bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in invasive pneumococcal disease among adults living with HIV following introduction of 13-valent pneumococcal conjugate vaccine, 2008–2014
Authors: Kobayashi Miwako , Adih William , Li Jianmin , Gierke Ryan , Almendares Olivia M , Watt James , Alden Nisha , Petit Susan , Farley Monica , Harrison Lee , Lynfield Ruth , Baumbach Joan , Thomas Ann , Schaffner William , Pilishvili Tamara 
Published: October 2017

Abstract

Background
People living with HIV (PLHIV) are at increased risk of invasive pneumococcal disease (IPD). Introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in children in 2010 reduced adult IPD burden (indirect effects). In 2012, PCV13 was recommended in series with 23-valent polysaccharide vaccine (PPSV23) for adults with immunocompromising conditions, including PLHIV. We evaluated changes in IPD incidence in adults ≥19 years old with and without HIV after PCV13 introduction for children in 2010 and for immunocompromised adults in 2012. PCV13 coverage for adults 19–64 years old with indications was 6% in 2014.

Methods
IPD cases, defined as pneumococcal isolation from sterile sites, were identified through CDC’s Active Bacterial Core surveillance, with counts projected nationally. HIV status was obtained from medical records. Isolates were serotyped by Quellung reaction or PCR and grouped into PCV13-types, PPV11-types (unique to PPSV23), or non-vaccine types. We estimated IPD incidence (cases per 100,000 people) using national case-based HIV surveillance (for PLHIV) or US Census data (for non-PLHIV) as denominators. We compared IPD incidence in 2011–12 and 2013–14 to the pre-PCV13 baseline (2008–09) by serotype groups.

Results
Overall IPD incidence at baseline was 354.0 for PLHIV and 15.5 for non-PLHIV. From baseline to 2013–14, IPD rates declined in both PLHIV (-36.3%; 95% CI: -38.8, -33.7%) and non-PLHIV (-27.3%; 95% CI: -28.2, -26.5%). The largest reductions were noted in PCV13-type IPD in both PLHIV (Figure 1) and non-PLHIV (Figure 2) for both periods (-46.8% for PLHIV and -45.9% for non-PLHIV in 2011–12; -60.3% for PLHIV and -65.8% for non-PLHIV in 2013–14). Overall IPD rates were 22.8 (95% CI: 22.2, 23.4) times as high in PLHIV compared with non-PLHIV at baseline, and 19.4 (95% CI: 18.8, 20.0) times as high in 2013–2014.

Conclusion
IPD rates declined significantly in both PLHIV and non-PLHIV during the study period due to reductions in PCV13-type IPD; however, IPD rates remained 20-fold in PLHIV compared with non-PLHIV. Similar magnitude reductions in PCV13-type IPD in both groups and low PCV13 coverage in immunocompromised adults suggest that most of the observed decline is due to PCV13 indirect effects from childhood immunization.

Disclosures
L. Harrison, GSK: Scientific Advisor, Consulting fee; W. Schaffner, Pfizer: Scientific Advisor, Consulting fee; Merck: Scientific Advisor, Consulting fee; Novavax: Consultant, Consulting fee; Dynavax: Consultant, Consulting fee; Sanofi-pasteur: Consultant, Consulting fee; GSK: Consultant, Consulting fee; Seqirus: Consultant, Consulting fee
Leveraging the ART Advantage: diabetes and hypertension along the HIV care cascade in rural South Africa
Authors: Manne-Goehler Jennifer , Siedner Mark , Geldsetzer Pascal , Harling Guy , Montana Livia , Rohr Julia , Gomez-Olive Xavier , Wade Alisha , Davies Justine , Barnighausen Till 
Published: October 2017

Abstract

Background
Participation in antiretroviral therapy (ART) programs has been associated with greater utilization of care for diabetes and hypertension in rural South Africa. However, there is limited data about whether this apparent “ART advantage” translates into improved chronic disease management indicators.

Methods
The Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) is a cohort of 5,059 adults &gt;40 in Agincourt. The study collects data on demographics, healthcare utilization, height, weight, blood pressure (BP), and blood glucose. HIV infection, HIV-1 RNA viral load (VL) and ART drug levels are tested via dried blood spots. We defined hypertension (HTN) based on measured BP or self-report of diagnosis by a healthcare provider or use of antihypertensive medication and diabetes (DM) by measured glucose or self-report of diagnosis by a healthcare provider or the use of DM medications. Our primary predictor of interest was stage along the HIV care cascade (HIV-, HIV+ not on ART, ART with a detectable VL, and with a suppressed VL). We compared the proportion in each sub-group who were aware of and treated for their hypertension or diabetes diagnosis, and fit adjusted linear regression models to estimate differences in systolic BP and glucose among those with diagnosed HTN or DM.

