bluuebunny/crossref_metadata_2025_split huggingface dataset:
1175. Influenza Vaccine Hesitancy in Hospitalized Children, Before and During the COVID-19 Pandemic
Authors: Orbea Marisa , Dominguez Jose , Cunningham Rachel , Mary Healy C , Boom Julie A , Bocchini Claire 
Published: December 2021

Abstract

Background
Influenza vaccine is recommended for all children ≥6 months, yet uptake is suboptimal. We aimed to quantify child influenza vaccine coverage and identify factors associated with influenza vaccine hesitancy (VH) before and during the COVID-19 pandemic.

Methods
We conducted a prospective, repeated cross-sectional assessment in English and Spanish of caregiver influenza knowledge, attitudes, behaviors, and associated VH among hospitalized children 6 months through 18 years at a large pediatric medical institution. Caregivers were enrolled 4-5 days per week, between 12/11/2019--1/31/2020 and 12/8/2020--4/5/2021. VH was assessed using the Parent Attitudes about Childhood Vaccines (PACV) survey; PACV score ≥50 denoted VH. Descriptive statistics and multivariable logistic regression were used.

Results
During 2019-2020 and 2020-2021 influenza seasons, 269/282 (95%) and 295/307 (96%) of approached caregivers enrolled, respectively. By caregiver report, 94% of children in 2019-2020 and 91% in 2020-2021 were up-to-date with routine childhood vaccines (p=0.13). Specific to influenza vaccine, 73% and 68% of children received or planned to receive influenza vaccine in 2019-2020 and 2020-2021, respectively (p=0.13). Based on PACV score, 13% of parents were VH in 2019-2020 compared with 17% in 2020-2021 (p=0.24; Figure 1).
Caregivers who had not/did not intend to vaccinate their children had a higher family income (71% vs. 57% &gt;&30,000, p&lt; 0.01) and were less likely to be Hispanic/Latino (35% vs. 47%, p=0.02). 77% of caregivers were satisfied with information about influenza vaccine received from healthcare providers. Overall, 36% believed “you can get the flu from the flu shot.” In 2020-2021, caregivers were less likely to believe that “flu can be a dangerous infection in children,” to be “scared of my child getting the flu” and to agree that “all children over 6 months of age should receive the flu shot every year” (Table 1).
Table 1. Caregiver knowledge and attitudes about seasonal influenza vaccine, 2019-20 versus 2020-21

Figure 1. Influenza vaccine uptake by PACV score during 2019-2020 (a) and 2020-2021 (b) seasons

Conclusion
During the COVID-19 pandemic, caregivers of hospitalized children were less concerned about influenza than pre-pandemic and misinformation about influenza and influenza vaccine persisted. Increased efforts may be needed to educate caregivers about the importance of influenza immunization during the 2021-22 season.

Disclosures
C. Mary Healy, MD, Dexcom (Shareholder)Intuitive (Shareholder)Quidel Corporation (Shareholder)Up to Date (Other Financial or Material Support, Honorarium)Vapotherm (Shareholder)
1177. Vaccinate Lurie (VaLu) a QI Project to Improve Pediatric Pre-Transplant Immunization Rates
Authors: Heald-Sargent Taylor , John Jordan D , Toia Jacquie , Newman Alexander , Vo Truc , Semp Melissa , Le Kevin , Rowley Anne H , Thush Philip , Joong Anna , Panek Natalia , Jhaveri Ravi 
Published: December 2021

Abstract

Background
Immunization prior to transplantation is important due to post-transplant immunosuppression. According to a national study, 15% of pediatric solid organ transplant recipients were hospitalized within 5 years post-transplant for a vaccine preventable illness or RSV. At our large academic pediatric hospital approximately 53% of heart and liver transplant recipients in 2016 -2018 were up to date with tetanus and pneumococcal vaccinations. This QI project was designed to improve our pre-transplant vaccination rates to minimize post-transplant infections.

