bluuebunny/crossref_metadata_2025_split huggingface dataset:
1192. Correlation Between SARS CoV 2 Viral Load and Clinical Evolution of Patients Under 15 Years of Age with COVID 19 in a General Hospital in the Province of Buenos Aires, Argentina
Authors: Brizuela Martin , Goñi Sandra , Cardama Georgina , Sommese Leandro , Farina Hernan 
Published: December 2021

Abstract

Background
SARS CoV2 infection produces clinical manifestations of different severity. The pediatric population represents less than 10% of cases, with a mortality of less than 1%. The severity of the condition and mortality are mainly associated with comorbidities. There is controversy about the correlation between the viral load of SARS CoV2 in respiratory samples and the evolution and severity of the clinical picture. The CT (cycle threshold) in the detection of the SARS CoV 2 genome in respiratory samples can be used as an indirect indicator of the viral load in the analyzed samples.

Goals
to determine the correlation between the SARS CoV 2 CT values in the detection of the viral genome with the severity of the clinical picture. Describe the clinical, epidemiological, and laboratory characteristics of patients with PCR-confirmed SARS CoV2 infection in respiratory samples.

Methods
A retrospective, observational and analytical study that included patients under 15 years of age with confirmed SARS CoV2 infection by PCR of respiratory samples treated at the Hospital Isidoro Iriarte in the city of Quilmes between March 1 2020 and April 30, 2021.

Results
485 patients (n) were included. The distribution by severity of the clinical picture was mild (84%, n = 408), moderate (12%, n = 59) and severe (4%, n = 18). Comorbidities were more frequent among patients with moderate and severe symptoms. Viral load was associated with severity of clinical manifestations. Patients with moderate and severe COVID19 required hospital admission more frequently for a longer time, the use of supplemental oxygen and antibiotics were more frequent in patients with moderate and severe symptoms. Symptoms of lower respiratory tract infection such as cough and respiratory distress were more frequent in patients with moderate and severe symptoms. No patient required admission to the ICU or mechanical ventilation. No patient died.

Conclusion
In this study, patients with moderate and severe COVID19 infection had a higher viral load in respiratory samples, a higher frequency of comorbidities, a higher frequency of hospitalization and a longer hospital stay. Lower respiratory symptoms were associated with moderate and severe symptoms, while odynophagia, vomiting, and diarrhea were associated with mild clinical symptoms.

Disclosures
All Authors: No reported disclosures
1193. Mucosal Antibody Responses to Respiratory Syncytial Virus (RSV) in Infants and Young Children
Authors: Souverbielle Cristina Tomatis , Ye Fang , Mertz Sara , Peeples Mark E , Ramilo Octavio , Mejias Asuncion 
Published: December 2021

Abstract

Background
The burden associated with RSV infection is substantial. Although RSV initially infects the upper respiratory tract, there is limited information of the mucosal concentrations of antibodies (Abs) directed to RSV specific proteins and whether patient’s age and disease severity influence production of mucosal Abs.

Methods
From 2017 to2019 we enrolled previously healthy children &lt; 2 years of age hospitalized with RSV infection and obtained acute and convalescent (day; D30) nasopharyngeal (NP) samples to measure preF and postF specific IgG and IgA Abs by ELISA. Demographic and clinical data were collected and analyzed according to Abs responses.

Results
We enrolled 77 children (median [IQR] age: 2.8 [1.5-5.2] months; 49 % females) within the first 24 hours of hospitalization. Of those 25 (33%) patients required PICU care. A significant increase in convalescent IgG preF Abs titers was detected in 62 (81%) children, while IgA preF titers significantly increased in all but one child on D30. The magnitude of the increase was 56-fold higher for preF IgA versus preF IgG (p&lt; 0.0001). PostF IgG and IgA titers were also increased on D30 but at significant lower levels.
Infants &lt; 3 months of age compared with those &gt;3-24 months had significantly higher baseline preF and postF IgG Abs titers (p &lt; 0.001) but not IgA antibodies. D30 preF and post F IgG titers were higher in children &gt; 6 months of age (p &lt; 0.0001) but only preF titers fold change significantly correlated with age (r=0.4, p&lt; 0.0001). These correlations were not identified with IgA preF antibodies. There were no statistical differences in antibody titers at baseline and on D30 according to breastfeeding, and disease severity as defined by the need for PICU care.

