bluuebunny/crossref_metadata_2025_split huggingface dataset:
1621. Acute Cardiovascular Events Among Adults Hospitalized with Influenza, FluSurv-NET, 2010–2018
Authors: Chow Eric J , Rolfes Melissa A , O’Halloran Alissa , Anderson Evan J , Bennett Nancy M , Billing Laurie M , Chai Shua , Dufort Elizabeth , Kim Sue , Irizarry Lourdes , Lynfield Ruth , Monroe Maya , Risk Ilene , Stephens Samantha , Talbot Keipp , Thomas Ann , Yousey-Hindes Kim , Reed Carrie , Garg Shikha 
Published: October 2019

Abstract

Background
Influenza virus infection most commonly causes acute respiratory tract illness, however may also lead to non-respiratory complications including acute cardiovascular (CV) events. We describe the frequency of and risk factors for acute CV events in adults hospitalized with influenza in the United States.

Methods
We included adults aged > 18 years hospitalized during influenza seasons 2010–2011 through 2017–2018 in FluSurv-NET, a multi-state population-based surveillance system that includes detailed medical chart review of patients hospitalized with laboratory-confirmed influenza. We defined acute CV events by International Classification of Diseases (ICD) primary and secondary discharge diagnosis codes for acute heart failure (aHF), acute ischemic heart disease (aIHD), hypertensive crisis, cardiogenic shock, acute myocarditis, acute pericarditis and cardiac tamponade. We calculated the frequency of acute CV events and used multivariable logistic regression among the 87% treated with influenza antivirals to identify independent factors associated with aHF and aIHD, the two most common diagnoses.

Results
Of 80,374 adults hospitalized with laboratory-confirmed influenza, 12% had > 1 acute CV event. We found that aHF (46%) and aIHD (42%) were the most common, followed by hypertensive crisis (8%), cardiogenic shock (3%), acute myocarditis (0.7%), acute pericarditis (0.4%) and cardiac tamponade (0.2%). Compared with treated patients without an acute cardiovascular event, treated patients with aHF (Figure A) and aIHD (Figure B) were more likely to be older, currently/formerly use tobacco and have underlying conditions including cardiovascular disease, diabetes mellitus, and kidney disease.

Conclusion
Among adults hospitalized with laboratory-confirmed influenza, acute CV events are common, particularly among those with prior cardiovascular disease. During the influenza season, clinicians should consider influenza virus infection in hospitalized adults who present with acute CV events. Non-respiratory complications, specifically aHF and aIHD, may be an under-recognized contributor to the burden of influenza.

Disclosures
All authors: No reported disclosures.
1623. Implementation of Electronic Readmission Alert for Discharged Patients Reduces Risk of Secondary Measles Exposure Events
Authors: Boston Kelley M , Ostrosky-Zeichner Luis , Ellsworth Misti G , McInnis-Cole Tawanna A 
Published: October 2019

Abstract

Background
Measles is a highly infectious illness that is causing increased numbers of outbreaks in the United States. Patients involved in a healthcare measles exposure and who have been discharged before identification of exposure are at risk of becoming infectious in the community, and may seek healthcare within their infectious window, creating a secondary exposure risk for healthcare systems. A measles exposure in an integrated healthcare system occurred, resulting in patient exposures in multiple locations at three campuses, including two community-based emergency departments and three inpatient units. There were 159 patients who were included in the exposure group; 123 were exposed in an ED, and 36 were exposed in an inpatient setting. Ninety-four percent (149/159) of the patients had been discharged at the time of measles case identification and were in the pre-infectious phase of illness. Of those, 36 percent (54/149) presented back to the healthcare system within the potentially infectious window; these 54 patients had 97 individual healthcare contacts in the potentially infectious period following the exposure event. Sixty-one of the 97 return visits (63%) were within the window in which the exposed patients were potentially infectious. Return locations included the three exposure facilities and inpatient and outpatient locations at 10 other system campuses.

Methods
An alert system was developed within the electronic medical record that identified patients that were involved in the exposure, and guided clinicians to mask and place in airborne isolation until measles immunity was verified.

