Kostera Josh , Santiago Jose 
Published: January 2021

Abstract

Background
Despite reports in the past few years that Americans are having less sex, the US Centers for Disease Control and Prevention (CDC) recently reported in 2019 that sexually transmitted infection (STI) cases are at an all-time high in the United States. The CDC report included statistics on confirmed cases of Chlamydia trachomatis and Neisseria gonorrhoeae, but did not include data for Trichomonas vaginalis and Mycoplasma genitalium. Although Trichomonas vaginalis and Mycoplasma genitalium are generally recognized agents responsible for STI’s, there is limited prevalence data in the United States.

Methods
Herein we present STI prevalence and socio-demographic epidemiological data associated with patients enrolled in a multicenter STI study using the automated multiplex qualitative CE marked assay, Alinity m STI. The enrolled study population reflected a diverse number of participants with an approximately equal male to female ratio, prior STI history, single and married, education levels from primary to post-graduate, as well as different ethnicities.

Results
Participants in this study population who have previously been diagnosed with an STI had an overall Mycoplasma genitalium prevalence rate that was approximately double those who have not been previously diagnosed with an STI. Furthermore, the co-infection rate for Mycoplasma genitalium and Trichomonas vaginalis was as high as 2.5% for vaginal swab specimens with an overall Mycoplasma genitalium prevalence of 11.6%. The overall prevalence of Trichomonas vaginalis in women was 12.3%. Neisseria gonorrhoeae had the lowest overall prevalence in men and women at 2.4%, and Chlamydia trachomatis at had an overall prevalence of 9.8%.

Conclusion
Mycoplasma genitalium infections are generally asymptomatic in both men and women that contributes to up to 35% of non-chlamydial non-gonococcal urethritis in men and linked to cervicitis and pelvic inflammatory disease in women. Left untreated or not accurately diagnosed, STIs can cause significant, serious long-term health consequences including sexual, reproductive, and psychological well-being that present an extensive challenge and burden to public health in the United States.

Disclosures
Jose Santiago, PhD, Abbott (Employee)
1533. Galapagos Islands: structuring of an HIV clinic in a captive territory
Authors: Jaramillo Ana Maria M Gomez , Teran Enrique 
Published: January 2021

Abstract

Background
Galapgos contributes 0.11% of the HIV cases in all Ecuador. There is a social and biological distinction, especially considering that the islands receive 245,000 tourists/year from all over the world, which also includes sex tourism by the LGTBI community. In 2016, the HIV Clinic project began in the Santa Cruz hospital, as an initiative carried out by a specialist in Internal Medicine.
Graphic 1. Distribution by type f case notification at the diagnosis of PLWHA at the Galapagos Islands

Graphic 2. Distribution by gender of PLWHA at the Galapagos Islands

Methods
An initial descriptive analysis of the variables was performed, frequency tables were used for the qualitative variables. For the quantitative variables, measures of central tendency (mean, median, mode). The analyzed data correspond to the period between 2016 to 2019.
Graphic 3. Impact of HIV Clinic on viral load value of the PLWHA at the Galapagos Islands

Graphic 4. Impact of HIV Clinic on CD4 cell count of the PLWHA at the Galapagos Islands

Results
The 43.1% of cases correspond to HIV+ and 58.8% of AIDS. 67.3% of PLWH are men and 32.7% are women. All cases occur due to unprotected sex (100%). 64% of HIV+ and 40.6% of AIDS patients report homosexual intercourse. Of the AIDS cases, 58.8% are in the A2 to C2 CDC category, and have less than 200 CD4+. The most frequent opportunistic infection in this group is Oropharyngeal Candidiasis (16.7%) followed by tuberculosis of any location (16.7%) and Pneumocistys jirovecii pneumonia (3.3%). 93.1% of patients receive ART, the remaining 6.9% corresponds to loss of follow-up. Thus, since the creation of the unit, a positive impact on the evolution of viral load as well as the values of CD4+ count can be seen. This would be related to the fact that PLWHA controls have been more frequent and are given in the context of a special care unit for their pathology.