Conclusion
Children hospitalized with RSV infection demonstrated significantly increased titers of mucosal preF and post F IgG and IgA specific Abs in convalescent samples. Baseline IgG Abs where higher in younger infants, which likely reflects maternally acquired antibodies. Age significantly correlated with Abs production, suggesting a more robust immune response in older children.

Disclosures
Mark E. Peeples, PhD, Janssen (Research Grant or Support)Pfizer (Research Grant or Support) Octavio Ramilo, MD, Adagio (Consultant)Bill & Melinda Gates Foundation (Grant/Research Support)Janssen (Grant/Research Support)Lilly (Consultant)Merck (Consultant, Grant/Research Support)NIH (Grant/Research Support)Pfizer (Consultant)SANOFI (Board Member) Asuncion Mejias, MD, PhD, MsCS, Janssen (Grant/Research Support, Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Roche (Advisor or Review Panel member)Sanofi (Advisor or Review Panel member)
1194. Assessing Healthcare Professionals’ Knowledge of Shigella Transmission, Risk Factors, and Prevention – DocStyles Survey, 2020
Authors: Haston Julia C , Esschert Kayla Vanden , Ford Laura , Plumb Ian D , Logan Naeemah Z , Watkins Louise Francois , Garcia-Williams Amanda 
Published: December 2021

Abstract

Background
Shigella infection typically manifests as a self-limited gastrointestinal illness (shigellosis) and affects some populations disproportionately, including children, travelers, people experiencing homelessness, and men who have sex with men (MSM). Healthcare professionals (HCPs) are positioned to play an active role in the prevention and control of shigellosis but may not be aware of the multiple routes of Shigella transmission, risk factors, and prevention strategies.

Methods
Porter Novelli Public Services’ Fall DocStyles 2020 web-based survey was administered to HCPs in the United States to assess their clinical practice and knowledge about many health-related issues. Questions about acute diarrhea and shigellosis were completed by pediatricians, primary care physicians, nurse practitioners, and physician assistants. We analyzed responses to four questions related to Shigella transmission, risk factors, prevention, and barriers to patient education.

Results
Of the 2196 panelists contacted, 1503 were included (68% response rate). Most identified contaminated food and water as potential routes of Shigella transmission (84.9% and 78.8%, respectively), but substantially fewer recognized person-to-person contact (39.5%), fomite transmission (32.5%), or sexual activity (17.6%) as ways adults can become infected. Similarly, MSM were infrequently identified as being at risk for shigellosis (34.5%). Many HCPs reported counseling patients to wash hands and avoid food preparation when ill with Shigella (85.9% and 77.2%), but only 29.4% reported recommending avoiding sex. Only 7.1% of respondents correctly identified all routes of transmission, 21% identified all risk factors, and 22% identified all prevention strategies. Delay in diagnosis was the most frequently reported barrier to educating patients about shigellosis.

Conclusion
HCP knowledge of shigellosis is incomplete. Identified gaps in knowledge were related to MSM as an at-risk population and transmission of Shigella through fomites and person-to-person contact (including sexual contact). Informing HCPs about transmission, risk factors, and opportunities for prevention could improve recognition and stop the spread of shigellosis in vulnerable communities.

Disclosures
All Authors: No reported disclosures
1195. Comparative Analysis Between Acute and Sub-Acute Brucellosis
Authors: Hammami Fatma , Koubaa Makram , Chakroun Amal , Rekik Khaoula , Marrakchi Chakib , Smaoui Fatma , Jemaa Mounir Ben 
Published: December 2021

Abstract

Background
Brucellosis remains a public health problem. Its myriad and non-specific manifestations vary according to the clinical presentation. We aimed to compare the clinical and laboratory features between acute and sub-acute brucellosis.