Results
Rates of HTN and DM were higher in HIV- than those with a suppressed VL (HTN: 68.4% v. 46.4%, DM: 12.9% vs.. 8.8%, respectively). However, the suppressed VL group had higher crude rates of awareness of HTN diagnosis and treated HTN as compared with the HIV- group (Aware: 69.9% vs.. 65.2%, p = 0.118; Treated: 50.2% vs.. 46.4%, p = 0.002). There were no significant differences in awareness or treatment rates for DM. In adjusted linear regression models among those with diagnosed HTN or DM, having a suppressed VL was associated with lower mean systolic BP (-5.94mm Hg, 95% CI: -9.68 – -2.20) and lower mean glucose (-3.74 mmol/L, 95% CI: -5.95 – -0.58), compared with being HIV-. This effect was preserved in models restricted to overweight and obese participants.

Conclusion
The HIV care delivery platform in South Africa appears to offer a vehicle for healthcare delivery for other chronic conditions. Future studies are needed to assess causality of these relationships, and to determine optimal methods of integrating chronic disease with HIV management.

Disclosures
All authors: No reported disclosures.
Prevalence of Systemic Hypertension Among HIV-Infected and HIV-Uninfected Young Adults
Authors: Ryscavage Patrick , Still William , Nyemba Vimbai , Stafford Kristen 
Published: October 2017

Abstract

Background
Advances in HIV care and treatment have resulted in perinatally infected children aging into adulthood. These patients may be at higher risk of HIV-associated non-AIDS conditions, including systemic hypertension (HTN). This study examined the association between HIV infection and the prevalence of HTN among young adults receiving care in West Baltimore.

Methods
We conducted a cross-sectional study of young adults with perinatally-acquired (PA) HIV frequency matched on race and sex to a stratified random sample of young adults with non perinatally-acquired (NPA) HIV and HIV-uninfected young adults (UI). All subjects were aged 18–29 years of age as of September 1, 2014. The outcome of HTN was ascertained through chart review (two systolic blood pressure measurements &gt; = 140 mmHg or diastolic &gt; = 90 mmHg at least three months apart; and/or physician prescription for an antihypertensive mediation). Logistic regression was used to estimate adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI) for the association between HIV infection and HTN. All data were collected from clinics within the University of Maryland Medical System.

Results
Three hundred and twenty-four patients were included in the study, 108 per exposure group. The prevalence of HTN was 23% among PA patients, 10% among NPA patients, and 9% among UI patients. The median age was 24 (IQR 22 - 26), 95% were African American, and 42% were male. PA patients had the highest prevalence of chronic kidney disease (CKD) and dyslipidemia (19% and 13% respectively) compared with NPA (1% and 3%) and UI (0% and 5%). PA patients had 3 (95% CI 1.4 - 6.6) times the base odds (controlling for matching variables) of prevalent HTN compared with UI patients and NPA had 1.1 times the base odds (95% CI 0.5 - 2.7) compared with UI patients. After controlling for race, gender, family history of HTN, and CKD, the prevalence odds ratio for HTN was 2.7 (95% CI 1.06 - 7.0) times higher for PA compared with UI, and 1.3 (95% CI 0.5 - 3.4) times higher for NPA compared with UI.

Conclusion
Our findings suggest that the prevalence of HTN among young adults with PA HIV is significantly higher than sex and race matched UI patients of similar age. HIV providers should carefully monitor these patients for the development of HTN, particularly as they enter adulthood.

Disclosures
All authors: No reported disclosures.
Impact of an Antibiotic Stewardship Program in Long-term Care Facilities: A Nursing Home Network Experience
Authors: Romero Fabian Andres , Mathews Evette , Flores Ara , Seo Susan 
Published: October 2017

Abstract

Background
Antibiotic stewardship program (ASP) implementation is paramount across the healthcare spectrum. Nursing homes represent a challenge due to limited resources, complexity of medical conditions, and less controlled environments. National statistics on ASP for long-term care facilities (LTCF) are sparse.

Methods
A pilot ASP was launched in August 2016 at a 270-bed nursing home with a 50-bed chronic ventilator-dependent unit. The program entailed a bundle of interventions including leadership engagement, a tracking and reporting system for intravenous antibiotics, education for caregivers, Infectious Disease (ID) consultant availability, and implementation of nursing protocols. Data were collected from pharmacy and medical records between January 2016 and March 2017, establishing pre-intervention and post-intervention periods. Collected data included days of therapy (DOT), antibiotic costs, resident-days, hospital transfers, and Clostridium difficile infection (CDI) rates. Variables were adjusted to 1,000 resident-days (RD) and findings between periods were compared by Mann–Whitney U test.

