bluuebunny/crossref_metadata_2025_split huggingface dataset:
1203. A Descriptive Analysis of an Opioid Use Disorder Care Continuum in an Infectious Diseases Clinic
Authors: Blevins Sarah R , Grubbs James A , Stivers Tiffany , Sabitus Kathryn , Weeks Ryan , Thornton Alice 
Published: December 2021

Abstract

Background
On December 17, 2020, U.S. CDC released an advisory reporting the highest drug overdose rate on record. Kentucky ranks in the top 5 states for opioid overdose deaths. Retention in opioid use disorder (OUD) treatment is associated with decreased overdose deaths. University of Kentucky HealthCare’s infectious disease division (UKID) implemented a multi-disciplinary approach to expand access to medication for opioid use disorder (MOUD) for patients with injection drug use-associated infections (IDU-AI). This program is modelled after the Ryan White Cares Act to engage and retain patients.

Methods
. This ongoing project began enrollment in June 2019. Any patient ≥18 years old with IDU-AI and OUD is eligible for enrollment unless pregnant or incarcerated. Patients are eligible for transportation assistance, mental health services, and medical case management. They may start MOUD with UKID or be referred elsewhere. In this analysis, we describe our opioid use disorder care continuum and identify reasons for patient attrition and areas to improve

Results
Our continuum components are referral, eligible, enrolled, start MOUD, and retention at month 1, 3, and 6. To date, 533 patients have been referred. Of these, 383 (71.9%) were eligible and 150 (39%) enrolled. Reasons patients did not enroll: discharged stable (41.5%), left AMA (16.9%), declined (10.8%), deceased (6.7%), discharged to other hospital (3.6%), missed clinic visit (9.7%), hospice (1%), other (10.8%). Reasons patients declined: no reason (28.6%), refused to discuss (19.1%), no interest (14.3%), travel (4.8%), declined ID follow-up (4.8%), time limits (9.5%). Ninety-three patients have been enrolled ≥6 months; 83 are on MOUD. Sixty-seven, 29, and 20 patients were retained at month 1, 3, and 6, respectively.

Conclusion
UKID engages patients in OUD treatment, but retention rates are comparable to those described in non-ID settings. Most attrition occurs between eligibility and month 3, suggesting patients are most vulnerable when they consider change and start MOUD. These time points should be priority for patient engagement by clinic staff. Also our staff size struggles to meet the demand. The number of referrals is prohibitive for our small team to approach everyone in a timely manner. More programs like this one are needed.

Disclosures
All Authors: No reported disclosures
1205. Vaccine Hesitancy in Paediatric Practice and Predictors of Physician-Reported Vaccine Compliance
Authors: Allan Kate E 
Published: December 2021

Abstract

Background
This study explores the frequency with which Canadian paediatricians encounter vaccine hesitancy in their clinical practice, the most common approaches to parent resistance, impact of hesitancy practice and predictors of physician-reported vaccine compliance.

Methods
This analysis used data collected from Canadian paediatricians and paediatric subspecialists via a one-time survey distributed by the Canadian Paediatric Surveillance Program in the fall of 2015. Descriptive analyses were conducted to determine the frequency of hesitancy, approaches to parent resistance and impact on clinical practice. A classification tree was generated to determine the most important predictors of physician-reported vaccine compliance.

Results
A total of 669 paediatricians completed the survey. Eighty-nine percent (n=588) of respondents indicated they had encountered hesitancy in their practice, with the top concerns including: Autism, too many vaccines, risk of a weakened immune system, and vaccine additives. The most common responses to parent resistance included discussing risks of non-vaccination, restating the vaccine recommendation and referring to reliable patient resources. Forty-five percent (n=301) of physicians indicated that hesitancy impacted their practice. Overall, the best predictor of physician-reported vaccine compliance was the use of a personal endorsement or anecdote (x2=6.955,df=1, adj.p&lt; 0.01). Among physicians who did not use a personal endorsement, the next best predictor of vaccine compliance was spending 10 minutes or more discussing vaccination (x2=7.418, df=1,adj.p&lt; 0.05).

