bluuebunny/crossref_metadata_2025_split huggingface dataset:
No Viral Spreading After Rotavirus Vaccination in NICU
Authors: Hiramatsu Hiroyuki , Suzuki Ryota , Yamada Shigeki , Ihira Masaru , Nagatani Arisa , Miyata Masafumi , Miura Hiroki , Hattori Fumihiko , Sugata Ken , Taniguchi Koki , Nishimura Naoko , Ozaki Takao , Yoshikawa Tetsushi 
Published: October 2017

Abstract

Background
Preterm and low birth weight infants are considered to be high risk for severe rotavirus gastroenteritis. However, it has been demonstrated that many infants are ineligible for receiving rotavirus vaccine due to over the age limitation within the neonatal intensive care unit (NICU). We sought to elucidate the safety of rotavirus (RV) vaccination in NICU by assessing vaccine virus transmission from vaccine recipients in NICU.

Methods
This study was designed as the prospective study conducted at the NICU of Fujita Health University hospital and Konan Kosei Hospital. This study was approved by the ethical committee in our university. Premature age-eligible infants were recruited to administer rotavirus vaccine. Stool samples were serially collected from unvaccinated infants (UVI) and vaccinated infants (VI) who received either the pentavalent rotavirus vaccine (RV5) or monovalent rotavirus vaccine (RV1). During October 10, 2014 and December 25, 2015, 19 VIs and 49 UVIs were enrolled in this study. Contact precaution was carried out in NICU. All stool samples were analyzed by real-time RT-PCR for detection of RV5, RV1, and wild-type strain’s genomes.

Results
Total of 676 stool samples (89 samples collected from the 9 RV5 vaccinated infants, 110 samples collected from the 10 RV1 vaccinated infants, and 477 samples collected from the 49 UVIs) were analyzed in this study. Nineteen VIs received with first dose of vaccine demonstrated persistent shedding of rotavirus vaccine genome during 1–8 days after the first dose of the vaccine. Meanwhile, in comparison to VIs received with first dose of vaccine, the detection of viral genome in stool samples decreased gradually in there VIs after second dose of vaccine. In contrast to the VI, no vaccine genome was detected in any of the stool samples collected from the UVIs.

Conclusion
This study suggests that RV vaccine may be safe for administration of preterm and low birth weight infants in NICU. Accordingly, the contact precaution measures may play an important role in prevention of vaccine virus transmission between VIs and UVIs.

Disclosures
All authors: No reported disclosures.
M Protein-Deficient Respiratory Syncytial Virus (RSV) Vaccine Protects Infant Baboons Against RSV Challenge
Authors: Welliver Robert C , Oomens Antonius , Wolf Roman , Papin James , Ivanov Vadim , Preno Alisha , Staats Rachel , Piedra Pedro , Yu Zhongxin 
Published: October 2017

Abstract

Background
RSV bronchiolitis is the most common cause of hospitalization of infants in the US, and may lead to the development of long-term airway disease. Inactivated vaccines may lead to enhanced disease, while replicating vaccines have caused unacceptable degrees of illness, and may revert back to wild type. We developed an RSV vaccine lacking the gene for the M protein (Mnull RSV). The M protein is responsible for reassembly of the virus after it infects cells and expresses its proteins. Infant baboons vaccinated intranasally (IN) with Mnull RSV develop serum neutralizing antibody (NA) responses, but the virus does not replicate.

Methods
2-week-old baboons (n = 12) were primed IN with 107 vaccine units of Mnull RSV or a control preparation, and a similar booster dose was given 4 weeks later. Mnull RSV vaccination did not cause tachypnea, airway inflammation or other signs of illness when compared with sham-vaccinated controls. Two weeks after boosting, all infants were challenged intratracheally with human RSV A2. We continuously monitored respiratory rates and levels of overall activity. On various days following challenge, we obtained BAL fluids for leukocyte counts and degree of virus replication, and evaluated alveolar-arterial oxygen gradients (A-a O2).

