bluuebunny/crossref_metadata_2025_split huggingface dataset:
1342. TOSCANA: The Observational Seroepidemiologic Study of COVID-19 at the United States Naval Academy
Authors: Millar Eugene , Laing Eric , Saperstein Adam , Modi Jitu , Heaney Christopher , Fraser Jamie , Shaikh Saira , Pollett Simon , Broder Christopher C , Burgess Timothy , Coles Christian L 
Published: December 2021

Abstract

Background
University students, including those at military service academies, are at increased risk of acute respiratory infection (ARI), including SAR-CoV-2, due to crowded living conditions, frequent social interaction and other factors that facilitate pathogen transmission. Unlike many universities, the United States Naval Academy (USNA) continued in-person instruction in Fall 2020 in the midst of the COVID-19 pandemic. The Observational Seroepidemiologic Study of COVID-19 at the United States Naval Academy (TOSCANA,) a longitudinal cohort characterizes the burden and risk factors of SARS-CoV-2 in USNA midshipmen.

Methods
Midshipmen were enrolled August- October 2020. Participants were queried about their ARI risk factors, COVID-19 history, and recent receipt of medical care for any ARI at enrollment, in December 2020 and again in May 2021. Subjects were also asked to provide blood and saliva samples to assess their SARS-CoV-2 serostatus at the same three timepoints. A saliva sample was collected by a subset of subjects in February 2021. Presence of anti-SARS-CoV-2 serum IgG in dried blood spots and saliva was measured by multiplex magnetic microparticle-based immunoassays.

Results
181 midshipmen consented to the study and completed the baseline survey (Table 1). 17 (17.5%) of the 97 subjects who submitted baseline blood sample were SARS-CoV-2 seropositive. Only 4 (24%) positive individuals reported having been tested for or diagnosed with COVID-19 prior to arrival at USNA. 121 participants completed the midyear survey, of whom 61 (50%) submitted a blood sample. 16 (26%) of the midyear specimens were SARS-CoV-2 positive. Of these, 3 were new infections. 73 subjects completed the May survey, and 63 (100%) of the submitted blood samples were positive. 83 subjects provided baseline saliva samples, and ~55 submitted saliva at each successive time point. 1 (5%) was positive at enrollment, 9 (17%) were positive at midyear and 47 (96%) were positive in May.

Table 1. Key characteristics of TOSCANA participants

Conclusion
SAR-CoV-2 prevalence in a sample of USNA midshipmen was &lt; 20% at enrollment. A small proportion of subjects seroconverted between the September and December visits. SARS-CoV-2 positivity rose in May, following a COVID-19 outbreak in February and COVID-19 vaccination efforts in March at USNA.

Disclosures
Jitu Modi, MD, GSK (Speaker’s Bureau)
1343. Viral and Bacterial Pneumonia Hospitalizations — New York City, 2001–2016
Authors: Huang Chaorui , Foerster Steffen , Iskhakova Faina , Aracena Joaquin 
Published: December 2021

Abstract

Background
This study was to investigate the burden and trend of viral and bacterial pneumonia hospitalization in New York City (NYC) from 2001 to 2016.

Methods
We analyzed hospital discharge data for NYC residents during 2001–2016 using Statewide Planning and Research Cooperative System. Annual crude hospitalization rate and percentage of in-hospital all causes death were calculated, using NYC population as denominator. Poisson regression was performed to assess temporal trends of pneumonia hospitalization rate and percentage of in-hospital death from 2001 to 2016.

Results
During 2001–2016, there were 122,324 pneumonia hospitalizations with identified viral or bacterial pathogen in NYC, of which 7,826 (6.4%) were influenza, 13,059 (10.7%) were other viruses, 11,847 (9.7%) were pneumococcus, and 89,592 (73.2%) were other bacteria. From 2001 to 2016, there was significantly increased viral and bacterial pneumonia hospitalization rate, except for pneumococcal pneumonia, and pneumococcal pneumonia had significantly decreased hospitalization rate (p&lt; 0.0001). From 2001 to 2016, the percentage of in-hospital death for viral pneumonia except influenza significantly increased (p=0.0002), whereas decreased for bacterial pneumonia (p&lt; 0.0001). Patients aged ≥65 years old had the highest percentage of in-hospital death among all ages for both viral and bacterial pneumonia, especially there was 19.5% of in-hospital death for pneumococcal pneumonia and 23.4% for other bacterial pneumonia.