Conclusion
We can conclude that the behavior of HIV infection in the Galapagos Islands has a distribution in vulnerable groups as in the continental Ecuador. It is important to mention that the diagnosis of HIV is late in the insular region. The creation of an HIV clinic strategically located on the island of Santa Cruz has significantly improved the status of infection in PLWH, however, large population and qualitative studies are needed to determine other factors related to the quality of life of these patients and the behavior of the infection in this population.

Disclosures
All Authors: No reported disclosures
1534. Gonorrhea Testing and Ceftriaxone Resistance in the Department of Veterans Affairs (VA), 2010-2019
Authors: Schirmer Patricia , Lucero-Obusan Cynthia , Oda Gina , Holodniy Mark 
Published: January 2021

Abstract

Background
Gonorrhea (GC) infections caused by Neisseria gonorrhoeae are an ongoing public health issue and have shown resistance to nearly all antibiotic classes, including cephalosporins which are a CDC recommended treatment. We investigated national GC testing and Ceftriaxone resistance in VA.

Methods
GC cases identified from VA data sources from 1/1/2010-12/15/2019 by either molecular laboratory testing or GC culture with sensitivity testing. Patients were reviewed for positive results, whether culture testing was performed after 2 positive molecular GC results in &lt; 90 days, and sensitivity patterns.

Results
10,642 of 644,968 (2%) GC molecular results were positive with annual number of positive cases (1,365 to 3,225), number of tests performed (97,636 to 164,085) and percent positive for GC (1.4% to 2%) increasing over the time period studied. 2,358/10,642 (22%) of positive molecular test results had repeat testing &lt; 3mo with 351 (15%) positive on repeat testing which is concerning for possible resistance. 2,624 GC cultures were performed with 2,179 (83%) positive. 1,480/2,179 (68%) positive GC culture tests had some sensitivity testing performed. Culture testing remained stable with 287 in 2010 to 289 in 2019 with percent positive ranging from 78-89%. Of the 351 patients with repeat positive GC molecular testing done &lt; 3mo from their positive molecular test, only 18 (5%) had GC culture testing performed proximal to the second positive test. Among all cultured isolates, resistance to Ceftriaxone was noted in 1 sample in 2017 in Missouri (also intermediate resistance to Tetracycline) and 1 in 2019 in New Jersey (also resistant to Penicillin, Tetracycline, and Ciprofloxacin).

Conclusion
In VA, GC infections have increased from 2010 to 2019 and GC culture testing has remained stable despite increasing molecular testing. Only 2 samples were identified with Ceftriaxone resistance. However, the low percentage of GC culture testing after persistent positive molecular testing in VA could mask treatment failures and possible resistance. Culture testing with sensitivity testing should be increased in VA in cases where patients may have resistance to initial treatments (i.e., – repeat positive testing less than 3 months after a positive test).

Disclosures
All Authors: No reported disclosures
1535. Impact of Defunding Family Planning Health Centers on Gonorrhea and Chlamydia Cases in Iowa: A Spatiotemporal Analysis
Authors: Srinivas Megan L , Yang Eileen , Tang Weiming , Tucker Joseph 
Published: January 2021

Abstract

Background
Fifteen states have defunded family planning health centers (FPHCs), causing thousands to be left without health services. This has accelerated in the COVID-19 era. FPHCs provide low-income individuals in rural areas with essential primary care services, including sexually transmitted infection prevention, testing, and treatment. The purpose of this analysis is to use spatiotemporal methods to examine the impact of FPHC closures in Iowa on the reported number of gonorrhea and chlamydia cases at the county level.