Conclusion
This study contributes to a nascent body of literature related to paediatricians’ experience with vaccine hesitancy in a Canadian context, particularly as it relates to the impact of hesitancy on practice. This study demonstrates the ubiquity of hesitancy in clinical practice, the profound impact of hesitancy on paediatricians and highlights promising responses to parental hesitancy that may improve vaccine compliance. Future research should explore potential hesitancy interventions including using a personal endorsement and prolonged engagement using more rigorous methods of evaluation.

Disclosures
Kate E. Allan, PhD, Pfizer (Other Financial or Material Support, Postdoctoral Fellowship at the Centre for Vaccine-Preventable Diseases (at University of Toronto) is funded by Pfizer.)
1206. Effects of Climatic Variability on Lyme Disease Outbreaks in California
Authors: Kangath Raghesh Varot , Ramachandra Rajasree Pai , Madurapperuma Buddhika , Scaroni Luke 
Published: December 2021

Abstract

Background
Climate change has increased the risk of tick borne infections. The life cycle and prevalence of deer ticks are strongly influenced by temperature. Warmer temperatures associated with climate change are projected to increase the range of suitable tick habitats driving the spread of Lyme disease (LD). Short winters could also increase tick activity increasing the risk of exposure. This study examines the relationship between LD incidence and temperature-precipitation and their anomalies in CA counties.

Methods
Trends and relationships of Lyme Disease (LD) cases and climatic factors were analyzed among the California counties from 2000 to 2019. Lyme disease tabulate data and climatic data were obtained from Centers for Disease Control, and NOAA, and Climate Data Guide respectively. Canonical correspondence analysis (CCA) was performed using variables: (i) LD cases, (ii) precipitation & anomaly, and temperature & anomaly. The CCA ordination explained the variability between LD cases and climatic variables. Biplots were used to visualize the associations between LD cases and climatic anomalies.

Results
We compared the countywide LD cases in relation to climatic factors in California from 2000 to 2019. A total of 96 cases in 2000, 117 cases in 2009, and 144 cases in 2019 were reported in the 55 counties of California. Santa Clara reported the highest LD cases in 2003 (23 cases; 16%), followed by Los Angeles in 2013 (20 cases; 18%) and Santa Cruz in 2017 (19 cases; 13%). CCA ordination showed distinguishable clustering patterns between southern California counties (Santa Clara, Santa Cruz, Alameda, and San Diego) and northern coast and Klamath mountains range (Humboldt, Trinity, Shasta, and Siskiyou) regions (Fig. 1). Moderate mean annual temperature (56.5 °F - 62.5 °F) and temperature anomaly (3.8 °F - 5.5 °F) were the most important variable predictor for high LD outbreak.

The CCA ordination shows the relationships between Lyme Disease and climatic variables for the 55 Counties of California. The bottom right circle represents Lyme cases positively correlated with temperature anomaly (3.8 °F - 5.5 °F) and moderate annual mean temperature (56.5 °F - 62.5 °F). The upper left circle represents Lyme cases negatively correlated with mean annual precipitation.

Conclusion
Moderate temperature with low moist spell anomalies in the south neighboring CA counties showed a positive influence on LD outbreak. The climatic conditions in those areas suitable for Oak trees and masting acorn resulting in the establishment of tick and host (deer) populations. We recommend robust surveillance and lab testing for patients with a history of tick bites in these regions.

Disclosures
All Authors: No reported disclosures
1207. Coronavirus Disease, 2019 (COVID-19) in Long-Term Care Facilities (LTCF): One Large County’s Response, California 2020-2021
Authors: Chinn Raymond Y , Thihalolipavan Sayone , Wheeler Jennifer , Kang Grace , Malone John D , McDonald Eric 
Published: December 2021

Abstract

Background
The coronavirus-19 disease (COVID-19) outbreak has had a particularly devasting effect on skilled nursing facility (SNF) residents and healthcare workers (HCWs). While representing only 11% of COVID-19 cases, the residents accounted for 43% of deaths in the United States.