Conclusion
While hospital discharge data are subject to limitations particularly for large amount of un-identified pathogens for pneumonia, our analysis showed increased viral activities considering the changes in hospitalization rate and percentage of in-hospital death in NYC during 2001–2016. There was a reduced pneumococcal pneumonia hospitalization rate and percentage of in-hospital death, likely related to the increased vaccine uptake, and a reduced percentage of in-hospital death for overall bacterial pneumonia, likely related to improved antibiotic treatment management. Further studies are warranted to evaluate the necessity of increasing the pneumococcal vaccine coverage in elderly, as well as reducing antimicrobial resistance to improve the management of bacterial infection.

Disclosures
All Authors: No reported disclosures
1344. Predicting Measles Outbreaks in the United States: Application of Different Modeling Approaches
Authors: Kujawski Stephanie , Ru Boshu , Das Amar K , Afanador Nelson L , baumgartner richard , Liu Zhiwen , Lu Shuang , Pillsbury Matthew , Lewnard Joseph , Conway James H , Pawaskar Manjiri D 
Published: December 2021

Abstract

Background
Although measles is still rare in the United States (U.S.), there have been recent resurgent outbreaks in the U.S. To improve the accuracy of prediction given the rarity of measles events, we used machine learning (ML) algorithms to model measles case predictions at the U.S. county level.

Methods
The main outcome was occurrence of ≥1 measles case at the U.S. county level. Two ML prediction models were developed (HDBSCAN, a clustering algorithm, and XGBoost, a gradient boosting algorithm) and compared with traditional logistic regression. We included 28 predictors in the following categories: sociodemographics, population statistics, measles vaccination coverage, healthcare access, and exposure to measles via international air travel. The models were trained on 2014 case data and validated on 2018 case data. Models were compared using area under the receiver operating curve (AUC), sensitivity, specificity, positive predictive value (PPV), and F2 score (combined measure of sensitivity and PPV).

Results
There were 667 measles cases in 2014 and 375 in 2018 in the U.S. We identified U.S. counties for 635 (95.2%) cases in 2014 and 366 (97.6%) cases in 2018 through published sources, corresponding to 81/3143 (2.6%) counties in 2014 and 64/3143 (2.0%) counties in 2018 with ≥1 measles case. HDBSCAN had the highest sensitivity (0.92), but lowest AUC (0.68) and PPV (0.04) (Table). XGBoost had the highest F2 score (0.49), best balance of sensitivity (0.72) and specificity (0.94), and AUC = 0.92. Logistic regression had high AUC (0.91) and specificity (1.00) but the lowest sensitivity (0.16).

Conclusion
Machine learning approaches outperformed logistic regression by maximizing sensitivity to predict counties with measles cases, an important criterion to consider to prevent or prepare for future outbreaks. XGBoost or logistic regression could be considered to maximize specificity. Prioritizing sensitivity versus specificity may depend on county resources, priorities, and measles risk. Different modeling approaches could be considered to optimize surveillance efforts and develop effective interventions for timely response.

Disclosures
Stephanie Kujawski, PhD MPH, Merck & Co., Inc. (Employee, Shareholder) Boshu Ru, Ph.D., Merck & Co. Kenilworth, NJ (NYSE: MRK) (Employee, Shareholder) Amar K. Das, MD, PhD, Merck (Employee) richard baumgartner, PhD, Merck (Employee) Shuang Lu, MBA, MS, Merck (Employee) Matthew Pillsbury, PhD, Merck & CO. (Employee, Shareholder) Joseph Lewnard, PhD, Merck (Consultant, Grant/Research Support) James H. Conway, MD, FAAP, GSK (Advisor or Review Panel member)Merck (Advisor or Review Panel member)Moderna (Advisor or Review Panel member)Pfizer (Advisor or Review Panel member)Sanofi Pasteur (Research Grant or Support) Manjiri D. Pawaskar, PhD, Merck & Co., Inc. (Employee, Shareholder)
1345. Patient Perspectives and Journey with Influenza and Seeking Care from US National Survey
Authors: Way Nate , Martin Ashley , Wallick Chris , Neuberger Edward , Corral Mitra 
Published: December 2021

Abstract

Background
In the 2017-2018 influenza season, 49 million people in the US presented with influenza symptoms, resulting in substantial morbidity, mortality, and a significant humanistic and economic burden. Although there are currently four FDA-approved antivirals for influenza, such treatments continue to be widely underutilized. The aim of this study was to better understand the patients’ perspective and experience with a flu episode and seeking care during the 2019-2020 influenza season.