Methods
This analysis investigates the association between FPHC closures and changes in the number of gonorrhea and chlamydia cases between 2016 and 2018. Iowa implemented defunding policies for family planning clinics, resulting in four FPHC closures in June 2017. 2016 pre-closure STI incidence rates were compared to 2018 post-closure rates. Gonorrhea and chlamydia rates in the four Iowa counties with clinic closures were compared to the 95 Iowa counties without closures. T tests were used to compare changes in reported gonorrhea and chlamydia rates in the two settings. Linear regression modeling was used to determine the relationship between clinic closures and changes in gonorrhea and chlamydia cases.

Results
The gonorrhea burden in Iowa increased from 83 cases per 100,000 people in 2016 to 153.8 cases per 100,000 people in 2018. The four counties with clinic closures experienced a significantly larger increase (absolute 217 cases per 100,000 population) in their gonorrhea rate compared to counties without FPHC closures (absolute 121 cases per 100,000 population). There was also a significant relationship between clinic closures and increasing gonorrhea rates (p = 0.0015). Over the three-year period, there was no change in chlamydia rates (p = 0.1182). However, there was a trend towards counties with more FPHC closures having a higher number of chlamydia cases (p = 0.057).

Conclusion
Despite the fact that many STI diagnoses are made and reported by FPHCs, our data suggest that clinic closures may have contributed to an increase in gonorrhea and chlamydia cases. This is consistent with delayed diagnoses and missed opportunities for providing essential STI services to vulnerable and under-served rural residents. Legislative action is urgently needed to curtail this trend.

Disclosures
All Authors: No reported disclosures
1537. Incidence, Reinfection, and Discrepancy Between Site Positivity and Reported Sexual Practice of Sexually Transmitted Infections in HIV-Positive Adolescents and Young Adults in Atlanta, GA
Authors: Loerinc Leah , Scheel Amy , Jordan-Thompson Sierra L , Gillespie Scott , Camacho-Gonzalez Andres 
Published: January 2021

Abstract

Background
HIV-positive adolescents and young adults (AYAs) are disproportionately affected by sexually transmitted infections (STIs). Despite national recommendations, STI screening remains low. Incomplete screening in addition to inconsistent reported sexual practices may lead to missed infections. This study aimed to determine the incidence and reinfection rates of co-STIs in HIV-positive AYAs and the discrepancy between site positivity and self-reported sexual history in this group.

Methods
Retrospective chart review was conducted for all patients aged 13-24 at Grady Ponce and Family Youth Clinic in Atlanta, GA from 2009-2018. Data were collected on demographics and STI events. STIs included gonorrhea (GC), chlamydia (CT), human papillomavirus (HPV), syphilis, trichomonas, herpes simplex virus (HSV), lymphogranuloma venereum (LGV), hepatitis C (HCV), bacterial vaginosis (BV), and chancroid. First STI incidence and incidence of reinfections were calculated by dividing new cases over corresponding person follow-up time.

Results
621 sexually active HIV-positive AYAs were included. The mean age at first observation was 18.7 (±3.29) years. 72.1% of patients were male, 92.3% were Black, and 79.7% were horizontally infected. 83.7% of patients had at least one STI during the study period. The overall first STI incidence rate was 35.8 per 100 person-years with HPV, GC, CT, and syphilis as the most common STIs reported (Table 1). The overall recurrent incidence rate was 72.1 per 100 person-years with GC, CT, and syphilis as the most common recurrent infections (Table 1). Of all GC and CT infections, the majority were rectal (48.7% and 49.9%, respectively) (Table 2). Only 65.8% of patients with rectal GC and 68.5% with rectal CT infections reported recent receptive anal sex (Table 3).
Table 1: First and recurrent incidence rates of any STI and individual STIs per 100 person-years

Table 2: STIs by site, all infections

Table 3: Reported exposure history vs. STI site positivity

Conclusion
Our study demonstrates disproportionately high incidence and reinfection rates of co-STIs in HIV-positive AYAs. Furthermore, many patients did not report exposure at their site of infection. If screening is done based off reported exposure history alone, many infections may be missed. Our data support the urgent need for increased STI screening in this population, including routine extragenital testing for GC and CT even without reported exposure at these sites.

Disclosures
All Authors: No reported disclosures