Results
Vaccinated animals (vs. unvaccinated controls) had lower respiratory rates (P = 0.0014), improved A-a O2 (P = 0.0063) and reduced viral replication (P = 0.0014). Activity scores were higher in vaccine recipients than in unvaccinated animals. Vaccine recipients also were primed for earlier serum and secretory neutralizing antibody responses, and greater airway lymphocyte responses. Airway lymphocyte numbers (but not antibody responses) were associated with lower respiratory rates and reduced viral replication (P &lt; 0.01).

Conclusion
Vaccination intranasally with Mnull RSV protected infant baboons against an RSV challenge without causing respiratory disease or enhanced illness, and is a promising candidate for use in human infants. Lymphocyte responses to vaccination may play an equal or greater role in protection against RSV infection than antibody responses.

Disclosures
All authors: No reported disclosures.
Reported History of Measles and Long-term Impact on Antibody to Tetanus in Children 6–59 Months of Age Receiving DTP in the Democratic Republic of Congo
Authors: Ashbaugh Hayley , Cherry James D , Gerber Sue , Higgins Stephen G , Gadoth Adva , Alfonso Vivian H , Mukadi Patrick , Hoff Nicole , Doshi Reena , Rimoin Anne W 
Published: October 2017

Abstract

Background
Recent studies suggest a measles-induced immune amnesia that could have long-term immunosuppressive effects via preferential depletion of memory B and T CD150+ lymphocytes.

Methods
We examined the association between past measles and tetanus antibody levels among children participating in the 2013–2014 Democratic Republic of Congo (DRC) Demographic and Health Survey (DHS). Our sample consisted of 833 children aged 6–59 months whose mothers were selected for interview. Mothers reported (via recall) history of measles within the lifetime of the child. Classification of children who previously had measles was completed using maternal recall and measles immunoglobulin G (IgG) serostatus obtained via dried blood spot (DBS) analysis. A multiplex chemiluminescent immunoassay platform was used to obtain serologic results and Assay Score (AS) was calculated as a ratio to a positive control included in each run. Tetanus serostatus was categorized as being above or below the sample median serology AS value. Tetanus vaccination status was obtained via dated vaccination card and limited to children receiving the complete 3-dose vaccination series.

Results
The median AS for tetanus serology among the entire sample of 833 children was 0.085, while children with history of measles had a median AS of 0.053 (N = 41) and children with no history of measles had a median AS of 0.088 (N = 792), chi-square P-value &lt; 0.05. A random intercept logistic regression model was used to examine the association between previous measles disease and odds of having below median levels of tetanus antibody. Controlling for potential confounding variables, the odds of a child with past history of measles having less than the median level of tetanus antibody was 3.86 (95% CI: 1.70, 8.78) among children fully vaccinated for tetanus.

Conclusion
The results suggest that, among children 6–59 months in DRC, measles may have a long-term impact on levels of pre-existing, vaccine-induced immunity to tetanus. These findings suggest the need for laboratory studies examining measles’ impact on pre-existing, vaccine-induced immunity and underscore the need for continued evaluation and improvement of DRC’s measles vaccination program.

Disclosures
All authors: No reported disclosures.
Trends in the Burden and Seasonality of Rotavirus in the United States, 2000–2016
Authors: Aliabadi Negar , Haynes Amber , Tate Jacqueline , Parashar Umesh D , Curns Aaron T 
Published: October 2017

Abstract

Background
Before implementation of rotavirus vaccination in 2006, rotavirus caused 55,000-70,000 hospitalizations and 410,000 clinic visits annually in US children. This report examines the long-term impact of vaccine introduction on rotavirus detection and seasonality through comparison of pre (2000–2006) and post (2007–2016) vaccine seasons through the National Respiratory and Enteric Virus Surveillance System (NREVSS).

Methods
NREVSS is a passive laboratory system collecting results of weekly total and rotavirus-positive stool specimens. Seasons are defined as July through June. To characterize changes in rotavirus detection, total and positive specimens for each post vaccine season from 11 continuously reporting (≥26 weeks per season) laboratories were compared with median values for 2000–2006. Data from 20 participating laboratories were used to determine changes in season characteristics. ArcGIS software was used to document the annual geographic trend across the United States between 2000 and 2015. For season 2015–2016, data are available through April and are not included in the ArcGIS analysis.