Methods
Data were obtained from an online quantitative survey of influenza patients. Participants were recruited from two data sources: A pool of respondents who previously completed the National Health and Wellness Survey (NHWS) (N=74,977) or from Lightspeed M3 Global online “General Panel” (N=500,000+) in the US from January 2020 through May 2020. The sample included patients &gt;18 years of age and having a self-reported diagnosis of influenza by a healthcare professional within the last 90 days. Outcomes related to patient demographics, health-related characteristics and perspectives on the influenza episode were collected.

Results
1,005 patients were included. Of those, 30.2% visited their primary health care professional (HCP) in person, 20.2% visited urgent care walk-in facility and 19.2% called their HCP. Important aspects of flu treatment included: feeling better quickly (69.5%), not transmitting to others (51.5%), and ease of administration (40.7%); 375 patients were treated with an antiviral. Of those, it took~4.6 days to feel generally better and ~8.8 days to feeling totally better. About 73% of patients took all of their antiviral medication, 9% took “some”. 43.9% of respondents considered themselves to be more likely to get serious flu-related complications, 52.5% reported that they were told by an HCP that they belong to a high-risk group that may be more likely to get flu-related complications. 41.3% reported they did not experience any high risk factors while experiencing influenza.

Conclusion
Influenza patients reported different attitudes and treatment approaches to handling their infection. It is critical to understand what matters most to patients regarding both influenza and treatment to optimally provide outreach and care.

Disclosures
Nate Way, PhD, Genentech, Inc. (Grant/Research Support)Kantar Health (Employee) Ashley Martin, PhD, Genentech, Inc. (Grant/Research Support)Kantar Health (Employee) Chris Wallick, PharmD, MS, Genentech, Inc. (Employee, Shareholder) Edward Neuberger, PharmD, MBA, MS, Genentech, Inc. (Employee, Shareholder) Mitra Corral, MS, MPH, Genentech, Inc. (Employee, Shareholder)
1346. The Risk of Readmission after RSV Hospitalization Among Children Younger than 5 Years
Authors: Choi Yoonyoung , Heller Evan G , Gesteland Per H , Amoafo Linda , Zhang Yue , Finelli Lyn , Ampofo Krow 
Published: December 2021

Abstract

Background
Respiratory Syncytial Virus (RSV) is one of the most common causes of childhood lower respiratory tract infection (LRTI) leading to hospitalization worldwide. Readmissions following viral LRTI hospitalization are common, however rates, timing and causes of readmission following RSV LRTI hospitalization are understudied. We evaluated readmissions occurring during 1-year post-discharge of RSV hospitalization.

Methods
We prospectively identified children &lt; 5 years of age hospitalized with laboratory-confirmed RSV LRTI at Primary Children’s and Riverton hospitals in Salt Lake City, Utah during the 2019-2020 RSV season. An electronic alert system identified all-cause readmission between November 2019 and April 2021. Discharge diagnoses of readmissions were reviewed by two pediatricians. We calculated the incidence rate of all-cause and respiratory-related readmission.

Results
A total of 297 children had laboratory-confirmed RSV LRTI hospitalizations during the 2019-2020 RSV season, with 24% admitted to the intensive care unit (ICU) during index RSV hospitalization and 24% having a chronic medical condition. During the 1-year follow-up period, 59 readmissions occurred among 47 patients (Table 1). The incidence rate of all-cause and respiratory-related readmission was 19.9 (95%CI 15.5-24.9) and 13.1 (95%CI 9.5-17.5) per 100 patients, respectively. Median age of readmitted patients was 11 months (interquartile range 5.9-11 months). Median number of readmissions was 1 (range: 1-4), with initial readmissions occurring within 28 days (median) of index admission; most (74%) due to a respiratory-related illness. Second and 3rd admissions were less common and occurred at 67 (median) and 160 (median) days respectively. During all readmissions, 19% of children required ICU admission and 25% had chronic medical conditions.

