bluuebunny/crossref_metadata_2025_split huggingface dataset:
LB18. Healthcare Utilization for Acute Respiratory Illness by Race/Ethnicity across Ambulatory, Emergency, and Hospital Settings
Authors: Mellis Alexandra M , Gilmer Matthew , Reed Carrie 
Published: December 2021

Abstract

Background
Given the disproportionate impact of COVID-19 among racial/ethnic minority groups across the United States on emergency visits, hospitalizations, and deaths, we examined healthcare utilization more broadly for acute respiratory illness (ARI across healthcare settings by racial/ethnic group.

Methods
Using data on 33,992,254 unique nonpharmacy healthcare encounters from the IBM Explorys Electronic Health Record database from January 1, 2020–May 1, 2021, across healthcare settings (ambulatory care or telehealth, emergency department, and hospitalizations) with nonmissing bridged racial/ethnic data. Encounters were classified as ARI based on ICD-10 and SNOMED codes and aggregated by month and US Census region. We estimated the population denominator as the total number of persons by bridged racial/ethnic group with encounters recorded during 2019. We both estimated the rate of ARI visits per 100,000 persons across healthcare settings and the rate ratio of ARI visits to non-ARI visits. We performed comparisons of these values by race/ethnicity, taking White persons as referent, using Poisson generalized estimating equations clustered within geographic regions.

Results
A total of 244,137 (6.5% of 3,745,135) hospitalizations, 237,873 (18% of 1,305,474) emergency visits, and 1,636,383 (5.7% of 28,941,645) ambulatory visits were associated with ARIs. We observed similar rates of ARI visits across race/ethnicity groups in all settings combined and in ambulatory settings, but higher rates of ARI hospitalization among Hispanic persons (IRR [95% CI]: 2.5 [1.7–3.7]) and higher rates of ARI emergency department visits among Black persons (2.5 [1.9–3.2]) (Figure). We also observed differences in the relative proportion of care received for ARI vs. other visits types by setting, for example with Black persons utilizing higher rates of hospital visits for ARI vs non-ARI care (2.2 [1.7–2.7]) but lower rates of ambulatory care for ARI (0.9 [0.7–0.96]).
ARI Visits Per 100k Persons

Conclusion
Population rates of ARI visits and relative proportions of ARI vs. non ARI visits differed between racial/ethnic groups by setting. Understanding how utilization of care varies for ARI across settings can inform future monitoring efforts for health equity.

Disclosures
All Authors: No reported disclosures
LB19. Intramuscular therapeutic immunization targeting RelMtb/MIP-3 induces immune signatures associated with better TB control in vivo compared to
Authors: Karanika Styliani , Gordy James , Neupane Pranita , Markham Richard , Karakousis Petros 
Published: December 2021

Abstract

Background
Tuberculosis (TB) is one of the leading causes of death from a single infectious agent worldwide. The lengthy treatment regimen reflects the unique ability of a subpopulation of “persister” bacteria to remain in a nonreplicating state in the infected host through various adaptive strategies, including induction of the stringent response. The key stringent response enzyme, RelMtb, is essential for long-term Mycobacterium tuberculosis (Mtb) survival under physiologically relevant stresses in vitro and in animal lungs. Recently, our group has generated a therapeutic, parenteral, relMtb DNA vaccine, which induces RelMtb-specific cellular immunity and augments the activity of the first-line drug isoniazid against active TB in mice and guinea pigs. Our group also has applied a novel vaccination strategy involving the fusion of an antigen of interest with the immature dendritic cell (iDC)-targeting chemokine MIP-3α/CCL20, which significantly enhances antigen-specific T-cell responses. We sought to determine if this iDC-targeting strategy improves the immunogenicity of the therapeutic relMtb DNA vaccine.

