bluuebunny/crossref_metadata_2025_split huggingface dataset:
1328. Risk Factors for Severe Influenza Outcomes Among Infants Born Between 2011 and 2019
Authors: Chamseddine Sarah , Zaheer Haniah A , Williams John V , Martin Judith M , Rick Anne-Marie , Liu Hui 
Published: December 2021

Abstract

Background
Influenza in infancy can cause significant morbidity and mortality. This study aimed to characterize influenza outcomes in infants &lt; ορ = 12 months and identify risk factors for severe infection.

Methods
A retrospective cohort of infants ≤ 12 months born between 2011-2019 who received longitudinal ambulatory and inpatient care within a multi-facility hospital system and had laboratory-confirmed influenza were included. Perinatal, medical and illness characteristics were described. Risk factors for severe influenza (hospitalization, intensive-care unit (ICU) admission, secondary bacterial infections) were analyzed using Chi-square analysis and multivariate logistic regression.

Results
Among 421 infants with influenza, 134 (32%) were &lt; 6 months (m), 28 (6.5%) were born prematurely (&lt; 35 weeks gestational age), and 41(10%) had chronic medical conditions (CMC). 62 (15%) required hospital admission, 13 (21%) of which required ICU care. No deaths were reported. Secondary bacterial infections were diagnosed in 101 (24%) including acute otitis media (84%), pneumonia (15%) and sinusitis (3%). Prematurity (OR 3.6, 95%CI:1.5-8.3), age &lt; 6m (OR 3.4, 95%CI:1.9-5.9), and CMC (OR 7.6, 95%CI 3.8-15.3) were significantly associated with hospitalization. Prematurity, age &lt; 6m, and CMC were also associated with ICU admission. Infants &gt; 6m (OR 2, 95%CI:1.2-3.5) were more likely to be diagnosed with a secondary bacterial infection than younger infants. Among infants &gt; 6m, complete influenza vaccination (2 doses) was associated with lower rates of antibiotic use (OR 0.5, 95% CI:0.3-0.9) compared to partial or no vaccination, but did not significantly affect hospitalization, ICU admission, or frequency of secondary bacterial infections. Adjusting for prematurity, age &lt; 6m remained associated with hospitalization (aOR 4, 95%CI: 2.1-7.3) as did presence of CMC (aOR 7.3, 95%CI 3.3- 15.7). For ICU admission, age &lt; 6m (aOR 6.3, 95%CI:1.6-24.1) and CMC (aOR 19.7,95%CI:4.9-79.5) were also independent risk factors.

Conclusion
Younger age and chronic medical conditions were independent risk factors for severe influenza infection. Complete influenza vaccination in eligible age groups was associated with decreased antibiotic use.

Disclosures
John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member, Independent Data Monitoring Committee)Quidel (Advisor or Review Panel member, Scientific Advisory Board) Judith M. Martin, MD, Merck Sharp and Dohme (Consultant)
1330. Clinical Associations and Trajectory of “Long COVID”
Authors: Jacobson Karen , Balasubramanian Vidhya , Bonilla Hector F , Madrigal Martina , Hack Isabelle , Purington Natasha , Singh Upinder , Hedlin Haley , Jagannathan Prasanna 
Published: December 2021

Abstract

Background
Persistent symptoms after acute COVID-19 are being increasingly reported. To date, little is known about the cause, clinical associations, and trajectory of “Long COVID”.

Methods
Participants of an outpatient clinical trial of Peginterferon-Lambda as treatment for uncomplicated SARS-CoV-2 infection were invited to long term follow-up visits 4, 7, and 10 months after initial COVID-19 diagnosis. Ongoing symptoms and functional impairment measures (work productivity and activity index (WPAI), NIH toolbox smell test, 6-minute walk test) were assessed and blood samples obtained. “Long COVID” was defined as presence of 2 or more typical symptoms (fatigue, hyposmia/hypogeusia, dyspnea, cough, palpitations, memory problems, joint pain) at follow up. Associations between baseline characteristics, initial COVID-19 clinical course, and presence of “Long COVID” during follow-up were assessed using generalized estimating equations accounting for repeated measurements within individuals.