Results
Nationally, there was a 53–93% reduction in rotavirus positivity in the post vaccine period as compared with the median in 2000–2006. Trends in rotavirus positivity declined steeply after vaccine introduction in 2006, and have remained low compared with the pre-vaccine period, with alternating years of lower and greater activity (figure). All regions had similar reductions in positive tests. ArcGIS data indicate that peak seasonal activity was largely restricted to January-April for each pre-vaccine year. In the 2006–2007 season, peak activity occurred during January-April, for 2007–2008, this shifted to March-April, for 2008–2009, the peak activity nationwide occurred at all months of the year from the reporting laboratories. This diffuse activity occurred for all subsequent years, save 2009–2010 and 2012–2013, where peak seasonal activity was again confined to January-April.

Conclusion
Rotavirus vaccine substantially and sustainably reduced the burden and changed the epidemiology of rotavirus in US children. The biennial pattern observed may be explained by accumulating unvaccinated children over two successive seasons resulting in stronger rotavirus seasons every alternate year.

Disclosures
All authors: No reported disclosures.
Perception of Japanese Physicians about Human Papillomavirus Vaccine
Authors: Katsuta Tomohiro , Moser Charlotte , Offit Paul , Feemster Kristen 
Published: October 2017

Abstract

Background
Current vaccination coverage of Human Papillomavirus vaccine (HPVV) in Japan is less than 1% because the Ministry of Health, Labour and Welfare (MHLW) suspended its proactive recommendations for HPVV in 2013 after some reports of possible adverse events following immunization. We evaluated the perception of Japanese physicians about HPVV in order to consider the appropriate countermeasure to improve HPVV coverage in Japan.

Methods
We conducted a cross-sectional study using a postal questionnaire targeting 330 Japanese physicians (78 pediatricians, 225 internists and 27 obstetricians-gynecologists (OB-GYNs)) in Kawasaki, Japan in 2016. The questionnaire comprised questions about education frequency, physicians’ perception and recommendation behavior related to adolescent vaccines (HPVV, diphtheria tetanus toxoid (DT) and inactivated influenza vaccine (IIV)).

Results
Valid responses were obtained from 148 (44.9%) physicians (pediatricians 80.8%, internists 31.6% and OB-GYNs 51.9%). Very few (8.0%) of physicians provided HPVV during the past month. Only 21.3% of physicians educated aggressively about HPVV, which was significantly less frequently than DT (61.7%) and IIV (88.6%). Similarly, 53.1% of physicians recommended HPVV aggressively, which was significantly less frequently than DT (83.1%) and IIV (80.3%). We found no significant differences in the frequency of HPVV education or recommendation by pediatricians, internists and OB/GYNs (22.4% vs. 16.9% vs. 35.7% and 54.8% vs. 47.9% vs. 71.5%, respectively). However, 90.0% of physicians answered that if MHLW were to reinstate its HPVV recommendation, they would more aggressively recommend HPVV for adolescents.

Conclusion
Although Japanese physicians were cautious about HPVV and infrequently provided education or made a recommendation for HPVV compared with other adolescent vaccines, our survey suggested such a passive attitude could be improved by the MHLW resuming its proactive recommendation in Japan.

Disclosures
All authors: No reported disclosures.
Fixed vs. Free-text Documentation of Indication for Antibiotic Orders
Authors: Javaid Waleed , Cavanaugh Shaelyn , Lupone Christina , Stewart Telisa , Fazili Tasaduq , White Benjamin 
Published: October 2017

Abstract

Background
Requiring indications for antimicrobial orders can allow stewardship programs to evaluate adherence to guidelines and assess outcomes. We extracted indication data from our institution’s EPIC system and found that in a 29-month time frame there were 12,218 uniquely entered indications. Only 136 of these were standardized drop-down (fixed) menu options; the rest were entered manually (free-text). Enormous variation in these uniquely typed entries emphasizes the value and necessity of fixed indication options to allow for better evaluation of stewardship program outcomes.

Methods
We evaluated the 718 most commonly used indications accounting for a total of 113,741 unique antibiotic orders for 42,665 patients. We excluded indications used for less than 36 orders during the study period. We analyzed the characteristics of these orders to identify opportunities for improvement in indication documentation and developed a new list of less than 200 indications that could account for nearly all of the various indications entered.

