bluuebunny/crossref_metadata_2025_split huggingface dataset:
23. Did You Pneu?: Impact of an Adult Pneumococcal Immunization Campaign Across Independent Community Pharmacies
Authors: Faggioni Mara , Wong Rachel , Tilli Tiana 
Published: January 2021

Abstract

Background
Canada’s pneumococcal immunization goal for adults 65 years and older aims to achieve 80% coverage, yet uptake is only 58% in this population. Barriers include lack of awareness and lack of recommendations by healthcare providers. A pneumococcal immunization campaign was designed to address barriers and increase vaccine uptake from independent community pharmacies.

Methods
A “Did You Pneu?” pneumococcal immunization campaign was developed by a pharmacist at the head office of an independent community pharmacy banner. The campaign consisted of pharmacist educational materials, in-pharmacy marketing materials, and pharmacy operational supports (Figure 1). In November 2018, a month-long in-pharmacy campaign was carried out across the banner. Feedback collected from pharmacists via telephone interviews was used to inform updates to campaign materials for the November 2019 campaign. A convenience sample of ten independent community pharmacies located across Ontario was selected for a retrospective observational analysis of pneumococcal vaccine purchases from January 2017 to December 2019.
Figure 1. “Did You Pneu?” campaign toolkit showing pharmacist educational materials, in-pharmacy marketing materials, and pharmacy operational supports developed and distributed across a banner of independent community pharmacies as part of an adult pneumococcal immunization campaign.

Results
Analysis of ten independent community pharmacies revealed an increase in the total number of pneumococcal vaccines purchased in November in years a campaign took place compared to baseline. The total number of pneumococcal vaccines purchased in November increased 23% during the first campaign and another 213% during the second campaign (13 vs. 16 vs. 50 vaccines purchased in November 2017, 2018, and 2019, respectively).
Increased vaccine uptake was also observed in months subsequent to the in-pharmacy campaign. Analysis of ten independent community pharmacies revealed a 47% increase in the mean number of pneumococcal vaccines purchased per month by the banner (8.8 mean number of pneumococcal vaccines purchased per month twelve months pre-implementation vs. 12.9 twelve months post-implementation).

Conclusion
A comprehensive pneumococcal adult immunization campaign implemented across a banner of independent community pharmacies led to immediate and sustained increases in vaccine uptake. As pharmacists have a role in promoting adult pneumococcal immunizations, advocacy efforts should be undertaken to include pharmacists in publicly funded immunization programs.

Disclosures
Tiana Tilli, PharmD, RPh, ACPR, Pfizer Canada Inc. (Grant/Research Support, Speaker’s Bureau)
25. Effectiveness of High Dose Influenza Vaccine in HIV-positive Patients for the Winter 2017–2018 Season
Authors: Kato Mikiro , Kunkel Tori , Bram David , Newman Jessica , Lopez Angela , Santana Pheadra , Clough Lisa A , Hinthorn Daniel , El Atrouni Wissam 
Published: January 2021

Abstract

Background
Antibody response after high dose influenza vaccine (HDIV) approved for age ≥ 65 years, is superior to a standard-dose vaccine in HIV-infected persons. We report the effectiveness data of HDIV compared to the standard dose quadrivalent vaccine (SDIV) in our HIV clinic.

Methods
We conducted a retrospective cohort study at the University of Kansas Medical Center to evaluate the effectiveness of HDIV in HIV-infected patients during the 2017–2018 influenza season. A phone survey was utilized to verify vaccination status and interval development of influenza-like illness (ILI). A modified CDC definition of ILI (mCDC ILI = fever and cough, sore throat or shortness of breath (SOB)) and a broader protocol defined ILI (PD ILI = sore throat, cough or SOB with either fever, chills, headache or myalgia) were utilized. The electronic medical record was reviewed to confirm vaccine type and influenza testing when available.

Results
Of 560 HIV-infected patients in the clinic, 219 (39.1%) were available and willing to participate (197 males, 21 females, 1 transgender female). The median age was 53 years and BMI 27.2 kg/m2. Five percent had CD4&lt; 200 cells/uL, and 13.7% had an HIV viral load &gt; 40 copies/mL. HDIV was given to 119 (54.3%), SDIV to 77 (35.2%) and 23 (10.5%) were not vaccinated (Table 1). A mCDC ILI occurred in 8 (10.4%) in the SDIV group compared to 6 (5.0%) in the HDIV group (p=0.16). A PD ILI was reported in 16 (20.8%) in the SDIV group compared to 12 (10.1%) in the HDIV group (p=0.04). There was no difference in confirmed influenza cases between the two groups (Table 2). On logistic regression only vaccine dose (SDIV OR 2.34 95% CI 1.04–5.37, p=0.04) and age in years (OR 0.97, 95% CI 0.94–1.0, p=0.045) were associated with PD ILI. HDIV remained protective after adjustment for age. Vaccine side effects were mild and occurred in 11/77 (14.3%) in the SDIV group compared to 13/119 (10.9%) in the HDIV group (p=0.5).