Results
Eighty-seven participants returned for at least one follow-up visit. At four months, 29 (34.1%) had “Long COVID”; 19 (24.7%) met criteria at 7 months and 18 (23.4%) at 10 months (Figure 1). Presence of “Long COVID” symptoms did not correlate significantly with functional impairment measures. Female gender (OR 3.01, 95% CI 1.37-6.61) and having gastrointestinal symptoms during acute COVID-19 illness (OR 5.37, 95% CI 1.02-28.18) were associated with “Long COVID” during follow-up (Figure 2). No significant associations with baseline immunologic signatures were observed.

Figure 1. Alluvial plot of long term follow-up participants showing outcomes of symptoms at each visit.

Figure 2. Generalized Estimating Equations Model showing associations with “Long COVID” (presence of 2+ symptoms) at month 4, 7, and 10 following acute infection using unstructured correlation matrix.

Conclusion
“Long COVID” was prevalent in this outpatient trial cohort and had low rates of resolution over 10 months of follow up. Female sex and gastrointestinal symptoms during acute illness were associated with “Long COVID”. Identifying modifiable risk factors associated with the development of persistent symptoms following SARS-CoV-2 infection remains a critical need.

Disclosures
All Authors: No reported disclosures
1332. Clinical Indicators for When Bronchoalveolar Lavage (BAL) Is Needed Beyond Nasopharyngeal Swab (NP) Testing for Viral Respiratory Infections
Authors: Ulrich Patrizia , Chen Derrick 
Published: December 2021

Abstract

Background
This study evaluated the yield of testing NP vs BAL specimens using a multiplex PCR respiratory viral panel (RVP).

Methods
A retrospective chart review was conducted on all patients from 10/2017-3/2021 who had both an NP swab and BAL tested by RVP within a 4-week period.

Results
There were 477 cases where patients had both an NP and BAL specimen tested by RVP. Results were NP-/BAL- for 361 (76%) cases, NP+/BAL+ for 58 (12%), NP-/BAL+ for 40 (8%), and NP+/BAL- for 18 (4%). For NP+/BAL+, NP-/BAL+, and NP+/BAL-, respectively, rhinovirus was detected in 23 (40%), 3 (8%), and 16 (89%) cases (p&lt; 0.001); influenza A or B in 9 (16%), 7 (18%), and 0 (0%) (ns); adenovirus in 3 (5%), 10 (25%), and 2 (11%) (p&lt; 0.05); metapneumovirus in 9 (16%), 8 (20%), 2 (11%) (ns); RSV in 8 (14%), 6 (15%), and 1 (6%) (ns); and, parainfluenza in 7 (12%), 6 (15%), and 1 (6%) (ns), respectively. Average ages were 48, 48, and 48 years; numbers of males were 34 (58%), 28 (70%), and 11 (61%); immunocompromised were 56 (97%), 37 (92%), and 17 (94%); and, 16 (28%), 10 (25%), and 6 (33%) had an active malignancy, respectively (all ns). Average symptom durations prior to presentation were 7.0, 13.1, and 9.6 days (ns); pulmonary exams were abnormal in 35 (60%), 24 (60%), and 5 (28%) cases (p&lt; 0.05); shortness of breath (SOB) was present in 40 (69%), 25 (62%), and 8 (44%) (ns); lower respiratory tract infection (LRTI) symptoms were absent in 1 (2%), 12 (30%), and 8 (45%) cases (p&lt; 0.01); when spirometry values were available, they were reduced in 28/31 (90%), 15/19 (79%), and 3/8 (37%) cases (p&lt; 0.05); and, mean SpO2 levels were 91.5%, 93.9%, and 93.7% (ns), respectively. Mean temperatures were 99.0F, 99.0F, and 99.1F (ns); chills, sweats, and malaise were present in 27 (47%), 13 (33%), and 3 (17%) cases (p&lt; 0.05); GI symptoms were present in 20 (34%), 5 (13%), and 10 (56%) cases (p&lt; 0.05); and, acute kidney injury was present in 38 (66%), 13 (33%), and 6 (33%) cases (p&lt; 0.05), respectively.