Conclusion
All cause and respiratory readmission after Initial hospitalization with RSV LRTI commonly occurred among children &lt; 5 years. These data support the need for RSV vaccines and immunoprophylaxis to prevent RSV hospitalization. A further study with a control group is needed to determine the role of RSV in readmission.

Disclosures
Yoonyoung Choi, PhD, MS, RPh, Merck (Employee) Lyn Finelli, DrPH, MS, Merck (Employee)
1351. Use of Mail-Out Sexually Transmitted Infection Test Kits in a Telehealth Pre-exposure Prophylaxis Clinic
Authors: Sikka Monica K , Do Long , Ha Hanifa , Smothers Dana , Evans Christopher , Pfeiffer Christopher D 
Published: December 2021

Abstract

Background
Standard of care for patients receiving pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) includes HIV screening and testing for sexually transmitted infections (STIs) at all sites of potential exposure every three months. We implemented a provider and pharmacist telehealth based PrEP program as part of the HIV, Hepatitis Specialty Telehealth Access Resource (H-START) Collaborative. Due to the COVID-19 pandemic and care via telehealth, we had limited ability to collect pharyngeal or rectal swabs in clinic. We created mail-out kits including swabs and instructions for self-collection to test for rectal and pharyngeal Neisseria gonorrhea and Chlamydia trachomatis.

Methods
Kits were mailed out to patients between June 2020 and May 2021. Providers first confirmed patient comfort with self-swab collection during telehealth appointments. Kits included: an instruction sheet with visual diagrams for collection, swabs with appropriate labels; and a pre-paid envelope for patients to mail swabs back to our facility for laboratory testing. Prospective data collection included the date kits were mailed out to patients, the date of kit receipt at our facility and the test result. Charts were retrospectively reviewed to determine treatment completion.

Results
54 self-swab kits were mailed to patients. 53 of the patients were male and the average age was 41.3 years old. 38 (70.3%) swabs were returned. The median time for return of swabs was 21 days (Range 2-289). Of those returned, 5 (13.1%) were positive and all 5 patients were treated for their infection.

Conclusion
Mail-out STI testing was effective in identifying STIs for a telehealth PrEP program and for maintaining standard of care practice during the COVID-19 pandemic. This model may increase rates of testing compliance for care provided via telehealth and decrease rates of STI transmission and complications. Better communication around returning kits in a timely-manner and understanding reasons for non-return warrant further investigation.

Disclosures
Monica K. Sikka, MD, FG2 (Scientific Research Study Investigator) Christopher D. Pfeiffer, MD, MHS, C. difficile Vaccine Trial (Scientific Research Study Investigator)
1355. Cluster of Multi-drug Resistance Neisseria gonorrhoeae Isolates with Reduce Ceftriaxone Susceptibility, First Report in Thailand
Authors: Wannigama Dhammika Leshan , Kueakulpattana Naris , Luk-In Sirirat , Hongsing Parichart , Hurst Cameron , Badavath Vishnu Nayak , Jenjaroenpun Piroon , Wongsurawat Thidathip , Teeratakulpisan Nipat , Kerr Stephen J , Abe Shuichi , Pearson Lachlan , Saethang Thammakorn , Chantaravisoot Naphat , Higgins Paul G , Chatsuwan Tanittha 
Published: December 2021

Abstract

Background
Rapid emergence of global azithromycin resistance, with ceftriaxone reduce susceptibility/resistant strains, threatens the current recommends dual therapy with ceftriaxone and azithromycin for gonorrhea to ensure effective treatment. Thailand is a major risk area for gonorrhea because it as a key destination for sex tourism industry, where antibiotic resistance gonorrhea can spread easily and quickly across the region. Here, we identified a first cluster of Neisseria gonorrhoeae isolates with decreased ceftriaxone susceptibility in Thailand.