Conclusion
During the 2017–2018 winter season, the CDC reported an influenza attack rate of 14.7% in adults in the US and overall vaccine effectiveness of 38%. Our study demonstrated a 50% reduction in ILI with the HDIV compared to the standard-dose vaccine in HIV-infected patients. A larger prospective randomized control trial is warranted.

Disclosures
Wissam El Atrouni, MD, ViiV (Advisor or Review Panel member)
34. Oops, I Didn’t Follow My Post Vaccinaton Instructions
Authors: Manandhar Sabina , Ramsey Keith , Buffaloe Valerie 
Published: January 2021

Abstract

Background
Smallpox vaccine is derived from vaccinia virus, a large, double-stranded DNA virus. With the worldwide eradication of smallpox, routine vaccination with vaccinia virus is no longer performed. However, at-risk laboratory and health care personnel continue to be vaccinated against smallpox, and large numbers of military personnel in the United States resumed smallpox vaccination after the anthrax bioterrorism in 2001. Two available smallpox vaccines are part of the strategic stockpile in the United States; one is a replication-deficient modified vaccinia Ankara vaccine (MVA), and the other is a replication-competent smallpox vaccine (ACAM2000). Among others, one of the potential complications of smallpox vaccine is an accidental autoinoculation or accidental inoculation of close contacts.

Methods
A 27-year-old female presented to the employee health clinic at Vidant Medical Center with a 7-day lesion on her right upper extremity. She denied any fever, chills, pets at home, insect bites or trauma to the area. She was using inhaled nebulizers for her asthma and lived in Greenville, NC, with her boyfriend. The lesion was non itchy, approximately 5 mm blister like rash that ulcerated with a grayish, white center and had a surrounding red border. On further questioning, she disclosed that her boyfriend was a marine, who was recently vaccinated against smallpox two weeks before she developed the skin lesion, but he did not cover the site as instructed. Her lesion was unroofed and a sample was collected and sent to NC State Laboratory of Public Health for identification. It was also reported to the NC State Department of Health for possible contact transmission of smallpox. In the meantime, the patient was instructed to cover the area while at work, keep the lesion open to air at home, and avoid skin-to-skin contact.
Initial Lesion

Lesion after Unroofing

Results
The sample returned positive for Orthopoxvirus DNA by PCR.

Conclusion
Recipients of smallpox vaccine have a potential for autoinoculation and inoculation of close contacts. Hence, the vaccine recipients should be well educated about proper care of the vaccination site for preventing possible contact transmission of the virus. These include covering the vaccination site, proper hand washing after bandage changes, and avoiding skin-to-skin contact.

Disclosures
All Authors: No reported disclosures
35. Pneumococcal Vaccination in High-Risk Adults: An Initial Analysis Incorporating Social Determinants of Health
Authors: Gatwood Justin , Chiu Chi-Yang , Shuvo Sohul A , Ramachandran Sujith , Hohmeier Kenneth , Hagemann Tracy 
Published: January 2021

Abstract

Background
Despite CDC’s recommendation, vaccination rates for adults at high-risk of invasive pneumococcal disease are below HealthyPeople 2020 goals. Comparatively little is known about influencers on vaccine-seeking behavior in this population, particularly related to social determinants of health. To address this gap, this study assessed the potential influence of select social determinants on uptake of and time to pneumococcal vaccination among a high-risk, insured US population.

Methods
Using the MarketScan commercial claims databases between 2013–2016, adult patients (aged 18–64 years) were followed from their first diagnosis for a condition deeming them high-risk for invasive pneumococcal disease through one year following the diagnosis and observed for pneumococcal vaccination in outpatient clinics and pharmacies. Publicly-available data on select social determinants of health were incorporated into analyses, guided by the WHO vaccine hesitancy matrix. Logistic regression determined predictors of vaccination and a generalized linear model compared days to being vaccinated while controlling for baseline demographic and clinical characteristics.