Conclusion
Most (88%) RVP test results were concordant between NP and BAL. There were significant differences between cases of NP+/BAL+, NP-/BAL+, and NP+/BAL-. Rhinovirus and GI symptoms were more common for NP+/BAL- vs NP-/BAL+. Conversely, pulmonary exams were more often abnormal and spirometry values reduced for NP-/BAL+ vs NP+/BAL-.

Disclosures
All Authors: No reported disclosures
1333. A National Outbreak of Respiratory Syncytial Virus Associated with Emergence of a Genetically Distinct ON1 variant
Authors: Lin Wei Hsuan , Wu Fang-Tzy , Chen Yi-Yin , Tsao Kuo Chien , Hsieh Yu-Chia 
Published: December 2021

Abstract

Background
A national outbreak of respiratory syncytial virus (RSV) has been observed in the community since Fall 2020 in Taiwan.

Methods
We reviewed a national laboratory-based surveillance network established over 20 years by Taiwan Centers for Disease Control (TCDC) for respiratory viral positivity rate and viral pathogen in outpatient department and hospitalized patients. A retrospective study of children younger than 5 years old hospitalized with RSV infections at Chang Gung Memorial Hospital (CGMH) including Lin Kou and Kaohsiung branch between 2018 and 2020 was conducted. Samples positive for RSV A were sequenced. Patients’ clinical data was obtained from medical files and stratified by genotype and year.

Results
2020 showed a 4-fold surge in RSV cases in Taiwan, in which surpassed both 2011 (the appearance of ON1 strain in Taiwan) and 2013 (ON1 strain predominates in Taiwan)(Figure1,Table1). Phylogenetic analysis of G protein sequences showed that most strains in 2020 were clustered apart from 2018, 2019 seasons and other ON1 reference strains between 2011 and 2016, indicating a novel ON1 variant had been circulating in the community(Figure2). The novel ON1 variants carried six amino acid changes, of which T113I,V131D, H258Q,H266L,Y304H located in the mucin domains and N178G in central conserved domain. These changes emerged gradually in 2019 and showed a high consistency in 2020. The unique amino acid substitution E257K in the second mucin domain was noticed in 2020 exclusively. Besides, 10 substitutes in F protein were appeared between 2018 and 2020, of which R213S and N276S were in antigenic sites. Furthermore, substitutes T12I and H514N in F protein were first emerged since 2020. On multivariate analysis, age (OR 0.97; 95% CI 0.94-0.99; p 0.02) and ON1 variant in 2020 (OR 2.52; 95% CI 1.13-5.63; p 0.025) were independently associated with oxygen saturation &lt; 94% during hospitalization (Table 2).

Figure 2. The phylogenetic tree of G protein sequences including ON1 strains in our study from 2018 to 2020 and reference strains from 2011 to 2016

The phylogenetic tree showed that most strains of the 2020 season clustered apart from those of the previous seasons, which indicated there was a novel ON1 variant circulating in the community associated with 2020 RSV epidemic.

Variables with p&lt;0.1 in the univariate analysis were included in the multivariate analysis.

Conclusion
An unprecedented RSV epidemic within the last 10 years caused by a novel ON1 variant has occurred in 2020 (Figure 1), suggesting the sets of mutations may confer fitness advantage. Further studies on viral replication, infectivity and virulence is needed to understand the evolution and spread of RSV.

Disclosures
All Authors: No reported disclosures
1335. High Serum Levels of Interleukin-10 as a Predictor Factor of In-Hospital Mortality in COVID-19 Patients
Authors: Gomez-Duque Salome , Gamboa-Silva Enrique , Bustos-Moya Ingrid G , Fuentes Yuli , Lozada-Arciniegas Julian , Ibañez-Prada Elsa Daniela , Narváez - Ramírez Oriana , Morales-Cely Lina , Bravo-Castelo Laura A , Ramirez Paula , Parra-Tanoux Daniela , Caceres Edar , Santos Ana , Londoño Jhon , Reyes Luis F 
Published: December 2021

Abstract

Background
Since the spread of SARS-CoV-2 worldwide, there has been the need for scores and biomarkers to identify patients at risk of died or requiring admission to the intensive care units (ICU) admission. Interleukin-10 (IL-10) is released as a response to the infection, stimulating inflammatory pathways in the acute phase response. Thus, previous studies have shown that high serum concentrations IL-10 can be identify patients with severe community acquired pneumonia (CAP). Nevertheless, there is a lack of information regarding the capacity of IL-10 to identify severe COVID-19. Thus, the aim of this study was to determine the capacity of IL-10 as a prediction factor for mortality in hospital admitted patients with COVID-19 compared with CAP patients.