Methods
An interdisciplinary team was convened including pharmacists, nurses, nurse practitioners, and physicians from cardiology, hepatology, and infectious diseases. After evaluating our current processes and key drivers, we selected interventions to implement via the PDSA model. Our first intervention was to have team members gain access to our statewide vaccine database (ICARE). Our second cycle was to link ICARE to our electronic medical record system (EPIC) for automatic immunization record integration.
Process Map

Key Driver Diagram

Results
Our outcome measure was up to date tetanus and pneumococcal vaccines per the CDC recommendations by age at transplant, as documented in the medical record. We saw an improvement in immunization rates to 100% during the third quarter of 2020 with an overall rate of over 80% for late 2019 - mid 2020. With the understanding that our average wait time for a heart and liver transplant was 2.4 and 3.8 months, respectively, the initiation of our QI project and obtaining access to ICARE by our team members was likely related to the improved vaccination rates. Unfortunately, after the team stopped meeting during the pandemic our immunization completion rates have decreased in 2021, despite implementing institutional access to ICARE.
Control Chart

Conclusion
It is possible to obtain optimal immunization rates for pneumococcal and tetanus vaccines in pediatric heart and liver transplant recipients. Our future interventions include improving vaccinations after catch-up recommendations have been made and sustaining our interventions. Additionally, we look to expand our analysis to include outcomes related to vaccine-preventable diseases after transplantation.

Disclosures
Jacquie Toia, DNP, RN, APN, QarTek (Board Member) Ravi Jhaveri, MD, AstraZeneca (Consultant)Dynavax (Consultant)Elsevier (Other Financial or Material Support, Editorial Stipend as Co-editor in Chief, Clinical Therapeutics)Seqirus (Consultant)
1179. PCV13 Pediatric Routine Schedule Completion and Adherence Before and During the COVID-19 Pandemic in the US
Authors: Huang Liping , Nguyen Jennifer L , Perdrizet Johnna , Alfred Tamuno , Arguedas Adriano 
Published: December 2021

Abstract

Background
Coronavirus Disease 2019 (COVID) mitigation measures may have unintended consequences, such as reduced or delayed access to routine immunizations. This study examined (1) PCV13 routine vaccination completion and adherence (C&A) among US infants before and during the COVID pandemic and (2) the relationship between primary dose C&A and booster dose C&A.

Methods
Retrospective data from the Optum’s de-identified Clinformatics Data Mart Database were used to create 3 cohorts: C1, Pre-COVID; C2, During COVID; C3, Cross-COVID (Figure 1). The completion was defined as number of PCV13 doses received within 8 months of birth, and the adherence was defined number of doses received at ACIP recommended time (@2, 4, 6 months, +/- 5 days). Univariable logistic regression was used to compare the odds of primary dose C&A in cohorts C1 and C3 vs C2 and descriptive analyses were used to explore primary dose C&A in relation to booster dose C&A.
Figure 1: Study population and inclusion criteria

Results
A total of 172,916, 70,049, and 34,854 infants were included in C1, C2, and C3. Among infants with &gt; 8 months of follow-up from birth (N=132,183 for C1&C3, 16,522 for C3), 3-primary dose completion was statistically significantly higher before COVID than during COVID (crude OR = 1.10, 95% CI: 1.06-1.15). The 3-primary dose adherence was also higher before COVID than during COVID (crude OR = 1.10, 95% CI: 1.05-1.15). Among infants with ≥2, 4 and 6 months of follow-up, adherence of each individual dose was consistently higher before COVID than during COVID (1st dose: OR = 1.03, 95% CI: 1.01–1.04; 2nd dose: OR = 1.04, 95% CI: 1.01 – 1.06; 3rd dose: OR = 1.12, 95% CI: 1.08 – 1.15) (Table 1). Booster dose completion was higher in infants who completed or adhered to 3 primary doses than infants who completed or adhered to only 1 or 2 primary doses (Figure 2, Overall) and booster dose C&A was generally higher before COVID than during COVID (Figure 2, Cohort 1 vs. Cohort 3).
Table 1. Comparison of completion and adherence of primary dosing series per-COVID vs. during-COVID era

Figure 2: Booster dose completion and adherence in relation to primary dosing completion (A) and adherence (B)

Conclusion
These results indicated that PCV13 full completion was statistically lower during COVID, but the magnitude of the difference in infants was not extensive. Infants who completed or adhered to all three primary doses were more likely to complete or adhere to the booster dose. Further research is warranted as structured datasets mature to capture the full time span of COVID-19 mitigation measures.