Methods
We cloned the relMtb and chemokine MIP-3α genes into the eukaryotic expression plasmid pSectag2b. We conducted an immunogenicity study using C57BL/6J mice, comparing the T-cell responses between the relMtbvs. MIP-3α/relMtb DNA intramuscular vaccination groups.

Results
Intramuscular administration of the DNA vaccine expressing the MIP-3α/relMtb gene fusion induced increased production of various Mtb-protective cytokines (IL-17α, IL-2, TNF-α, IFN-γ) in various mouse tissues, including the spleen, draining lymph nodes and peripheral blood mononuclear cells, relative to the vaccine expressing relMtb alone.

Conclusion
Intramuscular immunization with a DNA vaccine expressing relMtb/MIP-3α induces robust in vivo Mtb-protective immune signatures, suggesting this may be a promising adjunctive approach in combination with standard anti-TB therapy.

Disclosures
All Authors: No reported disclosures
170. Reduction in Bloodborne Pathogen Splash Exposures After Implementation of Universal Masking and Eye Protection for COVID-19
Authors: Drees Marci , Mase Tabe , Garvin Jennifer , Miller Kimberly 
Published: December 2021

Abstract

Background
While splashes to the eyes, nose and mouth can often be prevented through appropriate personal protective equipment (PPE) use, they continue to occur frequently when PPE is not used consistently. Due to the COVID-19 pandemic, we implemented universal masking and eye protection for all healthcare personnel (HCP) performing direct patient care and observed a subsequent decline in bloodborne pathogen (BBP) splash exposures.

Methods
Our healthcare system, employing &gt;12,000 healthcare personnel (HCP), implemented universal masking in April 2020 and eye protection in June 2020. We required HCP to mask at all times, and use a face shield, safety glasses or goggles when providing direct patient care. Occupational Safety tracked all BBP exposures due to splashes to the eyes, nose, mouth and/or face, and compared exposures during 2020 to those in 2019. We estimated costs, including patient and HCP testing, related to splash exposures, as well as the additional cost of PPE incurred.

Results
In 2019, HCP reported 90 splashes, of which 57 (63%) were to the eyes. In 2020, splashes decreased by 54% to 47 (36 [77%] to eyes). In both years, nurses were the most commonly affected HCP type (62% and 72%, respectively, of all exposures). Physicians (including residents) had the greatest decrease in 2020 (10 vs. 1 splash exposures [90%]), while nurses had a 39% decrease (56 vs. 34 exposures). Nearly all of the most common scenarios leading to splash exposures declined in 2020 (Table). We estimated the cost of each BBP exposure as &2,940; this equates to a savings of &123,228. During 2020, we purchased 65,650 face shields, safety glasses and goggles (compared to 5303 similar items in 2019), for an additional cost of &238,440.
Specific activities identified as leading to bloodborne pathogen splash exposures, 2019 vs. 2020.

Conclusion
We observed a significant decline in splash-related BBP exposures after implementing universal masking and eye protection for the COVID-19 pandemic. While cost savings were not observed, we were unable to incorporate the avoided pain and emotional trauma for the patient, exposed HCP, and coworkers. This unintended but positive consequence of the COVID-19 pandemic exemplifies the need for broader use of PPE, particularly masks and eyewear, for all patient care scenarios where splashes may occur.

Disclosures
All Authors: No reported disclosures
174. Increase in Candida auris cases in New Jersey healthcare facilities during the COVID-19 pandemic — 2017–2020
Authors: Magleby Reed , Innes Gabriel , Cherian Diya , Arias Jessica , Mehr Jason , Forsberg Kaitlin , Lyman Meghan , Greeley Rebecca 
Published: December 2021

Abstract

Background
Candida auris is a fungal pathogen associated with multidrug resistance, high mortality, and healthcare transmission. Since its U.S. emergence in 2017, to March 19, 2021, 1708 clinical infections were reported nationwide, of which 235 (13.8%) were reported in New Jersey. The New Jersey Department of Health (NJDOH) maintains C. auris surveillance in healthcare facilities (HCF) such as acute care hospitals, long-term acute care hospitals (LTACHs), and skilled nursing facilities, to monitor clinical infections and patient colonization. We aimed to characterize the epidemiology of C. auris infection and colonization among HCF patients during 2017–2020.

