bluuebunny/crossref_metadata_2025_split huggingface dataset:
472. Clinical Outcomes of Solid Organ Transplant Recipients with Severe Acute Respiratory Syndrome Coronavirus 2: 2021 Update
Authors: Jandhyala Deeksha , Lewis Jessica , Adekunle Ruth 
Published: December 2021

Abstract

Background
The Centers for Disease Control and Prevention identified solid organ transplant (SOT) recipients as persons at high risk to develop severe illness secondary to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). We reviewed the clinical characteristics and outcomes of SOT recipients who had SARS-CoV-2 at our center.

Methods
This was a retrospective review of SOT recipients diagnosed with SARS-CoV-2 between March 1st 2020 and February 28th 2021 in the Medical University of South Carolina (MUSC) Health Care system. Subjects were included if they had undergone SOT at any time prior to a positive SARS-CoV-2 PCR. Descriptive statistics were used to analyze demographic and clinical characteristics. Primary outcomes included need for hospitalization, complications, and estimated all-cause mortality.

Results
96 SOT recipients were diagnosed with SARS-CoV-2. Seven patients were excluded as they initially tested positive and were admitted to another facility or had a simultaneously positive IgG. 89 SOT recipients were analyzed, of which, 39 (44%) were managed as an outpatient and 50 (56%) required admission. 13 (33%) of outpatient recipients were treated with a monoclonal antibody. Of those hospitalized, 24 (48%) were male, 34 (68%) were Black, and 34 (68%) were kidney transplant recipients. Median age at positive test was 53 years of age and median time from transplant to positive test was 3.1 years. Median length of stay was three days (range 0.1–108.6). 17 (34%) patients required supplemental oxygen and 11 (22%) received care in the intensive care unit. Complications, including bacterial infections (16%), fungal infections (2%), CMV reactivation (6%), and rejection (2%) were rare. Three patients (3%) died during the study time period.

Conclusion
The majority of SOT recipients with SARS-CoV-2 in our cohort required admission, however they experienced few complications and a low mortality, despite their high-risk status.

Disclosures
All Authors: No reported disclosures
473. Clinical Outcomes of a Pediatric COVID Monoclonal Antibody Program based at an Urban Academic Center
Authors: Lee Philip J , Cruz Carlos , Anosike I J 
Published: December 2021

Abstract

Background
Growing clinical evidence in adults has demonstrated use of COVID monoclonal antibody (mAB) therapy results in a reduction of hospitalization and/or emergency room (ER) visits with the greatest benefit following early administration. While the FDA has authorized use of mAB therapy in children ages 12-17 years, clinical outcomes in this population have yet to be described. This study aims to assess the pediatric clinical experience in a low social economic setting.

Methods
Retrospective study conducted among children and adolescents who tested positive for SARS-CoV-2 from 12/1/2020 to 6/1/2021, met ≥ 1 eligibility criterion based on pre-determined institutional guidelines. Individuals were identified by patient-level data linked to pharmacy and medical claims with ICD-10 codes for COVID-19. Electronic medical records were reviewed for demographic characteristics, comorbidities, time to receipt of mAB therapy from positive test, adverse effects, and clinical outcomes. Primary clinical end point was hospitalization and/or medical visit at 28 days. Descriptive summary statistics were used for the entire cohort.

Results
Overall, 17 met eligibility criteria. Thirteen patients with a mean age of 16 years, received casirivimab and imdevimab mAB therapy: 4 declined treatment. Among the treated patients, 61.5% (n=8) were male, 38.6% (n=5) Hispanic/Latino; 38.6% (n=5) non-Hispanic Black; 7.7% (n=1) White. Seven out of 12 had a BMI ≥ 95th% for gender and age. Eight patients (61.5%) met ≥ 1 criteria with obesity (n=8) as the most common factor followed by immunocompromised state (n=6, 46.2%) tied with neurodevelopmental disorder (n=6, 46.2%). Median time from positive test to mAB therapy was 2 days [IQR:1-3]. One patient had a severe adverse event. Overall, none required hospitalization/ER visit with COVID like symptoms.
Demographics and Results Table

The table describes the pediatric patients and clinical outcome of receiving monoclonal antibody treatment for COVID-19.

Conclusion
Though limited by numbers, our findings may suggest a role of mAB therapy in children and adolescents in our setting. With increasing rates of SARS-CoV-2 in this age group coupled with vaccine hesitancy, mAB therapy may serve as an important outpatient intervention with a need for further studies to assess clinical benefit and establish optimal, cost-effective, practice guidelines for these highly vulnerable patients.