Results
The alert activated 13 days after the exposure was identified, and identified 100% of returns to healthcare at all sites within the system, representing 48% of all potential secondary exposure events (29 /61). No secondary exposures or transmission occurred.

Conclusion
Measles exposures are an enormous burden on healthcare organizations and public health systems. When exposures occur, healthcare organizations need systems to rapidly identify discharged patients who may return within the potentially infectious window. Rapid development of electronic readmission alerts can help standardize identification and reduce the risk of subsequent exposure.

Disclosures
All authors: No reported disclosures.
1630. Voluntary HIV Testing and Self-Realization of Risk of HIV Infection Among Young Men-Who-Have-Sex-with-Men in the Miami-Dade Area
Authors: Ocon Hampton , Sabbag Samir 
Published: October 2019

Abstract

Background
According to the Centers for Disease Control and Prevention, Miami-Dade County has the highest rate of new HIV diagnoses in the Nation. So far, a large focus of public health initiatives has been spreading awareness of HIV testing locations, but this form of voluntary testing relies on individuals realizing that they are at risk of HIV infection in the first place. Consequently, a major obstacle to encouraging young men-who-have-sex-with-men (YMSM) to test themselves for HIV is their own self-perceived risk of having an undetected infection.

Methods
In an effort to better understand the discordance between high-risk sexual behavior and HIV testing among this high-risk population, YMSM (18–24) were surveyed through smartphone applications that facilitate sexual encounters in the Miami-Dade area (eg Grindr, Scruff). Users were asked about their history of condomless anal intercourse (CAI), their HIV testing habits, and whether or not they believe it possible that they are currently infected with HIV. An analysis of the relationship between CAI and self-perception of possible HIV infection was performed using Cochran-Mantel–Haenszel testing.

Results
Of the 843 eligible responses, 667 reported a history of voluntary HIV testing while 176 had never voluntarily tested. 726 respondents reported a history of CAI and 131 of these have never voluntarily tested. Of the 843 total participants, 1.6% were in the highest HIV risk group, which is those who have engaged in CAI with an exchange/casual partner, have never voluntarily tested for HIV, and have no self-perceived risk of being currently infected. According to data analysis, YMSM who have engaged in CAI but have never been tested for HIV were not more likely to have a self-perceived possibility of infection when compared with those who have voluntarily tested (P < 0.595).

Conclusion
This suggests that many high-risk YMSM are not voluntarily testing themselves for HIV not because they do not have access to testing, but rather because they do not perceive themselves as being possibly infected in the first place. Therefore, in addition to increasing access to HIV testing, new public health initiatives must be designed to facilitate YMSM understanding their own personal HIV risk.

Disclosures
All authors: No reported disclosures.
1637. Antibiotic Use in Lower Respiratory Tract Infections: Insights From Patient Interviews in Sri Lanka
Authors: van Melle David T , ten Asbroek Guus H A , Vanderburg Sky , Abeysinghe Yohana W , Halloluwa Chathurangi , Zhang Helen L , Sheng Tianchen , Sewwandi Kanchana , Bodinayake Champica K , Nagahawatte Ajith , Woods Chris W , De Silva Vijitha , Tillekeratne L Gayani 
Published: October 2019

Abstract

Background
Antibiotic resistance is an emerging global public health threat with inappropriate use of antibiotics as one of the major drivers. In Sri Lanka, antibiotic consumption is increasing, while little is known about how patients perceive antibiotics. We conducted a qualitative study to better understand patients’ knowledge, perceptions, and attitudes toward antibiotics.

Methods
Semi-structured interviews were conducted in the local language (Sinhala) and audio recorded for 18 patients with lower respiratory tract infections (LRTI) admitted to a large, public tertiary care hospital in southern Sri Lanka. Interviews were transcribed and then translated into English. Translated interviews were analyzed for themes regarding care-seeking behavior, patients’ knowledge of disease etiology and treatment of LRTI.