Methods
We report a retrospective review of the support provided by our local health department (LHD) to long-term care facilities in response to the COVID-19 pandemic. This group comprised of staff from healthcare-associated infections (HAI); the Medical Operations Center (MOC); Testing, Tracing, and Treatment (T3); and the Healthcare Provider Status Taskforce (Table 1 outlines their functions). The HAI team with the State Public Health Department provided infection prevention and control (IPC) outbreak investigation, education, recommendations, and ongoing access to technical assistance. The T3 team focused on rapid response testing and tracing; the HPSTF team collected data and issued questionnaires; the MOC responded to staffing and PPE requests; and the Long-Term Care Facility sector presented routine telebriefings to update the facilities on public health guidance, share resources, and answer questions during and in between briefings.
Table 1. Sectors and Function of Response Teams to COVID-19

Results
From March 2020 through May 2021, there were 504 outbreaks in LTCFs; the HAI team performed 281 outbreak investigations (Figure 1). In the same period, 308,264 molecular tests were performed using various platforms; laboratory services were outsourced during peak testing requests (Figure 2); “strike teams were deployed to facilitate testing on 404 occasions. Self-reported fully vaccination rate for SNF staff was 73% (March 2021) and 76% for residents (April 2021). There were 568 staff requested; total orders for PPE were 4,839 and 16,892,823 PPE items were fulfilled (Figure 3). In addition to knowledge gaps in IPC, other challenges included shifting IPC guidance, PPE shortages, timeliness of test results that impacted cohorting, community acquisition of disease with transmission to residents, interfacility spread among staff, staffing shortages, and vaccine hesitancy issues.

Figure 1. Number of Outbreaks and Number of Outbreak Investigations

Figure 2. Number of Tests Performed by the Public Health Laboratory and the Number of Visits by “Strike Teams”

Figure 3. Personal Protective Equipment Fulfillment during COVID-19 Pandemic

Conclusion
The management of the recent COVID-19 outbreaks required a multi-pronged approach. Lessons learned are applicable to other highly transmissible infectious diseases.

Disclosures
All Authors: No reported disclosures
1208. Omadacycline In Vitro Activity Against Bacillus Anthracis
Authors: Serio Alisa W , Carl Gelhaus H , Eichelberger Noah , Heine Henry S , Anastasiou Diane M , Eichhorst Kristina 
Published: December 2021

Abstract

Background
Bacillus anthracis, the etiological agent of anthrax, is one of the agents most likely to be used in a biologic attack. Omadacycline previously has demonstrated potent in vitro and in vivo activity against B. anthracis. This project evaluated the in vitro activity of omadacycline against a larger set of B. anthracis strains across two laboratories.

Methods
Methods: Antibiotic susceptibility testing followed Clinical Laboratory Standard Institute methods against a collection of 53 B. anthracis strains at the University of Florida (UF) and 50 B. anthracis strains at MRIGlobal, representing human and animal isolates from North America, Africa, Europe, Asia, and Australia. Minimum inhibitory concentrations (MICs) for omadacycline and comparators at both sites (doxycycline, ciprofloxacin, levofloxacin, moxifloxacin) were determined by broth microdilution.