Methods
A prospective observational study was carried out at the Clinica Universidad de La Sabana, Colombia. Patients older than 18 years and old, hospitalized due to COVID 19 or CAP, were included. Patients were stratified into COVID-19 and non-COVID-19 patients. IL-10 levels were quantified in serum samples using the LUMINEX technology. Serum samples were collected within the first 24 hours of hospital admission. Afterward, concentrations of interleukinwere statistically compared among groups. ROC curves were calculated.

Results
A total of 88 patients with CAP and 152 patients with COVID-19 were enrolled in the study. The median [with IQR] serum concentration of IL-10 were higher in those patients who died (81.1 [30.7-148.9] vs 18.8 [8.3-48.4] p-value &lt; 0.0001). Then, comparing the study group, the median concentration of IL-10 levels among patients deceased by COVID-19 were higher than patients those who survived (85.1 [40-149.8] vs 32.4 [13.9-56.7] p-value &lt; 0.001). In addition, IL-10 levels were higher in patients who survived COVID-19 compared with those who survived CAP (32.4 [13.9-56.7] vs 10.6 [4.9-18] p-value &lt; 0.0001). The area under curve (AUC) ROC of IL-10 to predict mortality risk was 0.754 for all cohort. DeLong′s test comparing ROC curves in COVID-19 and CAP patients had a p= 0.744.

Conclusion
High serum levels of IL-10 are a good predictor of in-hospital mortality among COVID-19 patients. However, this risk association was not observed in CAP patients. Further studies are needed.

Disclosures
All Authors: No reported disclosures
1336. Outcomes of COVID-19 in Recent Kidney Transplants Recipients at a Large Transplant Center in Miami
Authors: Mendoza Maria A , Coro Ana , Natori Yoichiro , Anjan Shweta , Guerra Giselle , Mattiazzi Adela , Chen Linda , Morsi Mahmoud , Figueiro Jose , Raveh Yehuda , Simkins Jacques 
Published: December 2021

Abstract

Background
Outcomes of COVID-19 have been reported in deceased donor kidney transplant (DDKT) recipients. However, data is limited in patients that underwent recent DDKT.

Methods
This single-center retrospective study evaluated the differences in demographics and post-transplant outcomes between those who tested positive and negative for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by polymerase chain reaction, after undergoing recent DDKT. The treatments and outcomes for the SARS-CoV-2-positive patients were assessed. Patients who underwent DDKT from 3/2020 to 8/2020 were included and followed until 9/2020.

Results
201 DDKT recipients were analyzed [14(7%) SARS-CoV-2-positive and 187(93%) negative]. There was no difference in delayed graft function and biopsy-proven rejection between both groups. The patient survival at the end of the study follow-up was lower among SARS-CoV-2-positive patients (Table 1). The median time from DDKT to COVID-19 diagnosis was 45 (range: 8-90) days; 5(36%) patients required intensive care unit and 4(29%) required mechanical ventilation; steroids were used in all the patients, therapeutic plasma exchange (TPE) and convalescent plasma (CP) in 7(50%) patients each, remdesivir in 6(43%) and tocilizumab in 1(7%); 9(64%) patients recovered, 3(21%) died and two were still requiring mechanical ventilation at the end of the follow-up.

Conclusion
Our cohort demonstrated a lower survival rate among SARS-CoV-2-positive patients, which highlights the vulnerability of the transplant population. Transplant patients must comply with the CDC recommendations to prevent COVID-19.