Results
A total of 47,423 resident-days and 1,959 DOT were analyzed for this study. Antibiotic use decreased from 54.5 DOT/1000 RD pre-intervention to 27.6 DOT/1000 RD post-intervention (P = 0.017). Antibiotic costs were reduced from a monthly median of US $17,113 to US $7,073 but was not statistically significant (P = 0.39). Analysis stratified by individual antibiotic was done for the five most commonly used antibiotics and found statistically significant reduction in vancomycin use (14.4 vs. 6.5; P = 0.023). Reduction was also found for cefepime/ceftazidime (6.9 vs. 1.3; P = 0.07), ertapenem (6.8 vs. 3.6; P = 0.45), and piperacillin/tazobactam (1.8 vs. 0.6; P = 0.38). Meropenem use increased (1.3 vs. 3.2; P = 0.042). Hospital transfers slightly trended up (6.73 vs. 7.77; P = 0.065), and there was no change in CDI (1.1 s 0.94; P = 0.32).

Conclusion
A bundle of standardized interventions tailored for LTCF can achieve successful reduction of antibiotic utilization and costs. Subsequent studies are needed to further determine the impact on clinical outcomes such as transfers to hospitals and CDI in these settings.

Disclosures
All authors: No reported disclosures.
Silent Polio Transmission: A Spatial Analysis
Authors: Jarvis Christopher , Altamirano Jonathan , Sarnquist Clea , Garcia-Garcia Lourdes , Reyes Leticia Ferreyra , Montero-Campos Rogelio , Cruz-Hervert Luis Pablo , Holubar Marisa , Talib Aisha , Purington Natasha , Halpern Meira , Behl Rasika , Ferreira Elizabeth , Delgado Guadalupe , Quintero Sergio Canizales , Desai Manisha , Edmunds John , Maldonado Yvonne 
Published: October 2017

Abstract

Background
As wild poliovirus is eradicated and countries switch from Oral Polio Vaccine (OPV) to Inactivated Polio Vaccine (IPV) per WHO recommendations, preventing circulation of vaccine-derived poliovirus is a top priority. However, spatial dynamics of OPV transmission are not well understood. Understanding these trends will improve resource targeting in the event of OPV reintroduction in undervaccinated communities. Mexico provides a natural environment to study OPV as it provides IPV routinely and bi-annual OPV campaigns.

Methods
Children in three villages near Orizaba, Mexico were randomized to three levels (10%, 30%, 70%) to receive OPV. We measured distance to nearest OPV shedding, and the amount of shedding close to unvaccinated individuals. We used maps to show the proximity and amount of shedding. Distance and density of shedding was analyzed separately using mixed effects logistic regression with random effects for household and time, adjusted for age, gender, area, and running water.

Results
The median distance to nearest OPV shedding was 85 meters (IQR 46, 145). The median number of shedding individuals within 200m was 3 (2, 6). Shedding and between household transmission occurred rapidly with unvaccinated individuals shedding on day one of the study (Figure 1). There was little evidence (Odds Ratio [OR] 1.04 (95% Highest Posterior Density [HPD] 0.92, 1.16)) of an association between distance (per 100 m) from OPV shedding and odds of shedding. There was some suggestion that the number of OPV shedding within 200 m may have some effect on unvaccinated shedding with OR 0.93 (HPD 0.·84, 1·01) but not at 100 or 500m. Results were consistent across the three villages.

Conclusion
Household structure appears to have limited value in predicting transmission of poliovirus shedding. The use of OPV results in rapid but low levels of transmission throughout the community and this would usually go undetected. The only way to avoid this is to not use OPV or to have strong controls such as quarantine, or strict hygiene protocols. After withdrawal of OPV worldwide the decision to reintroduce due to an outbreak should not be taken lightly as it appears a small amount of OPV is needed to result in transmission.

Disclosures
All authors: No reported disclosures.
Murine Typhus: a Common Cause of Acute Febrile Illness with Potential for Serious Complications
Authors: Afzal Zeeshan , Kallumadanda Sunand , Wang Feng , Hemmige Vagish S , Musher Daniel 
Published: October 2017

Abstract

Background
Individual cases and outbreaks of murine typhus have been documented in South Texas. We report 90 cases from Hidalgo County, Texas, enumerating complications and comparing results in children and adults.