Methods
HCFs report C. auris cases identified from clinical specimens and surveillance activities such as admission screenings and point prevalence surveys (PPS) to NJDOH. Cases are classified as either infection or colonization using National Notifiable Diseases Surveillance System case definitions. We analyzed cases reported during 2017–2020 to describe types of cases, facilities reporting cases, and demographics of affected patients. We analyzed PPS results to calculate percent positivity of tests from patients without previously identified infection and compared percent positivity between types of facilities. We examined quarterly trends for all variables before and after the COVID-19 pandemic peak in the second quarter of 2020.

Results
During 2017–2020, 614 C. auris cases identified from clinical specimens were reported to NJDOH [243 (39.6%) infection, 371 (60.4%) colonization]; of these, 139 (57.2%) and 301 (81.1%) , respectively, were identified at long-term acute care hospitals (LTACHs). PPS percent positivity was higher at LTACHs (mean 7.6%) compared with all other facility types (mean 3.6%) for 13 of 16 quarters during 2017–2020. Case reports increased 2.6-fold from the Q2 2020 peak of the COVID-19 pandemic to Q3 2020.From Q1 to Q4 2020, PPS percent positivity increased from 4.8% to 10.5%.
Figure 1. Candida auris cases reported to New Jersey Department of Health, 2017–2020

Figure 2. Candida auris test percent positivity among healthcare facility patients sampled for point prevalence surveys* and total number of C. auris point prevalence tests performed, New Jersey, 2017–2020. *Excluding individuals already known to be cases

Conclusion
The COVID-19 pandemic may have exacerbated C. auris transmission in HCF and potential causes should be further explored. LTACHs carry a disproportionate burden of patients colonized with C. auris and should be prioritized for surveillance and containment efforts.

Disclosures
All Authors: No reported disclosures
180. Alterations to the Gut Microbiomes and Acquisition of Bacteria Resistance Elements among US International Travelers
Authors: Sridhar Sushmita , Worby Colin , Bronson Ryan , Turbett Sarah , Harris Jason , Ryan Edward T , Earl Ashlee , LaRocque Regina C 
Published: December 2021

Abstract

Background
This study investigated the impact of international travel on the acquisition and carriage of antimicrobial resistance (AMR). We prospectively assessed U.S. international travelers for the acquisition of resistant Enterobacterales species and evaluated changes in travelers’ gut microbiomes.

Methods
Metagenomic sequencing was performed on DNA extracted from pre- and post-travel stool samples of 273 U.S. international travelers. We used Kraken2 to assess microbial gut composition and analyzed antibiotic resistance gene (ARG) content using the Resistance Gene Identifier (RGI) and ResFinder, and read mapping to ARG databases. We assessed the change in gut profile and resistome associated with (i) all international travel; (ii) travel to specific geographic regions; and (iii) traveler’s diarrhea.

Results
International travel resulted in a perturbation of the gut microbiome, which was greater in travelers receiving treatment for diarrhea during travel (p = 4E-5). There was an overall loss in microbial diversity following travel, regardless of health outcome (p = 0.011); this was most consistently observed in travelers to South East Asia (SEA) (loss of gut diversity in 81% of SEA travelers). 78% of all travelers had a higher relative abundance of E. coli after travel, including 85% of travelers who acquired AMR bacteria during travel. Travel to South Asia was also associated with a significantly greater increase of E. coli relative to other destinations (p = 0.04). Additionally, the relative abundance of Pasteurellales was higher in the pre-travel samples of those who subsequently acquired AMR bacteria (FDR = 0.08). Furthermore, there was a significant increase in ARG content among the post-travel samples, with regional differences in the magnitude of acquisition (Figure 1). 72% of all travelers had a greater resistance burden post-travel. SEA was associated with the greatest increase in resistome diversity, while South America was associated with the greatest increase in overall ARG content.
Resistance genes present in the gut microbiome.