Results
Almost all patients mentioned multiple care visits and polypharmacy prior to admission. When seeking care, patients mainly focused on finding a quick cure, mostly by visiting several different private physicians. However, self-medication was also common. Patients reused prescriptions for antibiotics, kept antibiotics for later use after prematurely stopping their course of treatment and bought antibiotics over-the-counter. Patients’ knowledge of disease etiology and antibiotics was poor. Most patients described non-microbial causes such as exposure to dust and cold weather for their illness. Only a few patients were aware of antibiotic resistance. Despite the desire to receive more information regarding disease and treatment, transfer of information between patients and physicians was limited and mainly confined to prescription instructions.

Conclusion
This qualitative study in Sri Lanka suggests inappropriate use of antibiotics is a multifactorial problem. Patients’ poor knowledge of disease and treatment, poor information transfer between physicians and patients, high demand for medicines, overprescribing by physicians, and self-medication were found as possible obstructive factors to improve antibiotic usage. To improve antibiotic use, a multifaceted approach is needed with improvement of awareness by patients, public, and physicians regarding antibiotic use and antibiotic resistance.

Disclosures
All authors: No reported disclosures.
1638. Measles Outbreak Risk Assessment for Transplant Candidates and Recipients
Authors: Kreiger-Benson Elana , Gelb Bruce , Neumann Henry J , Sarah Hochman , Lighter Jennifer , Mehta Sapna A 
Published: October 2019

Abstract

Background
A measles outbreak began in 2018 with ongoing transmission in the New York City (NYC) area, affecting children and vulnerable adults. We developed a systematic 3-part approach to address measles risk in our solid-organ transplant program’s adult population by 1) identification of non-immune adults living in at-risk ZIP codes 2) education focused on risk reduction for all at-risk patients and families and 3) vaccination of non-immune waitlisted patients and consideration of prophylactic immunoglobulin G (IgG) for post-transplant non-immune patients at high risk for measles exposure.

Methods
All waitlisted and transplanted patients residing in any of 11 ZIP codes with recent measles cases in the NYC area as of April 4, 2019, were included. We also focused on the 4 ZIP codes in the NYC Health Commissioner’s vaccination order from April 9, 2019. We reviewed electronic medical records (EMR) of patients born after 1956 for measles immunity by serology or vaccine documentation. A 1-page measles patient education handout was created, reviewed for health literacy appropriateness and utilized in English and non-English language versions.

Results
118 waitlisted or previously transplanted patients resided in at-risk ZIP codes. Among the 118 patients, 56 (47.5%) were presumed immune based on birth year before 1957. Among 62 patients born in 1957 or later, 5 (8.1%) had preexisting positive measles IgG in the EMR and 1 patient had documentation of measles vaccination without measles IgG testing. Fifty-seven patients without EMR evidence of measles immunity were called to undergo measles IgG testing. 29 patients agreed to testing and an additional 19 patients had the test added to routine laboratories. Of these 48 patients, 1 was non-immune and 1 had equivocal immunity. Among transplanted patients identified as non-immune or with equivocal immune status, a recommendation for prophylactic IgG was made. All 118 patients received a measles informational handout by mail. Furthermore, we identified 21 patients born after 1956 living in the 4 zip codes targeted by the NYC health Commissioner’s order, and among those tested all were found to be immune.

Conclusion
A systematic risk assessment during a large measles outbreak identified at-risk transplant patients and provided timely education and screening for measles immunity.

Disclosures
All authors: No reported disclosures.
1639. Outbreak of Human Bartonellosis Due to Bartonella bacilliformis in the Ecuadorian Andes
Authors: Santiago Larreategui Romero David , Veronica Lafuente Cevallos Lizeth 
Published: October 2019

Abstract

Background
Bartonellosis affects small Andean communities in Peru, Colombia, and Ecuador. Research in this area has been limited; our study presents a continuous outbreak of cases that occurred in 2018 in areas near the cloud forest of the Ecuadorian Andes.