Disclosures
Liping Huang, MD, MA, MS, Pfizer Inc (Employee) Jennifer L Nguyen, ScD, MPH, Pfizer Inc. (Employee) Johnna Perdrizet, MPH, Pfizer Inc (Employee) Tamuno Alfred, PhD, Pfizer Inc. (Employee) Adriano Arguedas, MD, Pfizer (Employee)
1180. Comparing Changes in Pneumococcal Meningitis Incidence to all Invasive Pneumococcal Disease Following Introduction of PCV10 and PCV13: The PSERENADE Project
Authors: Yang Yangyupei , Knoll Maria Deloria 
Published: December 2021

Abstract

Background
The introduction of higher valency pneumococcal conjugate vaccines (PCV10 and PCV13) has reduced invasive pneumococcal disease (IPD) incidence. It is unknown whether the degree of reduction differs for pneumococcal meningitis, a small subset of pneumococcal disease but a major cause of severe childhood morbidity and mortality globally. We compared the impact of PCV10/13 on pneumococcal meningitis and all IPD by estimating the changes in incidence following the introduction of PCV10/13 among children &lt; 5 years of age.

Methods
Data on confirmed positive cases for pneumococcus in cerebrospinal fluid (CSF) were obtained directly from surveillance sites. PCV10/13 impact on all-serotype pneumococcal meningitis and all IPD were estimated using site-specific incidence rate ratios (IRRs) at each post-PCV10/13 year relative to the pre-PCV period, using Bayesian multi-level, mixed effects Poisson regression. All-site weighted average IRRs were estimated using linear mixed-effects regression. Results were stratified by product (PCV10 vs. PCV13) and amount of prior PCV7 use (none; some (1-3 years or 4-5 years with &lt; 70% uptake); or many (≥ 4 years with ≥ 70% uptake).

Results
40 surveillance sites (9 PCV10, 31 PCV13) in 28 countries, primarily high-income (82%) that had both CSF and IPD data were included in analyses. CSF+ accounted for 9.0% of IPD cases (IQR across sites: 6.2%-15.6%). The rate and amount of decline was generally similar between meningitis and IPD across all strata. At 5 years after PCV10/13 introduction, the IRRs across PCV7-use strata were 0.28-0.32 for pneumococcal meningitis and 0.22-0.43 for all IPD at PCV10-using sites, and 0.27-0.41 and 0.21-0.32, respectively, for PCV13-using sites. Only one site from the African meningitis belt contributed eligible data, which lacked pre-PCV data to estimate IRRs, but incidence rate of both IPD and meningitis decreased following PCV introduction.
Figure 1. All-Site Weighted Average Incidence Rate Ratios, Children &lt; 5 years

* Total sites indicate the number of sites with incidence rate data included and pre/post sites indicate the number of sites with both pre− and post−PCV data to estimate site−specific IRRs for each outcome. The size of point estimates is relative to the number of sites with both pre− and post− data. ** Year 0 indicates the year of PCV10/13 introduction and year −1 indicates the last year of PCV7 use prior to PCV10/13 introduction.

Conclusion
Net declines in all-serotype IPD and CSF+ meningitis in children &lt; 5 years were similar on average for both PCV10 and PCV13. Data from low-income, high-burden, and meningitis-belt regions were limited.

Disclosures
Maria Deloria Knoll, PhD, Merck (Research Grant or Support)Pfizer (Research Grant or Support)
1186. Increased Respiratory Syncytial Virus (RSV) Viral Replication Leads to Increased Cytokine Production and Polarized Interferon Response in Infant Mucosal Epithelium
Authors: Glowinski Rebecca M , Yun Ki Wook , Mejias Asuncion , Ramilo Octavio 
Published: December 2021

Abstract

Background
RSV is the most frequent etiology of pediatric lower respiratory tract infection. Most children hospitalized for RSV are previously healthy without known risk factors. Children with mild disease managed as outpatients (OP) have higher viral loads than those hospitalized with severe disease. OP children have higher concentrations of the mucosal interferon (IFN), IFNλ2/3, and IP-10, but no differences in IFNλ1. We examined how RSV replication impacts cytokine production kinetics in the nasal mucosa.

Methods
Primary infant human nasal epithelial (iHNE) cells were collected from nasopharyngeal swabs and cultured on an air-liquid interface. Cultures were infected with 0.1 or 0.001 multiplicity of infection (MOI) of RSV-A, or mock infected. Concentrations of IFN-related (IFNα2, β, γ, λ1, λ2/3, and IP-10) and inflammatory (IL-1β, -6, -12, and TNFα) cytokines secreted to the apical and basolateral surfaces were quantified via immunoassay. Kinetics according to viral inocula were compared by ANOVA with Dunn post-hoc testing of the area under the curve (AUC) for each cytokine. Peak concentrations were compared according to MOI and secretion surface by 2-way ANOVA.