Genes mapping to the Comprehensive Antibiotic Resistance Database were measured pre- (x-axis) and post-travel (y-axis) to assess the acquisition of resistance genes in association with travel, distinguished by geographic region. Colors indicate geographic regions visited by travelers: South America (red), South East Asia (blue), South Asia (green), Eastern Africa (purple), Southern Africa (orange), Other (grey).

Conclusion
International travel is associated with a perturbation in the gut microbial community, with the acquisition of AMR bacteria and genes, and an increase in the relative abundance of E. coli. These perturbations following travel may be important factors in the global spread of AMR.

Disclosures
All Authors: No reported disclosures
184. Inducible Clindamycin Resistance Testing on Pediatric Streptococcus pneumoniae Isolates
Authors: Olarte Liset , Swanson Douglas S , Tabakh Jennifer E , Banerjee Dithi , Selvarangan Rangaraj 
Published: December 2021

Abstract

Background
In 2013, the Clinical and Laboratory Standards Institute recommended inducible clindamycin resistance (ICR) testing on macrolide-resistant Streptococcus pneumoniae isolates, which arises due to the ermB gene. Ribosomal methylation by ermB confers resistance to macrolides (high-level resistance), lincosamides and streptogramin B. The goal of our study is to characterize the prevalence of ICR among pediatric pneumococcal isolates.

Methods
We identified erythromycin-resistant(R) (minimum inhibitory concentration [MIC] ≥ 1 µg/mL) and clindamycin-susceptible(S) (MIC ≤ 0.25 µg/mL) pneumococcal isolates from pediatric patients seen at Children’s Mercy Hospital from 2007 to 2017. Determination of ICR was achieved via disk approximation (D-zone test) with standard erythromycin (15 µg) and clindamycin (2 µg) disks. Isolates with high-level erythromycin resistance (MIC ≥ 32µg/mL) were also tested for ermB gene by PCR. Positive and negative controls were used for D-zone test and ermB PCR.

Results
We identified 289 erythromycin-R pneumococcal isolates; of those 194 (67.1%) were clindamycin-S (Figure 1). One-hundred and sixty-nine isolates were available for ICR testing, 166 (98%) isolates represented non-invasive disease samples. Median age of patients with erythromycin-R and clindamycin-S isolates was 19 (range 0.1 – 180) months. None of the isolates expressed ICR based on the D-zone test. Thirteen of those isolates (7.7%) expressed high-level erythromycin-R (MIC range 32-128 µg/mL); all were negative for ermB. The most common serotypes/serogroups among erythromycin-R and clindamycin-S isolates were: 15 (n=22), 35B (n=19), 11 (n=16), 6 (n=16), 19A (n=14) and 33 (n=12).

Conclusion
Erythromycin-R and clindamycin-S pneumococcal isolates did not express ICR and isolates with high-level erythromycin-R did not carry ermB. Multicenter studies are needed to determine if ICR testing is required for macrolide-resistant pneumococcal isolates in the PCV13 era.

Disclosures
Liset Olarte, MD, MSc, GSK (Research Grant or Support)Merck (Research Grant or Support)Pfizer (Research Grant or Support)Sanofi (Research Grant or Support) Douglas S. Swanson, MD, Merck (Research Grant or Support)Pfizer (Research Grant or Support)Sanofi (Research Grant or Support)
186. Characteristics of COVID-19 Vaccine Breakthrough Cases in Minnesota, 2021
Authors: Meyer Stephanie , Saupe Amy , Bieringer Aaron , Holtzman Corinne , Magnuson Luke , Bye Erica , Muscoplat Miriam , Wang Xiong , Lorentz Alexandra , Como-Sabetti Kathryn , Lynfield Ruth , Lynfield Ruth 
Published: December 2021

Abstract

Background
Over 600,000 COVID-19 cases, including &gt;7000 deaths reported to MN Dept of Health (MDH) by June 1, 2021. Clinical trials demonstrated high effectiveness of COVID vaccines. We assessed COVID-19 cases among fully vaccinated residents [vaccine breakthrough (VB) cases].