Disclosures
All Authors: No reported disclosures
475. The Utility of Community-Academic Partnerships in Promoting the Equitable Delivery of COVID-19 Vaccines in Black Communities
Authors: Abdul-Mutakabbir Jacinda , Casey Samuel , Jews Veatrice , King Andrea , Simmons Kelvin , Peteet Bridgette , Belliard Juan Carlos , Hogue Michael , Peverini Ricardo 
Published: December 2021

Abstract

Background
In the U.S., non-Hispanic Black individuals are disproportionately represented amongst COVID-19 mortalities. The COVID-19 vaccines are poised to change this outcome; however, inequitable access and decades of medical mistreatment have resulted in healthcare mistrust and an associated low uptake within this group. Loma Linda University (LLU) houses the largest mass vaccination site in San Bernardino County (SBC) California; nevertheless, there has been a perpetual low representation of Black vaccinees. To increase the number of Black persons vaccinated, a selected team at LLU leveraged a community-academic partnership model to address vaccine hesitancy and increase access to the COVID-19 vaccines. The objective of this study was to evaluate the number of Black persons vaccinated in community settings compared to the mass clinic.

Methods
LLU developed a tiered approach to increase COVID-19 vaccinations within Black SBC communities. The first tier engaged faith leaders with the academic community in disseminating COVID-19 health information, the second included culturally representative LLU healthcare professionals in the delivery of COVID-19 educational webinars, and the third was to conduct low barrier, remote-site vaccination clinics, within targeted Black communities. Following these efforts, we compared the number of Black individuals vaccinated in the LLU mass clinic to those vaccinated in the community remote-site clinics.

Results
The remote-site COVID-19 vaccination clinics commenced in February 2021. From February 1 until April 30, 2021, 24,808 individuals were vaccinated in the LLU mass clinic with a first dose (Pfizer or Moderna) or single dose (Janssen) of a COVID-19 vaccine, however, only 908 (3.7%) were Black vaccinees. Contrastingly, the LLU remote site clinics vaccinated 1,542 individuals with a first or single dose of a COVID-19 vaccine. Of those vaccinees, 675 (44%) were Black.

Conclusion
The multi-tiered community approach (remote-site vaccination clinics) resulted in a necessary overrepresentation of Black vaccinees, previously underrepresented in the LLU traditional mass vaccination clinic effort (44% vs. 3.7%, respectively). Further research is warranted to examine the key elements to increase vaccinations amongst minoritized groups.
COVID-19 Vaccination Comparisons Between Models

This table includes data from the Loma Linda University Mass Vaccination Clinic and the Remote-Site Vaccination Efforts compared to the San Bernardino County Demographics

Disclosures
All Authors: No reported disclosures
478. Contemporaneous Evaluation of Kawasaki Disease and Multi-system Inflammatory Syndrome in Children in Northern Virginia
Authors: Nuibe Andrew , Rubbab Beenish , Levorson Rebecca E 
Published: December 2021

Abstract

Background
Multi-system inflammatory syndrome in children (MIS-C) can present like Kawasaki disease (KD). After Centers for Disease Control and Prevention guidance was issued in May 2020, we implemented local management strategies emphasizing limited laboratory work up of non-toxic children with suspected MIS-C or KD. We then re-evaluated our management recommendations to ensure appropriate resource utilization for children with MIS-C and KD.

Methods
We identified MIS-C and KD cases via convenience sampling of Pediatric Infectious Diseases records at Inova Fairfax Medical Center from May 1, 2020 to February 28, 2021. Manual chart review extracted clinical points of interest and descriptive statistics compared cohorts. Oral changes included edema, erythema, cracking, or strawberry tongue. Abdominal symptoms included pain, emesis, and diarrhea. Respiratory symptoms included shortness of breath, tachypnea, cough, and need for mechanical ventilation. Musculoskeletal symptoms included pain and edema. Neurological symptoms included headache, dizziness, altered mental status, and irritability.