Disclosures
All Authors: No reported disclosures
153. Gone Are the Other Respiratory Viruses During COVID…but the Rhinovirus/Enterovirus “Cockroach” Persists!
Authors: Singh Jasjit , Huff Beth , Nieves Delma , Gornick Wendi 
Published: December 2021

Abstract

Background
In a typical winter respiratory season, Influenza A, Influenza B, Respiratory Syncytial Virus (RSV) and human Metapneumovirus (hMPV) infections are common in pediatrics. During the COVID-19 pandemic, we noted a marked decrease in all except for Rhinovirus/Enterovirus at our free-standing quaternary level children’s hospital.

Methods
We prospectively reviewed all patients with positive testing for viral respiratory pathogens from October 1, 2018 through May 29, 2021. Testing was done by polymerase chain reaction (PCR) (BioFire® FilmArray® Respiratory 2 Panel, UT) and by SARS-CoV-2 PCR testing (Cepheid®, CA). The latter may have been done for pre-procedure or admission screening. We submitted 74 specimens to the California Department Public Health (CDPH) for definitive identification and serotyping analysis.

Results
The number of Rhinovirus/Enterovirus (RV/EV) infections was compared with Influenza A & B, RSV, and hMPV over the past 3 years. There was a 152% increase in RV/EV from 2018-2019 to 2020-2021 with near absence of other respiratory viruses (Figure 1). In 2020-2021, RV/EV (N=877, 84%) made up a larger percentage of all viral etiologies compared to 2018-2019 (N=348, 11%) (Figure 2). Healthcare acquired infections (HAI) due to respiratory viruses decreased in 2020-2021 compared to both of the prior seasons, though all cases were due to RV/EV (Figure 3). There were no RV/EV associated deaths. Of 74 submitted, CDPH did typing on 24 samples; all were found to be rhinovirus (RV).
Figure 1. High-Risk Winter Viral Infections 2019-2021.

Figure 2. Distribution of Winter Viral Pathogens 2018-2019 Compared to 2020-2021 Season.

Figure 3. Winter Viral Healthcare Associated Infections 2019-2021.

Conclusion
We experienced a marked increase in RV/EV during COVID precautions, despite a near absence of other common respiratory viruses. This was reflected in both our community data and HAI due to respiratory viruses. There was a marked increase in RV/EV starting with week 18 (Figure 4). We hypothesize this is due to schools’ re-opening. Understanding RV epidemiology and transmission is important, as it may inform return to school and work protocols for the upcoming respiratory viral season.
Figure 4. Rhinovirus/Enterovirus by Week for the 2020-2021 Season.

Disclosures
All Authors: No reported disclosures
1338. Before and After: The Impact of the COVID-19 Pandemic on Influenza-Like Illness Trends in PAIVED
Authors: Colombo Rhonda E , Richard Stephanie A , Schofield Christina , Collins Limone , Ganesan Anuradha , Geaney Casey , Hrncir David , Lalani Tahaniyat , Markelz Ana E , Maves Ryan C , Maves Ryan C , McClenathan Bruce , Mende Katrin , Modi Jitu , Montgomery Jay R , Seshadri Srihari , Skerrett Catherine , Spooner Christina , Utz Gregory , Williams Alan , Burgess Timothy , Coles Christian L 
Published: December 2021

Abstract

Background
The Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) is a multicenter study assessing influenza vaccine effectiveness in active duty service members, retirees, and dependents. PAIVED recently completed its third year and offers a unique opportunity to examine influenza-like illness (ILI) trends prior to and during the COVID-19 pandemic in a prospective, well-defined cohort.

Methods
During the 2018-19, 2019-20, and 2020-21 influenza seasons, PAIVED enrolled DoD beneficiaries presenting for annual influenza vaccination. After collecting baseline demographic data, participants were randomized to receive egg-based, cell-based, or recombinant-derived influenza vaccine. Weekly throughout the influenza season of enrollment, participants were surveyed electronically for ILI, defined as (1) having cough or sore throat, plus (2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a daily symptom diary for seven days and submitted a nasal swab for pathogen detection.