Results
AUC of IFNs in both surfaces of RSV infected cells were significantly higher than those of mock infected. The 0.1 MOI RSV inoculum resulted in significantly higher AUCs for all IFN cytokines on both surfaces than the 0.001 MOI. Peak IFNλ1 concentrations were higher on the apical than basolateral side; peak IFNλ2/3 concentrations were higher on the basolateral side than apical. AUCs of inflammatory cytokines in RSV infection were significantly higher on the basolateral, but not apical, surfaces than mock; all basolateral inflammatory cytokines were higher in the 0.1 MOI than the 0.001 MOI.

Conclusion
Higher RSV inoculum induces higher concentrations of IFN-related cytokines on both sides of epithelial cells, and higher concentrations of inflammatory cytokines on the basolateral side. Differential secretion of IFNλ1 and IFNλ2/3 to the apical and basolateral surfaces suggests they may play different roles in immune response during RSV infection. These data support viral replication as an important factor influencing RSV pathogenesis and severity through cytokine production.

Disclosures
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) 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)
1187. Neurodevelopmental Outcomes of Children with Congenital Cytomegalovirus (cCMV) Infection: Does Antiviral Treatment Matter?
Authors: Jia Margaret R , Medoro Alexandra K , Pifer Traci , Rijal Manish , Borghese Teresa , Findlen Ursula M , Malhotra S , Adunka Oliver , Shimamura Masako , Mejias Asuncion , Maitre Nathalie , Sanchez Pablo J 
Published: December 2021

Abstract

Background
cCMV infection is a major contributor to childhood neurologic and cognitive disabilities including sensorineural hearing loss (SNHL). Neonatal treatment with ganciclovir/valganciclovir improves hearing outcomes, but its impact on neurodevelopmental outcomes remains an important knowledge gap. We describe the neurodevelopmental outcomes of children with cCMV infection and evaluate the effect of neonatal antiviral therapy on outcomes.

Methods
Since 2013, infants with cCMV infection referred to Nationwide Children’s Hospital’s NEO-ID Clinic have had a complete evaluation at diagnosis as well as follow-up neurodevelopmental assessments. Pertinent demographic, clinical, laboratory, radiographic, and follow-up data were obtained and managed using REDCap. Neurodevelopmental assessments were performed using Bayley Scales of Infant and Toddler Development (BSID) III/IV (cognitive, language, motor domains) at ~ 24 months of age. The Gross Motor Function Classification System was used to classify functional motor impairment. Neurodevelopmental outcomes were compared by receipt of antiviral therapy in early infancy.

Results
95 infants (mean ± SD; gestational age 35 ± 5 wk, birth weight 2121 ± 948 g; Table 1) with cCMV infection had follow-up neurodevelopmental assessments. 62% had central nervous system involvement, 37% had SNHL, 23% developed cerebral palsy (CP), and 6% were diagnosed with autism spectrum disorder. The majority had normal BSID scores (≥ 85) in cognitive and motor domains (65% and 54%, respectively) while 48% had normal scores in the language domain. 35% had severe impairment (&lt; 70) in ≥ 1 domain (Table 2). 9 children had clinically inapparent cCMV infection; 2 (22%) had abnormalities on BSID testing (1, cognitive score: 80; 1, cognitive, language, and motor scores: 65, 68, 73, respectively). 11 (12%) children, including 6 who received antiviral therapy, had severe neurodevelopmental impairment, with CP and severe (&lt; 70) BSID scores in both the cognitive and motor domains.
Table 1. Demographic and Clinical Characteristics of 95 Children with Congenital CMV Infection by Receipt of Antiviral Treatment

Table 2. Neurodevelopmental Outcomes Based on Testing with the Bayley Scales of Infant and Toddler Development (BSID) III/IV

Conclusion
A substantial proportion of children with cCMV infection had moderate (29%) or severe (33%) neurodevelopmental impairment, CP, or autism spectrum disorder, irrespective of antiviral treatment. Urgency exists for antenatal preventive strategies and vaccine development.

Disclosures
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)
1188. The Effect Of The COVID-19 Pandemic On Influenza-Related Hospitalization, Intensive Care Admission And Mortality In Canadian Children
Authors: Groves Helen E , Papenburg Jesse , Mehta Kayur , Bettinger Julie A , Sadarangani Manish , Halperin Scott , Morris Shaun 
Published: December 2021

Abstract

Background
The COVID-19 pandemic resulted in unprecedented implementation of wide-ranging public health measures globally. During the pandemic, dramatic decreases in seasonal influenza virus detection have been reported worldwide. Information on pediatric influenza-related hospitalizations is limited. We describe influenza-related hospitalization in Canadian children during the 2020/2021 influenza season compared to ten previous seasons.