Methods
We reviewed records of 101 patients in three hospitals in Hidalgo County, Texas, who had positive typhus serology (IgG or IgM titer ≥1:128) during 3 years, 2014–2016 and were categorized as suspected, probable or confirmed murine typhus cases in accord with CDC definitions. We excluded 11 cases because a concurrent infection may have confounded our tabulation of manifestations or there was insufficient information to make a clinical diagnosis.

Results
The majority presented with typical typhus: fever, headache, myalgias and fatigue. Rash, thrombocytopenia and elevated hepatic transaminases were frequent (Table). Clinical complications in 25 cases (28%) caused a less typical syndrome, including bronchiolitis, pneumonia, pancreatitis, cholecystitis, mesenteric adenitis, myositis, rhabdomyolysis, meningitis and septic shock. Procalcitonin was &gt;0.5 in 10 of 14 (71%) cases. Once the diagnosis was suspected, patients were treated with doxycycline with a rapid response in every case. Generally fever disappeared within 24–36 hours of the first dose.

Conclusion
Murine typhus is a common endemic infection in South Texas. Although most patients had a typical syndrome, the disease is multisystem, and complications appeared in 28% of cases. Procalcitonin was usually elevated. Rats and opossums are common reservoirs for Rickettsia typhi, and a search for cases of murine typhus may be warranted in other parts of the US as well, so that treatment with doxycycline can be begun promptly.

Disclosures
All authors: No reported disclosures.
Invasive Pneumococcal Disease in Massachusetts Children 6 Years Following Introduction of PCV13
Authors: Yildirim Inci , Little Brent , Pelton Stephen I 
Published: October 2017

Abstract

Background
A second generation 13-valent-pneumococcal conjugate vaccine (PCV13) replaced PCV7 in the childhood immunization schedule in Massachusetts (MA) beginning in April,2010

Methods
Cases of invasive pneumococcal disease (IPD) in children &lt;18 years of age were detected through an enhanced surveillance system in MA since 2001. All cases in children and Streptococcus pneumoniae (SP) isolates, when available, are submitted to Department of Public Health (MDPH) and parents/physicians are interviewed for confirmation of demographic and clinical data. All available isolates are confirmed as SP, serotyped by Quellung reaction

Results
Three-hundred-thirty-seven IPD cases have been identified in MA children between 4.January 4, 2010 and 03.31.2017(Figure). Thirty-five(10.4%) were in infants &lt;6 months; 41(12.2%) in children between 6 and 12 months; 60 (17.8%) in toddlers 12 to 24 months; 100 (29.7%) in children between 2 and 5 years of age and 101 (29.9%) were in children &gt;5 years old. Among children under 2; incidence of IPD declined to 6.8/105 children (95% CI 2.6–11.1) in 2015/16 period which represents a 72.1% decline compared with 2010/11; however in 2016/17 IPD incidence increased by 41.2% to 9.6/105 (95% CI 4.6–14.6) for the first time since the implementation of PCV13.Bacteremia was the most common clinical presentation (62.9%) followed by pneumonia(30.5%) and CNS disease(6.6%). Children with at least one comorbidity were an increasing proportion of cases reaching 37.9% in 2016 (p 0.004). The overall mortality rate was 4.3%. Isolates from 301 (90.1%) were available for serotyping; vaccine serotypes (VST) were identified in 101 (33.6%) cases [serotype 19A(49 cases), 7F(21 cases), 3(18 cases), 19F (7cases), 6A(3 cases), serotypes 14, 18C and 5(1 case each)]. The proportion of VST disease declined to 24.1% from 59.2% over 6 years after PCV13 (p &lt; 0.001). Serotypes 15BC (13.5%), 33F (12.5%) and 22F (12.5%) were the most common nonvaccine serotypes (NVST).

Conclusion
In the post-PCV13-era, IPD is primarily due to NVSTs and disproportionately observed in children with comorbid conditions. In the most recent year (4.1.2016 through 3.31.2017) an increase in incidence was observed in MA children after six years of declining cases following implementation of PCV13.

Disclosures
S. I. Pelton, Pfizer: Board Member and Grant Investigator, Consulting fee, Research grant and Speaker honorarium; Merck vaccines: Board Member, Consulting fee and Speaker honorarium; GSK: Board Member, Consulting fee and Speaker honorarium; Sequiris: Board Member, Consulting fee and Speaker honorarium
Trends in Neisseria Gonorrheae Antimicrobial Susceptibility in California, 2005–2016
Authors: Stoltey Juliet , Han Emily , Burghardt Nicole , Chow Joan , Bauer Heidi 
Published: October 2017

Abstract

Background
Resistant Neisseria gonorrheae (NG) is a growing concern in California, nationally, and globally. Since 1987, California has participated in the Gonococcal Isolate Surveillance Project (GISP), a Centers for Disease Control and Prevention-funded project to monitor trends in antimicrobial susceptibility in sentinel STD clinic sites throughout the United States. We sought to describe trends in California NG susceptibility to ceftriaxone (CRO) and azithromycin (AZI), recommended therapy for NG, for 2005–2016.