Results
A total of 173,712 patients were analyzed of which 25.3% were vaccinated against invasive pneumococcal disease within the first year of being deemed high risk, nearly all of which (98.5%) were received in outpatient clinics. The odds of vaccination were higher in urban areas (OR: 1.18; 95% CI: 1.144–1.223), areas of higher health literacy (OR: 1.02; 95% CI: 1.019–1.025), and more liberal-voting communities (OR: 1.5; 95% CI: 1.23–1.88). Conversely, the odds of vaccination were particularly low in areas of higher poverty (OR: 0.14; 95% CI: 0.068–0.304) and with more limited Internet access (OR: 0.14; 95% CI: 0.062–0.305) as well as among adults who did not also get a seasonal influenza vaccine (OR: 0.05; 95% CI: 0.048–0.052). Time to vaccination was longer in rural areas (B=8.3, p&lt; 0.0001) and communities with less Internet access (B=75.6, p&lt; 0.001).

Conclusion
Results suggest that some social determinants may be influencing pneumococcal vaccine-seeking behavior among those deemed high-risk. A more formal framework must be assessed to determine the full impact of these factors across vaccines recommended in adults.

Disclosures
Justin Gatwood, PhD,MPH, AstraZeneca (Grant/Research Support)GlaxoSmithKline (Grant/Research Support)Merck & Co. (Grant/Research Support) Tracy Hagemann, PharmD, GSK (Grant/Research Support)Merck (Grant/Research Support)
36. Safety and Reactogenicity of the Adjuvanted Recombinant Zoster Vaccine after Allogeneic Hematopoietic Stem Cell Transplantation
Authors: Baumrin Emily , Izaguirre Natalie E , Bausk Bruce P , Feeley Monica M , Bay Camden P , Ho Vincent T , Issa Nicolas C , Baden Lindsey R 
Published: January 2021

Abstract

Background
Herpes zoster (HZ) is common after allogeneic hematopoietic stem cell transplantation (HCT) and associated with high morbidity. While antiviral prophylaxis reduces incidence, increased risk remains after discontinuation and vaccination strategies are needed. A non-live adjuvanted recombinant zoster vaccine (RZV) has been developed but not yet studied in this population.

Methods
In this single center prospective observational cohort study, allogeneic HCT recipients ³18 years old and 9–24 months from HCT were eligible to receive 2 doses of RZV separated by ³8 weeks as part of revised institutional vaccination guidelines. The primary endpoint was safety and reactogenicity in the total vaccinated cohort (TVC). The secondary endpoints were incidence and severity of chronic graft versus host disease (cGVHD) in the TVC compared to historical controls and incidence rates of HZ in the TVC and modified total vaccinated cohort (mTVC).

Results
Of the 158 participants (mean age 55 years, 91 [58%] male) in the TVC, 150 (95%) received second vaccine. 92.1% had solicited reactions with 87.3% injection site reactions (18.7% grade 3) and 82.8% general reactions (26.5% grade 3). In the subgroup receiving first vaccine at 9–12 months after HCT, cumulative incidence of cGVHD was similar to historical controls at predefined time points between 9–15 months (unadjusted incidence rate ratio [IRR] 1.1 [95% CI 0.84–1.44], adjusted IRR 1.05 [95% CI 0.8–1.38]); there was also no difference in severity of cGVHD, or incidence of death or disease relapse. There were 4 (2.5%) HZ cases during the study period with IR 28.34/1000 person-years over median follow up 281 days (IQR 190, 354) in the mTVC. All cases occurred after antiviral prophylaxis discontinuation and one case resulted in death.

Conclusion
Two doses of RZV after allogeneic HCT was safe and acceptable despite high rates of reactogenicity. There was no evidence of an increase in cGVHD, relapse, or death compared to historical controls and overall low rates of breakthrough HZ similar to those reported after autologous HCT. Immunogenicity studies and placebo-controlled trials are needed to determine vaccine response and efficacy so that timing of RZV and its potential impact on discontinuation of antiviral prophylaxis can be determined.

Disclosures
Nicolas C. Issa, MD, AiCuris (Scientific Research Study Investigator)Astellas (Scientific Research Study Investigator)GSK (Scientific Research Study Investigator)Merck (Scientific Research Study Investigator)
40. The Role of Health Literacy in Vaccination Disparities: Do Patients Understand the Health Messages?
Authors: Kricorian Katherine , Lopez Daniel , Seu Michelle , Pham Tuyen , Kigoonya Rita , Equils Ozlem 
Published: January 2021

Abstract

Background
Numerous public health campaigns are organized with the goal of improving immunization rates. However, vaccination uptake remains low among certain racial/ethnic minority groups including Hispanic patients. The level of health literacy (HL), ability to recognize the words used, may impact patients’ understanding of health-related messages and consequently health behavior and vaccination.