Methods
A 134 N. gonorrhoeae isolates collected from Thai Red Cross Anonymous Clinic, Bangkok, during 2016–2018 were studied. Broth micro-dilution and plate dilution methods to define resistance or decreased susceptibilityaccording to CLSI guidelines. Select isolates were subjected to whole genome sequencing with an Illumina MiSeq V2 instrument and analysis using CLCBio Genomics Workbench v6.5. Molecular docking studies were carried out to understand binding mode analysis and orientation of ceftriaxone in the active site of PBP2. Biofilm formation measured by confocal laser scanning microscopy.

Results
Among the N. gonorrhoeae clinical isolates, two isolates had significant reduced susceptibility to ceftriaxone (MICs of 0.125 mg/L), which were isolated from urethral swab in male heterosexual patients. Both were multidrug resistance and strong biofilm producers with ceftriaxone tolerance (MBEC &gt; 128 mg/L). One isolate was resistant to azithromycin (MIC of 1 mg/L), and other one remained susceptible (MIC of 0.5 mg/L). Reduced susceptibility to ceftriaxone associated with alterations in PBP2, PBP1, PorB, MtrR, and mtrR promoter region with one belonged to ST7235 and second one had new allele number of tbpB with new sequence type (ST). Ceftriaxone weakly occupy the active site of mosaic XXXIV penicillin-binding protein 2 (PBP2) variant in both. Molecular epidemiology results reviled that both isolates display similarities with isolates from UK, USA, and Netherlands.

Conclusion
This first cluster of genetically related gonococcal isolates with decreased ceftriaxone susceptibility may bring threat of treatment failure in Thailand. Also highlighted the importance of maintaining surveillance for antimicrobial resistance.

Disclosures
All Authors: No reported disclosures
1356. Association Between Marital Status and Pre-pregnancy STI Counseling Among Women Who Have Recently Given Birth: RI PRAMS 2016-2018
Authors: Jang Eun Ji , Gjelsvik Annie , Amanullah Siraj 
Published: December 2021

Abstract

Background
As rates of sexually transmitted infections (STIs) continue to rise, all women of reproductive age can suffer from complications particularly during pregnancy which can lead to adverse neonatal outcomes. Currently, data on STI counseling among married women are limited. This study aims to assess differences in pre-pregnancy STI counseling based on marital status among women who have recently given birth.

Methods
We utilized the Rhode Island Pregnancy Risk Assessment Monitoring System (RI PRAMS) 2016-2018, a population-based survey of postpartum women. Mothers self-reported if they have received STI counseling for chlamydia, gonorrhea, and syphilis during any health care visit in the 12 months before becoming pregnant. Marital status was obtained from the birth certificate. Multivariable logistic regression analysis was performed adjusting for age, race, Hispanic ethnicity, education, insurance, income, and previous live birth. We accounted for weighting and complex survey design.

Results
Our analytic sample included 2,361 mothers. More than half of the women reported never having received pre-pregnancy STI counseling about the 3 most reported and curable STIs in the US. Among them, an estimated 78.9% (n=1,207) of married women did not receive pre-pregnancy STI counseling compared to 53.6% (n=429) of unmarried women (Table 1). Married women had 0.61 (95% CI: 0.46, 0.81) odds of receiving STI counseling before pregnancy compared to unmarried women (Figure 1). Other risk factors for not receiving STI counseling included having a college education or higher or having a previous live birth.
Table 1. Characteristics of Women who have Recently Given Birth by Marital Status, RI PRAMS 2016-2018 (n=2,361)

*Unknown/missing values for each category &lt;10%.**Uninsured population &lt;1%
Figure 1: Adjusted Odds of Having Received Pre-pregnancy STI Counseling among Recent Mothers, RI PRAMS 2016-2018 (n=2,361)

*P-value &lt;0.05Reference Group; Marital Status: unmarried, Age: &lt; 25 years old, Race: White, Hispanic: Non-Hispanic, Education: High school degree or less, Insurance: Public insurance, Income: &lt; &24,000, Previous live birth: No previous live birth

Conclusion
Selective STI counseling creates gaps and missed opportunities to address STIs early before pregnancy. All women regardless of their perceived risk for STI or assumptions based on their marital status should receive proper STI counseling as all women are vulnerable and at higher risk of developing complications. Health care providers should increase efforts to address this gap and counsel all women about STIs during every visit irrespective of their marital status.

Disclosures
All Authors: No reported disclosures