Methods
Retrospective review of 101 cases of human bartonellosis managed in Quito - Ecuador, during the last outbreak in our country in the last year (2018). The study focused upon the most recent outbreak in order to look at current manifestations of disease and existing practices in diagnosis and management, and how closely these followed the latest guidelines to manage this disease.

Results
Of the 101 patients reviewed, 52% were male and 48% were female. The mean age of cases was 24.3 years, (mean age of males = 23.7, mean age females = 25.3). The median age of patients was 20 years (min = 4 years, max = 71 years, IQR = 15). There was a peak in acute cases after the rainy season; mainly in moths march to June, chronic cases presented less constantly throughout the year. The sensitivity of blood smear against blood culture in acute disease was 35%. The most commonly used treatment for chronic disease was rifampicin; chloramphenicol and ciprofloxacin was used to treat most acute cases. Complications arose in 16.8% and the most frequent was anemia, and there were 2 deaths.

Conclusion
Recognize the physiopathological and microbiological characteristics of the disease, as well as improve the diagnostic and treatment algorithms for acute and chronic bartonellosis which have been developed without a strong evidence base. Preparation of ready-to-go operational research projects for future outbreaks would strengthen the evidence base for diagnostic and treatment strategies and enhance opportunities for control and prevent deaths.

Disclosures
All authors: No reported disclosures.
1646. Education Level is Associated with Tetanus Vaccine Coverage: Results from the 2016 BRFSS
Authors: Rencken Camerin , Amanullah Siraj , Gjelsvik Annie , Dunsiger Shira 
Published: October 2019

Abstract

Background
Vaccination coverage among US adults for tetanus, a potentially fatal disease, continues to be lower than the national goals. Education has been considered to have positive impact on vaccination coverage. However, recently there have been outbreaks of vaccine preventable conditions in areas with high college completion rates. This study aims to assess the relationship between education and vaccination coverage. Specifically, we looked at the association between education level and tetanus vaccination status of the US adults.

Methods
Data from the 2016 Behavioral Risk Factor Surveillance System, a self-reported annual survey for non-institutionalized adults in the United States from the Centers for Disease Control, were analyzed. The outcome was up-to-date tetanus coverage (within the last 10 years) defined by the response to: have you received tetanus vaccine since 2005? Education was stratified into four categories: (1) grade 11 or less, (2) grade 12/GED, 3) college 1–3 years, and (4) college 4 or more years. Bivariate analyses and multivariable logistic regression were conducted on the analytic sample (n = 417,473) using Stata 15, accounting for weighting and the complex survey design of the BRFSS.

Results
This study identified that 59.9% of US adults are up-to-date on the tetanus vaccine status (Table 1). Higher education level was found to be associated with increased odds of up to date tetanus vaccination. The highest odds were for those with 4 or more years of college education [aOR = 1.31; 95% CI: 1.26–1.35)] while the lowest odds were for those less than grade 11 education, when compared with those with a high school degree [aOR = 0.93; 95% CI: 0.88–0.98] (Figure 1). Other covariates identified as negatively associated with up-to-date tetanus status were race/ethnicity, female sex, unemployment, not being married, not having insurance or a personal healthcare provider, and being above 45 years of age (Figure 1).

Conclusion
This study identified a positive association between up-to-date tetanus status and higher education level. Introducing community-specific vaccination education programs for those without tertiary education, especially for those above age 45 and without insurance, may help increase the overall vaccination status in the United States.

Disclosures
All authors: No reported disclosures.
1648. Prevalence of Orientia tsutsugamushi, Anaplasma phagocytophilum, and Leptospira interrogans in Striped Field Mice in Gwangju, Republic of Korea
Authors: Kim Dong-Min , Seon Bang Mi , Kim Choon-Mee , Ra Yun Na , Seo Jun-won 
Published: October 2019

Abstract

Background
Scrub typhus, anaplasmosis, and leptospirosis are well-known diseases that are considered common, widespread rodent-borne infectious diseases

Methods
This study investigated the prevalence of Orientia tsutsugamushi, Anaplasma phagocytophilum, and Leptospira interrogans in wild rodents through molecular detection using organ samples and through serological assay using blood samples of mice collected from two distinct sites in Gwangju Metropolitan City, Republic of Korea (ROK).