Results
We identified 8 KD cases and 29 concurrent MIS-C cases. MIS-C cases tended to be older and have presenting abdominal symptoms (median age 8 years old versus 2 years old, p &lt; 0.01) and hypotension (20 versus 0, p &lt; 0.01), otherwise there was no difference in the frequency of oral changes, rash, conjunctivitis, musculoskeletal symptoms, or neurological symptoms. 7 KD cases and 8 MIS-C cases did not require intensive care. Patients with MIS-C who did not need intensive care still had a lower initial absolute lymphocyte count (ALC) (median 1275/µL, p &lt; 0.01), lower initial platelet count (median 217/µL, p = 0.05), and higher initial C-reactive protein (CRP) (median 18.3 mg/dL, p = 0.06) compared to KD cases; other results were not different between the two cohorts.

Conclusion
We observed differences in the initial ALC, platelet count, and CRP between KD and MIS-C cases not requiring intensive care, whereas other labs such as ferritin, troponin, B-natriuretic peptide, and initial echocardiograms did not significantly differ between the two cohorts. Thus, our diagnostic management recommending limited laboratory evaluation for non-toxic patients with suspected KD or MIS-C is reasonable.

Disclosures
All Authors: No reported disclosures
479. Real-world Evaluation of SARS-CoV-2 Monoclonal Antibodies in Solid Organ Transplant Recipients
Authors: Zeitler Kristen , Piccicacco Nicholas , Bowman Lyndsey , Montero Jose , Cancio Margarita , Houston Sally , Kim Kami 
Published: December 2021

Abstract

Background
Patients with COVID-19 infection at highest risk for poor outcomes include immunocompromised patients, such as solid organ transplant (SOT) recipients. Monoclonal antibody (mAb) infusions were developed to promote passive immunity. Analysis of the first 200 patients who received SARS-CoV-2 mAb at our hospital showed a 27 % absolute reduction in hospitalization and emergency department (ED) visits. Understanding the role of SARS-CoV-2 mAb therapy in management of the SOT population is likely to inform decision making for these patients.

Methods
We conducted a retrospective chart review of SOT patients diagnosed with COVID-19 who received mAb therapy between 11/18/20 and 04/26/21. Patients were excluded if they were &lt; 18 years of age or if they weighed &lt; 40 kg. We compared those patients who were hospitalized or visited the ED within 29 days of mAb therapy to those who recovered without further visits to our hospital.

Results
A total of 50 SOT patients receiving mAb therapy were included in this analysis. Bamlanivimab was given to 33 patients, while 9 patients received bamlanivimab/etesevimab and 8 patients received casirivimab/imdevimab. Twelve (24 %) patients were hospitalized or visited the ED within 29 days of mAb therapy; 38 patients did not. These 2 groups did not significantly differ by age, gender, body mass index, time from SOT, or other risk factors for severe COVID-19 illness per FDA Emergency Use Authorization guidance. Both groups were primarily made up of kidney transplant recipients (66.7 % and 68.4 %, respectively). Significantly more patients in the hospitalization/ED group were receiving antimetabolites as part of their immunosuppression (IS) regimen prior to COVID-19 diagnosis (100 % vs 68.4 %, p = 0.047). Patients in the hospitalization/ED group received mAbs within a median of 6 days (IQR 3.8) of symptom onset compared to 4 days (IQR 4) (p = 0.006).

Conclusion
SOT recipients were more likely to be hospitalized or visit the ED due to COVID-19 after mAb if they were receiving antimetabolite IS or received mAb later after symptom onset. These data stress the importance of early mAb administration in all SOT patients, particularly in those on antimetabolite therapy.

Disclosures
Lyndsey Bowman, PharmD, Veloxis Pharmaceuticals (Advisor or Review Panel member, Speaker’s Bureau) Kami Kim, MD, Regeneron Pharmaceuticals Inc. (Scientific Research Study Investigator)Sanford Guide (Other Financial or Material Support, Editorial Board Member)
482. SARS-CoV-2 Prevalence in Feces of Very Young Children, A Longitudinal Study
Authors: Nashed Lydia M , Mani Jyoti , Hazrati Sahel , Richards Tiana , Nerikar Naya , Ravi Shreeya , Mattei Lisa , Levy Shira , Maxwell George , Hourigan Suchitra 
Published: December 2021

Abstract

Background
Understanding the disease burden of SARS- CoV-2 in young children has been challenging as the majority are asymptomatic or experience mild symptoms and were rarely tested. SARS-CoV-2 is traditionally detected through respiratory secretions but has also been reported in feces where shedding may continue for weeks after respiratory samples show resolution. We examined the prevalence of SARS-CoV-2 in already collected fecal samples from young children through the pandemic as well as associated demographic factors.