Results
66,404 (58%) orders were placed using fixed options available in the menu (Figure 1). 32,427 (29%) orders were placed with no indication listed. The remaining 14,910 (13%) orders were documented with free-text indications. Within these manual entries, 59% were identical or nearly identical to an option that was available in the drop down menu. 37% of free-text indications could not be appropriately placed with an option available in the menu. For example, the menu contained a fixed option for “Severe C. difficile infection” forcing all non-severe cases to be entered as varied free-text alternatives (Figures 2 and 3).

Conclusion
In our sample, use of fixed menu options was high but robust evaluation of proper antimicrobial use was substantially limited by failure to document indication and free-text entry by providers. Free-text entry and blank fields can be used as quality metrics, with high use indicating poor quality. We recommend that standard comprehensive indication lists are developed, providers are encouraged and empowered to utilize menu options consistently, and computerized order systems are programmed to prevent orders from being placed without an indication listed.

Disclosures
All authors: No reported disclosures.
Antibiotic Prescription Patterns for Acute Diarrhea in a Hospital in Shanghai in 2016: A Cross-sectional Study
Authors: Hu Yanhong , Wang Shanjuan , Hua Sunying , Willcox Merlin , Moore Michael , Little Paul 
Published: October 2017

Abstract

Background
Unnecessary antibiotic use increases the risk for antibiotic resistance. The rates of antibiotic use for upper respiratory infections are high in hospitals in China. Although most guidelines advise against the use of antibiotics for acute diarrhea, little is known about antibiotic use practices for acute diarrhea in China.

Methods
A retrospective prescription review from a Shanghai hospital outpatient electronic health records system was conducted from 1 January 2016 to 30 December 2016. Records were included for adult patients. The microbial resistance seasonal data in 2016 were extracted. Chi-squared and multivariable logistic regression and adjusted odd ratio (aOR) were used to assess the relationships between demographic characteristics and antibiotic prescribing.

Results
In total, there were 16,565 prescriptions, 16,060 prescriptions were included in the final analysis after excluding the follow up visits. There were 12,131 (76%) prescriptions with antibiotics prescribed. 5505 (45%) of the antibiotics prescribed were injectable. Of the antibiotics prescribed, levofloxacin was the most frequent (85%), followed by various cephalosporins (14%). Of the cephalosporin prescriptions, third-generation products were the most common (97%). Treatment with oral rehydration salts (ORS) was prescribed 34 (0.2%) times, probiotics were prescribed 3414 (21%) times and smectite was prescribed 2209 (14%) times. Multivariable regression analysis showed that those more likely to receive antibiotics were age 31–50 aOR 1.3 (1.1–1.4), P &lt; 0.001, evaluated in the late evening (11pm to 7am) aOR 2.6 (2.2–2.9) P &lt; 0.001, in the early evening (6pm-11pm) aOR 2.0 (1.8–2.2) P &lt; 0.001, in the summer (June-August) aOR 1.7 (1.5–1.9) P &lt; 0.001. At the same time, the Gram-positive and Gram-negative resistance rates to levofloxacin exceeded 40%, including 50% of E. coliisolates.

Conclusion
High rates of antibiotic use were observed for acute diarrhea in this hospital. Given the inappropriateness of antibiotics for acute diarrhea and the nonsensical high rates of of intravenous levofloxacin use and the concurrent high rates of the levofloxacin resistance, a more effective antibiotic stewardship program is needed to improve patient outcomes, reduce costs, reinforce policy and address the underlying causes of antibiotic abuse.

Disclosures
All authors: No reported disclosures.
Changing Pattern of Antibiotics Usage Among Hospitalized Patients of a Tertiary Hospital in South Korea: 2004–2013
Authors: Kim Bongyoung , Hwang Hyeonjun , Lee Myoung-Jae , Kim Jieun , Pai Hyunjoo 
Published: October 2017

Abstract

Background
This study was performed to evaluate the changing pattern of antibiotics usage among hospitalized patients of tertiary hospital in South Korea.

Methods
Total antibiotics prescription record of hospitalized patients from 2004 to 2013 were collected at a tertiary university hospitals. The antibiotics is defined as class J01 from anatomical therapeutic chemical classification system (ATC). The consumption of each class of antibiotic was converted to defined daily dose (DDD)/1,000 patient-days by using ATC of World Health Organization.