Results
Results: In the UF study, omadacycline demonstrated an MIC50 of 0.015 mg/L and an MIC90 of 0.03 mg/L against B. anthracis. Omadacycline MIC values were equal to or lower than doxycycline. In the MRIGlobal study, omadacycline demonstrated an MIC50 of 0.06 mg/L and an MIC90 of 0.06 mg/L (Table 1). All comparator MIC values were within ranges previously observed against these strains. Against a ciprofloxacin-resistant strain (MIC = 2 mg/L), omadacycline had an MIC value of 0.015 mg/L; against a doxycycline-resistant strain (MIC = 4 mg/L), omadacycline had an MIC value of 0.06 mg/L. Reproducibility was observed between the 2 laboratories for omadacycline in vitro activity against B. anthracis (Table 2).
Table 1. MIC Concentration Summary for Omadacycline and Comparators Against B. anthracis Strains

Table 2. Reproducibility of Omadacycline in Vitro Activity Against B. anthracis Strains

Conclusion
Based on the in vitro activity in both studies, omadacycline has the potential to be effective in treating anthrax infection. Reproducibility of omadacycline in vitro activity against B. anthracis was observed at 2 independent study sites.

Disclosures
Alisa W. Serio, PhD, Paratek Pharmaceuticals, Inc. (Employee, Shareholder) Diane M. Anastasiou, BA, Paratek Pharmaceuticals, Inc. (Consultant)
1209. The Evolving Nature of Syndromic Surveillance During the COVID-19 Pandemic in Massachusetts
Authors: Willis Sarah J , Eberhardt Karen , Randall Liisa , DeMaria Alfred , Brown Catherine M , Madoff Lawrence C , Zambarano Bob , Ochoa Aileen , Klompas Michael , Cocoros Noelle 
Published: December 2021

Abstract

Background
We developed a syndromic algorithm for COVID-19 like illness (CLI) to provide supplementary surveillance data on COVID-19 activity.

Methods
The CLI algorithm was developed using the Electronic Medical Record Support for Public Health platform (esphealth.org) and data from five clinical practice groups in Massachusetts that collectively care for 25% of the state’s population. Signs and symptoms of CLI were identified using ICD-10 diagnosis codes and measured temperature.
The algorithm originally included three categories: Category 1 required codes for coronavirus infection and lower respiratory tract infections (LRTI); Category 2 required an LRTI-related diagnosis and fever; Category 3 required an upper or lower RTI and fever.
The three categories mirrored statewide laboratory-confirmed case trends during spring and summer 2020 but did not detect the increase in late fall. We hypothesized this was due to the requirements for fever and LRTI. Therefore, we added three new categories defined by milder symptoms without fever: Category 4 requires LRTI-related diagnoses only; Category 5 requires upper or lower RTI or olfactory/taste disorders; and Category 6 requires at least one sign of CLI not identified by another category.

Results
The six-category algorithm detected the initial surge in April 2020, the summer lull, and the second surge in late fall (see figure). Category 1 cases were not identified until mid-March, which coincides with the first laboratory-confirmed cases in Massachusetts. Categories 2 and 3, which required fever, were prominent during the initial surge but declined over time. Category 5, the broadest category, declined during February and March 2020, likely capturing the end of the influenza season, and successfully detected the spring surge and fall resurgence. Weekly number of COVID-19 like illnesses by category, February 2, 2020 through May 8, 2021

Conclusion
A syndromic definition that included mild upper RTI and olfactory/taste disorders, with or without fever or LRTI, mirrored changes in laboratory-confirmed COVID-19 cases better than definitions that required fever and LRTI. This suggests a shift in medically attended care and/or coding practices during initial vs subsequent surges of COVID-19, and the importance of using a broad definition of CLI for ongoing surveillance.

Disclosures
Michael Klompas, MD, MPH, UpToDate (Other Financial or Material Support, Chapter Author)
1212. COVID-19 and the Importance of Institutional Trust to Public Health
Authors: Kricorian Karin , Kricorian Katherine 
Published: December 2021

Abstract

Background
Institutional trust is a key component of the public health system’s effectiveness. However, the COVID-19 pandemic highlighted gaps in institutional trust and hesitation. Analysis was conducted to understand correlates of institutional trust to inform communication strategies for the ongoing pandemic and future public health crises.