Results
Over the three seasons, there were 10,656 PAIVED participants: 1514 (14.2%) in 2018-19, 5876 (55.1%) in 2019-20, and 3266 (30.6%) in 2020-21. The majority were male (68-73% per year) with a mean age of 34±14.8 years at enrollment. 2266 participants reported a total of 2673 unique ILIs. The highest percentage of participants with ILI was in 2019-20 (28.2%), versus 19.6% in 2018-19 and 9.6% in 2020-21. Figure 1 depicts the percent of individuals reporting ILI by week of the season for each of the PAIVED seasons. Notably, after March 21, 2020, the weekly incidence of participants reporting ILI never exceeded 1%.
Figure 1. Percent of PAIVED participants reporting ILI by week of season.

Conclusion
The low incidence of reported ILI in PAIVED participants during the COVID-19 pandemic is consistent with national influenza surveillance reports of influenza and outpatient ILI activity, suggesting that mitigation measures taken to reduce transmission of SARS-CoV-2 reduced the spread of other respiratory viruses.

Disclaimer

Disclosures
Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) Jitu Modi, MD, GSK (Speaker’s Bureau)
1341. Relative Vaccine Effectiveness Against Influenza-related Hospitalizations and Respiratory Events During the 2019/20 Influenza seAson in U.S. Children and Adults. A Real-World Evidence Comparison Between Quadrivalent Cell-based and Egg-based Influenza Vaccines
Authors: Pelton Stephen I , Postma Maarten , Divino Victoria , Mould-Quevedo Joaquin F , Anupindi Ruthwik , DeKoven Mitchell , levin myron J 
Published: December 2021

Abstract

Background
Non-egg-based influenza vaccine manufacturing reduces egg adaptation and therefore has the potential to increase vaccine effectiveness. This study evaluated whether the cell-based quadrivalent influenza vaccine (QIVc) improved relative vaccine effectiveness (rVE) compared to standard-dose egg-based quadrivalent influenza vaccine (QIVe-SD) in the reduction of influenza-related and respiratory-related hospitalizations/emergency room (ER) visits among subjects 4-64 years old during the 2019/20 influenza season.

Methods
A retrospective analysis was conducted among subjects 4-64 years old vaccinated with QIVc or QIVe-SD using administrative claims data in the United States of America (U.S.) (IQVIA PharMetrics® Plus). Inverse probability of treatment weighting (IPTW) was used to adjust for baseline confounders. Post-IPTW, the number of events and rates (per 1,000 vaccinated subject-seasons) of influenza-related hospitalizations/ER visits, respiratory-related hospitalizations/ER visits and all-cause hospitalizations were assessed. Poisson regression was used to estimate adjusted rVE. To avoid any influenza outcome misclassification with COVID-19 infection, the study period ended March 7,2020. A sub-analysis for a high-risk subgroup was conducted. Urinary tract infection (UTI) hospitalization was assessed as a negative control endpoint.

Results
During the 2019/20 influenza season, 1,150,134 QIVc and 3,924,819 QIVe-SD recipients were identified post-IPTW. Overall adjusted analyses (4-64 years old) found that QIVc was associated with a significantly higher rVE compared to QIVe-SD against influenza-related hospitalizations/ER visits (5.3% [95% CI: 0.5%-9.9%]), all-cause hospitalizations (14.5% [95% CI: 13.1%-15.8%]) and any respiratory-related hospitalization/ER visit (8.2% [95% CI: 6.5%-9.8%]). A similar trend was seen for the high-risk subgroup; for instance, rVE for QIVc compared to QIVe-SD against influenza-related hospitalizations/ER visits was 10.5% [95% CI: 2.9%-17.4%]. No effect was identified for the negative control outcome.

Conclusion
QIVc was significantly more effective in preventing influenza-related and respiratory-related hospitalizations/ER visits, as well as all-cause hospitalizations, compared to QIVe-SD.

Disclosures
Stephen I. Pelton, MD, Seqirus (Consultant) Maarten Postma, Dr., Seqirus (Consultant) Victoria Divino, PhD, Seqirus (Consultant) Joaquin F. Mould-Quevedo, PhD, Seqirus (Employee) Ruthwik Anupindi, PhD, Seqirus (Consultant) Mitchell DeKoven, PhD, Seqirus (Consultant) myron J. levin, MD, GSK group of companies (Employee, Research Grant or Support)