Methods
COVID-19 VB cases were MN residents with completed COVID-19 vaccination series ≥14 days prior to symptom onset or positive for SARS-CoV-2 by nucleic acid amplification or antigen test. COVID-19 cases were reported to MDH and COVID-19 vaccinations reported to the MN Immunization Information Connection (MIIC). COVID-19 cases were matched to MIIC to identify VB and interviewed; medical records of hospitalized cases were reviewed. Available VB case specimens underwent whole genome sequencing (WGS) at MDH or collaborating lab.

Results
Jan 19 – June 1, 2021, 2765 VB cases were reported among &gt;2.45 million fully vaccinated residents and 147,445 COVID-19 cases. VB case median (MED) age was 52 y (IQR 38, 68), 83% white, 65% female; MED age of fully vaccinated was 55 y (IQR 30, 68), 77% white, 54% female. Of VB cases, 273 (10%) were hospitalized and 32 (1%) died (MED age 74 y; IQR 66, 85). 2212 (80%) VB cases were interviewed; 60% reported symptoms; most common were fatigue (53%), rhinorrhea (49%), cough (42%), headache (41%). 35% reported a comorbidity.
Of hospitalized VB cases, 120 had completed record reviews. 64 were admitted for COVID-19 related illness (MED age 74 y, IQR:65, 83) including 27 admitted to ICU (MED age 71 y, IQR: 65, 83). 90% (108) reported a comorbidity, most common being chronic metabolic conditions (46%), obesity (45%), renal disease (31%) and chronic lung disease (26%); 27 were immunocompromised (not mutually exclusive), including immunosuppressive therapy (15), hematological malignancy (9), other cancer (11), and organ transplant recipients (8).
Of 604 VB case specimens, 79% were B.1.1.7, 9% B.1.427/429, 3% P.1, and 2% B.1.351; lineage distribution was similar to overall 24,157 MN SARS-CoV2 WGS data.

Conclusion
Identified VB cases were 0.1% of those vaccinated and &lt; 2% of total cases reported in the time period. COVID-19 vaccines are an important tool in preventing COVID-19. Additional surveillance, including WGS and case characteristics will be useful to monitor VB.

Disclosures
Ruth Lynfield, MD, Nothing to disclose
188. Visualizing the Impact of a Wedding Leading to COVID-19 Outbreaks in Healthcare Settings, Washington State, July – August 2020
Authors: Brezak Audrey , Unutzer Anna , Lewis James W , Clark Shauna , Ferro Jessica , Bliesner Siri , Loughran Julie , Kawakami Vance , Deya Ruth , Makayoto Rhodah , Maier Em , Whitney Holly , Bevers Elyse , Templeton Allison A , Burlingham Bonnie , Lewis Larissa , Podczervinski Sara T 
Published: December 2021

Abstract

Background
Large social gatherings during the COVID-19 pandemic have been linked to extensive community transmission. Healthcare workers (HCW) that engage in these social gatherings pose a risk to the vulnerable patients they serve. Public Health—Seattle & King County identified a COVID-19 outbreak associated with a wedding in July 2020 when the 14-day incidence rate was 105 cases per 100,000 residents. HCW who attended the wedding were subsequently linked to 45 outbreaks in healthcare settings across three counties in the next month.