Methods
We conducted a retrospective study including all patients hospitalized for acute and sub-acute brucellosis in the infectious disease department between 1992 and 2020.

Results
We encountered 104 patients (50.2%) with acute brucellosis and 103 patients (49.8%) with sub-acute brucellosis. Patients with sub-acute brucellosis were significantly older (45.1±17.2 years vs 36.5±17.5 years; p&lt; 0.001). Male gender represented 64.4% of acute brucellosis cases and 67% of sub-acute brucellosis cases (p=0.6). Night sweats (78.8% vs 65%; p=0.027), myalgia (34.6% vs 21.4%; p=0.034) and asthenia (70.2% vs 45.6%; p&lt; 0.001) were significantly more frequent among acute brucellosis cases. Back pain was significantly more frequent among sub-acute brucellosis cases (78.6% vs 28.8%; p&lt; 0.001). Fever (89.4% vs 83.5%; p=0.2), weight loss (29.8% vs 32.4%; p=0.6) and arthralgia (56.7% vs 51.5%; p=0.4) were noted among acute and sub-acute brucellosis group, with no significant difference. Lymph nodes were significantly more frequent among acute brucellosis cases (15.5% vs 1.9%; p=0.002). Splenomegaly (13.5% vs 6.8%; p=0.1) and hepatomegaly (6.7% vs 5.8%; p=0.7) were more frequent among acute brucellosis group, with no significant difference. Laboratory investigations revealed leukopenia (21.2% vs 8.7%; p=0.012) and thrombocytopenia (19.2% vs 7.8%; p=0.016), which were significantly more frequent among acute brucellosis group. While elevated C-reactive protein levels were more frequent among sub-acute brucellosis group (52.4% vs 39.4%; p=0.06), elevated liver enzymes were more frequent among acute brucellosis group (38.8% vs 23.1%; p=0.087), with no significant difference. The mean duration of hospitalization was longer among sub-acute brucellosis cases (16±11 days vs 7±4 days; p&lt; 0.001).

Conclusion
The presence of sweating, myalgia and asthenia associated with leukopenia and thrombocytopenia was suggestive of acute brucellosis, while back pain, especially among the elderly, was suggestive of sub-acute brucellosis.

Disclosures
All Authors: No reported disclosures
1197. Development and Implementation of Innovative Syringe Service Programs for Veterans in Rural and Urban Settings
Authors: Ho Minh Q , Dinges Elizabeth , Slazinski Karen , Byrd Jacqueline , Ahmed Mohammed 
Published: December 2021

Abstract

Background
Syringe Services Programs (SSPs) is one aspect of a comprehensive Harm Reduction approach necessary to reduce the transmission of blood borne infections including Hepatitis B, Hepatitis C, and HIV. Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that in 2019 that 595,000 veterans engage in opioid misuse with at least 57,000 veterans engaging in heroin. Stigmas to SSP are pervasive in the community and within the government system. Federal law prohibited the use of federal funds to purchase sterile needles or syringes for the purposes of illegal use of drugs by injection. It was officially clarified in May 24, 2021 that the prohibition to purchase syringes does not apply to Veterans Health Administration (VHA). While awaiting approximately 2 years to secure this clarification, syringes were obtained through a community donation. We aim to describe our process including difficulties encountered and data collected for SSP at two locations. Difficulties included developing an anonymous process to track quality, motivating providers to refer, educating highest risk veterans, providing face to face engagement during COVID-19 pandemic and ability to mail Harm Reduction kits containing sterile syringes.
Illiana VA Program Information Sheet

Orlando VA Program Information Sheet

Methods
Of the 140 facilities within VHA, there are currently only two SSPs established, Illiana VA and Orlando VA. A retrospective analysis of Harm Reduction benefits was performed among veterans who engaged with the two SSPs between 2018 to 2021.
Orlando VA SSP Intake Process Map

Process that veteran undergo when they engage with Orlando VA SSP
Contents of Standard SSP Kit Distributed to Veterans at Orlando VA

Results
Approximately 3000 syringes were dispensed. Of the 17 veterans, 65% received syringes, 82% received naloxone, 100% engagement in mental health and 94% engagement in substance use disorder clinics. In total, 65% were screened for HIV, 82% for HCV and 29% for sexually transmitted infections.