Results
A total of 47 wild rodents, identified as Apodemus agrarius (A. agrarius), were captured from June to August 2016. The seroprevalence of antibodies against bacterial pathogens in A. agrarius sera was analyzed; 17.4% (8/46) were identified as O. tsutsugamushi through indirect immunofluorescence assay and 2.2% (1/46) were identified as Leptospira species through passive hemagglutination assay. Using polymerase chain reaction, the spleen, kidney and blood samples were investigated for the presence of O. tsutsugamushi, A. phagocytophilum, and L. interrogans. Out of the 47 A. agrarius, 19.1% (9/47) were positive for A. phagocytophilum and 6.4% (3/47) were positive for L. interrogans, while none were positive for O. tsutsugamushi. Four out of 46 (8.7%) blood samples, six out of 45 (13.3%) spleen samples, and one out of 47 (2.1%) kidney samples were positive for A. phagocytophilum. Three out of 47 (6.4%) kidney samples were positive for L. interrogans. The sequencing results of PCR positive samples demonstrated >99% similarity with A. phagocytophilum and L. interrogans sequences

Conclusion
A. phagocytophilum was mostly detected in the spleen, whereas L. interrogans was mostly detected in the kidneys. Notably, A. phagocytophilum and L. interrogans were detected in A. agrarius living in close proximity to humans in the metropolitan suburbans. The results of this study indicate that rodent-borne bacteria may be present in wild rodents in the metropolitan suburban areas of ROK

Disclosures
All authors: No reported disclosures.
1653. Strong Partnership and Effective Communication Between a Tertiary Hospital and a County Health Department Were Critical in Controlling a 2019 Measles Outbreak in Southeast Michigan (SEM)
Authors: Mathew Trini , Johnson Paul , Kamerer Diane , Jones Amber , Ditkoff Jeffrey , Ziadeh James , Carpenter Christopher 
Published: October 2019

Abstract

Background
Measles, declared eliminated in the US 2000, is a reemerging vaccine-preventable airborne disease. The 2019 case count (704 as of April 30, 2019) has surpassed the number of 2014 cases (667), the highest since 1994. Many healthcare personnel (HCP) have not seen a case of measles, and this lack of clinical experience may contribute to missed or delayed diagnoses leading to its spread. We describe the processes and measures implemented at Beaumont Hospital, Royal Oak (B-RO) Michigan in collaboration with the Oakland County Health Department (OCHD) to prevent secondary spread during an outbreak.

Methods
Soon after the initial report of the index case in Oakland County in March, the B-RO epidemiology team connected with OCHD. As both exposed and suspected cases were expected to seek care at B-RO, a one-page informational document was sent to B-RO providers. This document detailed isolation precautions and testing methods, post-exposure prophylaxis (PEP), and contact information. During subsequent days, as measles cases increased, frequent calls between B-RO and OCHD addressed numerous issues, including: media notifications, contact of exposed persons, vaccine and immunoglobulin supply for PEP, safe referral of cases to the EC, and the process of measles specimen submission for testing. As needed, these communications occurred after business hours and during weekends. Serologic testing to confirm measles immunity was ramped up.

Results
As of April 30, 41 cases have been confirmed in MI associated with the index case. OCHD facilitated the exposure control for 40 patients, of which 6 came to B-RO during their infectious period (Figure 1). To date, there have been no secondary cases developing in B-RO patients, HCPs or visitors, which may be related to successful engineering controls, appropriate protective equipment, mandatory measles immunity confirmation as condition of Beaumont employment since the late 1980s, institution of furlough procedures, PEP for hospitalized patients, and widespread communications with patients, visitors and HCPs (Figure 2).

Conclusion
During an outbreak, close healthcare facility and local health department collaboration is essential in rapidly limiting an airborne disease outbreak.

Disclosures
All authors: No reported disclosures.