Methods
Data on influenza-related hospitalizations, intensive care unit (ICU) admissions and in-hospital deaths in children across Canada were obtained from the Canadian Immunization Monitoring Program, ACTive (IMPACT). This national surveillance initiative comprises 90% of all tertiary care pediatric beds in Canada. The total study period included eleven influenza seasons from September 2010 to April 2021 inclusive. Time series modelling was used to compare trends in influenza-related hospitalizations during the 2020/2021 season (September 2020 to April 2021 inclusive) with the ten previous seasons.

Results
During the 2020/2021 influenza season there were no pediatric influenza infection-related hospitalizations. This was a significant decrease compared to the predicted total influenza-related hospitalizations for this period (p&lt; 0.001). No pediatric ICU admission or deaths were reported for the 2020/2021 influenza season.

Conclusion
We show complete absence of influenza infection-related hospitalization in children in Canada during the 2020/2021 season. This significant decrease is likely related in large part to non-pharmacological public health interventions implemented during the COVID-19 pandemic, although the potential role of viral interference is unknown. Our findings suggest measures such as use of facemasks, hand-washing, distancing and school closures may be beneficial for influenza control and mitigation of future influenza epidemics.

Disclosures
Helen E. Groves, PhD, MBBCh BAO, Abbvie (Other Financial or Material Support, Dr. Groves reports personal fees from Honoraria received from Abbvie for education meeting presentation, not relevant to the submitted work.) Jesse Papenburg, MD, AbbVie (Grant/Research Support, Other Financial or Material Support, Personal fees)Medimmune (Grant/Research Support)Sanofi Pasteur (Grant/Research Support)Seegene (Grant/Research Support, Other Financial or Material Support, Personal fees) Manish Sadarangani, BM BCh, DPhil, GlaxoSmithKline (Grant/Research Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support)Sanofi Pasteur (Grant/Research Support)Seqirus (Grant/Research Support)Symvivo (Grant/Research Support)VBI Vaccines (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)
1191. Pediatric Long Haul Post COVID-19: Is New Jersey’s Experience Different?
Authors: Bhargava Aakriti , Farrand Lauren , Zieniewicz Stephen , Brenner Dennis J , Yeh Timothy S , Hasan Uzma 
Published: December 2021

Abstract

Background
COVID-19 impacted nearly 4 million children, accounting for 14% of total cases in the US, 1.3-3.2% of total reported hospitalizations and less than 1% deaths attributed to COVID-19. Many studies report persistent symptoms in adults several months after acute COVID-19. Similar findings have been reported from a small cohort of children in Italy. To date there are no studies reviewing long haul symptoms in children in the US.

Methods
With the goal of defining long haul in pediatric population, and providing comprehensive care to these patients, RWJBarnabasHealth launched a post-COVID CARE program in October 2020 for children. The program has provided care for approximately 16 patients with COVID related Multisystem Inflammatory Syndrome (MIS-C) and 48 pediatric patients with COVID. The goal of the Pediatric Post-COVID CARE program was to provide a multidisciplinary approach for children ages 0-21 years impacted with COVID-19. This included patients who experienced ongoing symptoms &gt;4 weeks from initial COVID-19 illness. All children were assessed by a pediatric infectious disease physician and triaged to appropriate subspecialties, all part of the long-haul care team. In addition, physical therapy and psychology support services were provided to facilitate return to normalcy.

Results
To date, our program has evaluated 64 patients. 28% experienced at least 1 symptom 4 weeks after acute COVID-19. Median age was 14 years and 77.8% were female. The follow-up study was conducted from October 2020 to May 2021. Data was collected 2 weeks, 6 weeks, 3 months, and 6 months post discharge or initial evaluation in clinic. 28% of patients were antibody positive, 55.6% experienced fatigue, 50% experienced shortness of breath or cough, 50% experienced ‘brain fog’,33% chest pain and 44.4% experienced anxiety and/or depression.

Conclusion
Early identification of patients and comprehensive protocols may facilitate return to normalcy for children with lingering somatic symptoms worsened by impact of social isolation, economic stresses, lost parental jobs, and food insecurity among many other contributing factors. Further research is needed to determine why children of certain ethnicities are impacted differently.

Disclosures
All Authors: No reported disclosures