Methods
As part of an ongoing longitudinal microbiome study in Northern Virginia, serial stools samples were collected from infants before and throughout the Covid-19 pandemic. Reverse transcription quantitative-PCR detecting SARS-CoV-2 nucleocapsid gene in the N1 and N2 regions was performed. Penalized logistic regression models were developed to evaluate the association between fecal positivity and potential risk factors.

Results
The overall prevalence of SARS-CoV-2 in infant feces was 1.69 % (13 samples) with a prevalence at delivery, 2, 6, 12 and 24 months of 0, 0, 2.56, 1.96, and 0.85 % respectively. Fecal positivity was first detected 31 days before the reported first case of Covid-19 in Northern Virginia; prevalence rates peaked in September at 4.5% (Figure 1). Only one infant who tested positive was symptomatic with COVID-19 21 days before his stool was collected. Of the 13 positive samples, 8 reported Hispanic ethnicity and 7 reported an essential worker (Table 1). Penalized logistic regression model showed association between Hispanic ethnicity and testing positive (OR 5.04 (95% CI 1.7 – 15.0)) that remained after controlling for the presences of an essential worker (OR 4.7 (95% CI 1.6 – 14.0)).

Conclusion
Prevalence of SARS- CoV-2 in infant stool correlated with the prevalence of COVID-19 during the pandemic, with higher rates in those of Hispanic ethnicity corelating with regional trends. Fecal positivity in asymptomatic infants even before quarantine restrictions supports the early but silent transmission of SARS-CoV-2. This study likely underestimates true prevalence rates as stool samples were stored without viral preservative. There are many socioeconomic factors that predispose to disease while ethnicity may be a mediating or confounding factor

Disclosures
All Authors: No reported disclosures
483. Disease Severity and Clinical Manifestations of SARS-CoV-2 Infection Among Infants Over the First Year of the Pandemic in Canada
Authors: Piché-Renaud Pierre-Philippe , Panetta Luc , Farrar Daniel , Hepburn Charlotte Moore , Drouin Olivier , Kakkar Fatima , Morris Shaun 
Published: December 2021

Abstract

Background
There is limited data on outcomes of SARS-CoV-2 infection among infants (&lt; 1 year of age). In the absence of any approved vaccines for infants, understanding the risk factors for hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and targeted public health interventions. The objective of this study was to describe the clinical manifestations, disease severity, and risk factors for hospitalization among infants with SARS-CoV-2 infection in Canada.

Methods
This is a nationwide prospective observational study using the infrastructure of the Canadian Paediatric Surveillance Program. All cases of infants aged &lt; 1 year of age with microbiologically confirmed SARS-CoV-2 infection were reported from April 8th 2020 to May 11th 2021, and classified by disease severity, and primary cause of hospitalization. Logistic regression was performed to identify risk factors for hospitalization and severe disease.

Results
A total of 393 cases were reported, including 229 (58.3%) non-hospitalized and 164 (41.7%) hospitalized infants. The most common symptoms included fever (63.4%), runny nose (45.0%), cough (35.1%) and decreased oral intake (24.9%). Significant risk factors for hospitalization included younger age and presence of comorbid conditions (excluding prematurity), as shown in the Table. Among hospitalized infants, 108 (65.9%) were admitted because of COVID-19-related illness, and 52 (31.7%) were admitted for reasons other than COVID-19. A total of 31 (7.9%) infants developed severe or critical disease. Risk factors for severe disease included prematurity and younger age (Table).

Conclusion
We describe one of the largest cohort of infants with SARS-CoV-2 infection. Severe disease in this age group is uncommon, with younger age and prematurity being significant risk factors for severe COVID-19.

Disclosures
Pierre-Philippe Piché-Renaud, MD, Pfizer Global Medical Grants (Competitive grant program) (Research Grant or Support, Investigator-led project on the impact of COVID-19 on routine childhood immunizations) Olivier Drouin, MDCM MsC MPH, Covis Pharma (Research Grant or Support) Shaun Morris, MD, MPH, DTM&H, FRCPC, FAAP, GSK (Speaker’s Bureau)Pfizer (Advisor or Review Panel member)Pfizer (Grant/Research Support)
485. Pediatrics Institutional COVID-19 Review
Authors: Karna Prakash , Farrand Lauren , Hasan Uzma 
Published: December 2021

Abstract

Background
Coronavirus disease (COVID-19) caused by SARS-COV2 represents global public health concern, with varied severity of illness in different ages and racial groups. This study aims to describe clinical presentation and outcomes in children aged 0-21 years in a community hospital setting in New Jersey.