Methods
We conducted a HL survey among adult female attendees of a health fair in an underserved area of Los Angeles. Attendees visiting a youth education booth were surveyed using an electronic tool. Respondents were surveyed on their familiarity with and recognition of specific words including: measles, shingles, pertussis, hepatitis, meningitis, stroke, diabetes, pneumonia, and human papilloma virus (HPV). Comparisons were analyzed using chi-squared tests.

Results
Forty-three women (n=28 Hispanic; n=15 Non-Hispanic) completed the survey. The mean ages of Hispanic and non-Hispanic (predominantly Caucasian and Asian) respondents were 35.4 ±14 years and 29.9 ±12 years, respectively. A significantly lower percentage of Hispanic vs. Non-Hispanic women reported recognition of words associated with vaccine-preventable diseases: “meningitis” (15% vs. 60%, p&lt; .01), “hepatitis” (18% vs. 69%, p&lt; .01), and “HPV” (33% vs 67%, p&lt; .05). Substantially lower recognition was also reported for “pneumonia”, although this did not reach statistical significance (46% vs 77%, p=.06). The percentage reporting recognition of “diabetes” did not differ significantly between groups (68% vs 60%, p=0.43).

Conclusion
Immunization campaigns often use words that patients may not understand, potentially impacting patients’ relationship with the healthcare system and health behavior change. We found a lower level of recognition (health literacy) of words associated with vaccine-preventable diseases among Hispanic vs. Non-Hispanic women attending a community health fair. These findings have implications for developing culturally-tailored communication tools and educational strategies using a language easily recognized by a specific community to help reduce racial disparities in vaccination uptake.

Disclosures
All Authors: No reported disclosures
42. A Pharmacist-Led Intervention to Decrease Anaerobic Coverage for Hospitalized Patients with Community-Acquired Pneumonia
Authors: Enzmann Maxx O , Pagels Courtney M , Perry Emily J , Jones Justin , Carson Paul 
Published: January 2021

Abstract

Background
Community-acquired pneumonia (CAP) is frequently mis-categorized as aspiration pneumonia, prompting the addition of anaerobic coverage to the antibiotic regimen. In our institution, this usually takes the form of adding metronidazole to ceftriaxone. The 2019 American Thoracic Society and Infectious Diseases Society of America CAP guidelines recommend anaerobic coverage only for hospitalized patients with a suspected lung abscess or empyema. The objective of this study was to determine if a pharmacist-led workflow could increase adherence to the 2019 CAP guideline recommendations by limiting anaerobic coverage to those rare occasions.

Methods
The hospital antimicrobial stewardship committee approved a pharmacist workflow and guidance document which outlines criteria to evaluate appropriateness of anaerobic coverage for hospitalized patients with CAP and no other indications for antibiotics. If anaerobic coverage is not indicated, the pharmacist submits a standardized message to the treating provider via the electronic medical record, recommending discontinuation of metronidazole. This workflow was implemented on October 3, 2019. Metronidazole days of therapy (DOT) per 1000 patient days in quarters 1 through 4 of 2019 and quarter 1 of 2020 were collected as well as percent acceptance of documented pharmacist interventions from October 3, 2019 until March 31, 2020.

Results
Between October 3, 2019 and March 31, 2020, a total of 221 interventions were made by pharmacists to discontinue metronidazole in hospitalized CAP patients where anaerobic coverage was not indicated. Out of those 221 interventions, 164 (74%) were accepted by providers and only 57 (26%) were rejected.
The DOT per 1000 patient days of metronidazole was assessed for the three quarters prior to our intervention and the two quarters after the intervention. Compared to the three quarters prior, metronidazole DOT per 1000 patient days decreased by 26.6% for the two quarters following implementation of the pharmacist-led intervention (Figure 1).
Figure 1: Metronidazole DOT per 1000 patient days from January 1, 2019 through March 31, 2020. Vertical line indicates when pharmacist workflow was implemented.

Conclusion
A pharmacist antimicrobial stewardship intervention at our institution increased adherence to CAP guidelines and decreased unnecessary antibiotic exposure in hospitalized CAP patients when anaerobic coverage was not indicated.