Conclusion
These numbers, while modest, are notable, especially given the financial and organizational barriers that were in place. Furthermore, the COVID-19 pandemic impacted full implementation and outreach. With the recent, official clarification on syringe purchase and support for SSPs, the number of SSPs in the VA will grow, along with opportunity for more robust data collection. The experience of both facilities is a model for programs currently in development and moves us closer to ending the HIV epidemic by 2030.

Disclosures
All Authors: No reported disclosures
1198. Lyme Disease Post-Exposure Prophylaxis by Single-Dose Doxycycline in Three Healthcare Systems
Authors: Marx Grace E , Schotthoefer Anna M , Schwartz Brian S , Draper Evan , Rivera Christina G , Zeuli John , Scotty Erica , Pollak Jonathan S , Schwartz Amy M , Beck Alyssa , Hinckley Alison F 
Published: December 2021

Abstract

Background
Lyme disease, the most common tickborne disease in the United States, may be prevented by taking a single 200-mg dose of oral doxycycline after a high-risk bite from a blacklegged tick. Currently, it is not known how Lyme disease post-exposure prophylaxis (PEP) might vary by region and healthcare system. We identified single-dose doxycycline medication orders in three healthcare systems in states with high incidence of Lyme disease and compared associated patient and provider characteristics.

Methods
Electronic health record data during 2012 – 2016 were obtained from three healthcare systems: Geisinger (Pennsylvania), Marshfield Clinic (Wisconsin), and Mayo Clinic (Minnesota/Wisconsin). Creation of analytic variables and analysis were harmonized across the three sites. Medication orders for single-dose doxycycline ≤200 mg that were accompanied by specific key words or diagnostic codes (e.g., tick bite; Lyme disease prevention) were considered evidence of PEP. Manual chart review was performed from a random subset to evaluate the algorithms used to identify PEP.

Results
Among 2,937,585 patients with at least one medication order or clinical encounter during the study period, 14,102 single-dose doxycycline orders for Lyme disease PEP for 13,172 unique patients were identified. The typical patient receiving PEP was older (mean age 51 – 58 years), male (56 – 59%), and non-Hispanic White (81 – 98%). The annual seasonality of medication orders was bimodal, with peaks occurring during April – July and October – November. The most common encounter setting was an outpatient clinic or urgent care center (80 – 91%); medication orders after patient phone calls in the absence of an in-person visit occurred frequently (14 – 19%) in two health systems. Chart abstractions (n=600) revealed instances of PEP prescribed inappropriately (e.g., bite from a non-blacklegged tick; patient with symptoms of acute Lyme disease).

Conclusion
Lyme disease PEP with a single dose of doxycycline was frequently prescribed in healthcare systems where there is a high incidence of Lyme disease. PEP was most commonly prescribed to non-Hispanic Whites over the age of 50 years. Public health initiatives for tickborne disease prevention should include clinician education on the appropriate use of Lyme disease PEP.

Disclosures
Anna M. Schotthoefer, PhD, HelixBind (Other Financial or Material Support, salary support) John Zeuli, PharmD, INSMED (Other Financial or Material Support, honoraria for educational speaking)
1201. Diphtheria in Veterans Health Administration (VHA), 2000-2021
Authors: Schirmer Patricia , Lucero-Obusan Cynthia A , Sharma Aditya , Oda Gina , Holodniy Mark 
Published: December 2021

Abstract

Background
Diphtheria is caused by Corynebacterium diphtheriae and can cause respiratory or skin infections. Transmission occurs primarily person-to-person via respiratory tract and rarely from skin lesions or fomites. In the Veterans Health Administration (VHA), we perform surveillance for nationally notifiable diseases such as diphtheria. In early 2021, there were 4 alerts for C. diphtheriae. Therefore, we investigated diphtheria prevalence in VHA over the last 20 years.