Methods
COVID-19 case interview data was used to identify HCW cases who reported the wedding as their exposure event. The Washington Disease Reporting System (WDRS), the state database in which COVID-19 cases and epi-linkages are tracked, was queried to identify healthcare outbreaks linked to the HCW wedding-attendee cases and the HCW that they infected. NodeXL was used to visualize the resulting chains of wedding-associated healthcare transmission using a Harel-Koren Fast Multiscale layout where the network visualization’s directed arrows represent putative links and direction of transmission. Numbers of associated settings, cases, and deaths were calculated.

Results
Seven HCW wedding attendees were linked to outbreaks in healthcare facilities that they worked at while infectious; HCWs linked to as many as six subsequent healthcare outbreaks. In total, the wedding was connected to 45 healthcare facilities: adult family homes (N=1), hospitals (N=1), supported living agencies (N=7) and associated group homes (N=38), assisted living (N=1), home health services (N=1), behavioral health (N=2), and rehab centers (N=1). Across the settings, 277 cases were identified, including 15 deaths.

Conclusion
A series of COVID-19 healthcare outbreaks was traced back to a wedding. Cases worked in multiple homes, agencies, and other healthcare settings which likely facilitated rapid and wide transmission; the structure of these healthcare settings often do not facilitate a single job providing enough hours and income to support an individual. In terms of public health learnings, addressing these outbreaks require effective contact tracing, multijurisdictional coordination, and for supported living, interventions need to be applied across households sharing staff.

Disclosures
All Authors: No reported disclosures
190. Epidemiology of COVID-19 Breakthrough Infections in Dallas County, Texas, 2021
Authors: Wada Suzanne , Wiegand Jared , Markarian Mary , Hung Victoria , Zhu Christina , Parayil Megin , Shim Kyoo , Serrano Jose , Chung Wendy 
Published: December 2021

Abstract

Background
From March 2020 through May 2021, Dallas County reported a total of 304,056 cases of COVID-19, including 4,073 deaths. During the month of December 2020, a post-holiday surge of cases led to peak daily average case rates of over 50 cases per 100,000. COVID-19 cases and deaths have since declined substantially following the rollout of COVID-19 vaccine delivery. As of June 8, 2021, about 1,831,588 Dallas County residents have received at least one COVID-19 vaccine dose and 910,067 are fully vaccinated. Recent county integration of immunization and case databases enabled identification and analysis of COVID-19 breakthrough infections.

Methods
A COVID-19 breakthrough infection was defined as a positive test (PCR or antigen) collected from an individual ≥ 14 days after receiving the full series of an FDA-authorized COVID-19 vaccine. Nationally, 10,262 vaccine breakthrough infections had been reported from 46 US states and territories, through April 2021. Vaccine breakthrough cases were reviewed and medical records abstracted to collect demographic information, clinical characteristics, and medical conditions. Data analysis was performed using R, version 4.0.2 (2020).

Results
Of the 700 vaccine breakthrough cases reported in Dallas County residents as of June 8, 2021, 304 (43%) were male and 396 (57%) female, with an average age of 53 years. The majority of the vaccine breakthrough cases were White (42%); 25% were Hispanic/Latino; and 20% were Black. Almost all breakthrough cases were confirmed with PCR testing, with 451 (64%) cases receiving the Pfizer vaccine. Of breakthrough cases, 49% were symptomatic; 52% (358) had underlying conditions including: tobacco use, obesity, or immunocompromised state; 68 (10%) were hospitalized; and 11 (1.6%) died. Whole genome sequencing was performed on 51 cases, with 14 (27.5%) variants identified, including: eight B.1.1.7, two B.1.429 and one P.1 variants.

Conclusion
Despite the high levels of vaccine efficacy documented in US vaccine trials, COVID-19 breakthrough infections, though currently uncommon, do occur and are important to investigate. Ongoing close public health surveillance of variants is needed to discern changes in patterns of vaccine efficacy and characteristics of populations at greatest risk of severe disease from COVID-19.

Disclosures
All Authors: No reported disclosures