Disclosures
All Authors: No reported disclosures
43. A Pharmacoepidemiologic Evaluation of Echinocandin Use
Authors: Jo Jinhee , Hendrickson Joshua , Gonzales-Luna Anne J , Beyda Nicholas D , Garey Kevin W 
Published: January 2021

Abstract

Background
Invasive candidiasis (IC) is a common healthcare-associated infection. Rates of IC caused by drug-resistant Candida spp., designated by the CDC as a serious threat, are increasing, and Candida auris alone was recently added as an urgent threat. Echinocandins are guideline-preferred for the treatment of invasive candidiasis due to in vitro potency, a favorable toxicity profile, and convenient dosing. The purpose of this study was to perform a pharmacoepidemiologic analysis on patterns of echinocandin use at a large, quaternary care medical center.

Methods
Data reporting echinocandin use, pharmacy data, and clinical microbiologic data obtained from 2017–19 were pooled. Monthly days of therapy (DOT) per 1,000 patient days were calculated during the study period along with number of unique orders. Investigators evaluated the proportion of echinocandin-treated patients with or without positive Candida cultures; the relationship between echinocandin use and hospital admission and discharge dates was also evaluated.

Results
Echinocandin monthly DOT/1,000 patient days present averaged 26 (± 5) DOT and did not change appreciably during the study period. Of the patients with microbiologic evidence of Candida, 842 (51%) received echinocandin courses. Length of echinocandin therapy was significantly longer for patients with positive Candida cultures (5.5 ± 5.9 days) compared to those without positive cultures (3.9 ± 5.0 days; p&lt; 0.001). Of 1,659 echinocandin courses evaluated, 549 courses (33%) were initiated within 2 days of hospital admission and the average time from hospital admission to echinocandin start was 9 (± 13) days. A total of 505 (24%) echinocandin courses were continued until the day of discharge.

Conclusion
The rate of echinocandin use did not change appreciably during the study period. A significant proportion of echinocandin courses were either started upon hospital admission or were continued until the day of discharge. Further studies to evaluate antifungal stewardship opportunities for the echinocandin pharmacologic class are warranted.

Disclosures
Nicholas D. Beyda, PharmD, BCPS, Astellas (Advisor or Review Panel member)Cidara (Grant/Research Support, Scientific Research Study Investigator) Kevin W. Garey, PharMD, MS, FASHP, Merck & Co. (Grant/Research Support, Scientific Research Study Investigator)
45. Antimicrobial Stewardship for Urinary Tract Infection in Three Emergency Departments Across a Health System
Authors: Shoff Christopher , Funaro Jason , Fischer Kristen M , Boreyko John , Shroba Jenny , Mando-Vandrick Jennifer , Liu Beiyu , Lee Hui-Jie , Spires Steven S , Turner Nicholas A , Theophanous Rebecca , Staton Catherine , Moehring Rebekah W , Wrenn Rebekah 
Published: January 2021

Abstract

Background
Broad spectrum antibiotics are often prescribed to patients presenting to the emergency department (ED) for evaluation of urinary tract infection and pyelonephritis (UTI). We evaluated the effect of a target-specific antibiogram, education, and feedback on UTI diagnosis and antibiotic prescribing in this setting.

Methods
We created a urine-specific antibiogram from patients seen and treated without admission at three ED locations (one academic and two community hospitals). We then provided a treatment algorithm and supplemental educational content to ED providers in November 2019. Educational content highlighted appropriate diagnosis, antibiotic selection, and treatment duration for UTI. Adult encounters with appropriate ICD-9/10 codes within twelve months prior to content delivery comprised the preintervention cohort. The postintervention cohort consisted of adult visits following educational intervention until April 17, 2020. During the postintervention phase (November 2019 to April 2020), summary data regarding UTI diagnoses and guideline-concordant prescriptions were fed back routinely to ED providers through email. Guideline-concordant prescriptions were defined as those adhering to first or second-line therapy in the treatment algorithm. The proportion of prescriptions meeting this definition fulfilled the primary outcome. An interrupted time series analysis measured changes in guideline concordance.

Results
Data from 6,713 distinct encounters were analyzed across the three sites. While guideline concordant prescribing increased following intervention at all locations (30.9% to 38.8%, 48.1% to 49.1%, and 48.2% to 59.6%), these increases were not statistically significant (Figures 1, 2, and 3). The proportion of all ED encounters with a UTI diagnosis did not differ following the intervention. Interestingly, guideline concordance was greater in the academic ED, compared to the community hospitals.

Conclusion
Although guideline concordant prescribing for UTI increased in all three ED settings with education and email correspondence feedback, these results were not statistically significant. A variety of methods may be required to realize improved antibiotic prescribing across a diverse group of clinicians.

Disclosures
Rebekah W. Moehring, MD, MPH, Agency for Healthcare Quality and Research (Grant/Research Support)Centers for Disease Control and Prevention (Grant/Research Support)