Methods
Isolates of C. diphtheriae were identified from VHA data sources from 1/1/2000-2/28/2021. Patient demographics, co-morbidities, microbiologic data, treatment, outcomes, and vaccination status were obtained via electronic medical record (EMR) review.

Results
33 C. diphtheriae isolates were identified representing 32 unique individuals. 17 isolates were identified from 2000-2015 and 16 were identified from 2016-2021. Isolates were from cutaneous (16), blood (10), urine (4), pulmonary (2), and throat (1) specimens. In 11 individuals, clinical significance was unclear (no antibiotics given, note mentioned that it was being considered a contaminant - i.e., isolate may have been incorrectly labeled as “C. diphtheriae” instead of “diphtheroid”). Only 3 isolates had toxin testing documented. One C. diphtheriae biovar gravis blood isolate was associated with sepsis without another source identified. The throat isolate was a nontoxigenic strain. No cutaneous isolates underwent susceptibility testing, but all 15 individuals received antibiotics (1 patient had 2 isolates). 11 had additional organisms identified in addition to C. diphtheriae. Table 1 describes demographics, co-morbidities, and vaccination status of cutaneous cases. Only 1 case (in 2021) had EMR documentation of local public health department reporting.
Table 1. Characteristics of Unique Individuals with Cutaneous Diphtheria Isolates in VHA, 2000-2021

Conclusion
Nearly as many isolates have been identified in the last 5.5 years compared to the previous 15 years which may be related to more robust molecular identification methods available in VHA. Most C. diphtheriae isolated was from cutaneous sources that were acute in onset. About 33% were identified as C. diphtheriae but were not treated. EMR documentation of toxin production and public health department reporting was lacking.

Disclosures
All Authors: No reported disclosures
1202. Chagas Disease Awareness in a Hispanic Community of the Greater New Orleans Area
Authors: Hincapie Marcela , Bernabé Kerlly , DeCuir James , Thompson Julie , Avendano Mariana , Nawas George , Dumonteil Eric , Herrera Claudia , Echeverri Margarita 
Published: December 2021

Abstract

Background
Chagas disease is a neglected tropical disease responsible for severe disease burden in Latin American countries (≥ 6 million cases). It is increasingly reported in the Southern United States, with an estimated 89,410 human cases (nationwide estimate: 300,000), many of them acquired in endemic zones in Latin America.

Methods
Cross-sectional study to assess the change in knowledge about Chagas disease and triatomine vectors among Hispanic immigrants living in the Greater New Orleans area. All consented participants answered the baseline questionnaire, then received a short video presentation, and completed a post-test to evaluate change in knowledge. Consents, online questionnaires and training were administered in Spanish and English, as needed. Frequencies were computed to describe differences in demographic variables and questions in the pre-posttest. Data was analyzed with R software.

Results
A total of 64 adults (66% women, median age 58 years) completed the pre-post tests and attended the educational intervention. Participants have been living in the US for an average of 23 years and represented 11 countries. Majority were born in Honduras (27%) followed by Nicaragua (16%), United States (13%), Colombia (11%), Ecuador (9%), Guatemala (6%), Mexico (6%) and other counties (12%). Most participants recalled exposure to Chagas disease vectors. Although in the pre-test about half reported ever seeing a Triatomine, less than 20% correctly identified one of three images of a Triatomine provided in the questionnaire. Knowledge about how the disease is transmitted to humans increased from pre to posttest. While higher percentages of men (80%) than women (69%) answered correctly at the pre-test, in the post-test higher percentages of women (97%) than men (95%) responded correctly. In addition, 98% of participants reported that the presentation was clear, 85% would like to learn more about Chagas Disease, and 100% would like to be screened.

Conclusion
Results indicate the positive impact that an educational intervention may have on the knowledge about the disease. Considering the high percentage of Hispanic immigrants in US, increasing awareness of Chagas disease may contribute in the prevention and early detection of the disease among this high-risk population.

Disclosures
All Authors: No reported disclosures