Methods
This is a retrospective medical record review of pediatric patients (0-21 years) admitted to Saint Barnabas Medical Center between March 2020- December 2020 with confirmed diagnosis of COVID-19 infection. Diagnosis of COVID-19 infection is based on ICD-10 diagnosis code. Data was extracted from electronic medical records, including demographics, pre-existing conditions, presenting symptoms, treatments used and outcomes.

Results
We identified 48 cases of pediatric COVID-19 patients at Saint Barnabas Medical Center during period of 03/20-12/20. Review of demographic data showed 29 patients (60%) were female, and 19 (40%) were male. Race distribution was 38% black, 17% white, 4 % Asian Indian, and 41% others/unknown. Age distribution was as follows: 40% &gt;15 yrs, 15% 11-15 yrs, 15% 0-1 yrs, 13% 6-10 yrs, 13% 1-5 yrs, and 6% newborn. Fever (65%) was the most frequent symptom identified, followed by cough (31%), nausea/vomiting (29%), abdominal pain (19%), shortness of breath (17%), rash (15%), diarrhea (10%), headache (10%), myalgia/body-aches (8%), chest pain (6%), red eyes (6%), and loss of taste/smell (2%). Of 48 patients, 10 (21%) had positive chest X-ray findings of lung infiltrates or opacities, 4 (8%) had abnormal echocardiogram findings, and 1 (2%) had abnormal CT chest. 21 of 48 patients had underlying comorbid conditions, with Diabetes and Asthma being the most common. No deaths were reported. 8 of 48 COVID-19 patients were diagnosed with MIS-C. Of these MIS-C patients, 5 (63%) were male and 3 (38%) were female. 6 of 8 affected patients were black (75%). 50% of MIS-C patients were between 6-10 years. 3 of 8 patients (38%) had abnormal echocardiogram findings.

Conclusion
This review supports clinical findings from other studies and also suggests certain racial ethnicities may be disproportionately impacted, which warrants further exploration to determine genetics vs environmental factors that lead to increased predisposition to severe illness.

Disclosures
All Authors: No reported disclosures
486. Characteristics Associated with SARS-CoV-2 Infection in Children
Authors: Curtis Sudbury F , Williams Amanda , Kwon Michelle , Musser Leah , Gavigan Patrick , Ericson Jessica E 
Published: December 2021

Abstract

Background
We sought to describe the range of Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in children.

Methods
Patients &lt; 18 years of age who had a positive nasopharyngeal polymerase chain reaction (PCR) for SARS-CoV-2 at a single health system in central Pennsylvania from 3/19/2020-12/31/2020 were identified. Using a random number generator, 150 additional patients &lt; 18 years of age who had a negative PCR test were also identified. Asymptomatic patients and those without clinical data in the electronic medical record were excluded from analysis. Demographic characteristics, symptoms present at the time of testing, and outcomes were compared between PCR-positive and negative patients. Odds ratios were calculated using univariable and multivariable logistic regression models to patients with positive vs. negative PCR tests.

Results
We included 544 patients in analysis, 412 (76%) of which had a positive SARS-CoV-2 PCR. PCR-positive patients were statistically more likely to have a known contact, no comorbidities, and to present with cough, cold-like symptoms, headache, or loss of taste and smell. All patients who presented with loss of taste and smell were PCR positive at time of presentation. Positive patients were statistically less likely to present with fever or emesis than negative patients. Multivariable regression identified increased age, cough, cold symptoms, headache, and non-white race as predictive of PCR positivity. Patients who tested positive were statistically less likely to be admitted to the hospital and less likely to require respiratory support than negative patients.

Conclusion
Loss of taste and smell is a specific, though uncommon, indicator of SARS-CoV-2 infection in the pediatric population. Headache, cough, and cold-like symptoms are also suggestive of SARS-CoV-2 infection, while fever and gastrointestinal symptoms appear less common. This data suggests that screening questions developed for adults may be less applicable in children. Future research, including more dedicated and prospective studies, is warranted to identify patients in whom a positive SARS-CoV-2 test is sufficiently likely to warrant isolation and testing.

Disclosures
All Authors: No reported disclosures