Methods
The Roper Center for Public Opinion/ America’s Voice Project Coronavirus Index conducted a US online survey February 22-April 5, 2021 and included questions about COVID-19 experiences, attitudes and behaviors. Respondents also indicated trust in each of four institutions to provide accurate information about COVID-19: federal government, state government, CDC and national public health officials. Scores were summed to create an Institutional Trust (IT) index: the top third was classified as “High IT,” the middle third “Moderate IT” and the bottom third “Low IT.” Data were analyzed using χ2 tests, with z-tests for more granular between-group comparisons.

Results
Those with Low IT were significantly more likely than those with Moderate or High IT to be white, male, rural, politically conservative, married, and live with children under age 18. Low IT individuals were less likely to have been tested for COVID-19 themselves and less likely to know someone who had tested positive for COVID-19. However, Low IT respondents were more likely to have tested positive for COVID-19, even when controlling for their lower propensity to be tested. Low IT individuals were significantly more likely to have visited restaurants and stores in the past week and feel these activities posed no health risk; they also wore masks less often. Despite greater risk-taking, Low IT respondents were over five times more likely than High IT respondents to refuse the COVID-19 vaccine.

Conclusion
Low IT was associated with higher COVID-19 vaccine hesitancy as well as behavior that, at the time data was collected, put people at higher risk of contracting COVID-19. Public health officials should prioritize the development of more effective communications towards Low IT populations. Traditional methods of establishing message credibility may require modification in order to encourage Low IT individuals to participate in behaviors that enhance public health.

Disclosures
All Authors: No reported disclosures
1213. Vaccine Uptake Amongst Participants in the North Carolina COVID-19 Community Research Partnership Who Were Initially Receptive or Hesitant to Receive a COVID-19 Vaccine
Authors: Munawar Iqra , Seals Austin L , Sanders John W , Herrington David M , Wierzba Thomas F 
Published: December 2021

Abstract

Background
Public health officials are concerned that adults may refuse to be vaccinated with an approved COVID-19 vaccine thereby limiting the community health benefit. Here, we studied the self-reported intent to be vaccinated of persons in North Carolina (NC) and then measured whether they did or did not get vaccinated.

Methods
The Community COVID-19 Research Partnership (CCRP) is a large prospective study exploring COVID-19 epidemiology and sequelae in participants of several mid-Atlantic and Southern States. All participants complete an online daily survey where they are asked questions about COVID-like symptoms, infections, and their vaccination status. In addition to the daily survey, in December 2020, we implemented a short online cross-sectional survey questioning NC participants on whether they intended to be vaccinated. After completing the cross-sectional survey, we used daily survey data through 15 May 2021 to see if participants reported receiving vaccine. Unvaccinated participants who did not complete the daily survey 30 days or more prior to 15 May 2021 were excluded.

Results
18,874 participants completed the cross-sectional survey and reported vaccination status. Of these participants, 90% were white, 68% were female, 26% were healthcare workers, and 2% self-reported COVID-19 diagnosis The median age was 54 years (IQR: 41 – 65). 79%, 13%, 9%, and 2% answered yes, unsure, no, and prefer not to answer, respectively, about intention to be vaccinated (Table). 99% of the participants who intended to receive the COVID-19 vaccine reporting being vaccinated. Those who were unsure or intended not to get vaccinated had vaccination rates of 80% and 53%, respectively. 78% of the participants who preferred not to answer were vaccinated.

Table
Vaccine intent versus vaccine status – COVID-19 Community Research Partnership, North Carolina, December 2020 – May 2021

Conclusion
More than three-quarters of NC participants intended to get vaccinated and by mid-May 2021, the vast majority had received at least one dose. Similarly, those who were unsure or preferred not to say were mostly vaccinated. Even among those who reported they would not get vaccine in January, more than half had received vaccine by May. The nature of our sample makes it difficult to generalize results to the population of NC; nevertheless, further investigation as to the causes of the shift in attitudes is warranted.

Disclosures
All Authors: No reported disclosures