Results
Over the 10-year study period, the annual consumption of systemic antibiotics ranged from 815.10 to 1047.96. The proportion of broad-spectrum antibiotics and non-broad-spectrum antibiotics use are as follows: 45.4% (417.55/920.69) vs.. 54.6% (503.15/920.69), respectively. A 16.9% of decrease in total antibiotics consumption was observed in 2013 compared with 2004 (1000.69 in 2004 vs.. 831.46 in 2013). The decrease rate of non-broad spectrum antibiotics usage was 39.3% during the study period (607.21 in 2004 vs. 368.88 in 2013). In contrast, a stepwise increase in consumption of broad-spectrum antibiotics was observed (14.9% of increase; 393.48 in 2004 vs. 462.58 in 2013). Among broad-spectrum antibiotics, a significant decrease trend was observed for third-generation cephaloporins (P &lt; 0.001). In contrast, a significant increase trend was observed for β-lactam/lactamase (P &lt; 0.001). The monthly overall consumption trend of fluoroquinolones and glycopeptides remained stable (P = 0.061; P = 0.107, respectively). In addition, there were significant decrease trends for consumption of non-broad-spectrum antibiotics, including first generation cephalosporins (P = 0.019) and aminoglycosides (P = 0.004). However, the consumption of second generation cephalosporins, imidazole and penicillins showed a stable trend (P = 0.175; P = 320; P = 0.234, respectively).

Conclusion
A total antibiotics consumption showed significantly decrease trend from 2004 to 2013. In contrast, a stepwise increase in consumption of broad-spectrum antibiotics was observed in the tertiary hospital in South Korea.

Disclosures
All authors: No reported disclosures.
Comparison of Outcomes in Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients Receiving Vancomycin vs. Non-Vancomycin Anti-MRSA Therapy
Authors: Stoneking Carolyn , Moenster Ryan P , Linneman Travis W 
Published: October 2017

Abstract

Background
This evaluation set out to determine whether vancomycin therapy was associated with higher rates of clinical failure compared with non-vancomycin anti-methicillin-resistant Staphylococcus aureus therapy (NVAMT) in outpatient parenteral antimicrobial therapy (OPAT).

Methods
This was a retrospective, single center cohort study including patients who received ≥7 days of OPAT with vancomycin, ceftaroline, or daptomycin from January 1, 2009 through March 31, 2016 at the VA Saint Louis Healthcare System. The primary outcome was clinical failure, defined as a composite of acute kidney injury (AKI), creatinine phosphokinase elevations ≥ 500 units/L, adverse drug events necessitating a change in therapy, readmission due to recurrence of infection, or reinitiation of antibiotics after discontinuation. Secondary outcomes were the individual components of the composite primary outcome. Multivariate logistic regression was used to evaluate independent risk factors for clinical failure. Factors evaluated for inclusion in the multivariate model were age &gt;65 at initiation, creatinine clearance &gt;50 mL/minute, length of therapy &gt;28 days, concomitant antibiotic therapy, comorbid disease states, and vancomycin therapy.

Results
A total of 125 patients were included in the analysis – 72 receiving vancomycin and 53 receiving NVAMT. Baseline characteristics between groups were similar, except patients in the NVAMT group had a greater mean serum creatinine and a higher rate of CKD at baseline; 1.53 vs 1.23 (P = 0.032) and 35.9% vs. 19.4% (P = 0.04) respectively. Forty-three percent (31/72) of patients receiving vancomycin achieved clinical failure compared with 54.7% (29/53) of NVAMT patients (P = 0.197). Of the secondary outcomes analyzed, only readmission due to recurrence was significant between groups (vancomycin vs. NVAMT) – 13.8% vs. 30.2% (P = 0.026). In the univariate model only the choice of vancomycin met pre-defined criteria (P &lt; 0.2) for inclusion in the multivariate model. In the multivariate analysis the choice of vancomycin was not found to be significant (0.71 (95% CI 0.33–1.52), P = 0.37).

Conclusion
Vancomycin was not associated with an increased risk of clinical failure when compared with NVAMT in patients receiving OPAT.

Disclosures
All authors: No reported disclosures.