Methods
Per GISP protocol, cultures are collected from the first 25 men presenting with NG urethritis each month at GISP clinic sites in California, and antimicrobial susceptibility testing (AST) is performed via agar dilution at GISP regional laboratories. Reduced susceptibility (RS) to CRO was defined as minimum inhibitory concentration (MIC) ≥0.125 µg/ml and AZI MIC ≥2 µg/ml. Demographics and MIC trends over time were examined.

Results
Between 2005 and 2016, there were 9,692 NG isolates submitted in California GISP clinics. There were 24 (0.25%) isolates with RS to CRO and 92 (0.96%) isolates with RS to AZI. There was a higher proportion of isolates from men who have sex with men with RS to AZI (but not CRO) compared with men who have sex with women (chi-squared P-values: AZI = 0.0015; CRO = 0.70). In 2016, the percent of isolates demonstrating RS to AZI increased to 3.69% (n = 32), compared with 0.69% of isolates with RS to AZI in 2005–2015 (chi-squared P-value &lt; .0001); there was no significant difference in the percent of isolates with RS to CRO in 2016 compared with prior years (Figure 1). Figures 2 and 3 demonstrate the distribution of AZI MICs and CRO MICs, respectively, from 2005–2016. There have been no isolates to date in California GISP with RS to both ceftriaxone and azithromycin.

Conclusion
Gonococcal surveillance data demonstrate an increase in the proportion of isolates with decreased susceptibility to azithromycin in 2016 in California compared with prior years. Although there has never been a documented treatment failure to the recommended therapy of CRO and AZI in California, clinicians should remain vigilant for treatment failures given these concerning increases.

Disclosures
All authors: No reported disclosures.
Gonorrhea (GC) and Chlamydia (CT) Infection in a Large, Well-Characterized Military Cohort: Prevalence, Incidence, Site of Infection, and Patient Characteristics
Authors: Eickhoff Christa , Wang Xun , Deiss Robert , Okulicz Jason , O’Bryan Thomas , Maves Ryan , Schofield Christina , Ferguson Tomas , Whitman Timothy J , Agan Brian , Ganesan Anuradha 
Published: October 2017

Abstract

Background
In the US military, routine extra-genital (EG) GC/CT testing in persons living with HIV was implemented in 2012. This study examines the prevalence/incidence and risk factors associated with genital (GU) and EG GC/CT infections in the US Military HIV Natural History Study (NHS), a cohort of HIV-infected Department of Defense beneficiaries.

Methods
Since 2012, willing NHS subjects have undergone nucleic acid-based tests (NAAT) to identify anorectal (AR)/ pharyngeal (PH) GC/CT infections. Incident cases had a positive test following an initial negative test. Risk factors for incident GC/CT infections were assessed with a multivariate Cox proportional hazards model.

Results
A total of 405 GC and 457 CT infections were observed among 1998 subjects (median age 28.7 years, 94% male, 44.1% African-American [AA]); 21% of GC and 18% of CT cases were re-infections. The incidence of AR GC, PH GC, and AR CT increased over time (P = 0.02, P = 0.03 and P = 0.02, respectively). Incident GC infections were associated with younger age [HR 0.61 per 5 year increase (0.57–0.66)], AA ethnicity [HR 1.46 (1.06–2.00)], higher viral load [HR 1.63 per log increase (1.47–1.80)] and a prior history of syphilis [HR 2.20 (1.62–2.99)]. Incident CT infections were associated with younger age [HR 0.7 per 5 year increase (0.66–0.74)], male gender [HR 5.82 (1.86–18.20)], higher viral load [HR 1.61 for each log increase (1.47–1.76)], lower CD4 count [HR 0.86 per 200 cell increase (0.79–0.95)], prior GC [HR 1.55 (1.15–2.08)] and prior syphilis [HR 2.16 (1.67–2.79)].

Conclusion
Incident AR GC and CT infections are increasing in the NHS and approximately 20% of infections were repeat infections. The increased incidence is attributable at-least in part to the increased uptake of EG testing. Our study highlights the importance of prevention in positive programs to reduce the risk of HIV transmission.

Disclosures
All authors: No reported disclosures.